Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR A Study of 100 Cases of Arrhythmias in First Week of Acute Myocardial Infarction (AMI) in Gujarat: A High Risk and Previously Undocumented Population Mohit J Shah, Nikita R. Bhatt, Ajay Dabhi, P.B. Thorat, Ketan Chudasama, Jigar Patel <b>Aim:</b> To study the incidence of arrhythmias in the first week of Acute Myocardial Infarction (AMI) with respect to type of arrhythmia, age distribution, sex and location of infarctin a patient population from western India and to evaluate its prognostic value and assessment of effect of pharmacotherapy. <b>Study Design:</b> A prospective clinical study consisting of 100 patients was undertaken to investigate the relationship of arrhythmia with site of AMI, timing, complications and outcome in terms of mortality and morbidity. Materials and Methods: Hundred consecutive cases of AMI with arrhythmia admitted in ICCU of Sir Sayaji General Hospital, Vadodara were taken in the study. <b>Results:</b> Among 100 cases, maximum incidence (41%) was found after 6th decade. Incidence of arrhythmias was higher in males (70%) than females (30%). Anterior wall infarcts (69%) were more common than inferior wall (26%). Ventricular Premature Contraction (VPC) (36.23%) was the commonest arrhythmia is anterior wall MI while Complete Heart Block (CHB) (26.92%) was most frequent in inferior wall MI. A large number of arrhythmias were terminated pharmacologically (39%) whereas 13 % of the arrhythmias persisted in spite of treatment. <b>Conclusion:</b> Hence, in one of the largest study of this kind in a patient population of Western India, we established VPC’s as the most common arrhythmia in AMI patients. Older patients (sixth decade) and males are affected more commonly. Ventricular tachycardia is more fatal in acute inferior wall MI. Pharmacotherapy was successful in a large number of cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=58-61&id=3769 https://doi.org/10.7860/JCDR/2014/.3769 Clinico-Pathological Caracteristics, Therapeutic Features and Post-operative Course of Colorectal Cancer in Elderly Patients Mahdi Bouassida, Mohamed Fadhel Chtourou, Lamine Hamzaoui, Selim Sassi, Mohamed Mongi Mighri, Mohamed M’saddak Azzouz, Hassen Touinsi, Sadok Sassi <b>Statement of Problem:</b> Colorectal cancer is predominantly a disease of elderly people and is a major cause of morbidity and mortality in the elderly population. The geriatric colorectal population is a very heterogeneous group, including patients with excellent health status and others with comorbid conditions, functional dependency, and limited life expectancy. On the other hand, the effectiveness of surgery for colorectal cancer depends on it being carried out safely, which allows most patients to return to productive lives, with an improved post-operative life expectancy or at least one that is not diminished by the surgery. <b>Materials and Methods:</b> This work is a descriptive study of a retrospective cohort, based on administrative databases, of all patients with colorectal cancer diagnosed or treated in our institution. We extracted data on sociodemographic characteristics, comorbidity, type of cancer, stage of cancer, type of treatment received, post-operative complications and cause of post-operative death. We compared differences between an elderly group (Group A) (age >75 years) and a group of patients below 75 years (Group B). <b>Results:</b> We found that elderly patients with colorectal cancer were more likely to be operated in emergent conditions, had more non-specific complications and more post-operative mortality than patients below 75 years. On the other hand, tumours stages, tumours characteristics and post-operative specific morbidity have been proved to be similar, both in Group A and Group B patients. <b>Conclusion:</b> These results suggest that surgery is feasible and can be safe for patients above 75 years, but it needs much more evaluation of comorbidities, pre- and post-operative intensive care to avoid post-operative non-specific complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=77-79&id=3774 https://doi.org/10.7860/JCDR/2014/.3774 Is there a Need for Luteinizing Hormone (LH) Estimation in Patients Undergoing Ovarian Stimulation with Gonadotropin-Releasing Hormone (GnRH) Antagonists and Recombinant Follicle-Stimulating Hormone (rFSH)? Amar Ra machandran, Kshitij Ja mdade, Pratap Kumar, Satish Kumar Adiga , Ra jeshwari G Bhat, Sinatra R Ferrao <b>Aim:</b> To find out effect of serum luteinizing hormone (LH) levels on Day 1 (Day 2 of cycle) and Day 5 of stimulation and Day of trigger hCG in controlled ovulation stimulation with antagonist protocol of IVF-ICSI cycle on cycle outcome. <b>Materials and Methods:</b> This retrospective study was conducted in a University Hospital setting. One hundred and 62 patients underwent 165 cycles of controlled ovarian stimulation (COS) with recombinant Follicle stimulating hormone (rFSH) and Gonadotropin releasing hormone (GnRH) antagonist protocol in one year were included. Serum LH levels estimated on Day 1, Day 5 and the day of trigger hCG injections were divided into three groups based on the percentile and outcome measured. <b>Results:</b> The average number of follicles >18 mm in size were significant in the patients with LH levels between 25th to 75th percentile group on Day 1, Day 5 and Day of trigger hCG. The fertilization rate was significant (p= 0.04) in the patients with LH levels < 25thpercentile on the day of trigger hCG. Oocyte recovery rate, oocyte maturation rate and average number of best quality embryos (Grade 1) were not affected significantly in all three groups. <b>Conclusion:</b> In GnRH antagonist and rFSH protocols, low serum LH concentrations on the day of trigger hCG has better fertilization rate. LH levels between 25th and 75th percentile have an influence on the average number of > 18 mm size follicles. However, the LH level on Day 1, Day 5 and Day of hCG does not affect the cycle outcome in COS with antagonist protocol of IVF cycle. Hence, LH estimation is not mandatory in ART cycles with GnRH antagonist protocol. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=90-92&id=3778 https://doi.org/10.7860/JCDR/2014/.3778 Second Stage Caesarean Section: Evaluation of Patwardhan Technique Pradip Kumar Saha Richa Gulati, Poonam Goel, Rimpy Tandon, Anju Huria <b>Objective: </b>To compare the maternal and neonatal morbidities between the Patwardhan technique and the routine “Push” and “Pull” method for extraction of the foetus in second stage caesarean sections. <b>Method:</b> Retrospective analysis was done of all caesarean sections performed in full dilatation of cervix in 3 years between 2004 to 2006. All the cases were divided into two groups. Group 1 being the Patwardhan technique group and Group 2 where baby was delivered as cephalic or as breech. Maternal morbidity in terms of uterine extensions, need for blood transfusions, as well as, neonatal morbidity, was compared between the two techniques. <b>Results:</b> Review of 79 patients revealed significantly less number of uterine extensions, as well as, need for blood transfusions with Patwardhan technique, which thus amounted to a decreased maternal morbidity. However, there were no differences in neonatal outcomes in both the groups. <b>Conclusion:</b> Patwardhan technique is a superior and a safe technique for delivery of foetus in second stage caesarean sections as compared to “Push” and “Pull” methods. While foetal complications are comparable in both methods, maternal morbidities are lesser in Patwardhan technique. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=93-95&id=3782 https://doi.org/10.7860/JCDR/2014/.3782 Effect of Fast and Slow Pranayama Practice on Cognitive Functions in Healthy Volunteers Vivek Kumar Sharma, Rajajeyakumar M., Velkumary S., Senthil Kumar Subramanian, Ananda B. Bhavanani, Madanmohan, Ajit Sahai, Dinesh Thangavel <b>Objectives:</b> To compare the cumulative effect of commonly practised slow and fast pranayama on cognitive functions in healthy volunteers. <b>Settings and Design:</b> 84 participants who were in self-reported good health, who were in the age group of 18-25 years, who were randomized to fast pranayama, slow pranayama and control group with 28 participants in each group. <b>Material and Methods:</b> Fast pranayama included kapalabhati, bhastrika and kukkuriya. Slow pranayama included nadishodhana, Pranav and Savitri. Respective pranayama training was given for 35 minutes, three times per week, for a duration of 12 weeks under the supervision of a certified yoga trainer. Parameters were recorded before and after 12 weeks of intervention: Perceived stress scale (PSS), BMI, waist to hip ratio and cognitive parameters-letter cancellation test, trail making tests A and B, forward and reverse digit spans and auditory and visual reaction times for red light and green light. <b>Statistical Analysis:</b> Inter–group comparison was done by one way ANOVA and intra-group comparison was done by paired t-test. <b>Results and Conclusion:</b> Executive functions, PSS and reaction time improved significantly in both fast and slow pranayama groups, except reverse digit span, which showed an improvement only in fast pranayama group. In addition, percentage reduction in reaction time was significantly more in the fast pranayama group as compared to that in slow pranayama group. Both types of pranayamas are beneficial for cognitive functions, but fast pranayama has additional effects on executive function of manipulation in auditory working memory, central neural processing and sensory-motor performance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=10-13&id=3668 https://doi.org/10.7860/JCDR/2014/.3668 Midshaft Clavicular Fracture and Titanium Elastic Intramedullary Nail Pankaj Kumar Mishra , Anuj Gupta, Suresh Chandra Gaur <b>Introduction:</b>Clavicular injury is common in active and younger age group with male preponderance (male-female ratio is 2:1). Purpose of this study was to analyze the outcome of surgically treated displaced fracture midshaft clavicular fracture using Intra- medullary fixation by titanium elastic nail. <b>Materials and Methods:</b>We present a series of cases of midshaft clavicular fracture who were subjected to Intra medullary fixation with the average nail diameter of 2.5 to 3 mm titanium elastic nail system by the closed/open reduction method under Image intensifier control. <b>Results:</b>Average time taken for full clinical and radiological union was nine weeks (with minimum six weeks to maximum eleven weeks). Time taken for fully functional recovery (time of functional disability) was 35±7 days in all patients except in two cases of floating shoulder and one case of poly-traumatic patient in which it was 50 days. Follow-up period ranged between 9 months and 24 months with an average of 18 months. Average Constant- Murley-Score after assessment of shoulder function was 96.8. <b>Conclusion:</b>Titanium elastic intra-medullary nailing is a promising surgery with excellent functional outcome, safer percutaneous method with less invasive nature and rapid healing tendency with fewer complications in contrast to plate osteosynthesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=129-132&id=3896 https://doi.org/10.7860/JCDR/2014/.3896 Pre-eclampsia and Chorionicity in Women with Twin Gestations Anupama Singh, Arati Singh, Tarakeswari Surapaneni, Praveen Kumar Nirmalan <b>Background:</b>Pre-Eclampsia (PE) affects 6-31% of pregnant women with multiple gestations. There are conflicting reports on the association of PE with Chorionicity and zygosity; however, there is a lack of information on this potential association in a population of pregnant Asian Indian women. <b>Aim:</b>To determine as to whether chorionicity and zygosity were associated with PE in a population of Asian Indian women with twin gestations. <b>Settings and Design:</b>A retrospective observational study was done at a single tertiary care centre in Southern India. <b>Material and Methods:</b>The study included pregnant women with twin gestations, who was delivered at the study institute in 2012. Hypertension in pregnancy was categorized, based on the criteria of the International Society for the Study of Hypertension in Pregnancy. Chorionicity was determined by using ultrasonography and zygosity was determined, based on clinical criteria. Point estimates and the 95% confidence intervals around point estimates of PE and associations of chorionicity and zygosity with PE were determined by using bivariate analysis, logistic regression models and area under Receiver Operator Characteristic (ROC) curves. <b>Results:</b>This study included 208 women with twin gestations. The incidence of PE in dichorionic twin gestations was 13.17% (n=22, 95% CI: 8.66, 18.96), it was 4.87% (n=2, 95% CI: 0.83, 15.19) in monochorionic twin gestations, it was 16.36% (n=9, 95% CI: 8.29, 27.91) in dizygous twin gestations and it was 4.88% (n=2, 95% CI: 0.83, 15.19) in monozygous twin gestations. Neither chorionicity (adjusted OR: 2.59, 95% CI: 0.55, 12.19) nor zygosity (adjusted OR 2.72, 95% CI: 0.49, 15.13) were associated with PE In a multivariate logistic regression model. <b>Conclusion:</b>Although it was not statistically significant, the clinical incidence of PE was higher in dichorionic and dizygous twin gestations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=100-102&id=3902 https://doi.org/10.7860/JCDR/2014/.3902 Profile of Microbial Isolates in Ophthalmic Infections and Antibiotic Susceptibility of the Bacterial Isolates: A Study in an Eye Care Hospital, Bangalore Hemavathi, Pooja Sarmah, Poornima Shenoy Ocular infections are common and vary from self-limiting to sight-threatening. All the structures of the eye can be infected by various microbes.The present study was undertaken to determine the prevalence of bacterial and fungal infections of the eye and also to assess the antibiotic susceptibility pattern of bacterial isolates at an eye care hospital in Bangalore, India. <b>Material and Methods:</b> Two hundred thirty five samples were received from infections of the eye-conjunctivitis including dacrocystis, corneal ulcers, endophthalmitis and post-traumatic infections. Culture, Gram’s stain and potassium hydroxide (KOH) mount was done for allclinical specimens. Giemsa staining was done occasionally as required. Antibiotic susceptibility testing was performed for bacterial growth. <b>Results:</b> Out of 235 samples processed, 81(34.5%) yielded bacterial growth and 32 (13.6%) yielded fungal growth. One corneal scraping showed the presence of Acanthamoeba by microscopy. Predominant bacterial isolates were-Staphylococcus species 36 (39.9%), Pseudomonas species 20 (22.2%) and Escherichia coli 12 (13.3%). Among 25 fungal isolates, Aspergillus flavus 11(44%) and Fusarium 8 (32%) predominated. Bacterial strains were susceptible to gatifloxacin (86.4%), tetracycline (65.4%), chlorampenicol (69.1%) and least sensitive to the beta- lactam group like amoxicillin (23.5%). <b>Conclusion:</b> Conjunctival specimens yielded mainly bacterial growth with Staphylococcus species being the predominant isolate followed by Pseudomonas species. Maximum fungal isolates were from corneal scrapings with Aspergillus flavus and Fusarium being predominant. Majority of the bacteria were susceptible to gatifloxacin. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=23-25&id=3910 https://doi.org/10.7860/JCDR/2014/.3910 Lipid Parameters – Significance in Patients with Endogenous Depression Anita B. Kale, Sunil B. Kale, Shivaji S. Chalak , S.R. Tankhiwale, G. Bang, Mohit Agrawal, Meghali Kaple <b>Background:</b> People are aware of the consequences of high serum lipid levels, specifically, total cholesterol. Awareness about harmful effects of very low levels of serum lipids is still lacking. Very low levels of serum lipids lead to psychological consequences. <b>Objectives:</b> The objective of this study was to show whether there was a significant relationship between serum lipid levels and depression. <b>Material and Methods:</b> Total 70 subjects were included in this study. 40 subjects suffering from depression as assessed with the help of clinical findings and BDI scores were included in the study group, while control group comprised of 30 normal subjects. Lipid profile was done on blood samples obtained after overnight fasting. BDI scores were also obtained in control group using Beck Depression Inventory (BDI). Co-relation between BDI score and lipid levels was obtained in both the groups. <b>Results: </b>Serum lipid levels were significantly low in study group as compared to control group. There was a significant negative co-relationship between serum lipid levels with depression. Subjects of study group having lower lipid levels specifically TC (r = -0.78), LDL (r = -0.69), TG (r = -0.41) and VLDL(r = - 0.418), showed higher BDI scores (p<0.05). <b>Conclusion:</b> We can conclude that there is a significant relationship between low TC and depression. Similarly, low levels of serum LDL, TG and VLDL also showed significant relationship with depression. Lipid levels below a certain limit are not good as it may cause depression. Patients with low lipid levels should be screened for depression so that if necessary, corrective measures can be taken at the earliest. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=17-19&id=3911 https://doi.org/10.7860/JCDR/2014/.3911 Correlation of Waist-to-hip Ratio (WHR) and Oxidative Stress in Patients of Acute Myocardial Infarction (AMI) Anwar Hasan Siddiqui, Rajiv Gulati,Nazia Tauheed, Anjum Pervez <b>Background:</b> Obesity is associated with increased oxidative stress and lipid peroxidation is thought to play a crucial role in the generation of atherosclerotic lesions of Acute Myocardial Infarction (AMI). <b>Methods:</b> The case-control study contained 120 subjects divided in two groups, 60 patients with AMI and equal number of age- and sex-matched healthy subjects as controls. Ratio of Waist Circumference (WC) to Hip Circumference (HC) (waist-to-hip ratio) of all the subjects was recorded. Antioxidant status of the individuals was determined by measuring the serum levels of Glutathione Peroxidase (GPx) and Superoxide Dismutase (SOD). Estimation of Malondialdehyde (MDA), a marker of lipid peroxidation was used as a surrogate marker of free radical activity. <b>Results:</b> WHR was found to be significantly higher in patients of AMI as compared to controls. MDA levels were significantly high and antioxidants molecules GPx and SOD were significantly decreased in AMI patients as compared with control (p<0.001). WHR correlated positively to serum level of MDA and inversely to the serum level of antioxidant enzymes. <b>Conclusion:</b> High Waist-to-hip ratio is associated with high concentrations of malondialdehyde level and low concentration of antioxidant’s enzyme. This results in increased oxidative stress, a major causative factor of AMI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=4-7&id=3912 https://doi.org/10.7860/JCDR/2014/.3912 Efficacy and Pitfalls of FNAC of Thyroid Lesions in Children and Adolescents Vidya Vasudev, Hemalatha A. L., Rakh i B., Githanjali S. <b>Background and Objectives:</b> Fine-needle aspiration has proven safe and efficacious in the evaluation of nodular diseases in the adults. It has been used extensively to select patients for surgical exploration with a high degree of reliability. The purpose of this study was to assess the extent of its applicability in thyroid lesions in children and adolescents, as well as to determine distribution of thyroid lesions in pediatric and adolescent patients in whom the prevalence of thyroid nodules and probability of malignancy are different. <b>Methodology:</b> This is a four-year study undertaken between January 2009 and December 2012, during which, 284 fine-needle aspiration cytology were performed for palpable thyroid lesions in children and adolescents and analysed. Out of these 11, 52, 82 and 116 aspirates belonged to the age group between 7-<12 years, 12 -<16 years, 16 -<19 years, 19-21 years respectively. There were 261 (91.9%) satisfactory aspirates and 23 unsatisfactory aspirates (8.1%). These 261 satisfactory aspirates with adequate cellular material were taken up for interpretation and analysed. Thirty one patients underwent thyroidectomy. There were 4 true positives, 24 true negatives, 2 false positives and one false negative case in this study. Sensitivity, Specificity, Accuracy, Positive predictive value and Negative predictive value were calculated. <b>Results:</b> Benign cytology was reported in 89 cases (34.2%) where 11 cases (4.2%) were males. Thyroiditis was observed in 154 cases (59%) and 8 cases (3.1%) were males. Suspicious cytology was reported in 12 cases and comprised of 2 cases with a suspicion of Papillary Carcinoma and 10 cases (3.8%), with a suspicion of a Follicular lesion. Papillary Carcinoma was detected on 6 cases where all were females. The Sensitivity was 96%, Specificity was 66% and the Accuracy was 90%, Positive predictive value was 66%, Negative predictive value was 96%. <b>Conclusion:</b> Fine-needle aspiration cytology of palpable thyroid lesions in children and adolescents is a good screening test because of its high sensitivity. Majority of the nodules in this age-group are benign and fine-needle aspiration cytology helps prevent unnecessary surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=35-38&id=3913 https://doi.org/10.7860/JCDR/2014/.3913 Evaluation of Thrombocytopenia in Dengue Infection Along with Seasonal Variation in Rural Melmaruvathur Dost Mohamed Khan, Kumaresan kupp usamy, Sumathi S, Mrinalini V R <b>Introduction:</b> Dengue is one of the most prevalent mosquito-borne arboviral infection in India. Seventy percent of the 96 million apparent infections occur in Asia, in which India is making upto one third of the total. Despite considerable efforts to control the mosquito populations, dengue fever has emerged, spread and established itself rapidly. The most serious manifestations of the infection are Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). <b>Objectives:</b> Evaluation of thrombocytopenia in dengue infection along with seasonal variation. <b>Material and Methods:</b> The present study was conducted retrospectively for a period of 2 years in Melmaruvathur from January 2011-December 2012. Blood samples were collected from 1464 patients experiencing febrile illness, clinically consistent with dengue infection. Serological confirmation of Dengue infection and evaluation of platelet counts was done in all the serologically positive cases. <b>Results:</b> A total of 1464 fever cases were admitted during the study period and among them, 107 (7.3%) were found to be seropositive for dengue. A majority, 41 (38.3%) of the dengue cases was noted in the age group of 15-30 years, followed by less than 15 years of age and the mean age of the seropositive cases was 29.78 ± 15.3years. Among the dengue cases, 62.6% were males and 37.4 % were females. A statistically significant association (p<0.05) was found between the age groups and severity of thrombocytopenia, between severity of thrombocytopenia and clinical presentation of dengue infections. A significantly higher number of serologically positive cases were noted, when compared to serologically negative cases in the post monsoon period. <b>Conclusion:</b> This retrospective study highlighted significant dengue infection during seasonal variation. The median age of dengue patients has decreased and younger patients may be more susceptible. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=39-42&id=3914 https://doi.org/10.7860/JCDR/2014/.3914 Morphological Study of the Supracondylar Process of the Humerus and Its Clinical Implications Shivaleela C., Suresh B.S., Kumar G.V., Lakshmiprabha S. <b>Background:</b> The supracondylar process of the humerus, which is also called the supra-epitrochlear, epicondylar, epicondylic process or a supratrochlear spur, is a hook-like, bony spine of variable size that may project distally from the anteromedial surface of the humerus. It represents the embryologic vestigial remnant of climbing animals and seen in many reptiles, most marsupials, cats, lemurs and American monkeys. <b>Materials and Methods:</b> Two hundred and forty dried humeri were studied from department of Anatomy, Sri Siddhartha Medical College, Tumkur, Karnataka, India. The bones were examined for supracondylar process. On finding, the dimensions were recorded and photographed. <b>Results:</b> Out of 240 dried humeri examined we found only 1 humerus of the left side with an osseous spine on the anteromedial surface. The incidence calculated in this study was 0.41%. <b>Conclusion:</b> The supracondylar process is frequently misjudged as a pathological condition of the bone rather than as a normal anatomical variation. Though, this process has been of more interest to anatomists and anthropologists because of a possible link to the origins and relations of the human races than to clinicians, many of whom are not aware of its occasional presence. It is usually clinically silent, but may become symptomatic by presenting as a mass or can be associated with symptoms of median nerve compression and claudication of the brachial artery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=1-3&id=3915 https://doi.org/10.7860/JCDR/2014/.3915 Phenotypic and Genetic Characterization of Carbapenemase and ESBLs Producing Gram-negative Bacteria (GNB) Isolated from Patients with Cystic Fibrosis (CF) in Tehran Hospitals Parisa Vali, Fereshteh Shahcheraghi, Maryam Seyfipour, Maryam Alsadat Zamani, Mohammad Reza Allahyar, Mohammad Mehdi Feizabadi <b>Background:</b> Cystic Fibrosis (CF) is an autosomal recessive genetic disorder in white populations caused by mutation in a gene that encodes Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) protein. Since frequent respiratory tract infections are the major problem in patients with CF, obligation to identify the causative bacteria and determining their antibiotic resistance pattern is crucial. The purpose of this project was to detect Gram-negative bacteria (GNB) isolated from sputa of CF patients and to determine their antibiotic resistance pattern. <b>Materials and Methods:</b> The sputum of 52 CF patients, treated as inpatients at hospitals in Tehran, was obtained between November 2011 and June 2012. Samples cultured in selective and non-selective media and GNB recognized by biochemical tests. Antimicrobial susceptibility testing to cephalosporins, aminoglycosides and carbapenems was performed by disk diffusion method and MICs of them were measured. For phenotypic detection of carbapenemase and ESBLs production, the Modified Hodge test, double disk synergy test and the combined disk methods were performed. Subsequently, the genes encoding the extended spectrum beta-lactamases (blaPER, blaCTX-M) and carbapenemases (blaIMP-1, blaGES, blaKPC, blaNDM, blaVIM-1, blaVIM-2, blaSPM, blaSIM) in Gram negative bacteria were targeted among the resistant isolates by using PCR. PFGE was used to determine any genetic relationship among the Pseudomonas aeruginosa isolated from these patients. <b>Results:</b> Fifty five GNB were isolated from 52 sputum samples including Pseudomonas aeruginosa, Klebsiella ozaenae, Alcaligenes xylosoxidans, Achromobacter denitrificans, Klebsiella pneumonia and Stenotrophomonas maltophilia. The rates of resistance to different antibitics were as follows: cefixime (%80), ceftriaxone (%43), ceftazidime (%45) and meropenem (%7). The prevalence of genes encoding the ESBLs and Carbapenemases among the the phenotypically positive strains were as follows: blaCTX-M (19), blaIMP-1 (2), blaVIM-1 (2) and blaVIM-2 (3) genes respectively. No other genes were detected. PFGE analysis revealed 8 genotypes. Six isolates had mutually 3 similar patterns. <b>Conclusion:</b> This study showed the existence of important ESBLs and carbapenemases genes among the GNB isolated from patients with CF. Continuous surveillance of ESBLs and Carbapenemases, also identification of their types, in bacteria isolated from these patients have an important clinical impact, since, it can often provide valuable information for effective infection control measures and for the choice of appropriate antimicrobial therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=26-30&id=3916 https://doi.org/10.7860/JCDR/2014/.3916 Quality of Life (QOL) and Its Associated Factors Using WHOQOL-BREF Among Elderly in Urban Puducherry, India Ganesh Kumar S., Anindo Majumdar, Pavithra G. <b>Background:</b> Quality of Life (QOL) among elderly is a neglected issue especially in developing countries including India. <b>Aim:</b> To assess the QOL and its associated factors among elderly population. Materials and Methods: A community based cross-sectional study was conducted among 300 elderly subjects in urban Puducherry, India. Data on QOL was assessed by World Health Organization Quality of Life BREF (WHOQOL-BREF) and Activities of Daily Living (ADLs) by Katz ADL scale. Socio-demographic factors and chronic morbid conditions were recorded by using structured questionnaire. Statistical Analysis: Independent sample test and multiple linear regression analysis. <b>Results:</b> Majority (64%, 192) were in the (60-69) years’ age-group. Overall mean Standard Deviation (SD) score of QOL was 49.74 (10.21). QOL was significantly low among those with no schooling, nuclear family, not receiving pension, not with partner, having musculoskeletal disorder, low vision and impaired ADL groups in univariate analysis. Multiple linear regression analysis revealed that older age (p=0.014), no schooling (p=0.004), without spouse (p=<0.001), nuclear family (p=0.039), musculoskeletal disorder (p=<0.001), low vision (p=0.049) and hearing impairment (0.001) were associated with low QOL score. <b>Conclusion:</b> QOL score among elderly is average, while social relationship domain of QOL score was found to be low. Health education with regard to activity and environmental changes and increase in social relationship may help in improving the QOL among the elderly population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=54-57&id=3917 https://doi.org/10.7860/JCDR/2014/.3917 Therapeutic Response of Vitamin A, Vitamin B Complex, Essential Fatty Acids and Vitamin E in the Treatment of Phrynoderma: A Randomized Controlled Study Ragunatha S., Jagannath Kumar V., Murugesh S.B., Ramesh M., Narendra G., Meenakshi Kapoor <b>Background:</b> In the treatment of phrynoderma, various nutrients have been tried in different dosages and routes with variable therapeutic outcomes. Aims: The present study was undertaken to compare the efficacy of various nutrients in the treatment of phrynoderma. <b>Settings and Design:</b> An open label randomized controlled study was conducted in the out-patient department of Dermatology in a tertiary care hospital. Material and Methods: The patients were divided into group of five and each patient received one of the five regimens [10 injections of Vitamin A 1 lakh units, intramuscularly (IM) on alternate day, 10 injections of Vitamin B complex, 2cc IM on alternate day, 2 table spoon of safflower oil, two times daily with meals, Tab Vitamin E 400mg once daily, and only topical keratolytic (salicylic acid 3% ointment) two times daily] respectively. The first four regimens also received topical keratolytic. The primary outcome measured was therapeutic response at the end of regimen. The response was graded based on the percentage of flattening and decrease in number of lesions. Less than 25% improvement was graded as poor, 26-50% improvement as moderate, 51-75% improvement as good, and more than 75% improvement as excellent response. In the statistical analysis, comparison was done using Chi-square and Fisher’s exact test. <b>Results:</b> A total of 125 patients were included in the study with 25 patients each in five regimen groups. There were 79 (63.2%) males and 46 (36.8%) females with a ratio of 1.72:1. The age of the patients ranged from 3 to 26 years with mean of 10.1±4.3 years. Out of 125 patients, 105 completed the study. In regimen 1 and 2, significant number of patients showed good to excellent response whereas significant number of patients in remaining regimen showed moderate to poor response with a p value of <0.05. The therapeutic response to Vitamin A and Vitamin B complex therapy was significantly better than other regimens. <b>Conclusion:</b> Intramuscular injections of Vitamin A or Vitamin B are effective in the treatment of phrynoderma. Addition of topical keratolytics helps in faster clearance of keratotic lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=116-118&id=3918 https://doi.org/10.7860/JCDR/2014/.3918 A Prospective Study of Predictors for Post Laparotomy Abdominal Wound Dehiscence Garg Ramneesh, Shah Sheerin, Singh Surinder, Singh Bir <b>Introduction: </b>Break in continuity of the skin with or without deeper tissues, following laparotomy, results in abdominal wound dehiscence. This study was done to evaluate the risk factors that lead to wound dehiscence in post-operative period. <b>Material and Methods:</b> This was a prospective study done on 50 patients who developed wound dehiscence (partial or complete) following laparotomy. The pre-operative investigations, intra-operative findings and any post-operative complications were recorded in a specified Performa. <b>Results:</b> The highest incidence of wound dehiscence was found to be in patients of fourth decade, with male preponderance. 16 patients were found to be obese (BMI>30) and 13 patients were anemic. Twelve had low serum albumin, 16% had raised serum bilirubin while 4 patients were diabetics. Renal failure was found in 19 of 50 patients. 92% patients were with ASA score I E. In 88% of patients, laparotomy wounds were either contaminated or dirty. Post-operative nausea and vomiting was found in 10 patients and cough in 9 patients. <b>Conclusions:</b> Abdominal wound dehiscence after laparotomy is a surgical emergency with high morbidity and mortality leading to escalation in hospital costs and prolonged illness. This complication can be avoided if the factors involved in wound dehiscence are properly addressed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=80-83&id=3921 https://doi.org/10.7860/JCDR/2014/.3921 A Study on Pre-Emptive Analgesic Effect of Intravenous Paracetamol in Functional Endoscopic Sinus Surgeries (FESSs): A Randomized, Double-Blinded Clinical Study Chethan M Koteswara, Sheetal D <b>Background:</b> Functional Endoscopic Sinus Surgery (FESS) is associated with significant post-operative pain. Intravenous (iv) paracetamol provides pain relief in most patients who have undergone FESS. In some studies, it was found to be inadequate. It has been observed from previous studies conducted on patients undergoing other surgeries like abdominal surgeries that the analgesic efficacy of iv paracetamol improves when used Pre-emptively. There are no studies done previously on use of iv paracetamol Pre-emptively in FESS. <b>Objective:</b> The purpose of the study was to determine the post-operative analgesic effects of Pre-emptive intravenous (iv) paracetamol in FESS. Materials and Methods: Following institutional ethics committee approval, thirty nine American Society of Anesthesiology (ASA) physical status I-II patients were assigned in a randomized manner into two groups: Group I received iv paracetamol 1g, in 100mL, 15 minutes before induction and Group II received iv paracetamol 1g, in 100 mL, at the end of the surgery. The time to first analgesic use and the total analgesic consumed in 24 hours was recorded. Visual Analog Scale (VAS) pain scores were obtained from all patients at 0, 30 minutes, 1, 2, 6, 12 and 24 hours after the end of the Surgery. <b>Results:</b> Time to first analgesic requirement was significantly longer in Group I compared to Group II (p = 0.0329). Rescue analgesic consumption and post-operative VAS pain scores recorded were significantly lower in Group I compared to Group II (p < 0.05) until 24 after surgery. <b>Conclusion:</b> Pre-emptive iv paracetamol in comparison to intra-operative paracetamol, provided effective and reliable post-operative analgesia after FESS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=108-111&id=3922 https://doi.org/10.7860/JCDR/2014/.3922 Antibiotics Dispensing for URTIs by Community Pharmacists (CPs) and General Medical Practitioners in Penang, Malaysia: A Comparative Study using Simulated Patients (SPs) Alamin Hassan M. A. Alabid, Mohamed Izham Mohamed Ibrahim, Mohamed Azmi Hassali <b>Background:</b> In Malaysia, doctors in private clinics (often called dispensing doctors) are permitted to dispense medicines. This potentially may compromise rational dispensing of medicines in general and antibiotics in particular. <b>Aim:</b> This study explored, assessed and compared dispensing of antibiotics between Community Pharmacist (CP) and General Practitioners (GPs) regarding symptomatic diagnosis, antibiotic categories, adherence to therapeutic doses and promotion of generic antibiotics. <b>Method:</b> The study used trained Simulated Patients (SPs), who used a scenario of common cold symptoms at GP private clinics and community pharmacies to observe and explore the practice of antibiotics dispensing. The study was conducted within the period of May to September 2011 in Penang, Malaysia. The data was analysed using descriptive statistics, Chi-square and Fisher’s Exact Tests at alpha level of 0.05. <b>Results:</b> GPs dispensed more antibiotics than CPs (p= 0.001) for common cold symptoms. They dispensed more Amoxicillin (n = 14, 35%) than CPs (n = 11, 11%) (p < 0.001) and more Tetracycline (n = 3, 7.5%) while no CP dispensed this category (p = 0.022). On the other hand, CPs (n = 11, 11%) suggested brand antibiotics where as GPs dispensed only generic antibiotics (p < 0.001). Generally GPs comply better with the symptomatic diagnosis standard e.g. when asking SPs about the symptoms they had, all GPs (n = 40, 100%) complied better with this standard. Despite that, they dispensed more antibiotics (n = 26, 65%) than CPs (n = 29, 29%) (p = 0.001). GPs (n = 22, 55%) also are better than CPs (n = 16, 16%) in adherence to therapeutic doses (p< 0.001). <b>Conclusion:</b> Findings showed poor adherence to rational dispensing of antibiotics by both providers. Although, GPs adhere better to symptomatic diagnosis and therapeutic dosing of antibiotics than CPs, they unnecessarily prescribe and dispense more antibiotics for Upper respiratory tract infection (URTI) symptoms. Establishing prescription guidance and regulatory actions, especially for URTIs treatment, and separating of medication dispensing are seemed to be crucial steps for the reform. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=119-123&id=3923 https://doi.org/10.7860/JCDR/2014/.3923 Proportion of Depression Among the Elderly Population in A Rural Health Care Setting Shreyaswi Sathyanath M, Rashmi Kundapur, Shrinivasa Bhat U, N Udaya Kiran <b>Introduction:</b> Depression among elderly has serious public health implications. Integration of mental health into primary care may help in reaching the elderly population better and in identifying depression among them. <b>Objectives:</b> This study was done to determine the proportion and the correlates of depression among the elderly population which attended the rural psychiatry services and to compare the proportion with that of the middle aged population. <b>Material and Methods:</b> The outpatient data of the past one year in the rural psychiatry centre was analysed. Correlates of depression among the elderly were studied by Chi square test and the proportion in elderly was compared with that of the middle aged population using Z-test. <b>Results and Conclusion:</b> Depression among the elderly attendees was significantly higher than that in the middle aged group. Depression was more common among the young old and females and co-morbidities were more commonly seen in males and the young old compared to those who were aged 80 years and above. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=137-139&id=3905 https://doi.org/10.7860/JCDR/2014/.3905 Study of Aetiology and Anti-biogram of Uropathogens in Children-A Retrospective Analysis Dnyaneshwari Purushottam Ghadage, Swati Shivajirao Nale, Deepali Shivajirao Kamble, Vrushali Avinash Muley, Archana Bhimrao Wankhade, Rupali Jotiba Mali, Arvind Vamanrao Bhore <b>Objectives:</b> Urinary Tract Infections (UTIs) are the most common serious bacterial infections which are seen during infancy. The aim of the present study was to evaluate aetiology, and antimicrobial resistance patterns among infants and children who approached our hospital for treatment of UTIs. <b>Methods:</b> In this observational study which was carried out from 2007 to 2010, 1575 urine samples which were collected from children with suspected UTIs were studied. Demographic characteristics, aetiological agents and antimicrobial resistance were evaluated. <b>Results:</b> UTIs were more common in the 0-1 year age group, among males. Among females, UTIs were commonly seen after 2 years of life. The most common isolated pathogen was Escherichia coli spp (45.12%), followed by Klebsiella spp (18.17%) and Enterococcus spp (9.23%). Isolated pathogens were highly resistant to ampicillin, co-trimoxazole, and norfloxacin (82%–98%) and highly sensitive to gentamicin (83%),amikacin (76.5%), and nitrofurantoin (71.5%). <b>Conclusion:</b> The most common pathogen which caused UTIs in children was E. coli spp. The isolated pathogens were highly resistant to commonly used antibiotics, ampicillin and co-trimoxazole, while they were highly sensitive to gentamicin, amikacin and nitrofurantoin. So, these antibiotics may be used as alternative drug therapies for the treatment of UTIs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=20-22&id=3907 https://doi.org/10.7860/JCDR/2014/.3907 Comparative Evaluation of Efficacy, Safety and Haemostatic Parameters of Enoxaparin and Fondaparinux in Unstable Coronary Artery Disease Sanjay Shah, Vijay Khajuria, Vishal R. Tandon, Zahid H.Gillani, Mohan Lal <b>Aim:</b>To compare the safety and efficacy of Enoxaparin (EX) and Fondaparinux (FD) in patients with Unstable Coronary Artery Disease (UCAD). <b>Material and Methods:</b>A prospective, open label, randomized comparative study was designed to study the comparative efficacy and safety of EX and FD in UCAD patients. Recovery, recurrence, major and minor bleeding and biochemical investigations were evaluated and compared among two arms. <b>Results:</b>The baseline demographic characteristics were similar in both groups, with mean age of 56.05 and 56.05 years in EX and FD group respectively. Recovery was equal in two arms. Recurrent MI or angina was seen numerically more in EX group, but it did not statistically vary from that in the FD group. Incidence of haemorrhage was similar in both groups at 9 days, but at 30 days, EX showed a higher incidence (p<0.05). Deaths were prevented in both the treatment arms. Bleeding parameters such as BT, CT and platelet count were not altered in both groups. <b>Conclusion:</b>FD appeared to be better than EX in efficacy, as was indicated by a numerically more decrease in recurrence of angina or MI. FD regimen group also had better safety profile, as there was no incidence of haemorrhage at 30 days Therefore, we conclude that FD is an attractive option than EX in UCAD patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=31-34&id=3908 https://doi.org/10.7860/JCDR/2014/.3908 Assessment of the Potential of Pathological Stains in Human Prostate Cancer Anchit Khanna, Rani Patil, Abhay Deshmukh <b>Background:</b> Incidence of prostate cancer in India is relatively low compared to the western countries. Nevertheless, an increase by 1% yearly has been recorded in the last three years, thereby making early diagnosis of prostate cancer crucial for controlling its incidence. Differentiating between benign and malignant lesions has been a diagnostic dilemma, especially in prostate pathology. This is compounded by unavailability of modern tests in certain regions of developing nations. <b>Methods:</b> A cohort of one hundred seventy six prostatomegaly patients used in the current study was obtained both retrospectively and prospectively at the Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India. Details of the patients were recorded which included their age. The samples were then cut into 5 sections, each of 5micron thickness. One section was preserved and the other 4 sections were subjected to Hematoxylin and Eosin (H and E), Periodic Acid-Schiff (PAS), Alcian Blue and AgNOR stains. Degree of differentiation was estimated and correlated with the Gleason score and the outcome of the stainings. <b>Results:</b> Majority of benign prostatic hyperplasia and all primary carcinoma patients were in their sixth to eighth decade of life. While all the benign lesions were negative, 6 out of 9 primary prostate carcinomas were positive for Alcian Blue stain. Majority of both benign and malignant lesions were positive for Periodic Acid Schiff (PAS) stain. In terms of Argyrophilic Nucleolar Organiser Region (AgNOR) count per nucleus, the value in benign lesions was observed to be half the count observed in malignant lesions per nucleus. <b>Conclusion:</b> Although the potential use of the orthodox stains individually may not serve the purpose to differentiate between benign and malignant lesions, together they may have the potential to identify relatively more malignant cases. This may be helpful especially in low socio-economic countries and rural areas where molecular based tests may not yet be available https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=124-128&id=3938 https://doi.org/10.7860/JCDR/2014/.3938 Medical Students’ Perception of Their Educational Environment Preethi G Pai, Vishma Menezes, Srikanth, Atreya M. Subramanian, Jnaneshwara P. Shenoy <b>Background:</b>Students’ perception of the environment within which they study has shown to have a significant impact on their behavior, academic progress and sense of well-being. This study was undertaken to evaluate the students’ perception of their learning environment in an Indian medical school following traditional curricula and to study differences, if any, between the students according to the stages of medical education, i.e., the pre-clinical and clinical stages. <b>Methodology:</b>In the present study, the Dundee Ready Education Environment Measure (DREEM) inventory was administered to undergraduate medical students of first (n = 227), third (n = 175), fifth (n = 171) and seventh (n = 123) semesters. Scores obtained were expressed as mean ± Standard Deviation (SD) and analyzed using one-way ANOVA and Dunnett’s test. P-value < 0.05 was considered as significant. <b>Results:</b>The mean DREEM score for our medical school was 123/200.The first-year students were found to be more satisfied with learning environment (indicated by their higher DREEM score) compared to other semester students. Progressive decline in scores with each successive semester was observed. Evaluating the sub-domains of perception, the registrars in all semesters had a more positive perception of learning (Average mean score: 29.44), their perception of course organizers moved in the right direction (Average mean score: 26.86), their academic self-perception was more on the positive side (Average mean score: 20.14), they had a more positive perception of atmosphere (Average mean score: 29.07) and their social self-perception could be graded as not too bad (Average mean score: 17.02). <b>Conclusion:</b>The present study revealed that all the groups of students perceived their learning environment positively. However, a few problematic areas of learning environment were perceived such as: students were stressed more often; they felt that the course organizers were authoritarian and emphasized factual learning. Implementing more problem-based learning, student counseling and workshops on teaching-learning for educators might enable us to remedy and enrich our learning environment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=103-107&id=3944 https://doi.org/10.7860/JCDR/2014/.3944 Propeller Flaps and Its Outcomes - A Prospective Study of 15 Cases Over Two-years Ramesha K.T., Vijay J., Shankarappa M. <b>Introduction:</b> Cover flaps are needed in management of any bodily defect involving bone, tendon, nerve & vessels. The major objective of a plastic surgeon, facing a complex soft-tissue defect, is to replace “like with like” tissues at minimal donor site “cost” and with maximal accuracy & efficacy. <b>Aims:</b> To study the “Propeller Flaps” utility in reconstructive surgeries, evaluate its planning and complications involving donor site morbidity. <b>Methodology:</b> The prospective study was conducted on 15 cases (11 males/4 females) of propeller flaps during the period of two years (2010-12) in Department of Plastic Surgery and Burns, Bangalore Medical College and Research Institute (BMCRI), Karnataka, India. The propeller flaps were performed in cases with defects due to any cause. Exclusion criteria: Cases with Peripheral Vascular Disease(PVD). Flaps were performed and details recorded. <b>Results:</b> Overall results revealed problem resolution in 87% cases (13 cases). Comprehensive description of each flap type and its related cases are given in the table. It has been categorically found that there were 2 flap partial losses. Partial necrosis has been reported in heavy-smoker patients. <b>Conclusion:</b> This current study clearly justifies that careful application, optimal designing & judicious scientific application of local perforator flaps for lower-limb wounds including rest of the body is successful in many aspects providing high-quality reconstruction ensuring minimal morbidity. It is cost-effective as well as time-saving. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=87-89&id=3947 https://doi.org/10.7860/JCDR/2014/.3947 Cellular Telephone as reservoir of Bacterial contamination: Myth or Fact Satinder S. Walia, Adesh Manchanda, Ramandeep S. Narang, Anup N., Balwinder Singh, Sukhdeep S. Kahlon <b>Objective:</b> To assess bacterial contamination of cellular telephone of dental care personnel, and to determine factors contributing to their contamination. <b>Materials and Methods:</b> A descriptive, cross-sectional study was conducted, which included 300 people using a cellular telephone The study group (hundred in each group) comprised of Dental Health Care Personnel (DHCP), In-Hospital Personnel (IHP) and Out-Hospital Personnel (OHP) of a dental college cum hospital. Swab was wiped along the front and all sides of cellular handset and it was incubated in glucose broth. The swab was subplated onto growth media plates made with half Mac Conkey’s agar and half blood agar and allowed to incubate for 48 hours at 37oC. Isolates were tested for antimicrobial susceptibility. <b>Result:</b> The analysis of presence or absence of microorganisms in the DHCP, IHP and OHP group showed no pyogenic growth in 28%, 31% and 41% cases respectively, the distribution of which was not significant (p>.05). Among non potential pathogens, spore bearing gram positive bacilli were seen in 20 cases of DHCP group, 16 cases of IHP group and 17 cases of OHP group; the distribution of which was not significant (p>.05) Among potential pathogens, significant differences were observed in the distribution of growth of Enterobacter (p<.001), Pseudomonas species (p<.05), Acinetobacter bacteria (p<.05) and Methicillin-resistant Staphylococcus aureus (MRSA) bacteria (p<.001) between the participants of different groups. <b>Conclusion:</b> Results of this study showed that fomites such as cellular telephones can potentially act as “Trojan horses”, thus causing Hospital-Acquired Infections (HAIs) in the dental setting. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=50-53&id=3948 https://doi.org/10.7860/JCDR/2014/.3948 Non-Alcoholic Fatty Liver Disease (NAFLD) in Obesity Rushad Patell, Rupal Dosi, Harshal Joshi, Smit Sheth, Purav Shah, Sarfaraz Jasdanwala <b>Background and Objectives:</b> Limited studies have been undertaken to characterize Non-Alcoholic Fatty Liver Disease (NAFLD) in the Indian population. The main objective of our study was to document the prevalence of NAFLD amongst a cohort of obese Indian patients and demonstrate its relationship with other components of the metabolic syndrome. <b>Methods:</b> A total of 60 adult obese patients were subjected to a detailed history, clinical exam, anthropometric study and laboratory workup. Focus was on liver function and components of the metabolic syndrome like blood pressure, glycemic status and lipid profile. Subjects enrolled were divided into two groups Group A (n=48), with NAFLD and Group B (n=12) without NAFLD. The two groups were then compared amongst themselves as well as with data from previous similar studies. <b>Results:</b> A comparison of the anthropometric measurements revealed a statistically significant difference between the Body mass index (BMI) and Waist Hip Ratio of the two groups and in the mean triglyceride values between the two groups. Although the mean bilirubin levels measured in the serum were not statistically different the mean levels of SGOT and SGPT in the two groups was found to be statistically significant. On the contrary no significant difference in the values of alkaline phosphatase and synthetic liver functions could be discerned. A statistically highly significant difference in the mean liver span is seen. <b>Interpretation and Conclusions:</b> NAFLD is common in Indian obese populations and is associated with significant differences in anthropometric, clinical, laboratory and ultrasonographic aspects as compared with obese individuals not affected with liver disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=62-66&id=3953 https://doi.org/10.7860/JCDR/2014/.3953 Biotechnological Production of Inducible Defense-Related Proteins in Edible Radish (Raphanus Sativus) Found in Nepal Praval Khanal, Anil Karmacharya, Shishir Sharma, Ashwini K. Nepal, Kanti Shrestha <b>Background:</b> Fungal infection in plant leads to use of many hazardous antifungal chemicals. Alternative to these chemicals, defense related antifungal proteins can be used in case of fungal diseases. <b>Aims:</b> An experiment was done in two varieties of edible radish (Raphanus sativus var. Pyuthane Raato and Raphanus sativus var. all season) with aims to produce defense protein within the plant, to identify and perform molecular characterization of those antifungal proteins. The next aim was to compare the antifungal property of those proteins with commercially available synthetic pesticides. <b>Methods:</b> Both varieties of radish were infected with fungi (Alternaria alternata and Fusarium oxysporum). Protein samples were isolated from leaves following the standard protocol as described for ß-glucuronidase (GUS) assay and were run along with the standard protein marker of 10-250kDa in sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) to identify and molecularly characterize them. <b>Results:</b> An additional band in the range of 37-50kDa was observed in the fungal infected samples, which was not seen on uninfected samples. The antifungal assay was carried out for every sample in 96 wells microtitre plate. The extracted protein samples from fungal inoculated plants showed the significant inhibition of fungal growth compared to other samples. On the basis of molecular weight and their antifungal properties, the protein samples from the fungal infected plant were found to be PR2 (Glucanase) and PR3 (Chitinase). <b>Conclusion:</b> Defense related proteins were successfully produced in two varieties of radish found in Nepal. The use of such biologically produced proteins may reduce the use of biologically harmful synthetic pesticides. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=112-115&id=3956 https://doi.org/10.7860/JCDR/2014/.3956 Profile of Patients with Allergic Rhinitis (AR): A Clinic Based Cross-Sectional Study from Kolkata, India Animesh Deb, Shuvankar Mukherjee, Bikram Kumar Saha, Biswanath Sharma Sarkar, Jyotirmay Pal, Naren Pandey, T.K. Nandi , Sayantani Nandi <b>Background:</b> Allergic Rhinitis (AR) though quite common in India, does not receive its due importance as it deserves. <b>Aim of the Study:</b> To identify the demographic and clinical profile of the patients with AR and to find the association of pre-dominant disease symptoms with common allergens, type and severity of the disease and other co-morbidities. Settings and Design: This clinic-based cross-sectional, observational study was conducted among adult patients presenting with signs and symptoms suggestive of AR. <b>Methods and Material:</b> Consecutive 548 patients were initially screened for possible cases of AR by proper history taking and physical examination and confirmation was done by a battery of investigations, including modified skin prick test. A total of 462 patients who were finally diagnosed with AR were included in the study. Categorization of these patients was done following Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. Pulmonary function tests and X-ray/CT-scan of the para-nasal sinuses were done to confirm the presence of bronchial asthma and sinusitis, respectively. Statistical Analysis Used: Data were analyzed by Statistical Package for Social Scientists (SPSS version 10). Z-test was applied to compare between two rates, at 5% level of significance. <b>Results:</b> Proportion of “blockers” was found to be much higher than that of “sneezers-runners” (64.1% vs. 35.9%). “Blockers” had significantly more sensitization to polyvalent house dust, house dust mites and fungi (p < 0.05), while, “sneezers-runners” had more sensitization to pollens (p < 0.05). Significantly more “blockers” had “moderate/severe persistent” and “mild persistent” types of the disease (p < 0.05), while “mild intermittent” and moderate/severe intermittent” type of disease were significantly more common among “sneezers-runners” (p < 0.05). Both bronchial asthma and sinusitis were significantly more common among the “blockers” (p < 0.05). <b>Conclusion:</b> It can be concluded from the present study that the clinical profiles of the two main categories of AR namely “sneezers-runners” and “blockers” were distinct from each other. This knowledge can be useful to physicians at all levels for better management of patients with AR. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=67-70&id=3958 https://doi.org/10.7860/JCDR/2014/.3958 Atypical Manifestations of Dengue Fever (DF) – Where Do We Stand Today? Satya Sudhish Nimmagadda, Chakrapani Mahabala, Archith Boloor, Pavan Mani bettu Raghuram, Akshatha Nayak U. <b>Background and Objectives:</b> Dengue fever (DF) is transmitted by Aedes aegypti mosquitoes. With growing population, rapid urbanization and lack of appropriate sanitary measures, proliferation of mosquitoes and subsequent dengue infections have increased rampantly with an estimated 30-fold increase in incidence over last five decades. With rising disease burden, atypical manifestations have increased as well, which are missed most often due to lack of awareness. Our aim was to look for the atypical manifestations of dengue fever. <b>Materials and Methods:</b> A prospective hospital based observational study was conducted at hospitals of Kasturba Medical College in Mangalore over a period of two years (June–2010 to May–2012). One-hundred fifty ELISA confirmed IgM-dengue sero-positive cases satisfying WHO criteria were examined clinically and laboratory data assessed till they got discharged from hospital after ruling out other causes of fever. Atypical manifestations in dengue fever were noted and analyzed. <b>Results:</b> Most common symptoms noticed were myalgia, headache, rash, arthralgia, pain in abdomen and nausea. More than half of the study group had one or the other atypical manifestation. Liver function test derangement was most often seen. Most common atypical manifestation was hepatitis found in 40.6% patients. Febrile diarrhea, renal failure, Acalculous cholecystitis and conduction abnormalities of heart were among other common manifestations. Three patients died of multi-organ dysfunction, disseminated intravascular coagulation and shock. Platelet count did not correlate well with severity of bleeding. Overall recovery rate was good. <b>Conclusion:</b> Some of the atypical manifestations of dengue fever are no more a rare entity. Clinical vigilance for these manifestations is important for timely detection and management as some of them could be fatal. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=71-73&id=3960 https://doi.org/10.7860/JCDR/2014/.3960 Opinions about Blood Donation amongst Medical Personnel’s Joshua Daniel M., Prakash H. Mudd egowda, Dhivya K., Aswin Kumar S., Arun R., Subash S., Krishnamoorthy R. <b>Objective:</b> There is limited literature in the Indian subcontinent on the attitude of the medical personnel regarding blood donation. The purpose of the present study was to identify and assess the barriers that prevent people from becoming blood donors and also to devise recruitment strategies to increase the blood collection. <b>Materials and Methods:</b> This study was conducted in a tertiary care centre with attached medical college in Tamilnadu amongst 750 medical personnel. A self administered questionnaire was used for data collection from each individual. <b>Results:</b> Amongst the 750 medical personnel under study, 470 were never donors and 280 were lapsed donors. The foremost reason for not donating blood among lapsed donors and non donors was never being asked again. <b>Conclusion:</b> Donors often donate blood once and rarely return to make a second or subsequent donation. Further education, motivation and dissemination of information would help in recruitment and retention of non-remunerated blood donors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=43-45&id=3963 https://doi.org/10.7860/JCDR/2014/.3963 Study of the Effect of Stress on Skeletal Muscle Function in Geriatrics K.N.Poornima, N.Karthick, R.Sitalakshmi <b>Background:</b> Old age is associated with weakness of skeletal muscles and decrease in muscle functions. Usually in old-age, people undergo wasting of muscles, so they are more prone for fall and fracture. It has been stated that stress and cognition has an impact on muscle functions. This study was intended to demonstrate the effect of stress in muscle function in geriatrics. <b>Methods:</b> This was a cross sectional study done at a charitable home in Chennai sub urban. The geriatric males and females in the old age home were included in this study. Sixty-four subjects were included and the persons with previous history of musculo skeletal and neurological disorders were excluded. Anthropometric parameters were recorded Maximum Voluntary Contraction (MVC) and Endurance Time (ET) were measured by hand grip dynamometer. Perceived stress score was measured by perceived stress scale questionnaire. Muscle function parameters and stress score was compared. <b>Results:</b> Sixty-four subjects were included in this study and it was found out that there is a negative correlation between MVC & stress which was statistically significant. (r = -0.0675, P = 0.000). Age with MVC & ET showed a mild negative correlation but it was not significant. <b>Conclusion:</b> Hormones released during stress have a negative metabolic effect in skeletal muscle. Stress can induce earlier decline in muscle strength which will eventually lead to fall and fracture. Therefore, stress should be viewed as an independent risk factor for disability and other co morbid conditions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=8-9&id=3966 https://doi.org/10.7860/JCDR/2014/.3966 Predictive Factors for Pelvic Organ Prolapse (POP) in Iranian Women’s: An Ordinal Logistic Approch Ashraf Direkvand-Moghadam , Zeinab Ghazanfari, Kourosh Sayehmiri <b>Introduction:</b> To investigate the predictors factors of Pelvic Organ Prolapse (POP) in Iranian women by using ordinal logistic regression. <b>Materials and Methods:</b> The role of risk factors of POP was evaluated among 365 patients attending in two public centres in Ilam province, Iran. Exclusion criteria were of single, pregnant and lactate women receiving hormone replacement therapy. Both the unvaried and multi-variate ordinal logistic regression were used to find the predictive factors of POP and computing sensitivity and specificity of models. <b>Results:</b> In multi-variate ordinal logistic regression the variables of Body Mass Index(BMI) Maximum Birth Weight (MBW) and delivery mode were the most important factors for prediction of prolapse stage. The sensitivity and specificity of multi-variate ordinal logistic, as a screening test, were 95.7% and 48.7% respectively. <b>Conclusion:</b> BMI, MBW and delivery mode can use for prediction of POP stage. Stage of prolapse is an ordinal variable, therefore to show relationship between stage of prolapse and other variables ordinal logistic regression is an appropriate model. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=96-99&id=3970 https://doi.org/10.7860/JCDR/2014/.3970 To Compare the Effect of Vibration Therapy and Massage in Prevention of Delayed Onset Muscle Soreness (DOMS) Shagufta Imtiyaz, Zubia Veqar, M.Y. Shareef <b>Objectives:</b> To compare the effects of vibration therapy and massage in prevention of DOMS. <b>Methods:</b> Pre-test and Post-test Control-Group Design was used, 45 healthy female non athletic Subjects were recruited and randomly distributed to the three groups (15 subject in each group). After the subject’s initial status was measured experimental groups received vibration therapy (50 Hz vibration for five minutes) or massage therapy (15 minutes) intervention and control group received no treatment, just prior to the eccentric exercise. Subjects were undergoing the following measurements to evaluate the changes in the muscle condition: muscle soreness (pain perception), Range of Motion (ROM), Maximum Isometric Force (MIF), Repetition maximum (RM), Lactate dehydrogenase (LDH) and Cretain Kinase (CK) level. All the parameters except LDH, CK and 1RM were measured before, immediately post intervention, immediately post exercise, 24 hours post exercise, 48 hours post exercise and 72 hours post exercise. LDH, CK and 1 RM were measured before and 48 hours post exercise. <b>Result:</b> Muscle soreness was reported to be significantly less for experimental (vibration and massage) group (p=0.000) as compared to control group at 24, 48, and 72 hours of post-exercise. Experimental and control group did not show any significant difference in MIF immediate (p=0.2898), 24 hours (p=0.4173), 48 hours (p=0.752) and 72 hours (p=0.5297) of post-exercise. Range of motion demonstrated significant recovery in experimental groups in 48 hours (p=0.0016) and 72 hours (p=0.0463). Massage therapy showed significant recovery in 1RM (p=0.000) compared to control group and vibration therapy shows significantly less LDH level (p=0.000) 48 hours of post exercise compare to control group. CK at 48 hours of post exercise in vibration group (p=0.000) and massage group showed (p=0.002) significant difference as compared to control group. <b>Conclusion:</b> Vibration therapy and massage are equally effective in prevention of DOMS. Massage is effective in restoration of concentric strength (1 RM). Yet vibration therapy shows clinically early reduction of pain and is effective in decreasing the level of LDH in 48 hours post exercise periods. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=133-136&id=3971 https://doi.org/10.7860/JCDR/2014/.3971 TB- DOTS Outcome in Relation To HIV Status: Experience in a Medical College Chennaveerappa P.K., Jayashree Nagaral, Nareshkumar M.N., Praveen G., Halesha B.R., Vinaykumar M.V. <b>Background and Objective:</b> There is scarce information regarding TB associated with Human Immunodeficiency Virus (HIV) infection treated under routine program conditions in medical colleges of India. This study evaluates the clinical profile and outcome of TB-DOTS treatment by HIV status. <b>Methods:</b> Total two hundred and eighty TB patients registered under Revised National Tuberculosis Control Program Revised National TB Control Program (RNTCP) during January 2011 and December 2012 in a teaching hospital of South India were enrolled in the study. The demographic profile, treatment related data of these patients was obtained from RNTCP treatment card and the DOTS outcome of all enrolled cases depending on their HIV status was evaluated. Data was analysed using descriptive statistics and chi-square test. <b>Results:</b> Among 280 TB patients enrolled 41 were HIV positive patients and 239 HIV negative. About 21% patients were retreatment patients. Over all, pulmonary TB was still the commonest form of TB among the registered patients. However, Extra Pulmonary (EPTB) was high among HIV positive TB patients. Treatment success among HIV positive TB patients was lower than HIV negative TB patients (61% vs. 79%). Further, 19.5% HIV positive and 8.3% HIV negative patients died. The proportions of defaulters and failures were similar in HIV positive and HIV negative patients. <b>Conclusion:</b> HIV co-infected TB patients responded poorly to DOTS as evidenced by lower success rates and higher mortality than HIV negative TB patients. A significant proportion of retreatment patients in our study is the matter of concern. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=74-76&id=3975 https://doi.org/10.7860/JCDR/2014/.3975 Effect of Yoga Therapy on Heart Rate, Blood Pressure and Cardiac Autonomic Function in Heart Failure Bandi Hari Krishna, Pravati Pal, Pal G K, Balachander J, Jayasettiaseelon E, Sreekanth Y, Sridhar M G, Gaur G S <b>Background and Objective:</b> It is well known that a hall mark of heart failure is adverse changes in autonomic function. Elevated blood pressure is a powerful predictor of congestive heart failure and other Cardiovascular Disease (CVD) outcomes. In this study, we planned to examine the effects of a 12 week yoga therapy on blood pressure, heart rate, heart rate variability, and rate pressure product (RPP). <b>Methods:</b> Out of 130 heart failure patients recruited for the study, 65 patients were randomly selected to receive 12 week yoga therapy along with standard medical therapy (yoga group). Other patients (n=65) received only standard medical therapy (control group). Heart rate, blood pressure, cardiac autonomic function (by short-term heart-rate variability analysis) and myocardial oxygen consumption (by RPP) were assessed before and after 12 weeks. In the yoga group, 44 patients and in the control group, 48 patients completed the study. <b>Results:</b> There was a significant decrease in heart rate, blood pressure and RPP in yoga group compared to control group. Also, LFnu and LF-HF ratio decreased significantly and HFnu increased significantly in yoga group compared to control group. <b>Conclusion:</b> Twelve-week yoga therapy significantly improved the parasympathetic activity and decreased the sympathetic activity in heart failure patients (NYHA I&II) https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=14-16&id=3983 https://doi.org/10.7860/JCDR/2014/.3983 Pentoxifylline: A New Armamentarium in Diabetic Foot Ulcers Venkatesh Rewale, Kiran Ravi Prabhakar, Anjali M. Chitale <b>Background:</b> Diabetic foot ulcers are estimated to affect 15% of all diabetics and precede almost 85% of foot amputations. Pentoxyfylline a substituted xanthenes’ derivative has been reported to increase the blood flow to the microcirculation and enhances tissue oxygenation. It has been widely used in the treatment of intermittent claudication. <b>Materials and Methods:</b> Pentoxyfylline is known to decrease the rouleaux formation of RBC and hence helps in improving the microcirculation. Out of 67 patients 30 received pentoxyfylline and 32 were on traditional treatment and there was loss of follow-up in five cases. The response was observed subjectively, histologically and by Doppler studies. <b>Results:</b> It was observed that the patients on pentoxyfylline had early healing as compared to patients receiving only conventional treatment as evident on biopsy and Doppler. <b>Conclusion:</b> Here in this research our objective was to determine whether pentoxyfylline (trental 400 mg) taken orally TDS in addition to ambulatory compression bandages and dressings improves the healing rates of diabetic ulcers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=84-86&id=3984 https://doi.org/10.7860/JCDR/2014/.3984 Immunohistochemical (IHC) Analysis of Non-Hodgkin’s Lymphoma (NHL) Spectrum According to WHO/REAL Classification: A Single Centre Experience from Punjab, India Manisha Sharma, Rahul Mannan, Mohit Madhukar, Sanjay Navani, Mridu Manjari, Tejinder Singh Bhasin, Karamjit Singh Gill <b>Introduction:</b> The distribution of the major subtypes of non-Hodgkin’s lymphoma (NHL) differs across geographic regions. This study, from the north Indian state of Punjab, has incorporated immunophenotypic findings while investigating the distribution of NHL subtypes based on World Health Organization (WHO)/ Revised European-American Classification of Lymphoid Neoplasms (REAL) system of classification. <b>Patients and methods:</b> Over all seventy seven cases of lymphoma over a period of one year (between April 2012 and April 2013) were diagnosed in the Department of Pathology, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar (Punjab). Of these 30 cases (39%) were of Hodgkin’s Lymphoma (HL) and 47 cases (61%) were of Non Hodgkins lymphoma NHL. Of the total of cases of lympho-proliferative disorders, the diagnosis of NHL was done by light microscopy alone. All the cases diagnosed provisionally as NHL were taken up for immunophenotyping with Immunohistochemical (IHC) studies. There was 100 % concordance between the light microscopy and IHC studies. The individual NHL cases were classified according to the WHO/REAL classification according to the positive or relevant negative immonophenotypic expression and tabulated to ascertain the morphological spectrum of NHL in this part of the country. <b>Results:</b> B-cell lymphomas formed 89.3%, whereas T-cell lymphomas formed 10.7% of the NHLs. Diffuse Large B-Cell Lymphoma (DLBCL) was the most common subtype (46.8% of all NHLs). B-cell small lymphocytic lymphoma, Mantle-Cell Lymphoma (MCL), marginal zone B-cell lymphomas (including MALT lymphomas), Diffuse, mixed small cleaved cell and large-cell type and Follicular centre-cell lymphomas amounted to 17%, 12.8%, 2.1%, 2.1% and 4.3%, respectively. Among the T-cell lymphomas, T-cell lymphoblastic lymphoma, anaplastic large-cell lymphomas of T/null-cell type, and Angioimmunoblastic T-cell lymphoma (AITL) accounted for 6.4%, 2.1%, and 2.1% of all NHL cases, respectively. <b>Conclusions:</b> The distribution of NHL subtypes in India shows disparity with those from the rest of the world. Follicular Lymphoma (FL) and MCL are less common in India compared to Europe and the USA. Peripheral T-cell lymphomas and T/NK-cell lymphomas of nasal and nasal types, which are common in many other Asian countries, are also less prevalent. T-cell lymphoblastic lymphoma and anaplastic large T/null cell lymphoma are more prevalent in India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=46-49&id=3988 https://doi.org/10.7860/JCDR/2014/.3988 Right Bundle Branch Block: An Uncommon Cardiotoxic Manifestation of Hair Dye Poisoning-A Case Report Deepak Balasubramanian, Saravanan Subramanian, Pugazhenthan Thangaraju, Kani Shanmugam Hair dye poisoning has been rising in incidence in the recent years. Apart from the commoner manifestations of upper airway edema, rhabdomyolysis and acute renal failure, cardiac toxicity, convulsions and sudden cardiac death are relatively rare complications. We discuss a case of hair dye poisoning manifesting as oropharyngeal edema along with cardiac complication. The patient survived. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=174-176&id=3962 https://doi.org/10.7860/JCDR/2014/.3962 Unique Formation of Sciatic Nerve Below the Piriformis Muscle – A Case Report Jyothsna Patil, Ravindra S. Swamy, Mohandas Rao K.G., Naveen Kumar , Somayaji S.N. Dorsal and ventral divisions of ventral rami of lower lumbar and sacral spinal nerve were found to pass ventral and dorsal to the piriformis muscle respectively. These divisions joined each other below the piriformis muscle to form sciatic nerve. This low formation of sciatic nerve was observed in distal part of left gluteal region of a 50-year-old male cadaver. The sciatic nerve thus formed passed caudally into back of thigh and divided into tibial and common peroneal nerves in the upper part of popliteal fossa. In addition, a communicating nerve from the sciatic nerve was found to join the common peroneal nerve in the popliteal fossa. Such variations may lead to piriformis syndrome or non-discogenic sciatica. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=148-149&id=3977 https://doi.org/10.7860/JCDR/2014/.3977 Neonatal Gastric Teratoma: A Rare Entity Bikram Kharga, Vijay Kumar, P. Santosh Prabhu, Sundeep P.T., Sijo K. John Gastric Teratoma is an extremely rare neoplasm seen in children. It is mostly benign and predominantly seen in males presenting with an abdominal mass. The lung and stomach are very unusual sites for teratoma. Gastric teratoma accounts for less than 1% of all teratomas, less than 100 cases are reported in literature. We report a case in a 20-day-old infant who presented with large abdominal mass; our case is an addition to the few limited known gastric teratomas reported in the world literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=185-186&id=3972 https://doi.org/10.7860/JCDR/2014/.3972 Unusual Co-existence of Biaponeurotic Palmaris Longus and Accessory Abductor Digiti Minimi in Man Tejaswi Hiremarali Lokanathaathan, Manjappa Surendra, Ningaiah Ajay, Raja Rao Rajendra The present study describes a rarely reported co-existence of variant muscles in the right upper limb of a male cadaver of 57 years of age, observed during routine anatomical dissection. There was a presence of the biaponeurotic palmaris longus with a central muscle belly in the anterior forearm region which was closely related to the median nerve. In addition to this, an accessory abductor digiti minimi muscle was also reported in the corresponding hypothenar region, traversing the Guyon’s canal, passing superficial to the ulnar vessels and nerves. Biaponeurotic palmaris longus and accessory abductor digiti minimi are important structural causes of the entrapment neuropathies of forearm and wrist. Diagnosis of these muscles as a cause of entrapment neuropathies requires the sound knowledge of variant muscles in the forearm and wrist region. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=146-147&id=3968 https://doi.org/10.7860/JCDR/2014/.3968 Transanal Evisceration of Small Bowel-A Rare Surgical Emergency Narayana Swamy Chetty Y.V., Sridhar M., Pankaja S.S. Transanal evisceration of small bowel is an extremely rare surgical emergency. This is the condition in which the small bowel herniates through breach in the anterior rectal wall and seen eviscerating through the anal canal. It is challenging for a surgeon to deal and manage such a case during emergency, especially if he hasn’t dealt with such condition earlier. The present case reported is of 68 year old lady referred to an institution with history of transanal herniation of small bowel for three days duration, following manual reduction of chronic rectal prolapse. The case report illustrates aetiology, management & factors influencing the outcome of this rare emergency have been discussed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=183-184&id=3969 https://doi.org/10.7860/JCDR/2014/.3969 Can Treatment for Polycystic Ovarian Disease Induce Ovarian Tumour? A Case Report Gowri Dorairajan, N. Hima Bindu, Ramachandra V. Bhat Polycystic ovarian disease in adolescents is not uncommon. Usually underlying ovarian tumours can cause hirsutism and ovulation. A 15-year-old girl presented with infrequent cycles and hirsutism. Her baseline evaluation ruled out ovarian tumour and other endocrinological problems. She was treated with insulin sensitizers and hormone treatment. After more than a year of treatment she developed a large ovarian tumour which turned out to be a juvenile granulose cell tumour at laparotomy a year after treatment with insulin sensitizers. The authors recommend continued surveillance of ovaries of adolescent girls undergoing treatment for polycystic ovarian disease to monitor for formation of ovarian tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=191-192&id=3964 https://doi.org/10.7860/JCDR/2014/.3964 Twin Reversed Arterial Perfusion Syndrome (TRAP or Acardiac Twin)- A Case Report Kalyani R., Mandeep S. Bindra Twin reversed arterial perfusion (TRAP) syndrome is a rare condition (0.3:10,000 births) that occurs in monochorionic twin pregnancies, resulting in coexistence of a normal “pump” twin and an acardiac twin. The acardiac twin is dependent upon the normal twin to provide circulation by means of vascular anastomosis. Many of the bizarre defects are felt to be caused by low oxygen tension and this causes dramatic alteration in the twin fetal physiology and high prenatal mortality. The acardiac twin is a parasite, putting the pump fetus at risk of high output cardiac failure. Overall only 50% of pump twins survive. We present a case in a twenty year female, gravida two, para one, living one, full term normal pregnancy, ultrasound showed twin pregnancy. Following delivery, the first fetus survived only for one day and the second fetus showed features of TRAP syndrome https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=166-167&id=3965 https://doi.org/10.7860/JCDR/2014/.3965 Pagophagia – A Common but Rarely Reported Form of Pica M.S.Bhatia, Nirmaljit Kaur Pagophagia is a particular form of pica characterized by ingestion of ice, freezer frost or iced drinks often associated with iron or calcium deficiency. It occurs due to a complex interplay in between behavioural components. Only few cases of pagophagia have been reported from India.We report a case, a married lady, who presented with pagophagia and responded to fluoxetine. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=195-196&id=3959 https://doi.org/10.7860/JCDR/2014/.3959 Hypokalemic Quadriparesis: An Unusual Manifestation of Leptospirosis Mahendran K., Kannan R., Lal D.V., Rajiv G., Rajendran K. We report a 46-year-old male who presented with fever and flaccid weakness of all four limbs due to Leptospirosis associated hypokalemia. Acute hypokalemic quadriparesis is an uncommon presentation of leptospirosis, not yet widely recognised. Renal potassium wasting occurs in Leptospirosis and subsequently, the development of hypokalemia leads to paralysis. The patient had kaliuresis due to leptospirosis which improved with antibiotics and potassium replacement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=172-173&id=3957 https://doi.org/10.7860/JCDR/2014/.3957 Hodgkins Lymphoma of Bone - A Rare Case Report Mangala Gouri S R, Saraswathi G Rao, Sundaresh D.C. Primary Hodgkins lymphoma presenting as a lytic bone lesion is very rare. A 27 year old male presented with deformity and pain in lower back region from past 1 year. X-ray and CT scan revealed T12 and L1 vertebral destruction and an osteolytic lesion with destruction of the Right Ilium. Clinically a diagnosis of giant cell tumour was made. However histopathology & Immunohistochemical evaluation helped in diagnosing the case as a classical Hodgkin’s disease of the bone. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=160-161&id=3954 https://doi.org/10.7860/JCDR/2014/.3954 Hind Brain Agenesis A Rare Imaging Findings In Cerebro Cerebellar Lissencephalic Syndrome Praveen M. Mundaganur, Pradeep solwalkar, vishal nimbal A case report of cerebro cerebellar lissencephaly shows complete agenesis of cerebellum and brainstem which is rare imaging finding of group lissencephaly (type I lissencephaly). Though agenesis of cerebellum and brainstem were included in literature, in most of the cases we saw a hypoplasia or atrophy of cerebellum in lissencephaly syndrome. The CT scan findings of this patient shows features of lissencephaly with complete agenesis of brain stem and cerebellum associated with multiple congenital abnormalities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=140-141&id=3952 https://doi.org/10.7860/JCDR/2014/.3952 Preterm Neonate with Spontaneous Pneumopericardium without any Other Associated Air Leaks Suryawanshi P., Klimek J. We report a case of a preterm neonate with isolated spontaneous pneumopericardium occurring in the absence of a history of neonatal resuscitation, mechanical ventilation, major lung disease or another air leak. The pneumopericardium was asymptomatic and resolved without the need for aspiration, although the “nitrogen washout” technique was used. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=181-182&id=3945 https://doi.org/10.7860/JCDR/2014/.3945 Unilateral Variations in Upper Limb Arterial System: A Case Report with Literature Review Tanushree Roy, Hironmoy Roy Tanwi Ghosa l (Sen), Shabana Begum In a female cadaver unilateral variations were found in upper limb arterial system - as (1) high-up origin of ulnar artery at arm, (2) persistent prominent arteria nervii mediana or median artery, (3) common interosseous artery branching out of brachial artery. Literature review revealed these coexistent anomalies as the consequence of aberrant finalization of the path chosen by axis arterial network in embryonic life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=150-152&id=3939 https://doi.org/10.7860/JCDR/2014/.3939 A Case of Vesicouterine Fistula: Unwanted Medical Anomaly but Consequentiality of Most–Wanted Medical Intervention ‘Caesarean Section’ Kavitha Bakshi, Kusuma Lokam, J. Sasikumar Vesicouterine fistula is a rare entity, with unique presentation of cyclical haematuria, amenorrhoea, absence of urinary incontinence (Youssef syndrome). A 35 year old female patient, P2L2 with 2 previous LSCS presented with cyclical haematuria, amenorrhoea, repeated UTI, dating from 11th day of last LSCS. Transabdominal sonography revealed communication between bladder & uterus, confirmed by cystoscopy. At laparotomy fistulous tract delineated and bladder separated from uterus. Hysterectomy and closure of bladder done. Continuous bladder drainage with suprapubic and perurethral foleys catheters maintained. Postoperative period was uneventful. Cystoscopy during followup revealed healthy scar. Vesicouterine fistula is an avoidable complication of LSCS which can be prevented by sound surgical technique. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=189-190&id=3940 https://doi.org/10.7860/JCDR/2014/.3940 Intra–muscular Nodular Fasciitis Presenting as Swelling in Neck: Challenging Entity for Diagnosis Sankapp a. P. Sinhasan, Bharathi K.V., Ramachandra V. Bhat, Basavanandaswamy C. Hartimath The diagnosis of Nodular Fasciitis is a very challenging on cytological aspirations. Even in histopathological sections, it can be sometimes be mistaken for soft tissue sarcomas due to its high cellularity, presence of mitotic figures, poor circumscription and degenerative myxoid areas. Most commonly, nodular fasciitis is seen on extremities; and sub-cutaneous form is most common. We are hereby reporting a case of nodular fasciitis at a rare site (head and neck area) in its rare form (intra-muscular type: originating within sternocleidomastoid muscle), which was clinically suspected as a malignancy arising from solitary thyroid nodule. Cytological diagnosis was issued as benign spindle cell lesion (where chances of a misdiagnosis as malignant are very high), thereby preventing radical surgery. It was subsequently confirmed as intra-muscular nodular fasciitis after histopathological examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=155-157&id=3909 https://doi.org/10.7860/JCDR/2014/.3909 Microfilariae of Wuchereria Bancrofti in a Patient of Chylous Haematuria: Report of an Unusual Finding in Urine Cytology Mohd Jaseem Hassan, Zeeba S Jairajpuri, Sujata Jetley, Sabina Khan, Safia Rana, Musharraf Hussain Filariasis is a disabling parasitic disease and it constitutes as a major health problem in most of the tropical and sub-tropical countries. One hundred and twenty million people in at least 80 tropical and sub-tropical countries are infected with lymphatic filarial parasite, with one billion people being at risk of the disease. The laboratory diagnosis of filariasis is conventionally made by demonstrating microfilaria in peripheral blood smear. However, microfilaria have been incidentally detected by doing fine needle aspiration of various lesions in clinically unsuspected cases of filariasis. In 1982, detected microfilariae in the sediment smears of cystoscopically catheterized urine samples, but reports on detection of microfilaria in normally voided urine samples are extremely rare. Here, we are reporting, such a case of microfilariae of Wuchereria bancrofti in an 18–year–old boy who presented with chylous haematuria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=153-154&id=3906 https://doi.org/10.7860/JCDR/2014/.3906 Multiple Giant Cell Tumours of Tendon Sheath: A Rare Occurrence Smita Charandas Pathade, Ramkumar Kurpad, Mohammed Tauheed Giant Cell Tumours Of Tendon Sheath (GCTTS) are the second most frequent soft tissue tumours affecting the hand with an overall incidence of 1 in 50,000 individuals. These tumours are usually localized and solitary, with multiple GCTTS occurring rarely. Multi-centric origin is considered unusual and very few cases of multiple GCTTS have been reported till date. Here, we report a rare case of a 26-year-old female who presented with multiple painless swellings on palmar aspect of little finger of right hand since six months. Clinical diagnosis of Dupuytren’s contracture was given. Intraoperative examination revealed multiple separate nodules, firmly attached to the flexor tendon synovial sheath. Histopathology showed features of GCTTS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=170-171&id=3924 https://doi.org/10.7860/JCDR/2014/.3924 Gaint Peritoneal Loose Body: A Case Report and Review of Literature HEMANTH MAKINENI, POORNACHANDRA THEJESWI, SHIVANANDA PRABHU, RAHUL R.BHAT A 52-year-old man was presented with discomfort in lower abdomen and irritative voiding symptoms. Computed tomography showed a well circumscribed mass with calcification in front of bladder compressing the bladder diagnosed as leiomyoma with calcifications, probably araising from rectum. Surgery revealed a giant peritoneal loose body measuring 6cm in diameter. After the removal of peritoneal loose body patient was relieved of symptoms. Peritoneal loose bodies are usually small and are found incidentally at surgery. Giant peritoneal loose bodies are rare. A comprehensive review of literature is presented. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=187-188&id=3925 https://doi.org/10.7860/JCDR/2014/.3925 Anaesthetic Management of Pulmonary Stenosis Already Treated with Pulmonary Balloon Valvuloplasty Sushma K.S., Safiya Shaikh The presence of congenital valvular heart disease can pose a challenge to anaesthetists in paediatric patients planning for incidental surgeries. Most of the available case reports from various journals describe the anaesthetic management in adults, whereas, pulmonary stenosis can present anytime during childhood and adolescence. The present case-report highlights anaesthetic management in a 9-year-old child, who was diagnosed with severe pulmonary stenosis that was already treated with pulmonary balloon valvuloplasty, yet had an eventful perioperative period due to residual valvular dysfunction. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=193-194&id=3926 https://doi.org/10.7860/JCDR/2014/.3926 A Case of Diamond Blackfan Anemia (DBA) with Mutation in Ribosomal Protein S19 John Solomon, Rugmini Kamalammal, Godfred Antony Menezes, Mohamed Yaseen Sait, Harita Lohith, Revathy Ramalingam Diamond Blackfan Anemia (DBA) is a rare disorder which presents with anemia in early infancy. This disorder is genetically and clinically heterogeneous in nature. The inheritance is mainly autosomal dominant. Approximately 25% of the cases are associated with craniofacial anomalies and some cases may end up in malignancy. The diagnosis is made by blood investigations, and bone marrow studies in which red cell precursors are reduced or absent. Screening for the mutations including those encoding for ribosomal proteins in the patient and the family members confirms the diagnosis. Human Leukocyte Antigen (HLA) matched hemopoietic stem cell transplantation is the treatment of choice. In other cases, corticosteroids and cyclosporine A have been tried. The haemoglobin level is maintained with packed red cell transfusion. We are presenting here a female baby who had anemia at birth and was brought to us at the age of 2 months. The diagnosis of DBA was made since the patient presented with anemia and showed reticulocytopenia, gross reduction in Red Blood Cell (RBC) count, and reduction in red cell precursors in the bone marrow. Genetic screening revealed mutation in ribosomal protein S19 (RPS19) gene in both the infant and the father. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=179-180&id=3899 https://doi.org/10.7860/JCDR/2014/.3899 Intra-Abdominal Desmoid Tumour (DT) with Pelvic Extension-A Case Report Sathish Selva Kumar, Padmini Ramachandran, Veena. G, Napa Madhusudhan, Uday Kumbhar Desmoid Tumour (DT) is a rare benign, myofibroblastic tumour originating from muscle fascia with tendency to recur but, it rarely metastasizes. We are reporting here a case of DT that presented as an intra-abdominal mass with pelvic extension in a patient who underwent hysterectomy for fibroid uterus seventeen years ago. A clinical diagnosis of ovarian malignancy was made. Ovarian tumour markers for surface epithelial and germ cell tumours were negative. Imaging studies suggested DT and the same was excised surgically. A histopathological diagnosis of DT was made and confirmed with immunohistochemistry (IHC) markers. DT should always be considered especially in female patients with previous history of surgery. A complete surgical excision is the treatment of choice with recurrent cases requiring radiotherapy. A differential diagnosis like sarcoma and further toxic chemotherapy can be avoided with careful histopathological evaluation and IHC confirmation of DTs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=168-169&id=3901 https://doi.org/10.7860/JCDR/2014/.3901 Nasopharyngeal Mucoepidermoid Carcinoma - A Common Entity at an Uncommon Location A.L. Hemalatha , Sharath Kumar H.K, Geetanjali S., Giripunja M., Shashikumar S.D. Mucoepidermoid carcinomas mostly occur in the major salivary glands, the minor salivary glands of oral cavity and in the lacrimal glands. These tumours rarely occur in the sino-nasal tract. When they occur in the sino-nasal tract, the most frequent site is the maxillary antrum, followed by the nasal cavity, the nasopharynx and the ethmoidal sinuses. As per review of literature, nasopharyngeal mucoepidermoid carcinomas account for 0.6% of salivary gland tumours and 4.8% of mucoepidermoid carcinomas. Extensive literature search revealed 21 cases of nasopharyngeal mucoepidermoid carcinomas reported till date. These cases showed an age incidence ranging from 20 to 60 years with a female preponderance. In contrast to nasopharyngeal carcinomas, these tumours show low positivity rates for Ebstein-Barr virus serological test. Histochemical positivity for mucin may be demonstrated in the glandular and mucinous components of these tumours. High grade mucoepidermoid carcinoma of nasopharynx is treated with surgical excision combined with radiotherapy and is associated with poor survival. Therefore, early diagnosis and prompt treatment are of utmost importance. This case report highlights the rare occurrence of a high grade nasopharyngeal muco-epidermoid carcinoma in a 70-year-old male and is presented for its unusual occurrence in the nasopharynx which is the most infrequent location for this lesion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=164-165&id=3897 https://doi.org/10.7860/JCDR/2014/.3897 Greater Omental Pancake Tumour due to Metastasis of Ovarian Cancer – A Cadaveric Study Prashant A. Bhusari, Karan B. Khairnar <b>Introduction:</b> Cancer of ovary is the one of the common of all gynecological tumors and is the leading cause of death among women. A unique attempt is made to trace masses & its causes found in an abdomen of female cadaver during routine anatomy dissection. <b>Observation:</b> The mass was thick, hard and somewhat nodular in the region of greater omentum, After dissecting the pelvic cavity, it was found that both the ovaries were bulky, nodular & hard. Whole abdominal cavity was dissected & found that liver also involved by metastasis. <b>Conclusion:</b> Case suggests that there is the development of metastatic omental mass from grade IV ovarian cancer. Primary human omental adipocytes promote homing, migration and invasion of ovarian cancer cells. Adipokines like interleukin-8 (IL-8) mediate these activities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=7&issue=8&page=142-143&id=3798 https://doi.org/10.7860/JCDR/2014/.3798 Bilateral Multiple Renal Vessels, A Case Report Sulabha Hanumant Deshpande,Balappa Muregappa Bannur,Babasaheb Gurusiddappagoud Patil The kidneys receive arterial supply from the paired renal arteries. During routine dissection we observed in an adult male cadaver the following variation. Bilateral variation is seen in 5%-10% of individuals. The right kidney was receiving 3 renal arteries. Two were arising from the abdominal aorta just below the origin of superior mesenteric artery and the 3rd artery was arising from aorta, below the origin of Inferior Mesenteric artery. The left kidney received 2 renal arteries, both arising from aorta at a lower level than right, just below the origin of superior mesenteric artery. On the right side, 2 renal veins were independently draining into inferior vena cava. It is important to be able to depict all accessory renal arteries, because accessory renal arteries are end arteries.The main clinical significance of arteries entering the lower pole is that they may obstruct the ureter and lead to hydronephrosis. It is important to consider these results while using non-angiographic, non-invasive methods for investigating renal artery stenosis, as well as, during surgeries related to renal arteries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=144-145&id=3800 https://doi.org/10.7860/JCDR/2014/.3800 Cryptococcososis of Bone Marrow: A Case Report with Review of Literature Ashwini B.R, AR Raghupapathi, Srinarthana. Cryptococcus has been increasingly seen as a pathogen with the growing incidence of Acquired Immune Deficiency Syndrome (AIDS). Cryptococcosis commonly presents with pulmonary, CNS or skin involvement. Bone marrow involvement of Cryptococci has been rarely reported. We are reporting a case of bone marrow Cryptococcosis in a 50–year–old Human Immune Deficiency Virus (HIV) positive male, with review of literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=158-159&id=3807 https://doi.org/10.7860/JCDR/2014/.3807 Primary Leiomyosarcoma of the Penis: A Case Report Lawrence D’Cruze, Boobala A., Subalakshmi Balasubramanian, Swaminathan Rajendiran, Leena Dennis Joseph Primary leiomyosarcoma of the penis is a very rare tumour. Only 46 cases have been reported in the English medical literature. We are presenting this case of a 59-year-old patient with a ulceroproliferative growth in his penis. Histopathology was a high grade spindle cell sarcoma, which was proved by immunohistochemistry to be a leiomyosarcoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=162-163&id=3808 https://doi.org/10.7860/JCDR/2014/.3808 Posterior Reversible Encephalopathy Syndrome Unmasking Acute Glomerulonephritis Sathish Kumar .S, Kumar. M, Shobhana. S, Sowmya Sampath, R. Kulandai Kasthuri Posterior reversible encephalopathy syndrome (PRES) is a recently described condition, wherein there is vasogenic oedema, seen on neuroimaging, predominantly over the parieto occipital regions of the cerebrum. Though, as the name implies, the condition is reversible, there may be fatalities and neurological sequelae. We are reporting a 9-year-old female child in whom the typical clinical and neurological findings of PRES were caused by an atypical presentation of acute glomerulonephritis https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=177-178&id=3818 https://doi.org/10.7860/JCDR/2014/.3818 Growing Teratoma Syndrome of Ovary: Avoiding A Misdiagnosis of Tumour Recurrence Ananya Panda, Devasenathipapathy Kandasamy, Chandrashekhara SH , Manisha Jana Growing teratoma syndrome is characterized by conversion of immature gonadal germ cell tumour to a mature form, along with increase in size of the lesions. Being more frequently described in testicular germ cell tumours, growing teratoma syndrome in an ovarian tumour is uncommon. The exact cause of conversion and growth is unknown and is hypothesized to be induced by chemotherapy. On imaging, the diagnosis is suggested by the appearance of mature elements such as fat or calcium within these lesions and it is confirmed by normal serum markers despite the increase in its size. Knowledge of this entity is important, to avoid misdiagnosis as disease progression and continuing chemotherapy, as these lesions are refractory to chemotherapy. Though surgery is curative, they can also be safely followed-up in a majority of cases, with a favourable long term prognosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=197-198&id=3837 https://doi.org/10.7860/JCDR/2014/.3837 Leptospirosis Diagnosis: Competancy of Various Laboratory Tests Suman Veerappa Budihal, Khalid Perwez Leptospira can be found in virtually all tropical and temperate areas of the world and is presumed to be the most wide spread zoonoses in the world.Humans contact leptospirosis through mucosal or percutaneous exposure to leptospires in environments contaminated by the urine of chronically infected animal sources. Despite being common, the diagnosis of leptospirosis is often not made unless a patient presents with textbook manifestations of the so called Weil’s disease, such as fever plus jaundice, renal failure and pulmonary haemorrhage. Leptospiral infection often has minimal or no clinical manifestations; of the cases in which fever develops, as many as 90% are undifferentiated febrile illnesses. Because of the variety of clinical symptoms seen in the symptomatic cases, leptospirosis at its onset is often misdiagnosed as aseptic meningitis, influenza, hepatic disease or fever (pyrexia) of unknown origin. Moreover, clinicians may fail to recognize that transmission of leptospirosis can occur in the urban setting because it is incorrectly perceived to be a rural disease. Therefore, diagnosis is based on laboratory tests rather than on clinical symptoms alone. In developing countries, laboratory facilities may be inadequate for diagnosis despite a high prevalence of the disease. Of substantial clinical importance, the syndrome of leptospiral pulmonary haemorrhage has emerged in recent years, in diverse places around the world. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=199-202&id=3950 https://doi.org/10.7860/JCDR/2014/.3950 An Imaging Review of Intra-ocular Calcifications Sushil G. Kachewar, Devidas S. Kulkarni Intra-ocular calcifications can occur due to a variety of reasons. In cataract, the lovely lens gets calcified and the bright beautiful world becomes dark and dreadful. Cataract comes in various forms like; congenital, traumatic and senile. Asteroid Hyalosis (AH) occurs because of the accumulation of calcium soaps in vitreous of the eyes. Although it is asymptomatic and unilateral, it is seen more often in diabetic patients. Tumours of eye like retinoblastoma and optic nerve meningioma too are known to show calcifications. This review has focussed on imaging appearances of intra-ocular calcifications, a small process in a small organ that nevertheless has a wide impact on the entire organs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=203-205&id=3904 https://doi.org/10.7860/JCDR/2014/.3904 The Effect of Time of Post Space Preparation on the Seal and Adaptation of Resilon-Epiphany SE and Gutta-percha-AH Plus Sealer- A SEM Study Neha Dhaded, Sunil Dhaded, Chetan Patil, Roopa Patil, Joan Maria Roshan <b>Background:</b> The field of endodontics is dynamic and ever expanding. With the availability of a wide array of products in the dental market it is an absolute necessity to evaluate their efficiency before including them into routine clinical practice.Hence, the purpose of this study is to evaluate the effect of immediate and delayed post space preparation and sealing ability of new root canal filling material and sealers. <b>Aim:</b> The effect of time of post space preparation on the seal and adaptation of Resilon-Epiphany SE and Gutta-percha-AH Plus Sealer - A SEM study. <b>Settings and design:</b> Eighty extracted permanent maxillary central and lateral incisors selected for the study were decoronated. Roots canals were prepared and obturated. <b>Materials and Methods:</b> Samples were divided into four groups depending on the time of post, space, preparation and obturated material. GROUP I & II: Immediate and Delayed post space preparation respectively with Gutta-percha / AH Plus as obturating material. GROUP III and IV Immediate and Delayed post space preparation with Resilon / Epiphany as the obturating material. The samples were sectioned, then measured and studied by Scanning Electron Microscope (SEM). <b>Results:</b> There was a significant difference found between immediate and delayed post space preparation in Resilon –Epiphany group (p<0.001). Similarly significant difference was seen between immediate and delayed post space preparation in AH Plus-GP group (p<0.001). Difference in the adaptation of the two materials was seen in the delayed group (p = 0.030) but the immediate group showed no signifcant difference (p =0.971). <b>Conclusion:</b> Within the limitations of this study, immediate post space preparation shows less leakage in both the groups. Resilon–Epiphany shows better results when post space is delayed amongst the two whereas in immediate post space preparation there is no significant difference. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=217-220&id=3955 https://doi.org/10.7860/JCDR/2014/.3955 Hypohidrotic Ectodermal Dysplasia (ED): A Case Series Mallika Kishore, Sunil R. Panat, Ashish Aggarwal, Nupur Agarwal, Nitin Upadhyay, Kratika Ajai, Abhijeet Alok Ectodermal Dysplasia (ED) is a rare disorder with defects in two or more of the following structures: the teeth and the skin and its appendages including hair, nails, eccrine, and sebaceous glands. Dental manifestations include hypodontia, complete anodontia or malformed teeth. The most common form of the ED syndrome is hypohidrotic ED and is usually inherited as an X-linked recessive trait. Female carriers may have a variable degree of clinical manifestations. The condition is thought to occur in approximately 1 in every 100,000 live births. Dental treatment for these patients varies on an individual basis. Children with ED are often treated dentally with conventional adult appearing prosthesis which are focused only on the oral manifestations of the syndrome. We are here reporting two classical cases of hypohidrotic ED with a review of the literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=273-275&id=3951 https://doi.org/10.7860/JCDR/2014/.3951 Precision Attachments for Aesthetics and Function: A Case Report Nitin Bhaskar Shetty, Sanyuktha Shetty, Nagaraj E., Omkar Shetty, Raina D’so uza Successful restoration of the dentition requires plenty of contemporary and conventional treatment techniques and planning and attachment retained partial dentures are one such kind of treatment modality in prosthodontics. Limited space for extracoronal attachments is a serious gap in the design and the fabrication of a precision attachment Removable Partial Denture (RPD). A custom semi-precision attachment with a partial denture offers strength and improved aesthetics in cases with minimal space. This article presents a method of fabrication of semi-precision attachment to eliminate metal display and enhance aestheticity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=268-270&id=3949 https://doi.org/10.7860/JCDR/2014/.3949 An Epidemiological Study on the Selection, Usage and Disposal of Dental Burs among The Dental Practioner’s sumeet sharma, Ravi Shankar, K. Srinivas <b>Aim:</b> The purpose of this cross sectional study was to understand and evaluate local practioner`s knowledge on dental bur selection, its usage, sterilization procedures undertaken and the method of disposal of dental burs in restorative procedures. <b>Materials and Methods:</b> A questioner proforma was prepared with each question having 4 answers. A total of 20 questions were framed and were sub-divided in to 3 categories namely selection, usage sterilization and disposal. These questioners were sent to all the local practioner`s by mail and to ensure a high response rate as they were followed up by telephone calls. The results were analyzed statistically and were represented in the form of percentage. <b>Results:</b> A total 131 out of 150 practioner`s answered the questions, a response rate of 87%. Most of the practioner`s preferred diamonds (75%) over tungsten carbide (15%) burs. most of the dentists used burs till they were worn out (85%) and many of the dentists agreed that the cutting efficiency of bur decreased with usage (33%). Clinicians usually sterilized burs either once daily (35%) or for every patient (35%). Almost every practioner discarded their worn out burs into dustbin (100%). <b>Conclusion:</b> From the survey we came to know the operators attitude towards one group of burs in terms of cutting efficiency. In terms of cutting efficiency diamond burs predominated the choice irrespective of the grit size. Burs were used repeatedly till they were worn out and minimal coolant was used during tooth preparation and believed that it didn`t have any effect on the cutting efficiency. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=250-254&id=3946 https://doi.org/10.7860/JCDR/2014/.3946 Soft Tissue Esthetic Norms for Mahabubnagar Population of Southern India Jay Sinojiya, Kaladhar Reddy Aileni, Madhukar Reddy Rachala, Jaipal Redd y Pyata, Vankre Mallikarjun, C. Manjunatha Reddy <b>Aims:</b> The Aim of the study was to establish Soft Tissue Cephalometric Norms for skeletal and dental relationships amongst the Mahabubnagar adult population. <b>Materials and Methods:</b> Sixty subjects (30 Males & 30 Females) subjects from different part of Mahabubnagar in the age group 18-25 Years (Mean age 21.3 Years) were selected at random for the study and lateral cephalograms were taken. All the cephalograms were traced by two operators using conventional hand tracing. The parameters used in the study were taken from Arnett and Bergman soft tissue cephalometric analysis (STCA). Overall 46 measurements including 40 linear, 6 angular parameters were used. Mean and standard deviation values were calculated. The difference between males and females were evaluated using student t-test. <b>Results:</b> The values obtained from the study showed significant difference in most of the parameters from that of Arnett et al., norms and between males and females within Mahabubnagar population. <b>Conclusion:</b> Males had thicker soft tissue structures, acute nasolabial angle, increased facial lengths and heights, increased midface deficiency, recessive lower face, more convex profile and less upright mandibular incisors than females within Mahabubnagar population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=255-259&id=3936 https://doi.org/10.7860/JCDR/2014/.3936 Biomaterials in Tooth Tissue Engineering: A Review Sarang Sharma, Dhirendra Srivastava, Shibani Grover, Vivek Sharma Biomaterials play a crucial role in the field of tissue engineering. They are utilized for fabricating frameworks known as scaffolds, matrices or constructs which are interconnected porous structures that establish a cellular microenvironment required for optimal tissue regeneration. Several natural and synthetic biomaterials have been utilized for fabrication of tissue engineering scaffolds. Amongst different biomaterials, polymers are the most extensively experimented and employed materials. They can be tailored to provide good interconnected porosity, large surface area, adequate mechanical strengths, varying surface characterization and different geometries required for tissue regeneration. A single type of material may however not meet all the requirements. Selection of two or more biomaterials, optimization of their physical, chemical and mechanical properties and advanced fabrication techniques are required to obtain scaffold designs intended for their final application. Current focus is aimed at designing biomaterials such that they will replicate the local extra cellular environment of the native organ and enable cell-cell and cell-scaffold interactions at micro level required for functional tissue regeneration. This article provides an insight into the different biomaterials available and the emerging use of nano engineering principles for the construction of bioactive scaffolds in tooth regeneration. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=309-315&id=3937 https://doi.org/10.7860/JCDR/2014/.3937 Association of Serum Cholesterol, Triglyceride, High and Low Density Lipoprotein (HDL and LDL) Levels in Chronic Periodontitis Subjects with Risk for Cardiovascular Disease (CVD): A Cross Sectional Study R.M. Sandi, K.G. Pol, P. Basavaraj, Nitin Khuller, Shilpi Singh <b>Purpose: </b>To assess serum cholesterol, triglycerides, High and Low Density Lipoprotein (HDL and LDL) levels (serum lipid profile) in subjects with chronic periodontitis and the possible association for risk of Cardiovascular Disease (CVD). <b>Materials and Methods:</b> Total of 80 participants (42 males and 38 females) who were in the age range of 30-65 years were divided into test group (group I- 40 subjects with chronic periodontitis) and control group (group II- 40 subjects with healthy periodontium), based on their periodontal disease statuses. Three ml of venous blood samples were taken for measurement of parameters of lipid metabolism [serum cholesterol (chol); triglycerides (Tg); HDL and LDL. <b>Results:</b> Significant increase in serum cholesterol and LDL (P<0.05) were observed in test group (group I), whereas serum triglycerides and HDL (P>0.66) showed no significant increase in test group (group I) as compared to their values in the control group (group II). A P-value of < 0.05 was considered for statistical significance. <b>Conclusions:</b> Subjects with chronic periodontitis showed increased serum cholesterol and LDL levels. This may suggest that these subjects are potentially at a risk of getting CVD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=214-216&id=3927 https://doi.org/10.7860/JCDR/2014/.3927 Diagnostic Dilemma of a Double Tooth: A Rare Case Report and Review D.B. Nandini, B.S. Deepak, M. Selvamani, H.K. Puneeth Gemination or Schizodontism is a developmental anomaly affecting the tooth shape which is often confused with fusion. It affects primary dentition more often than permanent. It is a rare occurrence in the posterior teeth. Its etiology, pathogenesis, prevalence, differential diagnosis and management are discussed and a rare case of gemination of maxillary premolar is reported here. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=271-272&id=3928 https://doi.org/10.7860/JCDR/2014/.3928 Oro-Facio-Dental Findings of Rubinstein-Taybi Syndrome as a Useful Diagnostic Feature R. Ebru Tirali, Cagla Sar, S. Burc ak Cehre li Rubinstein-Taybi Syndrome (RTS) is a rare multiple congenital syndrome characterized by distinctive facial features, mental and growth retardation, broad thumbs and great toes. This case report describes the oro-dental manifestations, as well as, orthodontic evaluation of a 9-year-old male patient who had RTS. The remarkable oro-dental features were talon-like cingulum on maxillary central incisors, unerupted supernumerary teeth. Cone-beam computerized tomography was taken in order to identify his skeletal anomalies, bilateral cross-bite and a narrow maxilla were diagnosed. Dental treatments were completed under i.v sedation due to the patient’s inability to cooperate during dental treatment. Perioparetive and postoperative courses were uneventful. Following dental treatments, orthodontic therapy was initiated with a fixed rapid maxillary expansion appliance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=276-278&id=3929 https://doi.org/10.7860/JCDR/2014/.3929 Retrospective Evaluation of Pediatric Oral Biopsies from A Dental and Maxillofacial Surgery Centre in Salem, Tamil Nadu Ramesh Krishnan, Maya Ramesh, George Paul <b>Aim:</b> The aim of the study was to evaluate the pediatric oral biopsies received between 2002 -2011 from a dental and maxillofacial centre in Salem, Tamilnadu, India retrospectively based on age, sex, site and type of the pathologies. <b>Materials and Methods:</b> The records of dental and maxillofacial surgery centre were taken and a retrospective evaluation of the pediatric lesions biopsied over a period of ten years (2002-2011) was done. Patients aged 15 years and below were considered as pediatric patients and pathologies were grouped into 8 categories, according to age, gender, anatomic location and pathologic diagnosis. <b>Results: </b>A total of nine hundred twenty five biopsies were studied, of which 97 cases were from pediatric patients. The pathologies were predominant in mandible to maxilla (47:29).The distribution of the pathologies were 44 odontogenic pathologies, 18 connective tissue tumours, 3 salivary gland tumours, 5 fibro osseous lesions and 25 tumour like lesions. Out of this 44 odontogenic pathologies, 39 were odontogenic cysts, and 5 were odontogenic tumours. <b>Conclusion:</b> Unlike other studies, the lesions were more common in the mandible with a female predilection. The majority of oral and maxillofacial lesions detected in pediatric population were benign similar to the previous reports. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=221-223&id=3930 https://doi.org/10.7860/JCDR/2014/.3930 Comparison of The Effect of Implant Abutment Surface Modifications on Retention of Implant-Supported Restoration with A Polymer Based Cement Nabaprakash Sahu, Namratha Lakshmi, N.S. Azhagarasan, Yoshaskam Agnihotri, Manoj Rajan, Ramasubramanian Hariharan <b>Background:</b>In cement-retained implant-supported restoration it is important to gain adequate retention of definitive restoration as well as retrievability of prosthesis. The surface of the abutment, alloy of the restoration and the type of cement used influences the retention of the restoration. There is a need to analyze the influence of surface modifications of abutments on the retentive capabilities of provisional implant cements. <b>Purpose of study:</b>To compare the effect of implant abutment surface modifications on retention of implant-supported restoration cemented with polymer based cement. <b>Materials and Method:</b>Thirty solid titanium implant abutments (ADIN), 8mm height, were divided into 3 groups. Ten abutments with retentive grooves (Group I) as supplied by the manufacturer, Ten abutments milled to 20 taper circumferentially (Group II), and Ten abutments milled and air-abraded with 110 µm aluminum oxide (Group III) were used in this study. Ni-Cr coping were casted for each abutment and polymer based cement was used to secure them to the respective abutments. Using a universal testing machine at a crosshead speed of 0.5 cm/minute, tensile bond strength was recorded (N). <b>Results:</b>Mean tensile bond strength of Group I, II and III were found to be 408.3, 159.9 and 743.8 Newton respectively. The values were statistically different from each other (p<0.001). <b>Conclusion:</b>Abutments with milled and sandblasted surface provide the highest retention followed by abutments with retentive grooves and then by abutments with milled surface when cast copings were cemented to implant abutments with polymer based cement. <b>Clinical implications:</b>Retention of restoration depends on the surface of the abutment as well as the luting agents used. Incorporation of retentive grooves or particle abrasion can enhance retention especially in situation of short clinical crown. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=239-242&id=3931 https://doi.org/10.7860/JCDR/2014/.3931 Estimation and Comparison of Copper Content in Raw Areca Nuts and Commercial Areca Nut Products: Implications in Increasing Prevalence of Oral Submucous Fibrosis (OSMF) Philips Mathew, Ravi David Austin, Soma Susan Varghese, Manojkumar <b>Background:</b> Oral Squamous cell carcinoma (OSCC) is often preceded by potentially malignant disorders (PMDs) like oral submucous fibrosis (OSMF). The rate of transformation of OSMF to OSCC ranges from 3 to 19%. OSMF is etiologically related to chewing of areca nut (betel nut), a habit prevalent among the population groups in south-east Asia. Along with alkaloids, the high copper content in areca nut plays an important role in the pathogenesis of OSMF. The increased prevalence of OSMF in the last two decades or so corresponds with the increased processing and commercialization of areca nut products. <b>Aim:</b> The aim of the study was to estimate and compare the copper content of raw areca nuts in three different stages of maturity, and commercial areca nut products. <b>Materials and Methods:</b> Raw areca nut samples of three different maturities were obtained from four plantations in Sullia, Karnataka, India and commercial areca nut products were obtained from local shops in Chidambaram, Tamil Nadu, India. The samples were grounded and subjected to Atomic Absorption Spectrometry (AAS) for copper analysis. <b>Results:</b> There was statistically significant difference in copper content in raw areca nuts of all three maturities (p<0.05) and was highest in the exfoliated mature nuts. Importantly copper level was significantly higher in the commercial products compared to raw areca nuts of different degrees of maturity (p<0.05). <b>Conclusions:</b> The copper levels in commercial products are significantly higher than that of raw areca nuts in all three stages of maturity. The increase in copper content on processing and post commercialization can be related to the increasing prevalence of OSMF. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=247-249&id=3932 https://doi.org/10.7860/JCDR/2014/.3932 Massive Recurrent Chondroblastic Osteosarcoma of Maxilla: A Rare Case Report Dwarkadas Adwani, Anirudh Bhattacharya, Nitin Adwani, Rinku Adwani, Vijay W. Sharma The jaw bones are particularly difficult to manage because of their proximity to important structures and later limited options in the rehabilitation of their form and functional factors. This stands true especially in cases of maxilla as being situated in a very peculiar anatomic location, comprising of the skull base and its related structures, any radical treatment is deferred. In order to retain the maximum form and function as later there are few reconstruction options available for maxilla the trend always goes in favour of least morbid treatment option whether being surgery, chemotherapy or radiation therapy. Moreover in maxilla the anatomic complexities makes it very difficult to get wide and clear surgical margins which again accounts for a poor prognostic rate. Recurrences are common in osteosarcomas of maxilla and the line of treatment for recurrence is still a matter of research. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=288-290&id=3933 https://doi.org/10.7860/JCDR/2014/.3933 Comparison of Shear Bond Strength Between Fibre Reinforced Composite Posts with Three Different Composite Core Materials – An In vitro Study Sampathath Anche , Pranitha Kakarla , Krishna Kishore Kadiyala , Sreedevi B., Sandeep Chiramana , Sanjay Dutt Manne , Raviavi Rakesh Dev J., Deepthi G. <b>Aim:</b> The aim of this study is to compare the shear bond strength between fiber reinforced composite post with three different composite core materials <b>Materials and Methods:</b> The materials used for the study were: 30 maxillary central incisors, pre fabricated fiber reinforced composite post (postec plus posts), Multi-core heavy body, Ti-core, Fluoro-core, Etchant gel, Silane coupling agent, Dentin bonding agent, Standardized gutta percha points, Rely-X dual cure composite resin. A total of 30 human maxillary central incisor were selected for this study. They were divided into three groups of 10 specimens each namely A, B and C. <b>Results:</b> The results obtained were analyzed by using one way analysis (ANOVA) and Tukey Honestly Significant Difference and they showed highest mean shear bond strength for group C when compared with group A and group B. There is no significant difference in the shear bond strength values between group A and group B. <b>Conclusion:</b> The teeth restored with multicore HB showed highest shear bond strength. The teeth restored with Fluoro core showed lowest shear bond strength. No statistically significant difference exists between the shear bond strength values between Ti-core and Fluoro-core. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=236-238&id=3941 https://doi.org/10.7860/JCDR/2014/.3941 Ameloblastic Fibro-odontome (AFO) of the Mandible: A Case Report Sreenath G., Y. Indira Reddy , P. Sreenivasreddy , A. Ravi Prakash Odontoameloblastoma are tumours which represent a histological combination of ameloblastoma and complex odontoma. It behaves in an invasive manner like ameloblastoma and is more aggressive in nature. We report a new case of Ameloblastic Fibro-Odontoma (AFO). Clinical, radiographic and histopathological features are discussed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=260-262&id=3942 https://doi.org/10.7860/JCDR/2014/.3942 Cariogram Model in Assessment of Dental Caries among Mentally Challenged and Visually Impaired Individuals of Udaipur, India Hemasha Daryani, Ramesh Nagarajappa, Archana J Sharda, Kailash Asawa, Mridula Tak, Sudhanshu Sanadhya, Mehak Batra <b>Objectives:</b> To assess the caries risk and contribution of diet, bacteria, circumstances and susceptibility sectors among special groups in comparison to the normal group of Udaipur using the Cariogram model. <b>Materials and Methods:</b> A Cariogram model was used to identify risk factors among 160 subjects (40 mentally challenged, 60 visually impaired and 60 normal healthy individuals) aged 7-36 years. Statistical analysis was done using Chi-square/ Fischer’s Exact followed by Marascuilo procedure and Stepwise multiple linear regression. <b>Results:</b> Compared to the normal group (74%), mentally challenged (33%) and visually impaired (41%) groups showed less chances of avoiding future caries. Group (R= 0.660) was found to be strongest predictor for caries risk. Susceptibility sector contributed 61% for caries risk in all the groups. <b>Conclusion:</b> The caries risk was high among special groups compared to normal group. Susceptibility sector illustrated the highest contribution for caries risk in all groups. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=206-210&id=3844 https://doi.org/10.7860/JCDR/2014/.3844 Association of Xerostomia and Assessment of Salivary Flow Using Modified Schirmer Test among Smokers and Healthy Individuals: A Preliminary Study Sujatha Dyasanoor, Shweta Channavir Saddu <b>Background and Objective:</b> Several oral diseases such as dental caries, periodontitis and oral infections can be a major concern in patients suffering from mouth dryness. Whole mouth salivary flow is affected by many factors which may include habits like smoking. The aim of the present study was to investigate the incidence of xerostomia and hyposalivation among smokers. <b>Materials and Methods:</b> The study groups included 60 smokers and 60 healthy non-tobacco users as case and control groups respectively. A questionnaire was used to collect the smoking habits and symptoms associated with xerostomia. Measurement of unstimulated whole mouth salivary flow for three minutes was performed using modified Schirmer test. The results were subjected to statistical analysis. <b>Results:</b> The prevalence of xerostomia symptom was 37% in smokers and it was 13% in non-smokers, with a statistically significant difference between groups (p=0.003). The prevalence of hyposalivation was 43% in smokers, whereas it was only 8% in the control group (p< 0.001). <b>Conclusion:</b> Xerostomia symptoms with significant reduction in unstimulated whole mouth salivary flow were associated with long term smoking. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=211-213&id=3846 https://doi.org/10.7860/JCDR/2014/.3846 An Evaluation of Microbial Profile in Halitosis with Tongue Coating Using PCR (Polymerase Chain Reaction)- A Clinical and Microbiological Study Dinesh Kamaraj R., Kala S. Bhushan, Vandana K.L. <b>Background:</b> Medline search using key words halitosis, tongue coating, polymerase chain reaction, microbial profile did not reveal any study. Hence, the purpose of the present investigation was to assess the malodor using the organoleptic method and tanita device; to quantify odoriferous microorganisms using Polymerase Chain Reaction technique in chronic periodontitis patients. <b>Materials and Methods:</b> The study included 30 chronic periodontitis patients. Halitosis was detected using organoleptic assessment & tanita breath alert. Microbial analysis of Pg, Tf & Fn was done using PCR. Plaque index (PI), gingival index (GI), gingival bleeding index (GBI) were recorded. <b>Result:</b> The maximum score of 3 for tongue coating was found in 60% of selected subjects. The tanita breath alert measured VSC level of score 2 in 60% of selected subjects while organoleptic score of 4 was found in 50% of subjects. The maximum mean value of 31.1±36.5 was found to be of F. nucleatum (Fn) followed by P. gingivalis (Pg) (13±13.3) & T. forsythia (Tf) (7.16±8.68) in tongue samples of selected patients. A weak positive correlation was found between VSC levels (tanita score & organoleptic score) and clinical parameters. <b>Conclusion:</b> The halitosis assessment by measuring VSC levels using organoleptic method and tanita breath alert are clinically feasible. Maximum tongue coating was found in 60% of patients. Fn was found comparatively more than the Pg & Tf. A weak positive correlation was found between VSC levels and clinical parameters such as PI, GI & GBI. Thus,the dentist/ periodontist should emphasise on tongue cleaning measures that would reduce the odoriferous microbial load. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=263-267&id=3856 https://doi.org/10.7860/JCDR/2014/.3856 Intra-oral Mouth-Guard In Sport Related Oro-Facial Injuries: Prevention is Better Than Cure! Sneha S. Mantri, Shivkumar P. Mantri, Suryakant Deogade, Abhilasha S. Bhasin India is rapidly assuming a more health-conscious posture. Olympic competition and professional sports have turned from mere dreams into goals. Many major professional sports leagues are expanding. Sports dentistry is a composite of skills for treatment, prevention, education and research in which dentistry and sports come together. Custom athletic mouth guards present additional health-care opportunities. They are designed to reduce the impact force of a direct blow to the jaw and create a gap between the condyle and skull thereby reducing the transference of the impact to the brain. The prevalence and severity of injuries to the teeth, jaws and intra-oral and peri-oral soft tissues, concussions and neck injuries are reduced when mouth guards are used. The dentist can play a proactive role in helping to deliver important expanded health care services. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=299-302&id=3872 https://doi.org/10.7860/JCDR/2014/.3872 Iatrogenic Subcutaneous Emphysema of Endodontic Origin – Case Report with Literature Review Lora Mishra, Swarnav Patnaik, Sangram Patro, Nitai Debnath, Satyaranjan Mishra Surgical emphysema is well known and many case reports have been published on this. Many authors have reported this as a complication post dentoalveolar treatment. Diffusion of air into facial planes and periorbital area during endodontic procedures has been rarely reported. The use of three way air syringe and forceful irrigation of root canal can lead to surgical emphysema of subcutaneous tissue planes in and around the teeth which are involved. This case report highlights one such complication seen during endodontic treatment, discusses aetiology, complications and conservative management of this dental office emergency https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=279-281&id=3876 https://doi.org/10.7860/JCDR/2014/.3876 A Rare Co-occurrence of Amelogenesis Imperfecta (AI) and Various Non-Enamel Manifestations In Siblings-Report of Two Cases A.J. Sai Sankar, Y. Samatha, S. Suneela, D. Ankineedu Babu Amelogenesis Imperfecta (AI) is a hereditary enamel defect which is characterized by developmental abnormalities in the quantity and/ or quality of enamel. This condition has been associated with dental anomalies, including taurodontism, congenitally missing teeth, delayed eruption, crown resorption, pulpal calcifications and odontogenic fibromas. This paper presents two cases of AI which were associated with multiple impacted permanent teeth in both the cases; and pulpal calcifications and pericoronal odontogenic fibromas of W.H.O type additionally, in one of the cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=282-284&id=3716 https://doi.org/10.7860/JCDR/2014/.3716 Evaluation of Forces Generated on Three Different Rotary File Systems in Apical Third of Root Canal using Finite Element Analysis Ashish Medha, Suvarna Patil, Upendra Hoshing, Siddhesh Bandekar <b>Aim:</b> Aim of the study is to evaluate the distribution of forces on the instrument in the apical 3rd of curved canal with three Nickel Titanium rotary systems. <b>Methodology:</b> Three brands of instruments (ProTaper Universal; DENTSPLY Maillefer, RevoS; MicroMega and Hyflex; Coltene-Whaledent, Allstetten, Switzerland) were scanned with the Laser assisted computerized scanner to produce a real-size, 3-dimensional (3-D) model for each. The stresses on the instrument during simulated shaping of a root canal were analyzed numerically by using a 3-D finite element package, taking into account the nonlinear mechanical behavior of the nickel-titanium material. <b>Results:</b> RevoS shows lowest values for force generation in the apical 3rd of canal as compared to Protaper which shows highest values, while Hyflex shows intermediate values for forces. <b>Conclusion:</b> With FE simulation of root canal shaping by 3 files, it was observed that different instrument designs would experience unequal degree of force generation in canal, as well as reaction torque from the root canal wall. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=243-246&id=3903 https://doi.org/10.7860/JCDR/2014/.3903 Comparative Evaluation of Push-out Bond Strength of Three Endodontic Sealers with and without Amoxicillin-An Invitro Study Harikumar Vemisetty, Ravichandra P.V., Jayaprada Reddy S., Ramkiran D., Jaya Nagendra Krishna M., Rajani Sayini, Jyothsna Yellamanda S. <b>Introduction:</b> The purpose of this study was to evaluate the sealing ability of three different root canal sealers with and without amoxicillin, using a push-out bond strength test. <b>Material and Methods:</b> Sixty single-rooted extracted human teeth were used for this study. Each tooth was instrumented and irrigated with 5.25% Sodium hypochlorite (NaOCl) and 17% EDTA. The teeth were then divided into six test groups: Gutta percha (GP)/AH Plus (Dentsply, Germany), GP/AH Plus with 10% amoxicillin (TEVA Pharmaceuticals Sellersville, PA), GP/Pulp Canal Sealer EWT (Extended Working Time, SybronEndo Orange, CA), GP/Pulp Canal Sealer EWT with amoxicillin, GP/Apexit Plus, GP/Apexit Plus (Vivadent, Tulsa, US) with amoxicillin. After the sealer was set, the entire root was sectioned into 1 mm thick slices. A push-out bond strength test was performed by using a universal testing machine. The Student’s t-test was used to compare the sealer bond strength within the specific sealer test groups and within each sealer at apical, middle and coronal root levels. <b>Results:</b> There was no significant difference between the groups within each sealer (p>0.05) with or without amoxicillin at the same root level. <b>Conclusion:</b> This study demonstrated that the addition of 10% by weight of amoxicillin does not significantly (p> 0.05) change the overall push-out bond strength of three endodontic sealers when compared at the apical, middle, and coronal tooth level https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=228-231&id=3919 https://doi.org/10.7860/JCDR/2014/.3919 Root End Generation: An Unsung Characteristic Property of MTA-A Case Report Seema Dixit, Ashutosh Dixit, Pravin Kumar, Saurabh Arora Management of immature teeth with necrotic pulp and periapical lesion has long presented a challenge. The treatment of choice for such teeth is apexification, which is induction of apical closure to produce more favorable conditions for conventional canal obturation. Traditionally, calcium hydroxide has been used for the apexification of immature permanent teeth, however, Mineral Trioxide Aggregate (MTA) holds significant promise not only as an alternative to multiple treatment visits with calcium hydroxide but also having the potential to induce root end development, eventually forming a completed root apex. This case report presents a successful healing and apexification with the use of calcium hydroxide and MTA. A 5-year follow-up revealed root development with MTA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=291-293&id=3920 https://doi.org/10.7860/JCDR/2014/.3920 Estimation of Circulating Immune Complexes in patients with Oral Leukoplakia and Oral Submucous Fibrosis: A Case Control Study Maheswari H., Eswaran M.A., Srividhya S., Malavika R., Prabhu R., Geetha K.R. <b>Purpose of the Study:</b> The present study was conducted to estimate the serum levels of Circulating Immune Complexes in patients with Oral Leukoplakia ,Oral sub mucous fibrosis and normal subjects and correlate these values with the clinical grades of the diseases. <b>Materials and Methods:</b> The study consisted of 25 Oral Leukoplakia patients, 25 Oral sub mucous fibrosis patients and 25 Normal subjects. <b>Results:</b> The mean serum levels of CIC showed a gradual increase from normal subjects to Oral Leukoplakia patients and showed a high values in Oral sub mucous fibrosis patients. The mean serum levels of CIC also showed a gradual increase from clinical grade I to grade IV of Oral sub mucous fibrosis. <b>Conclusion:</b> Serum levels of CIC may be taken as a prognostic marker for disease progression of patients with Oral Leukoplakia and Oral sub mucous fibrosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=224-227&id=3967 https://doi.org/10.7860/JCDR/2014/.3967 Prognostic Significance of Lymph Node Pattern in Oral Squamous Cell Carcinoma (OSCC) Makesh Raj L.S., Karen Boaz, Srikant Natarajan <b>Background:</b> Assessment of lymph node reactivity pattern is an important indicator of the host response status and prognosis of oral squamous cell carcinoma (OSCC). <b>Aim:</b> To assess the prognostic significance of lymph node reactivity patterns in OSCC. <b>Settings and Design:</b> This is a cross-sectional study aimed correlating host status and prognosis of OSCC. <b>Materials and Method:</b> Morphological patterns of lymph nodes received from 30 histologically proven cases of OSCC were analyzed. Five different patterns of the lymph node reaction were categorized (lymphocytic predominance, germinal center predominance, sinus histiocytosis, normal lymph node and lymphocytic depleted) and compared with the prognosis of OSCC. <b>Statistical Analysis Used:</b> TNM, Histological grading parameters and Lymph node reactivity pattern were compared with the event of recurrence of OSCC and death of patient using Fisher’s Exact test. Survival of the patients was analyzed for association with lymph node patterns using Log rank test. Results: Recurrence of the tumour was seen in association with all the patterns, with higher rates of mortality seen in patients with sinus histiocytosis of lymph node. <b>Conclusion:</b> Morphological pattern being an aid in predicting prognosis, cannot be used as a lone predictor. An attempt is made to identify and discuss the possible pathogenesis for the reaction patterns. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=232-235&id=3974 https://doi.org/10.7860/JCDR/2014/.3974 Wilkodontics - A Novel Synergy in Time to Save Time Sirisha K., Srinivas M., Ravinravindranath D., Pratap Gowd The systematic search for improvements in orthodontic therapy is shared by several dental specalities especially periodontics. Rapid orthodontic treatment procedures are now focusing on performing Alveolar Corticotomies (ACS) shortly before the application of orthodontic forces. This method has been suggested to enhance tooth movement and, consequently, reduces orthodontic treatment time as a whole. Thus, this article attempts to review the historical perspective of these therapeutic approaches, discusses the biological reasons underlying its use, mentions its main indications and contraindications and its modifications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=322-325&id=3978 https://doi.org/10.7860/JCDR/2014/.3978 Recent Advances in Pulp Capping Materials: An Overview Asma Qureshi, Soujanya E., Nanda Kumar, Pratap Kumar, Sambas Hivarao Emphasis has shifted from the “doomed” organ concept of an exposed pulp to one of hope and recovery. The era of vital-pulp therapy has been greatly enhanced with the introduction of various pulp capping materials. The aim of this article is to summarize and discuss about the various and newer pulp capping materials used for protection of the dentin-pulp complex. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=316-321&id=3980 https://doi.org/10.7860/JCDR/2014/.3980 Rehabilitation of Partially Eviscerated Eye with Custom Made Ocular Prosthesis: A Case Report Ilango Thirunavukkarasu, Rathika Rai, R. Prabhu, Varun A. Deshpande, Arun Kumar S. Human eyes are the most precious God gifts; presence of a pair of eye not only gives expression to life but also adds dignity to the face. The loss of an eye causes disfigurement of the face and causes anxiety, stress and depression in their life. The rehabilitation of patients with congenital or acquired defects of the eye is a challenging job. The aim of the rehabilitation is to restore the patient’s normal appearance, comfort along with reasonable functional eye movements. This case report describes the rehabilitation of partially eviscerated eye of the patient with custom made ocular prosthesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=285-287&id=3976 https://doi.org/10.7860/JCDR/2014/.3976 Auricular Prosthesis-A Case Report Rajyalakshmi Ravuri, Bheemalingeshwarrao, Suchita Tella, Kiran Thota Loss of facial organs in an individual may be developmental anomalies or acquired. The missing parts of the face ear, eyes and nose are considered as maxillofacial defects which can be rehabilitated by the prosthesis and/or cosmetic surgeries. This art of science has developed into a more reliable and predictable process due to ever increasing development of materials and equipments used in the procedure. This article describes a simple technique to rehabilitate patients with auricular defects which are both aesthetically acceptable and economical for the individual. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=294-296&id=3986 https://doi.org/10.7860/JCDR/2014/.3986 Evaluation of Caries Dentin using Light-Induced Fluorescence: A Case Report Sebnem Erol, Hanife Kamak, Hülya Erten Minimal invasive therapy has been becoming more important day by day in dentistry. In minimally invasive dentistry, only the infected dentin is removed and the affected dentin is left behind while preparing to repair a cavity. Healthy enamel and dentin have particular fluorescence properties, compared to demineralized dental tissues, which absorb less light and thereby have a lower level of fluorescence properties. It helps clinicians detect caries and apply the most appropriate treatment strategy during cavity preparation. This study investigated the efficacy of the SoproLife camera system which is a novel light-induced fluorescence camera system. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=297-298&id=3987 https://doi.org/10.7860/JCDR/2014/.3987 Multiple Ileal Perforations Following Dilatation and Evacuation (D&E) for Missed Abortion Haritha Sagili, Verghese Yeldho, Dasari Papa https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=326-&id=3934 https://doi.org/10.7860/JCDR/2014/.3934 Images in Medicine - Bisphosphonate Induced Atypical Fracture Riddhi Das Gupta, Sahana Shetty, Hesargatta Shyamsunder Asha, Sandeep Albert, Thomas Vizhalil Paul https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=327-328&id=3961 https://doi.org/10.7860/JCDR/2014/.3961 Familiarisation of Children with Medicines and their Sources of Information Omar Thanoon Dawood , Mohamed Izham Mohamed Ibrahim, Anna Christina Abdullah https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=329-330&id=3898 https://doi.org/10.7860/JCDR/2014/.3898 IS Renal Osteodystrophy a Neglected Entity? Ramesh Narula, Yasir Salam, Kusum Narula https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=332-333&id=3877 https://doi.org/10.7860/JCDR/2014/.3877 A Brief Overview of the Role of Drugs and Novel Methodologies on the Stability and Growth of Hair Follicles: An Approach Towards Hair Regeneration Kaustubh Phansalkar, Nrupa Patil, Anand Ramani https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2014&month=January&volume=8&issue=1&page=331-&id=3881 https://doi.org/10.7860/JCDR/2014/.3881