Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Large Plunging Ranula Presenting as Isolated Neck Swelling: Steps in Diagnosis and Surgical Steps in Management Kumar Nilesh, Neelima A. Malik, Pankaj Patil, Mouneshkumar Devendrappa Chapi Ranula is a salivary gland cyst which typically present as localized superficial swelling over the floor of mouth. Complex or plunging ranulas develop when the mucus extravasation extends through or around the mylohyoid muscle, deeper into the neck, and present with neck lump along with or without swelling over floor of mouth. We report a case of large plunging ranula presenting as an isolated large neck mass in a 38-year-old female patient. The steps in diagnosis and surgical steps in management of the pathology are systematically described. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=MD01-MD03&id=6016 https://doi.org/10.7860/JCDR/2015/.6016 Variant Branching Pattern of Superior Thyroid Artery and Its Clinical Relevance: A Case Report Rohini Motwani, Saroj kaler Jhajhria Thyroid surgeries are most common neck surgeries; hence thorough knowledge of the blood supply of this gland to the surgeons is of immense importance to prevent any alarming haemorrhage. We report a rare unilateral branching pattern of superior thyroid artery (STA) on right side during routine dissection on an adult male cadaver in the Department of Anatomy, A.I.I.M.S, New Delhi. Left superior thyroid artery was normal. The common trunk (CT) arose from anterior surface of right external carotid artery (ECA) just above the bifurcation of common carotid artery (CCA) soon dividing into five branches i.e., infrahyoid, superior laryngeal, superior thyroid, cricothyroid and sternocleidomastoid artery. This variant branching pattern of STA is very rare. The inferior thyroid arteries did not show any unusual distribution. Knowledge of such arterial variations related to the thyroid gland is immensely helpful to the surgeons to avoid damage of the vital organs in this region. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=AD05-AD06&id=6065 https://doi.org/10.7860/JCDR/2015/.6065 Primary Malignant Mixed Germ Cell Tumour with Squamous Cell Carcinoma of the Mandible; A Rare Entity Saurabh kumar, Arun Paul, Harshad Parmar, Rabin chacko Germ cell Tumours (GCT) are neoplasm derived from germ cells. GCT usually occurs inside the gonads. Extragonadal GCT’s are rare. Most common GCT associated with head and neck region are the teratomas. Of the few teratomas found in the head and neck, malignant transformation of a teratomatous element is very uncommon, and primary bone involvement within the head and neck is even rare. We present a case of primary malignant mixed germ cell Tumour involving the mandible, the present case presented malignant transformation of the epithelial component showing foci of squamous cell carcinoma within the GCT. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD16-ZD18&id=6072 https://doi.org/10.7860/JCDR/2015/.6072 Rare Case of Spindle Cell Haemangioma Sunanda Chavva, M.Hima priya, Komali Garlapati, G.Siva Prasad Reddy, AshaLata Gannepalli Spindle cell haemangioma (SCH) is a benign vascular lesion which usually occurs on distal extremities. It was previously regarded as haemangioendothelioma and was initially perceived to be low grade angiosarcoma.They are characterized by cavernous blood vessels and spindle cell proliferation. It is now considered as a reactive lesion and conservative surgical excision is preferred treatment. Intraoral occurrence is rare; hence we present a case of SCH in a 33-year-old male that presented as a swelling below the tongue. Histopathology showed well circumscribed proliferating spindle cells attached to vessel walls, dilated vascular spaces. The lesion was positive for CD31 and CD34 markers suggesting it to be of endothelial cell origin. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD19-ZD21&id=6080 https://doi.org/10.7860/JCDR/2015/.6080 T-cell Lymphoblastic Lymphoma in the Maxilla and Mandible of a Child: A Rare Case Report Zohreh dalirsani, Ala Ghazi T-cell lymphoblastic lymphomas (T-LBL), defined as neoplasms of immature T cells, are the most common paediatric T-cell lymphoma. These account for approximately 90% of all lymphoblastic lymphomas. The primary manifestation of T-LBL rarely occurs in the oral cavity. In this case report, we describe a case of primary T-LBL affecting the maxilla and mandible of a 10-year-old male patient. This is the first case of T-LBL reported in this region. We emphasize that early diagnosis of aggressive lesions in the maxilla or mandible is one of the responsibilities of oral physicians, who can help patients to overcome the many challenges of malignant diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD22-ZD24&id=6087 https://doi.org/10.7860/JCDR/2015/.6087 Mature Mediastinal Teratoma Chikka Narasimhaiah Anushree, Vissa Shanti A teratoma is a tumour with tissue or organ components resembling normal derivatives of more than one germ layer. We present a case of mediastinal mature teratoma as they have a low incidence rate. A 45-year-old female presented with right sided chest pain and paroxysmal attacks of dry cough and fever. A diagnosis of pulmonary hydatid cyst was made on computed tomography (CT) examination. Microscopic study revealed a tumour composed of elements from all the three germ layers. A diagnosis of mature mediastinal teratoma was made which is the second common site for germ cell tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ED05-ED06&id=6088 https://doi.org/10.7860/JCDR/2015/.6088 Mixed Mucinous and Infiltrating Carcinoma Occurring in Male Breast- Study of Clinico-Pathological Features: A Rare Case Report Kavita Gupta, Swati Sharma, Ranjini Kudva, Sandeep Kumar Mucinous carcinoma is a less common histologic variant of breast cancer. Cases of mucinous carcinomas in male breast are extremely rare. Here, we describe a case of mixed mucinous carcinoma i.e. mucinous carcinoma with infiltrating ductal carcinoma component and showing apocrine differentiation in a 73-year-old man. This uncommon tumour entity has dismal prognosis and treatment depends largely on the tumour type, size, lymph node involvement and hormonal status. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ED07-ED08&id=6090 https://doi.org/10.7860/JCDR/2015/.6090 An Atypical Case of POEMS Syndrome with an Osteolytic Bone Lesion Kumar Rahul, Nayha Handa, SH Chandrashekhara, Thingujam Usha, Anuradha Singh POEMS syndrome is a rare multisystem disorder with an underlying plasma cell dyscrasia associated with Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy and Skin changes. Usually it is associated with sclerotic bone lesions. It usually manifests in 5th–6th decade of life with a mean survival period of eight years. We report an unusual case of a 28-year-old male diagnosed with POEMS syndrome and had a lytic bone lesion the in sternum. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=XD01-XD02&id=6099 https://doi.org/10.7860/JCDR/2015/.6099 Primary Diffuse Large B-cell Lymphoma Arising in the Tongue Accompanied by Ataxia-telangiectasia: A Case Report Hirofumi Tomioka, Ayano Kaneoya, Yumi Mochizuki, Hiroyuki Harada Ataxia-telangiectasia (AT) is a rare autosomal recessive disorder that is characterized by progressive cerebellar ataxia, telangiectasia, immunodeficiency, and a predisposition to leukemia/lymphoma. Here we report a rare case of lymphoma of the tongue accompanied by AT. Tumour extirpation was performed and diffuse large B-cell lymphoma was diagnosed following pathologic examination. A whole-body survey showed no other enlarged lymph nodes or tumour. The female patient then received a modified dosage of COPAD (cyclophosphamide, vinblastine, pirarubicin, and prednisolone) plus rituximab to avoid severe complications. As of follow-up after 3 years and 5 months, she remains in complete remission. Patients showing AT need careful surveillance and long-term continuous follow-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD25-ZD27&id=6107 https://doi.org/10.7860/JCDR/2015/.6107 Aesthetic Management of Fluoresced Teeth with Ceramic Veneers and Direct Composite Bonding – An Overview and A Case Presentation Kapil Jhajharia, Harsh Haren Shah, Ashutosh Paliwal, Viral Parikh, Shrikant Patel Tooth discolouration is a common problem and affects people of all ages. Apart from the conventional treatment modalities for the same, newer options are available today with better techniques and materials. The present case report describes a 17-year-old girl who had stained and pitted teeth, attributable to dental fluorosis and she desired aesthetic treatment for the same. The pros and cons of all treatment options were carefully weighed and a multistep treatment process involving ceramic veneers and direct bonding were planned. The execution of the planned treatment yielded a good aesthetic and functional outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD28-ZD30&id=6108 https://doi.org/10.7860/JCDR/2015/.6108 Sacral Agenesis with Neurogenic Bladder Dysfunction—A Case Report and Review of the Literature Seema Sharma, Vipin Sharma, Bhanu Awasthi, Manik Sehgal, Deeksha A Singla Sacral agenesis (part of the caudal regression syndrome) is a rare and severe sacral developmental abnormality. It is a congenital malformation of unknown aetiology with possible involvement of genetic and teratogenic factors. It is described by various degrees of developmental failure, the most extreme and rare being sirenomelia or mermaid syndrome. The associated malformations comprise anorectal, vertebral, urological, genital, and lower limb anomalies. Approximately 15-20% mothers of these children have insulin dependent diabetes mellitus. The case is being reported for its rarity and educative value because prognosis is good in isolated sacral agenesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=RD08-RD09&id=6113 https://doi.org/10.7860/JCDR/2015/.6113 Intraabdominal Pseudocyst Developed after Ventriculoperitoneal Shunt: A Case Report Erdogan Ayan, Halil Ibrahim Tanriverdi, Tezcan Caliskan, Ufuk Senel, Numan Karaarslan Abdominal pseudocyst is a rare complication developing after ventriculoperitoneal shunt treatment. It is more commonly seen particularly in children. The underlying pathogenesis may be associated with repeat revisions or infections. Morphologically, it has no complete cyst wall, presenting only with a pseudocapsule among the intestinal loops, around the lower shunt tip. The principal problem appears to be the reduced peritoneal absorption capacity. The treatment is complicated and difficult. In this report, we present an 8-year-old abdominal pseudocyst case with a history of many shunt revisions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PD05-PD06&id=6114 https://doi.org/10.7860/JCDR/2015/.6114 Retroperitoneal Accessory Spleen Presented As Metastatic Suprarenal Tumour- A Diagnostic Dilemma Rekha Porwal, Amit Singh, Pritesh Jain Accessory spleen may be formed during defective embryonic development. The retroperitoneal accessory spleen is a rare clinical entity and metastasis of renal carcinoma into this entity is extremely rare. We are presenting a case of a 50-year-old male patient who was admitted with complaints of left lower abdominal lump and pain. The computed tomography revealed a 7×4 cm mass at upper pole of left kidney. To rule out malignancy, we planned for surgical exploration. Suprarenal mass was densely adherent to left kidney so left nephouroureterectomy with suprarenal mass was performed. On histopathology examination left kidney showed transitional cell carcinoma with metastasis into suprarenal mass that was found to be an accessory spleen. Diagnosis was made retrospectively by histopathological observation. So this case highlights the difficulty in differentiation of these masses from malignant adrenal tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PD07-PD08&id=6120 https://doi.org/10.7860/JCDR/2015/.6120 Acute Psychosis after Recent Isoniazid Initiation Sidharth Arya, Gagandeep Sukhija, Harpreet Singh Isoniazid as part of Directly Observed Treatment-Short course (DOTS) regimen is universally used. Although, associated psychosis in certain cases is documented earlier, type of symptoms and onset of symptoms remains highly variable. We describe a case of 54-year-old female on anti-tubercular therapy with onset of psychosis within three days of Isoniazid initiation characterised by agitation, loosening of association, echolalia with spontaneous remission after drug stoppage. This case highlights the importance of remaining vigilant and considering isoniazid as possible causative agent for psychosis even within days of its intiation and avoiding delay in management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=VD01-VD02&id=6130 https://doi.org/10.7860/JCDR/2015/.6130 Juvenile Nasopharyngeal Angiofibroma Extending into the Oral Cavity: A Rare Entity Nilesh Pardhe, Neha Chhibber, Deshant Agarwal, Manish Jain, Pradkhshana Vijay Juvenile nasopharyngeal angiofibroma (JNA) is a rare vascular tumour which is benign but locally aggressive and occurs invariably in young and adolescent males. It seldom involves the oral cavity but has the tendency to invade the adjacent structures. Its characteristic features include slow progression, aggressive growth & an increased rate of persistence and recurrence due to its location in inaccessible areas. In literature, very few cases of JNA have been reported with extension into the oral cavity. Here, a case of JNA with extension into the oral cavity has been discussed who reported to our institute. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD31-ZD33&id=6118 https://doi.org/10.7860/JCDR/2015/.6118 Management of Radicular Cyst Using Platelet-Rich Fibrin & Iliac Bone Graft - A Case Report Gaurav Vidhale, Deepali Jain, Sourabh Jain, Alkesh Vijayrao Godhane, Ganesh R.Pawar Radicular cyst is one of the most commonly occurring cyst in the oral cavity it is usually preceded by trauma or an infectious condition which is followed by enlargement. In recent times there are several treatment procedures that are being applied in order to improve the postoperative condition and to accelerate the process of healing and regeneration in the affected site. A 22-year-old patient reported to our OPD with the chief complaint of swelling on the left side of the face since 2-3 months, on investigating it was diagnosed as Radicular cyst which was initially treated by endodontic treatment of the involved tooth followed by enucleation of the cyst further an apicoectomy was done. Finally a PRF and iliac crest graft was placed for aesthetic rehabilitation with 21. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD34-ZD36&id=6136 https://doi.org/10.7860/JCDR/2015/.6136 Ofloxacin Induced Cutaneous Reactions in Children Yerramalli Roja Ramani, Sailen Kumar Mishra, Bandana Rath, Saroj Sekhar Rath Cutaneous adverse effects to antimicrobials are a major health problem. Though majority of them are mild and self-limiting, severe variants like Steven Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN) are not uncommon. Ofloxacin, a fluoroquinolone widely used for the treatment of urinary tract infections, acute bacterial diarrheas, enteric fever, STDs and other soft tissue infections either as a single drug or in combination with other drugs. Earlier a case of mucocutaneous maculopapular rash with oral ofloxacin and was reported in an adult. In the present hospital set up there were few reports of such reactions to adults. Here we report three different variants of reactions associated with oral ofloxacin in chlidren. Early detection of cutaneous lesions and immediate withdrawal of the offending drug can prevent progression of such reactions to their severe variants as well as morbidity and mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=FD01-FD02&id=6137 https://doi.org/10.7860/JCDR/2015/.6137 Add-on Effect of Levetiracetam on Cognitive Activity of Carbamazepine and Topiramate Treated Healthy Rats Priti Dhande, Satish Gonarkar, Dhara Sanghavi, Vijaya Pandit <b>Background:</b> Many antiseizure drugs are used for non-epileptic indications like bipolar disorder, anxiety, neuropathic pain, prophylaxis of migraine, etc. Cognitive problems are known with many of these agents in epileptic situations but not to that extent in other situations. The antiepileptic Levetiracetam has been shown to improve a range of cognitive abilities. <b>Objective:</b> To study the effect of levetiracetam, carbamazepine, topiramate and co-administration of levetiracetam with carbamazepine and topiramate on cognition in healthy rats. <b>Materials and Methods:</b> Wistar albino rats of either sex were randomly assigned to 6 groups (n=6). Treatment groups: I - Normal saline; II, III & IV- Levetiracetam (180mg/kg), Carbamazepine (50mg/kg) and Topiramate (20mg/kg) respectively; V & VI- Levetiracetam + Carbamazepine and VI- Levetiracetam + Topiramate respectively orally for 21 days. Morris Water Maze was used to study the spatial learning and memory in rats and the change in Escape transfer latency (ETL) was recorded to see the effect of drugs on it. Data analyzed by ANOVA followed by Dunnett’s post-hoc test. <b>Results:</b> Twenty one days drug treatment significantly increased the ETL in rats treated with Topiramate (p=0.0001) and combination of Levetiracetam and Topiramate (p<0.0001) from their baseline values. At the same time, there was significant reduction in the time spent in target quadrant in Topiramate group (p= 0.033) and the combination group of Topiramate + Levetiracetam (p=0.026). No significant change was observed in the other groups when tested for both these parameters. <b>Conclusion:</b> Topiramate causes impairment of spatial memory in healthy rats after 21 days exposure and its combination with Levetiracetam could not overcome this cognitive deficit. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=FF01-FF04&id=6110 https://doi.org/10.7860/JCDR/2015/.6110 Inflammation During Gestation Induced Spatial Memory and Learning Deficits: Attenuated by Physical Exercise in Juvenile Rats Rajesh Thangarajan, Ramesh Rao Tantradi, Kiranmai. S. Rai, Sivakumar Gopalakrishnan, Vivek Perumal Background: Gestational infections induced inflammation (GIII) is a cause of various postnatal neurological deficits in developing countries. Such intra uterine insults could result in persistent learning-memory disabilities. There are no studies elucidating the efficacy of adolescence exercise on spatial learning- memory abilities of young adult rats pre-exposed to inflammatory insult during fetal life. A ims and Objectives: The present study addresses the efficacy of physical (running) exercise during adolescent period in attenuating spatial memory deficits induced by exposure to GIII in rats. Materials and Methods: Pregnant Wistar dams were randomly divided into control and lipopolysaccharide (LPS) groups, injected intra peritoneally (i.p) with saline (0.5ml) or lipopolysaccharide (LPS) (0.5mg/kg) on alternate days from gestation day 14 (GD 14) till delivery. After parturition, pups were divided into 3 groups (n=6/group) a) Sham control and LPS group divided into 2 subgroups- b) LPS and c) LPS exercise group. Running exercise was given only to LPS exercise group during postnatal days (PNDs) 30 to 60 (15min/day). Spatial learning and memory performance was assessed by Morris water maze test (MWM), on postnatal day 61 to 67 in all groups. Results: Young rats pre-exposed to GIII and subjected to running exercise through juvenile period displayed significant decrease in latency to reach escape platform and spent significant duration in target quadrant in MWM test, compared to age matched LPS group. Results of the current study demonstrated that exercise through juvenile/adolescent period effectively mitigates gestational inflammation-induced cognitive deficits in young adult rats. C onclusion: Inflammation during gestation impairs offspring’s spatial memory and learning abilities. Whereas, early postnatal physical exercise attenuates, to higher extent, cognitive impairment resulted from exposure to LPS induced inflammation during intrauterine growth period. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=CF01-CF04&id=6020 https://doi.org/10.7860/JCDR/2015/.6020 Unusual Cause of Bilateral Pleural Effusion K.Gowrinath, P.Jyothi, C.Raghavendra https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OJ02-OJ03&id=6109 https://doi.org/10.7860/JCDR/2015/.6109 Mental Foramen in Prediction of Age Tanuj Kanchan, Kewal Krishan https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=GJ01-&id=6083 https://doi.org/10.7860/JCDR/2015/.6083 Do We Still Need to Perform Routine Histological Examination of Appendectomy Specimens? Salman Yousuf Guraya https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PL01-&id=6134 https://doi.org/10.7860/JCDR/2015/.6134 A Study on the Dispensing Pattern of Over the Counter Drugs in Retail Pharmacies in Sarjapur Area, East Bangalore Manjushree Nagaraj, Ananya chakraborty, B.N Srinivas <b>Background:</b> Over the counter drugs (OTC) are sold without the prescription of a registered medical practitioner. There are reports that OTC drug market in India is on the rise. This is attributed to the rising cost of health care, difficulty in accessing healthcare, and an alarming tendency to self manage symptoms. The outcome of this is OTC related adverse effects, abuse, and hospitalizations. Literature on OTC is sparse. Hence this study was undertaken to evaluate the dispensing pattern of OTC drugs in retail pharmacies in Sarjapur area, East Bangalore. <b>Materials and Methods:</b> The study was conducted in 3 retail pharmacies in Sarjapur area, Bangalore East. The duration of the study was for a period of 10 days from August 1st to August 10th 2014. The common complaints for which the patients frequented the pharmacies were observed and recorded .The investigator personally interviewed the patients between 6pm to 9pm, near the respective pharmacies. During this study period around 216 patients visited pharmacies without prescription. The drugs supplied to 216 patients by private pharmacies without prescription was recorded. Data was analysed by descriptive statistics using Microsoft Excel. <b>Results and Observations:</b> Most commonly dispensed OTC drugs were analgesics (26.8%). The other categories of medications dispensed were antihistamines (15.2%), antacids (14.8%), antibiotics (10%), antipyretics (7.8%), Oral contraceptive (OC pills) (5.09%) and others (20%). The commonly dispensed antibiotics were Cefadroxil (250mg) for dental infection and Levofloxacin (500mg) for upper respiratory tract infection. The most common complaint for the use of OTC drugs was pain (25%). It was noted that 55.09% of the dispensed drugs belonged to schedule H. However, 13% patients were aware regarding the harmful effects of drugs. <b>Conclusion:</b> The use of OTC drugs is alarmingly high in Bangalore East. Pharmacists have to be trained and educated regarding rationale dispensing of drugs. The need for promoting the appropriate use of drugs in the Indian health care system is important. This can be achieved through educational, regulatory and managerial strategies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=FC11-FC13&id=6119 https://doi.org/10.7860/JCDR/2015/.6119 Hypovitaminosis D and Other Risk Factors of Femoral Neck Fracture in South Indian Postmenopausal Women: A Pilot Study Thomas V. Paul, Sivan Arul Selvan, Hesarghatta Shyamasunder Asha, Nihal Thomas, Krishnan Venkatesh, Anil Thomas Oommen, Thomas Mathai, Mandalamsubramanian Seshadri <b>Background:</b> Non-communicable diseases like hip fractures are a significant problem in a developing country like India. The risk factors for hip fractures vary according to local practices and the availability of preventive health care delivery systems. There is paucity of data on risk factors for hip fracture in the south Indian population. <b>Aim:</b> This study was undertaken to assess risk factors associated with femoral neck (FN) fracture in South Indian postmenopausal women along with subsequent one year mortality. <b>Materials and Methods:</b> One hundred four postmenopausal women with FN fracture and 104 age and BMI matched controls were included. Sedative use, visual impairment and other relevant risk factors were assessed. Bone biochemistry and Bone Mineral Density (BMD) were evaluated. A telephonic interview was done at the end of one year to ascertain the well-being. <b>Results:</b> Sedative use, visual impairment, low FN BMD and vitamin-D deficiency (<20 ng/ml) were seen more in fracture subjects compared to controls (p=0.05). At the end of one year, 20% of the fracture subjects and 5% of the controls had died (p=0.001). <b>Conclusion:</b. Risk factors identified in our study are potentially correctable, and needs special attention in an Indian context to prevent hip fractures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OC19-OC22&id=6131 https://doi.org/10.7860/JCDR/2015/.6131 Invitro Antifungal Evaluation of Denture Soft Liner Incorporated with Tea Tree Oil: A New Therapeutic Approach Towards Denture Stomatitis Koteswara Rao Pachava, Lakshmi Kavitha Nadendla, Leela Subhashini Choudary Alluri, Huma Tahseen, Navya poojitha Sajja <b>Aim:</b> Adherence and colonization of candida on denture soft liners is the most important contributing factor in development of denture stomatitis. This invitro study is undertaken to investigate whether the incorporation of tea tree oil into denture soft liners would inhibit the growth of candida albicans. <b>Materials and Methods:</b> Each 10 specimen disks incorporated with tea tree oil into soft liners (St) and without tea tree oil (S) were prepared. Both the tea tree oil daily. These disks were inoculated with candida albicans suspension for assessment of fungal growth and were rinsed with sterile water to remove loosely attached surface organisms. The attached yeasts were measured by inoculating them on saboraud’s agar. Treated and control disks were stored in distilled water for 1, 30, 60 days and washed daily with wet cotton. Data between treated and control disks were compared by applying t-test. <b>Results:</b> The mean colony forming units (CFU) per mm2 for specimens without tea tree oil after water storage and wash with wet cotton for 1, 30 and 60 days was 7.1 × 106, 6.5 × 106, 6.8 × 106, respectively and for specimens with tea tree oil CFU decreased significantly to 2.1 × 106, 2.8 × 106, 3.1 × 106 after 1, 30 and 60 days. Treated disks were effective in controlling the growth of C.albicans for two months following water storage. <b>Conclusion:</b> Addition of tea tree oil to denture soft liner significantly reduced growth of C.albicans suggesting a new form of intra oral effective antifungal management for denture stomatitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC62-ZC64&id=6132 https://doi.org/10.7860/JCDR/2015/.6132 Diagnostic Utility of Conventional Radiography in Head Injury Hitesh Chawla, Ranjana Malhotra, Rohtas Kumar Yadav, Mahavir S Griwan, Pramod Kumar Paliwal, Akash Deep Aggarwal Background: Head injury is the frequent cause of morbidity and mortality and frequently encountered in emergency department. Radiological examination of the skull is an indispensable part in the management of patients suffering from head trauma. Aim: To determine the accuracy of X-ray in detecting skull fractures, comparing the same with autopsy and CT evaluation. Materials and Methods: The medico-legal cases that died of traumatic head injury and brought for autopsy over a period of two years were included in the study. Only those cases were selected who had underwent both X-ray and CT evaluation prior to death. R esults: When compared with autopsy, X-ray missed 19.1% of fractures while 11.9% fractures missed in contrast to CT scan. C onclusion: Skull X-ray is of little benefit when a CT scan is obtained. It has no added advantage over CT scan. Whenever there is facility of CT scan is available, the patient of head injury should not underwent X-ray as it can only delay the diagnosis of an associated intracranial injury and exposes the already traumatised patient to harmful radiations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=TC13-TC15&id=6133 https://doi.org/10.7860/JCDR/2015/.6133 Spectrum of Oral Lesions in A Tertiary Care Hospital Ranjan Agrawal, Ashok Chauhan, Parbodh Kumar <b>Aim:</b> The present study was undertaken to study the spectrum and pattern of various oral cavity lesions in a tertiary care hospital in Rohilkhand region of Uttar Pradesh, India. <b>Background:</b> Oral cavity is one of the most common sites for tumour and tumour like lesions especially in males. It has been observed that benign lesions are more common than malignant ones. <b>Materials and Methods:</b> A retrospective study was carried out in a tertiary care hospital during the period of two years from June 2012 to May 2014. The study included 133 cases of oral cavity lesions. The parameters included in the study were age, gender, site of the lesion and histopathological diagnosis. Special stains and Immunohistochemical markers were applied as and when required. Data collected were analysed. <b>Results:</b> A total of 133 cases were included in the present study. The age ranged from 8 to 80 years. Males were affected more often than females with a Male: Female ratio of 3.3:1. The most common involved site was tongue 39 (29.32%) followed by tonsil in 30 (22.56%), buccal mucosa 27(20.32%), floor of mouth 14 (10.53%), palate 12(9.02%), lower lip 8 (6.02%), upper lip 2(1.50%) and vestibule in 1 (0.75%) cases. Of the 133 cases, 63 cases (47.36%) were malignant, 52 non-neoplastic (39.10%) and 18 cases (13.53%) of benign neoplasias. The various lesions included - Squamous cell carcinoma, Verrucous carcinoma, Carcinoma-in-situ, Leukoplakia, Fibroma, Lipoma, Squamous cell papilloma, Lymphoid hyperplasia, Pseudoepitheliomatous hyperplasia, Haemangioma, Schwannoma, Atypical Pleomor -phic adenoma, Pleomorphic adenoma, Epidermal cyst, Retention cyst, Parasitic infestation, Tubercular pathology, Granulation tissue, Chronic Sialadenitis and Chronic non-specific inflammatory pathology. A larger epidemiopathological study in this region needs to be carried out for detailed statistical analysis. <b>Conclusion:</b> Benign lesions were the predominant pathology. Squamous cell carcinoma was the commonest malignant lesion. Histopathological typing of the lesion is mandatory to confirm or rule out malignancy and is essential for the rational management thus avoiding mutilating surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=EC11-EC13&id=6121 https://doi.org/10.7860/JCDR/2015/.6121 Comparison of the Effect of Dentin Bonding, Dentin Sealing Agents on the Microleakage of Provisional Crowns Fabricated with Direct and Indirect Technique-An Invitro Study Peter John, B Muthukumar, M Vasantha Kumar <b>Background:</b> Postoperative sensitivity after temporization is a common complaint in Fixed Partial Denture patients. It is caused by weak and ill fitting temporary restorations which results in microleakage. This can be controlled by providing good temporary restorations and by coating the exposed dentinal tubules of the prepared tooth with dentin bonding agent or dental varnish. <b>Aim:</b> The purpose of the study was to determine the effect of dentin-bonding, dentin sealing agents on the microleakage of temporary crowns made by tooth colored auto polymerizing resin fabricated with direct and indirect technique. <b>Materials and Methods:</b> Thirty premolar and molar human teeth were collected which were extracted recently was used for the study. The teeth were marked and divided into 3 groups each containing 10 nos. They were individually mounted with self-cure acrylic resin. It was then mounted on a milling machine and crown preparations done. Temporary crowns were fabricated by direct and indirect method with two types of materials. In group A (Control group), the temporary crowns fabricated with both direct and indirect method were cemented directly with temporary luting cement. In group B dentine-bonding agent (solobond M) was applied once to the prepared surface of each tooth specimen before the cementation of temporary crowns where as in case of group C a single layer of dental varnish is applied prior to crown cementation. The entire specimens were immersed in 1% methylene blue and allowed to undergo thermal treatment. It was then sectioned in a hard tissue microtome. Each section was evaluated for dye penetration into the dentin tubules by comparing it with a visual scale. <b>Statistical Analysis:</b> SPSS Version 13 software was used for non-parametric data analysis by a qualified statistician. P-values less than 0.05 (p-value<0.05) were considered to be statistically significant. <b>Results:</b> Group B (Dentin Bonding Agent) specimens cemented with crowns fabricated in direct technique showed the least amount of microleakage when compared with group A and group C. Group C (Dental Varnish) specimen showed comparatively more amount of microleakage than that of group B. Group A (control group) specimens showed the maximum amount of microleakage. <b>Conclusion:</b> The application of a single layer of Dental varnish appears to be of no significant benefit when compared to crowns cemented with the application of Dentin bonding agent on the tooth surface. The application of a single layer of Dentin bonding agent (Solobond M) and temporary crowns fabricated with direct technique may be of some benefit for crown preparations as an interim measure prior to the luting of final crown. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC54-ZC57&id=6122 https://doi.org/10.7860/JCDR/2015/.6122 Survival of Implants in Immediate Extraction Sockets of Anterior Teeth: Early Clinical Results Mohammad Sabir, Mohammad Nazish Alam Background: The aims and objectives of this study were placement of implants in freshly extracted sockets of anterior teeth and to evaluate the implant stability, peri-implant radiolucency and gingival inflammation around implant over a short period of 30 months. Materials and Methods: A total of 12 patients (8 male and 4 female), ranging in the age from 20 to 50 years, from March 2007 to June 2007, were evaluated for immediate implant placement into 22 fresh extraction sockets. Only maxillary and mandibular anterior teeth/roots (central incisors, lateral incisors and canines) were considered for replacement with implants. One piece implant with integrated abutment and integrated surface, non-submerged, threaded and tapered at apical 5 mm, sand-blasted and acid etched surfaced implants (HI-TEC TRX-OP Implants of Life Care Company) were used. R esults: The mobility was not present in any of the implants at all the follow up visits. There were 2 implants at 6 month, 1 implant at 12 month, 1 implant at 18 month visits, showing peri-implant radiolucency at some sites at bone to implant contact site. Severe gingival inflammation was not observed in any of the implant site. At every follow-up visit, every implant met the criteria of success and none was found to be failed over a 30 months duration i.e. 100% success rate was achieved by implants in immediate extraction socket. C onclusion: The success rate of implant survival in this study was found 100%. These implants have fulfilled all the criteria of implant success and based on the defined criteria, the success rate of implants placed in immediate extraction sockets of anterior teeth compared favorably with the conventional implants. The early results of the present study showed that high survival rates with the implants in immediate extraction sockets can be achieved. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC58-ZC61&id=6123 https://doi.org/10.7860/JCDR/2015/.6123 Prevalence; Characteristics and Management of Endometriosis Amongst Infertile Women: A One Year Retrospective Study Vineet V Mishra, Rashmi A Gaddagi, Rohina Aggarwal, Sumesh Choudhary, Urmila Sharma, Ushma Patel Background: Endometriosis appears to affect every aspect of a women’s reproductive system resulting in infertility and spontaneous pregnancy loss. This study aims to find out the prevalence & clinical characteristics of endometriosis amongst infertile women. S ettings and Design: A Hospital based retrospective study over a period of one year. Materials and Methods: It is a retrospective study conducted in the gynaecology department in Institute of Kidney Diseases & Research Centre; Ahmedabad from April 2012 to March 2013 amongst women with a primary complaint of infertility (Primary/Secondary).A total of 372 patients underwent diagnostic hysterolaparoscopy and of these 180 patients who had laparoscopic evidence of endometriosis was included in the study. All of these patients and their findings were analysed with respect to the clinical signs and symptoms. The outcome after appropriate management was analysed in subsequent follow up. S tatistical analysis: All collected data was entered into the SPSS version 20. Categorical data are expressed in frequency or percentage. Chi-Square test and Fisher-Exact test has been performed to carry out p-value for categorical data. P-value <0.05 shows statistically significant difference. R esults: The frequency of endometriosis among women with infertility subjected to diagnostic hysterolaparoscopy was found to be 48.38%. Statistical significant association with severity of disease was associated with symptoms like dysmenorrhea, chronic pelvic pain, restricted uterine mobility and adnexal tenderness. (p < 0.01) Ultrasound finding of endometrioma with ground glas appearance also had statistical significant association with staging of disease (p < 0.01). C onclusion: Endometriosis amongst infertile women is increasingly being detected due to greater use of laparoscopy in evaluation of infertility.Though most signs do not correlate with severity of disease however the presence of restricted uterine mobility, adnexal tenderness & chronic pelvic pain should always raise the suspicion of endometriosis. Laparoscopy remains the gold standard for diagnosing and staging endometriosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=QC01-QC03&id=6125 https://doi.org/10.7860/JCDR/2015/.6125 Evaluation of Musculoskeletal Disorders in Dentists and Application of DMAIC Technique to Improve the Ergonomics at Dental Clinics and Meta-Analysis of Literature H.S.Bedi, Ninad josh iraomoon, Vineet Bhatia, Gagandeep Kaur Sidhu, Nadia Khan D<b>Introduction:</b> Musculoskeletal disorders (MSD) result in discomfort, pain and illness that can result in disruption or impairment of dental practice. <b>Materials and Methods:</b> A cross-sectional study consisting of 60 dentists was carried out to determine musculoskeletal work related pain in major cities of Northern India. The study was planned in two phases. In the first phase, the subjects were given questionnaire related to the musculoskeletal pain happened over the last twelve months. In the second phase of study, improvement was carried out by recommending the subjects to implement ergonomics at their workplace. After three months subjects were again approached and given questionnaire about the musculoskeletal disorders. DMAIC (define, measure, analyse, improve and control) methodology of six sigma strategy was used to access the MSDs. Chi-square test was used for the analysis and a p-value of less than or equal to 0.05 was considered statistically significant. <b>Results:</b> The overall prevalence of musculoskeletal problems in the present study was found to be 68.3%. After three months only 23 respondents applied ergonomics at their work place, prevalence of pain was reduced in neck from 47.8% to 21.7% out of total 23 respondents, shoulder pain 39.1% to 17.3%, pain in elbows from 26% to 21.7%, as well as in other locomotor organs. The p-value was significant with p <0.05. <b>Conclusion:</b> MSD represents a major occupational health issue for dentists in India as well as worldwide and result revealed necessitates the need of workshops to create awareness of ergonomics as effective measures for reducing MSD among dentists. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC01-ZC03&id=6126 https://doi.org/10.7860/JCDR/2015/.6126 Lymphomas in Ile-Ife, Nigeria: Immunohistochemical Characterization and Detection of Epstein-Barr virus Encoded RNA Ifeyinwa M. Onwubuya, Kayode A. Adelusola, Muheez A. Durosinmi, Donatus Sabageh, Kevin N. Ezike Background: The proper histopathological characterization of malignant lymphomas requires the use of immunohistochemistry along with other molecular pathology techniques. Materials and Methods: Malignant lymphomas histologically diagnosed in our hospital were reclassified according to the WHO scheme using immunohistochemistry while in-situ hybridization was performed for the detection of Epstein-Barr virus encoded RNA. Results: There were 83 cases of lymphoma. The male to female ratio was 1.9:1 while the overall mean age was 41.7 years. Non-Hodgkin lymphomas (NHL) constituted about 79.5% of cases. The majority of cases (98.8%) were B-cell lymphomas. Nine subtypes of lymphomas were identified with diffuse large B-cell lymphomas (56.4% of which were of the germinal centre type) constituting the largest group (47.0%). Intermediate and high grade subtypes were more common. The majority of cases (72.3%) were nodal lymphomas with cervical lymph node being the commonest site (48.2%). Only classical Hodgkin lymphoma (HL) (20.5%) was seen of which the mixed cellularity subtype was the most common. Epstein Barr virus (EBV) encoded ribonucleic acid was detected in 7 cases (8.4%) including 4 cases of HL, 2 cases of Burkitt lymphoma and the only case of plasmablastic lymphoma. About five cases were reclassified as non-lymphoid malignant lesions. Conclusion: Immunohistochemistry is vital to the proper classification of lymphomas even in a resource poor environment. Although nine subtypes of lymphomas were identified, diffuse large B-cell lymphomas formed the largest single group. Epstein-Barr virus probably plays an important role in lymphomatogenesis in this environment. A larger multicentre study is required to prove this. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=EC14-EC19&id=6127 https://doi.org/10.7860/JCDR/2015/.6127 Erythrocyte Antioxidant Defenses Against Cigarette Smoking in Ischemic Heart Disease Sandhya Metta, Doddamani R Basalingappa, Satyanarayana Uppala, Geeta Mitta Background: Cigarette smoke promotes atherogenesis by producing oxygen-derived free radicals. Aim: The present study was conducted to determine the effect of cigarette smoking on lipid peroxidation and erythrocyte antioxidant status in ischemic heart disease (IHD). Materials and Methods: A total of 327 male subjects were enrolled for this study, divided into two groups consisting of 200 patients, who were consecutively admitted for IHD in the intensive cardiac care unit (ICCU) of a Government Hospital and 127 age matched male healthy subjects. Both the groups were subsequently categorised into smokers and non smokers sub groups depending upon the smoking history {>/= 20 pack years of smoking; (20 cigarettes per day for one year constitutes one pack year)}. All 327 subjects were investigated for lipid profile, malondialdehyde (MDA) levels and the antioxidant enzymes catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPX). S tatistical Analysis: The differences in the parameters between the groups were tested for significance by one way ANOVA using the SPSS software version 19. A p-value of < 0.001 was considered to be significant statistically. Multiple comparisons were made between all the four groups by Post Hoc Tukey test. R esults: There was highly significant difference (p<0.001) observed in GPX activity, in comparison to CAT and SOD (p=0.032, p=0.009) between smokers vs non smokers in control group as well as patient group. The plasma MDA levels were found to be increased significantly (p<0.001) in IHD patients, who smoked as compared to those who did not. C onclusion: Chronic smoking enhances erythrocyte lipid peroxidation in IHD patients with concomitant failure of both plasma and erythrocyte antioxidant defense mechanisms. Along with conventional lipid markers and plasma MDA levels, the erythrocyte GPX activity was observed to be a better marker of oxidative stress, in chronic smokers, who are at risk of developing IHD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=BC08-BC11&id=6128 https://doi.org/10.7860/JCDR/2015/.6128 A Comparison of Masticatory Performance and Efficiency of Complete Dentures Made with High Impact and Flexible Resins: A Pilot Study Puja Hazari, Anjali Bhoyar, Sunil Kumar Mishra, Naveen S. Yadav, Harsh Mahajan <b>Background:</b> In patients with extensive tooth loss, restoration of masticatory function and aesthetics is main concern for a prosthodontist. <b>Aim of Study:</b> This study aimed to evaluate and compare differences in masticatory efficiency of patients treated with complete dentures made with either high impact or flexible resins. <b>Setting and Design:</b> The sample size consisted of 10 study subjects. Two sets of dentures first conventional followed by flexible dentures were fabricated for each subject and both the sets of dentures were accessed for masticatory performance and efficiency. <b>Materials and Methods:</b> This study compared the masticatory performance and efficiency of dentures by means of standardized mesh sieves. Masticatory efficiency was calculated by recording the total number of chewing cycles and time required to completely swallow a standardized food item. A patient satisfaction questionnaire was given and evaluated. <b>Statistical Analysis Used:</b> The statistical analyses were performed using Z-test of Proportion and Paired t-test. <b>Results:</b> The masticatory performance ratio was found to be more for hard food in conventional dentures. The values of masticatory performance ratios for soft food, time and number of masticatory strokes were indicating better masticatory efficiency of conventional dentures. <b>Conclusion:</b> Though masticatory efficiency and performance were found to be better for patient’s dentures made with Polymethyl methacrylate (PMMA), a statistically significant number of patients reported that the flexible dentures were more satisfying than the conventional dentures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC29-ZC34&id=6089 https://doi.org/10.7860/JCDR/2015/.6089 Influence of Vitamin D & Calcium Supplementation in the Management of Periodontitis Jayachandran Perayil, Kee Rthy S Menon, Seema Kurup, Anju Eli Zebath Thomas,Angel Fenol, Rajesh Vyloppillil , Anuradha Bhaskar, Sai Megha <b>Introduction:</b> It has long been recognized that vitamin D is a hormone and were many studies reporting that patients in periodontal maintenance programs taking vitamin D and calcium supplementation had a trend for better periodontal health compared to patients not taking supplementation. <b>Aim:</b> To evaluate the effect of vitamin D and calcium supplementation in reducing gingival inflammation, using clinical parameters like gingival index (GI), oral hygiene index-simplified (OHIS), probing pocket depth (PPD), clinical attachment level (CAL) and bone density (BD). Also, to assess whether calcium and vitamin D oral supplementation influences alveolar Bone Density (BD). <b>Design and Settings:</b> A nonrandomised clinical trial done in Amrita School of dentistry, Kochi, India. <b>Materials and Methods:</b> Group A taking vitamin D (250IU/day) and calcium (500 mg/day) supplementation, and Group B were not taking oral supplementation. All subjects had at least one or more teeth with chronic moderate periodontitis. Digital Orthopantomogram images were taken to assess bone density. Data were collected at baseline and three months. <b>Statistical Analysis used:</b> OHI-S, GI, PPD, CAL, and Bone Densities (BD) were calculated per group. Karl Pearson Coefficient of correlation was used to test correlation of bone density with GI and OHI -S. Intergroup comparison of parameters were done using Independent two Sample t-test. Intragroup comparison of parameters at recall interval was done using Paired sample t-test. The results were considered statistically significant when p-value was <0.05. <b>Results:</b> Both Groups showed significant change in the periodontal parameters and bone density after three months and intragroup comparison showed highly significant results for vitamin D group in relation to GI, OHI S and bone density. <b>Conclusion:</b> Calcium and vitamin D supplementation has got a positive effect on periodontal health and it can be used as an adjunct to non surgical periodontal therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC35-ZC38&id=6091 https://doi.org/10.7860/JCDR/2015/.6091 A Comparative Study of Efficacy and Safety of Agomelatine and Escitalopram in Major Depressive Disorder Ravi Babu. Komaram, Srikrishna. Nukala, Jayasr ee. Palla, Laks hmana Rao. Nambaru, Satyanarayana Murthy. Kasturi <b>Background:</b> Major depressive disorder (MDD) is a mental disorder characterized by episodes of depressed mood, loss of interest or pleasure, feeling of guilt or low self-esteem, loss of energy, altered sleep patterns and difficulty in concentration. <b>Objective:</b> This study was carried out to compare the efficacy and safety of Agomelatine with Escitalopram in the treatment of major depressive disorder. <b>Design and Setting:</b> This is a prospective study conducted at Outpatient Department of Psychiatry, GSL Medical College & General hospital, Rajahmundry, India. <b>Materials and Methods:</b> Patients with newly diagnosed major depressive disorder (DSM-IV-TR) with minimum score of 20 in Hamilton depression rating scale were randomly assigned Agomelatine (25-50 mg/day) or Escitalopram (10-20 mg/day) for a period of 8 weeks. The main efficacy outcome considered was the mean change of HAM-D17 score from baseline to end of therapy. Secondary outcome measures were Clinical Global Impressions–improvement (CGI) and severity (CGI-S) rating scales. <b>Statistical Analysis:</b> Student t-test was used for comparing the groups and chi-square test was used for assessing the qualitative variables. For all statistical analysis p<0.05 was considered statistically significant. <b>Results:</b> The drugs under study effectively reduced depressive symptoms at all the time points. The percentage of responders at 8weeks (last post baseline value) was 65.38% with Agomelatine and 57.40% with Escitalopram. The difference between the drugs was statistically not significant in all evaluations (p>0.05). The mean CGI-S and CGI-I scores were decreased in both the groups (p<0.05) and there was no statistically significant difference between the groups at any assessment during the study period. Both the treatment groups showed favourable safety profile. <b>Conclusion:</b> The study results supported that Agomelatine is therapeutically similar to Escitalopram in terms of antidepressant effect. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=VC05-VC08&id=6092 https://doi.org/10.7860/JCDR/2015/.6092 Sociodemographic Pattern of Depression in Urban Settlement of Karachi, Pakistan Areeba Altaf, Maham Khan, Syed Raza Shah, Kaneez Fatima, Sameer Altaf Tunio, Mehwish Hussain, Muhammad Asim Khan, Moazzam Ali Shaikh, Mohammad Hussham Arshad <b>Introduction:</b> Depression is a global issue prevalent among developing countries like Pakistan as compared to developed countries. We conducted a study to assess the prevalence and identify the significant predictors of depression in an elite urban settlement in Karachi, Pakistan. <b>Materials and Methods:</b> This cross-sectional study was done in the elitist residential area of Karachi; Defence Housing Authority (DHA). Four hundred and twenty three participants were included by going to their residences. Self-administered questionnaires were handed out after taking informed consent. Level of depression was assessed by Patient Health Questionnaire (PHQ-9). Data were entered and analysed in Predictive Analytical Software v. 18.0. <b>Results:</b> The mean and median total score of the scale were 5.9 ± 5.4 and 4 (7) respectively with minimum score 0 and maximum 27. In this sequence, 139 (32.86%) respondents were identified to be depressed. It was found that females were slight more depressed than males (p = 0.063). Regression Model identified only gender and marital status as significant predictors of depression. Having a female gender increased 0.658 times chance of being depressed (p = 0.047). Unmarried person had 0.296 times more likely to be depressed (p = 0.019). Boredom was considered as significant factor of depression by the participants (p< 0.0001). Odds ratio signified depression occurred 0.310 times more if one was bored. <b>Discussion:</b> Depression should be considered as a major public health issue for the city. Public awareness should be done in all parts of the city in an attempt to reduce depression especially among the female gender. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=VC09-VC13&id=6093 https://doi.org/10.7860/JCDR/2015/.6093 Proliferating Cell Nuclear Antigen in Premalignancy and Oral Squamous Cell Carcinoma Chandrashekar Poosarla, Maya Ramesh, K. Ramesh, Swetha Gudiseva Sekar Bala, Murali Sundar <b>Introduction:</b> Cancer has multifactorial aetiology and is a multistep process involving initiation, promotion and tumour progression. Cellular proliferation is one of the important indicators for the biologic aggressiveness of a malignant lesion. The dysregulated proliferation may be a significant change to determine the potential prognosis of various malignant tumours. <b>Aim:</b> The aim of this study was to evaluate the expression of proliferating cell nuclear antigen (PCNA) as an indicator for clinical aggressiveness in oral premalignancy and squamous cell carcinoma. <b>Materials and Methods:</b> A total of 50 blocks were taken from the Department of Oral Pathology which was diagnosed previously histopathologically. It comprised of normal oral mucosa (10), dysplasia (10) and grades of oral squamous cell carcinoma (30) of patients between the age group of 40–60 years. From each block, sections of 4 micro metre thicknesses were prepared and placed on poly- L lysine coated slides. These sections were immunohistochemically stained with monoclonal proliferating cell antibody (PC10). The stained slides were evaluated by a single examiner for cell count. <b>Results:</b> A comparison between study groups and controls showed a probability value (p-value) < 0.05. Significant increase in the proliferative index from the normal to oral squamous cell carcinoma was noticed. Poorly differentiated squamous cell carcinoma showed maximum proliferative index followed by moderately differentiated, well differentiated squamous cell carcinoma, dysplasia and normal mucosa. <b>Conclusion:</b> Present study concluded that PCNA index can be used to assess the proliferation and aggressiveness in dysplasia and different grades oral squamous cell carcinoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC39-ZC41&id=6094 https://doi.org/10.7860/JCDR/2015/.6094 Is MRI Necessary for Skeletal Evaluation in Sickle Cell Disease Ankita Arun Sachan, Bhushan. N. Lakhkar, Bhavana B Lakhkar, Shivam Sachan Background: More than 50% of the world’s cases of sickle cell anaemia are in India with an estimated population of 1.27 billion as against estimated world’s population of 7.24 billion. Aim: MRI of 103 patients of sickle cell disease were evaluated to assess the skeletal changes in proven cases of sickle cell disease and to find the incidence of bony infarcts in such patients. The conversion of red marrow to yellow marrow in these patients were also studied. Materials and Methods: Sickle cell patients with musculoskeletal pain as well as asymptomatic sickle cell patients were evaluated by MRI. The standard sequences used wereT1WI, T2WI, STIR, T1WI + Gd Contrast. R esults: Persistent Red marrow was seen in axial and appendicular skeleton (62 cases). Extramedullary haematopoiesis was found in 4 cases, avascular necrosis of femur head (32 cases) and bone infarcts (46 cases) were also observed in our study. Osteomyelitis, septic arthritis and tubercular infections were associated with sickle cell disease in our study. C onclusion: MRI is very sensitive in detecting early stages of avascular necrosis, red marrow persistence, extramedullary haematopoiesis, changes of arthritis, infections and joint effusion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=TC08-TC12&id=6095 https://doi.org/10.7860/JCDR/2015/.6095 The Effect of Whole Body Massage on the Process and Physiological Outcome of Trauma ICU Patients: A Double-Blind Randomized Clinical Trial Masoud Hatefi, Molouk Jaafarpour, Ali Khani, Javaher Khajavikhan, Taleb kokhazade <b>Background and Aim:</b> Hospitalization of traumatic patients in the Intensive Care Unit (ICU) and their critical condition can cause haemodynamic instabilities and deterioration in the level of consciousness. The study aimed to investigate the effect of whole body massage on the vital signs, Glasgow Coma Scale (GCS) scores and arterial blood gases (ABG) in trauma ICU patients. <b>Materials and Methods:</b> In a randomized, double-blind trial, 108 trauma ICU patients received whole body massage {experimental group (n=54)}, or routine care {control group (n=54)}. The patients vital signs; systolic blood pressure (SBP), diastolic blood pressure (DBP), respiratory rate (RR), pulse rate (PR), Temperature (T), GCS score and ABG parameters were measured by a nurse at the same time in both groups before the intervention and 1 hour and 3 hours after the intervention with a checklist. The patient in experimental group received full body massage in 45 minute by a family member. <b>Results:</b> According to the findings, significant differences were observed between experimental and control groups in SBP 1 hour and 3 hours after intervention (p< 0.001), DBP, RR and PR 1 hour after intervention (p<0.001) and GCS 1 hour and 3 hours after intervention (p<0.05). Of ABG parameters, significant differences were observed between experimental and control groups in O2 saturation (p<0.001), PH (p<0.001) and pO2 (p<0.05). No significant differences between experimental and control groups in Temperature, pCO2 and HCO3 (p>0.05). <b>Conclusion:</b> With respect to this study, massage therapy is a safe and effective treatment in intensive care units to reduce patient’s physical and psychological problems. Therefore the use of massage therapy is recommended to clinical practice as a routine method. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=UC05-UC08&id=6096 https://doi.org/10.7860/JCDR/2015/.6096 Molecular Characterization and Resistant Spectrum of Enterococci Isolated from a Haematology Unit in China Jiajia Yu, Jinfang Shi, Ruike Zhao, Qingzhen Han, Xuefeng Qian, Guohao Gu, Xianfeng Zhang, Jie Xu Objectives: The present study screened clinical isolates of E. faecalis and E. faecium to determine resistant spectrum and the potential virulence genes characterization among them of haematology patients. Methods: Clinical Enterococci isolates were obtained from a haematology unit in a tertiary care hospital in China. R esults: Among 125 isolates available for the investigation, 46 were identified as E. faecium, and 79 were E. faecalis. Urine was the most common source (82, 65.6%). E. faecium isolates were more resistant than E. faecalis. Among E. faecium, maximum resistance was seen against PEN 93.5% and AMP 93.5% followed by CIP 87%. Eight vancomycin-resistant E. faecium (VREfm) isolates were obtained, positive for vanA genotype. Of 125 enterococci isolates, 67(53.6%) were acm, and 42.4%, 25.6%, 25.6%, 24.8%, 23.2%, 20.8%, 10.4% and 7.2% of isolates were positive for esp, cylL-A, asa 1, cylL-S, cpd, cylL-L, gel-E and ace, respectively. E. faecalis isolates have more virulence genes (VGs) than E. faecium. MLST analysis of VREfm identified three different STs (ST17, ST78 and ST203). C onclusion: The study provides the molecular characterization and resistant spectrum of Enterococci isolated from a haematology unit in China. Molecular analysis showed that all VREfm isolates belonged to pandemic clonal complex-17(CC17), associated with hospital-related isolates. Therefore, determining resistant spectrum and virulence characterization is crucial for the prevention and control of the spread of nosocomial infections caused by Enterococci in the haematology unit. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=DC04-DC07&id=6097 https://doi.org/10.7860/JCDR/2015/.6097 Clinico-Epidemiological Study and Treatment Outcome of Multinodular Goitre at A Tertiary Care Hospital Karthik K S, Bharat Chandra, Balakrishna M A, Deepthi B R <b>Background:</b> Thyroid enlargement has been a common problem encountered in general surgical practice. Thyroid being an endocrine gland, its involvement has a diverse issue from a meagre cosmetic problem to a more concerned malignancy. <b>Aim:</b> This study was conducted to study the age and sex distribution along with the mode of presentation of Multinodular Goitre (MNG). The incidence of malignancy and the surgical complications in the study population were also studied. <b>Materials and Methods:</b> In this descriptive study, patients diagnosed with MNG from January 2011 to July 2012 were chosen from the in-patient of our teaching hospital. One hundred such patients who qualified to undergo surgery were included in the study after a detailed history and clinical examination. Patients underwent Fine needle aspiration cytology (FNAC) for preoperative pathological diagnosis and the goitre was confirmed to be benign. Patients diagnosed with malignancy were excluded from the study. Following thyroidectomy, the thyroid specimens were subjected to histopathological examination. <b>Results:</b> Among the 100 cases of MNG, 59% patients belonged to 3rd and 4th decade of life, 90% patients were females, 82% presented before 5yrs. The most common symptom at presentation was swelling (100%). Among the patients 80% were in euthyroid state, 19% were hyperthyroid and 1% hypothyroid. Most of the patients were treated with sub-total thyroidectomy (59%), followed by total (20%), near total (11%), and Hemithyroidectomy (10%). Following surgery complications like stridor and laryngeal oedema (3%), wound infection (2%), hypocalcemia (2%), haemorrhage (1%) and seroma (1%) were noted. On Histopathological examination (HPE) of the surgical specimen, 3% were reported to be malignant. <b>Conclusion:</b> As noted by this study, Multinodular Goitre is more common among females in the third and fourth decades. Patients can present with various complaints. MNG can present as hyperthyroid, hypothyroid but mostly in euthyroid state. The indication for surgery in patients with MNG includes cosmesis, hyperthyroidism, local compressive symptoms and most importantly malignancy. Subtotal thyroidectomy is the preferred surgery, but a trend towards total and near total thyroidectomy is noticeably replacing the old belief in subtotal thyroidectomy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PC22-PC25&id=6098 https://doi.org/10.7860/JCDR/2015/.6098 Assessment of the Presence of Carpal Tunnel Syndrome in Patients with Diabetes Mellitus, Hypothyroidism and Acromegaly Pelin Oktayoglu, Kemal Nas, Faruk Kilinç, Nebahat Tasdemir, Mehtap Bozkurt, Ismail Yildiz <b>Introduction:</b> Carpal tunnel syndrome (CTS) is one of the most common entrapment neuropathies of the upper limbs. It results from compromised median nerve function of the wrist that is caused by increased pressure in the carpal tunnel. Repetitive use of the hand and wrist, obesity, pregnancy, rheumatoid diseases, trauma and endocrinopathies are some of the risk factors for CTS. <b>Aim:</b> The purpose of this study was to find out whether patients with diabetes mellitus (DM), hypothyroidism and acromegaly have an increased incidence of carpal tunnel syndrome compared to each other and normal population. <b>Materials and Methods:</b> Patients were assigned into three groups as follows: patients with type II DM n: 100, patients with hypothyroidism n:48 and patients with acromegaly n:36. In addition, 50 healthy individuals were included in the study as control subjects. Patients were asked if they had any pain, symptoms of paraesthesia and numbness. Patients with peripheral neuropathy were excluded from the study. Boston Symptom Severity Scale and Functional Capacity Scale were used to assess symptom severity and functional capacity. CTS was investigated by performing electrophysiological study for both hands. <b>Results:</b> The incidence of CTS was significantly higher in all three groups compared to the control group (p>0.05). In addition, the incidence of CTS was significantly higher in the DM group compared to the hypothyroid and acromegaly groups (p<0.001). The incidence of bilateral CTS in the DM group was significantly higher compared to both hypothyroid and acromegaly groups and the control group (p<0.001). <b>Conclusion:</b> CTS has a higher incidence in DM, hypothyroid and acromegaly patients compared to healthy individuals. Clinicians should be careful about development of CTS in DM, hypothyroidism and acromegaly. They should adopt a multidisciplinary approach and co-operate with the psychiatrist. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OC14-OC18&id=6101 https://doi.org/10.7860/JCDR/2015/.6101 Pre-radiotherapy Haemoglobin Level is A Prognosticator in Locally Advanced Head and Neck Cancers Treated with Concurrent Chemoradiation Rajesh Kar Narayanaswamy, Mahadev Potharaju, A N Vaidhyswaran, Karthikeyan Perumal <b>Introduction:</b> Radiation plays a major role in treatment of locoregional control of Head and Neck Squamous cell carcinoma (HNSCC). Anaemia is considered a contributor to intra-tumour hypoxia and tumour resistance to ionizing radiation and most evidences are from developed world, we prospectively investigated the exact role of anaemia in treatment outcome of Stage III/IVA HNSCC in our patient population. <b>Aim of the Study:</b> Primary end point: To analyse the Pre-Radiotherapy haemoglobin level and early response of treatment in stage III/IVA HNSCC and to determine the relationship of Pre-Radiotherapy haemoglobin level with other prognostic factors. <b>Materials and Methods:</b> This non-interventional single blinded randomized study enrolled patients attending the OPD consecutively, who met our eligibility criteria. <b>Inclusion Criteria:</b> HNSCC patients of Stage III/IVA aged =18 years and = 70 years with ECOG status of 1or 2 and willing for concurrent chemoradiation and at least 6 weeks of follow up. <b>Exclusion Criteria:</b> 1) Previous history of treatment for malignancy or radiation in head and neck site. 2) Patients with other fatal and non-fatal pre-morbid or co-morbid conditions that can affect the outcome or the overall survival. Patients with Pre-radiotherapy haemoglobin status < 10 g/dl were given haematinic support and/or blood transfusion. All patients received concurrent chemotherapy (weekly cisplatin) and radiation in conventionally fractionated dose of 66Gy. Early treatment responses were evaluated with Revised RECIST version 1.1 and Data analysis using SPSS version 17.0. <b>Results:</b> Ninety one patients enrolled had mean age of 55.63 (range: 32-69), a median of 56 and mode of 60. Seventy one were males (78%) and 20 females (22%) with a performance status of ECOG 1 in 43 (47%) patients and ECOG 2 in 48 (53%); Pre-RT Hb level of <10.7 g/dl in 38 (42%) patients and =10.7 in 53 (58%) patients; Pre-RT Hb level was <12 g/dl in 67 (74%) patients and =12 in 24 (26%) patients. Tumour sites were - Nasopharynx 7 (8 %), Oral Cavity 18 (20 %), Oropharynx 32 (35 %), Hypopharynx 23 (25 %) and Larynx 11 (12 %). Twenty five (27%) had Grade 2 mucositis and 66 (73%) had Grade 3 mucositis. Fifty eight (64%) patients completed treatment with NO breaks and 33 (36%) with treatment breaks for =5 days. Pre-radiotherapy haemoglobin = 10.7 g/dl (p < 0.001), ECOG performance status (p = 0.0002), Treatment interruptions for > 5 days (p = <0.0001), Mucositis reaction (p = <0.0001) showed statistical significance with outcome of response. <b>Conclusion:</b> The study found that performance status, pre-RT haemoglobin level, radiotherapy interruptions > 5 days and non-development of grade III mucositis was found to be significantly associated with good loco-regional control. Haemoglobin level =10.7 g/dl was associated with better treatment outcome, higher performance status, fewer treatment interruptions and lesser degree of mucositis. Transfusion did not affect the outcome. Definitive conclusions and recommendations need further expansion of our study for better statistical power. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=XC14-XC18&id=6102 https://doi.org/10.7860/JCDR/2015/.6102 Maternal Dental Anxiety and its Effect on Caries Experience Among Children in Udaipur, India Shabnam Gulzar Khawja, Ruchi Arora, Altaf Hussain Shah, Amjad Hassan Wyne, Anshu Sharma <b>Context:</b> Dental caries is a common oral disease among children. There are various factors that influence caries development. Parents and family environment influence oral health behaviours among children. Dental Anxiety is a common hindrance in seeking dental treatment. Mothers’ dental anxiety may act as a barrier to seek professional advice about their children’s caries experience. <b>Aim:</b> To evaluate dental anxiety among mothers and its possible relationship with caries experience in their children in Udaipur city, India <b>Setting and Design:</b> The sample was selected from those attending Darshan Dental College and Hospital, Udaipur for dental treatment. The study period was from June 2014 to November 2014. <b>Materials and Methods:</b> A cross-sectional survey was designed. A total of 187 mother-child pairs were recruited for the study. The children’s age ranged from 3-14 years. Modified Dental Anxiety Scale (MDAS), Hindi version, was used to evaluate dental anxiety among the mothers that categorizes the dental anxiety into five levels. Demographic detail such as age, educational level, and family income was also collected. The World Health Organization (WHO) criteria was utilized for the diagnosis of dental caries in children. DMFT (Decayed, missing and filled teeth) and DMFS (Decayed, missing and filled surfaces) scores were then calculated. <b>Statistical Analysis:</b> Statistical Package for Social Sciences (SPSS) version 20.0 was used to interpret data. Maternal anxiety scores taken as mean MDAS were compared with various independent variables. Statistical tests were used to compare maternal anxiety and children’s caries experience. A p value equal or less than 0.05 was considered as statistically significant. <b>Results:</b> Almost half (49.7%) of the mothers reported as being ‘fairly anxious ‘or ‘very anxious’. There was a significant (p=.001) difference in maternal dental anxiety level in relation to age of the children. Mothers of younger children reported higher anxiety scores. Similarly, mothers with lesser education and lesser family income reported higher anxiety scores. The mean decayed score in children of very anxious mothers and phobic mothers was significantly (p=.001) higher as compared to the children of the mothers with lower anxiety levels. <b>Conclusion:</b> There was a strong positive association between maternal dental anxiety and children’s dental caries experience. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC42-ZC45&id=6103 https://doi.org/10.7860/JCDR/2015/.6103 Screening for Hearing Impairment in High Risk Neonates: A Hospital Based Study Muddasir Maqbool, Bilal Ahmad Najar, Imran Gattoo, Javed Chowdhary <b>Background:</b> Hearing loss very early in life can have multiple deleterious effects on the new born most commonly being related to attainment of speech and language. Also, it can affect social, emotional and academic achievement of the child.Early identification of hearing impairment has been shown to improve prognosis and hence screening programs have been widely and strongly advocated. <b>Aims and Objectives:</b> To estimate the incidence of neonatal hearing loss in high risk neonates admitted in tertiary level teaching hospital and to determine the risk factors predictive of hearing impairment in them. <b>Materials and Methods:</b> It was a prospective study over a period of one year. We screened high risk neonates for hearing impairment admitted to NICU using Brain stem Auditory Evoked Response (BAER).The morphology of the response and wave and interwave latencies was examined in respect to age-appropriate forms. Follow up BAER after one month was performed in cases where initial BAER was abnormal. Babies who tested abnormal on the follow-up were referred for detailed audiology diagnostic work up. <b>Results:</b> A total of 200 cases comprising 118 males (59%) and 82 females (41%) were enrolled. On initial BAER testing, 18 (15.25%) males and 14 (17%) female neonates had hearing loss. Whereas 7 males (70%) and 3 females (30%) had hearing loss out of the total 10 hearing loss cases in the Follow up-BAER testing. Two out of the 6 neonates with birth weight <1500g had hearing loss in the follow up of BAER testing. Use of ototoxic medications, hyperbilirubinemia requiring exchange transfusion, perinatal asphyxia and bacterial meningitis were the major risk factors occurring in 45%, 30% and 26% and 10%. Five neonates had unilateral hearing loss and the rest five (5%) had bilateral impairment.Meningitis was the significant independent clinical risk factors for predicting hearing impairment in high risk neonates.The risk of BAER increased cumulatively with BAER abnormality rate of 4.2%, 22.2% and 33.3% with one two and three risk factors respectively. <b>Conclusion:</b> The overall incidence of hearing loss in initial BERA testing was 16%, in males it was 15.25% in males and in 17% in females,only 62.5% of neonates had a persistent abnormal BAER, with male gender a significant risk factor for this. The incidence of hearing loss increased with number of risk factors. The study highlights that although universal hearing screening programs are warranted; most newborns with a detected hearing loss can be identified based on the risk factors. Thus, a targeted approach for hearing screening may be more feasible in resource limited settings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=SC18-SC21&id=6104 https://doi.org/10.7860/JCDR/2015/.6104 A Prospective Randomized Trial of Open Wound Treatment vs Occlusive Dressings in Elective Surgical Cases with Respect to Surgical Site Infections Anmol Grover, Amandeep Singh, D S Sidhu Background: Surgical wounds heal by primary intention in all the elective and emergency surgical procedures. Current practice is to place dressing over the closed wound before the patient leaves the sterile environment of the operating theatre. Dressing is a material applied to protect a wound and favour its healing. However, to leave wound open in direct contact to environment following any procedure by just applying some ointment on it, the so called open wound treatment is still controversial one. In the present study we have compared open wound treatment vs occlusive dressings in elective surgical cases with respect to surgical site infections. Materials and Methods: The present study was conducted on 100 patients admitted for elective general surgery after taking written informed consent. Patients were divided randomly in to two equal groups each comprising of 50 patients. In Group A, patients had occlusive dressing till removal of stitches and in Group B, patients wounds were kept exposed to environment after the surgical procedure. R esults: In present study we observed total 7% of postoperative wounds were infected of all the clean and clean contaminated wounds we studied. In Group A, patients had occlusive dressing and these patients had 8% infection rate whereas in Group B patients, wounds were kept exposed to environment and these patients had 6% infection rate. C onclusion: It is hereby concluded that in the elective surgical cases there is no harm in leaving the wounds open postoperatively. This method not only helps in arresting the infective pathology at a lesser stage but also saves surgeon’s time and patient’s money. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PC26-PC29&id=6105 https://doi.org/10.7860/JCDR/2015/.6105 Impact of Admission Time on Treatment and Outcome of Stroke in Patients Admitted to Tertiary Care Hospital: A Pilot Study from Central India Amit R. Nayak , Aliabbas A. Husain, Neha H. Lande, Anuja P. Kawle, Dinesh P. Kabra , Girdhar M. Taori, Hatim F. Daginawala, Rajpal S. Kashyap <b>Introduction:</b> Admission of patients within window period has been linked with efficacy of treatment outcome and recovery. The present study examined the effects of early vs delayed admission on functional outcome of Acute Ischemic Stroke (AIS) as well as added value of stroke markers in such patients admitted to a tertiary care hospital in Central India. <b>Materials and Methods:</b> Hundred and four patients admitted to Neurology department of Central India Institute of Medical Sciences were grouped as early referrals (within 24 hour admission) and late referrals (after 24 hour admission) based on onset of symptoms and time of admission. Baseline data, throm bolysis eligibility, hospital and long term outcomes were determined in early and later referrals. Stroke markers NSE, S-100 ßß and ITIH4 peptides were also screened in patients who were further categorized as improved and expired /dependent during hospital outcome. Outcome of death /dependency in both groups was analysed using multivariate regression analysis. Kaplan-Meier analysis was performed to determine the rate of stroke-mortality in hospital and over 12 and 15 month period. <b>Results:</b> Hospital outcome indicated higher percentage (90%) of improved cases in early referrals as opposed to 79% observed in late referrals. Similarly, the ratio of dependency was slighter higher in late referrals (18%) as compared to early referral (6%) cases. The long term outcome at 12 and 18 months showed more or less similar ratio of death/dependency in early (23%, 9%) and late referrals (32%,24%) respectively. Multivariate analysis revealed no significant impact of risk confounders at long term and short term outcome in both groups. Analysis of stroke marker revealed better prognosis with significant association between ITIH4 peptides and NSE & S-100 ßß level with level of improvement in early referrals. <b>Conclusion:</b> Early admission of AIS patients is associated with better hospital outcome. However admission time has no major impact on long term outcome in AIS patients. Moreover, stroke markers such ITIH4, can be used as a predictor of stroke outcome and may have prognostic importance in AIS cases in future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=BC01-BC07&id=6106 https://doi.org/10.7860/JCDR/2015/.6106 A Unique Bonding Technique for Immediate Orthognathic Surgery Biswas Palikunnu Padmaprabha, Hariprasad Ayinipully, Rosaline Tina Paul, Shaji Aboobacker Ponnambathayil, Althaf Thanimoottil Rasheed Introduction: A challenge in orthodontics is achieving ideal bracket position which determines treatment results and finishing. A new bonding method is done indirectly on the cast and bonded directly on the teeth, but it does not require conventional trays to carry the brackets to the teeth. M aterials and Methods: Heavy sized archwires like 0.019”x0.025” or 0.018” SS are bent to the malocclusion to generate a template which comprises of an Bracket -Archwire Assembly (BAA). This assembly is transferred onto the teeth using the molar bands with tubes which serves as a jig for proper orientation of the BAA, then the adhesive is cured at one shot to complete the bonding procedure. R esults: Two surgical cases successfully bonded with this technique is presented in this article. C onclusion: This bonding method finds specific advantages in surgical orthodontics – when the surgeon decides on a surgery-first treatment objective, management of single or a couple of periodontally extruded teeth, management of impacted teeth and in patients needing fixed functional appliance immediately before the completion of growth spurt. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC26-ZC28&id=6086 https://doi.org/10.7860/JCDR/2015/.6086 Prevalence of MLSB Resistance and Observation of erm A & erm C Genes At A Tertiary Care Hospital Ameer Abbas, Preeti Srivastava, Prem Singh Nirwan <b>Background:</b> The increasing resistance to macrolide, lincosamide, streptogramin B (MLSB) agents among Staphylococcus aureus is becoming a challenge to microbiologist. Clindamycin has been a useful drug for treatment of infection caused by the staphylococcus aureus, but change in clindamycin sensitivity pattern due to various mechanisms is leading to therapeutic failure. One of the important mechanisms is mediation of resistance by erm genes. Staphylococcus strains which have erm genes show inducible clindamycin resistance that cannot be determined by routine disk diffusion test resulting in treatment failure. <b>Aim:</b> This study was aimed to detect the prevalence of MLSBi and MLSBc resistance and observation of erm A & erm C genes among MLSBi isolates. Materials and Methods: A total 500 Staphylococcus aureus were isolated; they were checked by disk induction test (D- Test). Those isolates which showed inducible clindamycin resistance were randomly selected and subjected to PCR for the observation of erm A and erm C genes. <b>Results:</b> Prevalence of MLSBi and MLSBc isolates were almost similar that is 10.8% and 11.6% respectively. MLSBi isolates showed more resistance to drugs when compared to MLSBc isolates. Neither of MLSBi and MLSBc isolates was resistant to Vancomycin and Linezolid. Inducible clindamycin was mainly due to presence of erm A gene. <b>Conclusion:</b> D- test should be mandatory at every microbiology laboratory and should be used in routine antibiotic procedure which will minimize the misuse of drug ultimately minimize the risk of treatment failure. PCR should be performed for the detection of genes responsible for erythromycin resistance as it is a quick and most sensitive method. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=DC08-DC10&id=6112 https://doi.org/10.7860/JCDR/2015/.6112 A Study to Assess and Correlate Osteoporosis and Periodontitis in Selected Population of Maharashtra Mohini Lohana, Girish Suragimath, Keshava Abbayya, Siddharth Varma, Sameer Zope, Vishwajeet Kale <b>Background:</b> Osteoporosis is a systemic bone disorder characterized by decreased bone mass and increased risk for fracture. It has been proposed as a possible risk factor for periodontal disease progression. Recent literature has shown periodontitis to be a risk indicator for osteoporosis, suggesting a possible two way relationship. However the association between these two diseases still remains unclear leading to a scope of further research in this area. <b>Aim:</b> The aim of the present study was to assess and Correlate the severity of osteoporosis and periodontitis by using variables like probing pocket depth, clinical attachment loss, plaque index, body mass index and bone mineral density. <b>Materials and Methods:</b> A total of 65 subjects aged between 45-75 years suffering from periodontitis were considered. All subjects were assessed for periodontal disease severity by plaque index (PI), probing pocket depth (PPD) and clinical attachment loss (CAL). The bone mineral density (BMD) of patients was assessed using dual energy X- ray absorptiometry (DXA) at lumbar spine (L1 – L4). The severity of periodontal disease was correlated with severity of osteoporosis. Descriptive statistics like frequency and percentage were calculated for all the variables. Chi-square test was performed to assess the association between the study variables. <b>Result:</b> Among the entire group 78.46% had high plaque index score, and the severity of periodontitis increased with increase in plaque index score showing a statistical significance. Osteopenia was observed in 25.33% of the subjects, out of whom 63.15% suffered from severe periodontitis. Osteoporosis was observed in 17.33% of the subjects, and all the subjects (100%) suffered from severe periodontitis. <b>Conclusion:</b> The results of the present study suggest that increasing severity of periodontitis increased the risk of osteoporosis and vice versa. We conclude that there is a definite association between periodontitis and osteoporosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC46-ZC50&id=6116 https://doi.org/10.7860/JCDR/2015/.6116 Enhancing the Dental Professional’s Responsiveness Towards Domestic Violence; A Cross-Sectional Study Halappa Mythri, Korpathi R Kashinath, Ananda S Raju, K V Suresh , Jayanna V Bharateesh <b>Background:</b> Dentists may be the first health care professionals to treat patients who have experienced Oro-facial trauma resulting from Domestic violence (DV). Hence, as a national health concern, it challenges the social responsibility of a dentist in bringing down its prevalence. <b>Objective:</b> To assess the knowledge of Domestic violence among dentists of Karnataka. Materials and Methods: A cross-sectional questionnaire survey was conducted among dentists of Karnataka to know their knowledge, its relation to dentistry and measures they practice to bring down the prevalence of DV victims. <b>Results:</b> Overall knowledge about DV was very less among the dentists & out of 64% who said the dentist has a role in bringing down the prevalence, 28% reported the need for training. <b>Conclusion:</b> Based on analysis of the data, dentists were interested and would benefit from additional education opportunities concerning recognizing, referring and managing patients who may be the victim of domestic violence in order to enhance their role. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC51-ZC53&id=6117 https://doi.org/10.7860/JCDR/2015/.6117 Effect of Yoga Practice on Levels of Inflammatory Markers After Moderate and Strenuous Exercise Ambarish Vijayaraghava, Venkatesh Doreswamy, Omkar Subbaramajois Narasipur, Radhika Kunnavavil, Nandagudi srinivasavasamurthy Background and Objectives: To evaluate the effect of yoga practice and exercise challenge on Tumour Necrosis Factor alpha (TNF-a), Interleukin-6 (IL-6) levels and lipid profile. Materials and Methods: Two hundred and eighteen subjects participated in the study. One hundred and nine volunteers (51 males and 58 females) in the age group of 20 to 60 years, who practiced yoga regularly for over five years for a period of one hour daily, performed a bout of moderate exercise and a bout of strenuous exercise as per Standardized Shuttle Walk test protocol. Anthropometrically matched, age matched and gender matched subjects, who did not practice yoga (non-yoga group) were chosen as controls (non-yoga, n=109). The non-yoga group also performed similar exercises. The blood samples of both the groups were collected before and after the exercises. TNF-a and IL-6 was analysed before and after the exercise by Sandwich ELISA (Enzyme Linked Immunosorbent Assay). R esults: Resting plasma TNF-a concentration was significantly higher in non-yoga group when compared to yoga group (p<0.05). There was an increase in TNF-a levels in both the groups in response to strenuous exercise. There was no gender difference in TNF-a and IL-6 levels before and after exercise in yoga and non-yoga groups. C onclusion: Regular practice of yoga lowers basal TNF-a and IL-6 levels. It also reduces the extent of increase of TNF-a and IL-6 to a physical challenge of moderate exercise and strenuous exercise. There is no significant gender difference in the TNF-a and IL-6 levels. Regular practice of yoga can protect the individual against inflammatory diseases by favourably altering pro-inflammatory cytokine levels. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=CC08-CC12&id=6021 https://doi.org/10.7860/JCDR/2015/.6021 Assesment of Heart Rate Variability As A Measure of Cardiac Autonomic Status in Psychiatric Patients Exposed to Chemical Irritants Priyanka Srivastava, Supriya Gupta, Rajesh Rastogi, Manushree Gupta Background and Purpose: However, little is known about the cardiac autonomic activity due to chemicals in psychiatric patients. Therefore, the objective of this study was to assess the effect of chemical irritants on the ANS of the person and measure that in the form of Heart Rate Variability (HRV), a noninvasive method to estimate the cardiac autonomic activity. The autonomic nervous system can significantly compromised by use of chemical irritants. Materials and Methods: A cross-sectional hospital based study was conducted in which 33 patients (mean age: 29.94 years) of depression/anxiety were compared with 37 age matched controls (mean age: 28.10). The patients who were diagnosed as either depressed or anxious by the psychiatry were included in the study group by random sampling. Out of these 8 patients gave positive history of odour use. Thirty seven age matched healthy persons were taken as controls. Grading of patients was done according to DSMV-IV criteria and short- term HRV was recorded. Five minute HRV recording was done and time domain and frequency domain indices of HRV were assessed using RMS Polyearite D. The result in case and control groups was compared. R esults: We have reported a poor HRV compared to control group in patients of depression/anxiety as reflected by NN50 values (p< 0.05). Although not significant the trend shows a better HRV control in almost all the time domain and frequency domain parameters in controls compared to cases. Regarding the history of use of chemical irritants the trend showed a poor HRV control in these cases compared to the patients who did not give any such history. C onclusion: Our results suggest that impaired cardiac autonomic nerve function characterized by sympathetic over activity may occur in depression/phobic patients. The study also proves a poor HRV in psychiatric subjects with history of use of odoriferous substances. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=VC01-VC04&id=6022 https://doi.org/10.7860/JCDR/2015/.6022 Evaluation of Workload and its Impact on Satisfaction Among Pharmacy Academicians in Southern India Akram Ahmad, Muhammad Umair Khan, Akshaya B. Srikanth, Isha Patel, Anantha Naik Nagappa, Shazia Qasim Jamshed Objective: The purpose of this study was to determine the level of workload among pharmacy academicians working in public and private sector universities in India. The study also aimed to assess the satisfaction of academicians towards their workload. Materials and Methods: A cross-sectional study was conducted for a period of 2 months among pharmacy academicians in Karnataka state of Southern India. Convenience sampling was used to select a sample and was contacted via email and/or social networking sites. Questionnaire designed by thorough review literature was used as a tool to collect data on workload (teaching, research, extracurricular services) and satisfaction. R esults: Of 214 participants, 95 returned the filled questionnaire giving the response rate of 44.39%. Private sector academicians had more load of teaching (p=0.046) and they appeared to be less involved in research activities (p=0.046) as compared to public sector academicians. More than half of the respondents (57.9%) were satisfied with their workload with Assistant Professors were least satisfied as compared to Professors (p=0.01). C onclusion: Overall, private sector academicians are more burdened by teaching load and also are less satisfied of their workload. Revision of private universities policies may aid in addressing this issue. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=FC01-FC06&id=6023 https://doi.org/10.7860/JCDR/2015/.6023 Fibrinolytic Activity of Blood and its Determinants in Healthy Medical Students Nazeem I. Siddqui, M. Shoeb, S. Bose Background: Decreased fibrinolytic activity results in longer fibrinolysis time of blood and an increased propensity for hypercoagulable states of blood. Subjects with less fibrinolytic activity are prone to coronary artery disease, stroke and thromboembolic phenomena. Aim: The study aims to identify the impact of gender, dietary habits, body mass index, physical activity level and menstrual cycle on fibrinolytic activity in healthy subjects. Settings and Design: Cross-sectional study on randomly selected 206 healthy medical students aged 17 to 23 years. Materials and Methods: Anthropometric measurements, dietary habits, physical activity level and menstrual history were obtained. Fibrinolysis time of fasting venous blood sample was determined by Euglobulin Lysis Time (ELT) method. Results: Highly significant gender difference was noted in mean fibrinolytic activity (p=0.002). Mean fibrinolytic activity also showed a significant relationship with BMI (p=0.001) and with different phases of menstrual cycle in females (p=0.004). However, such relationship was not observed with diet and physical activity (p>0.05) in boys and girls. Conclusion: Gender difference, body mass index and menstrual cycle phases have influences on the fibrinolytic activity of blood. This might be due to cyclical changes in the sex hormones levels, endometrium-derived plasmin and plasminogen activators and excess production of plasminogen activator inhibitor type-1 (PAI-I) in visceral adipocytes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=CC05-CC07&id=6017 https://doi.org/10.7860/JCDR/2015/.6017 Use of 90° Hopkin’s Telescopic Examination as an OPD Tool to Clinically Evaluate and Record Oral Cavity Lesions: Our Experience in Early Detection, Especially in Patients with Limited Mouth Opening Dushyant Mandlik, Karan Gupta, Daxesh Patel, Purvi Patel, Rajendra Toprani, Kaustubh Patel Introduction: Restricted mouth opening due to premalignant lesions like oral sub-mucous fibrosis, malignancies of oral cavity and postoperative status is very common in Indian patients. It is very difficult to evaluate, document and biopsy the lesions due to inability to access, vast area and diversity of premalignant lesions and subject variations. 90° Hopkin’s slender out-patient examination telescope was found useful tool in this. Aim: The aim of the study was to evaluate the use of magnified view and reach of a slender telescope to document and examine the oral cavity for any premalignant and malignant lesions, especially for patients with restricted mouth opening and to study its impact on management. Materials and Methods: A 900 Hopkin’s telescope was used to evaluate and document oral cavity examination in the Out Patients Department (OPD). The data of first 2000 patients was analysed. R esults: Difficult to reach areas, where mouth opening was severely restricted was the significant subset. A total of 1394 patients approached OPD for primary diagnosis at our tertiary cancer care centre. Six hundred and six patients were the ones in follow up after treatment in form of Surgery, Chemotherapy or Radiotherapy, or combination. Five twenty three patients (of 1394) with mouth opening = 20mm formed the study group. Telescope guided biopsies were also taken in 50 patients from 56 sites. Serial recordings were compared objectively in premalignant, treatment evaluation and close watch groups. An increase of 5.6% in rate of diagnosis of malignancy was made possible with the help of telescopic examination in patients with mouth opening = 20mm. C onclusion: A 900 Hopkin’s telescopic examination is a useful tool to evaluate and record oral cavity lesions, especially in patients with restricted mouth openings. It is a useful tool for screening high risk group, giving definite advantage of objective evaluation and recording of the lesion. It can also be used to objectively evaluate response of neo-adjuvant chemotherapy and as a teaching tool for the fellows. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=XC01-XC04&id=6018 https://doi.org/10.7860/JCDR/2015/.6018 ‘Tamsulosin and Darifenacin’ Versus ‘Tamsulosin Monotherapy’ for ‘BPH with Accompanying Overactive Bladder’ Iqbal Singh, Gaurav Garg, Vivek Agarwal Purpose: To evaluate the efficacy/safety of ‘tamsulosin and darifenacin’ (TD) vs. ‘tamsulosin and placebo’ (TP) for patients with symptomatic benign prostrate hyperplasia (BPH) with accompanying overactive bladder (OAB) symptoms. Materials and Methods: This study included symptomatic patients of BPH with one or more of the following OAB symptoms; micturition frequency >8, nocturnal frequency > 2, urgency > 1 per 24 hour between November 2012 and February 2014. After protocol approval by ethics committee and obtaining informed consent, patients were randomly assigned to receive tamsulosin 0.4mg plus placebo (TP) (n=30) or tamsulosin 0.4 mg plus darifenacin 7.5 mg (TD) (n=30) for 8 weeks. The mean change from baseline in urinary frequency and incontinence episodes/24 hour (primary end points), and nocturnal frequency; mean change in PVR and changes in IPSS (secondary end points) were compared between groups at 0/eight week using voiding diary and ultrasonography. R esults: The mean change in frequency, incontinence, nocturnal frequency/24 hour and IPSS (International prostrate symptom score) were (-4.83 vs. -3.93, p=0.023), (-1.50 vs. 1.08, p=0.001), (-2.20 vs. -1.87, p<0.001) and (-7.90 vs. -6.27, p<0.001) in the TD/TP group respectively (significant). Apart from some minor side effects (12 vs. 9) all interventions appeared to be safe and well tolerated. The mean change in the PVR (Postvoid residual) was marginal (+10.84ml and -16.93) and the incidence of urinary retention was 13% and 3% in the TD and TP groups respectively (p=0.35). C onclusion: Treatment with tamsulosin and darifenacin for 8 weeks is an effective and safe treatment modality in select patients of BPH with accompanying OAB symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PC08-PC11&id=6019 https://doi.org/10.7860/JCDR/2015/.6019 Variation in Tendinous Intersections of Rectus Abdominis Muscle in North Indian Population with Clinical Implications Anita, Mahboobul Haque, Amrita Gupta, Areeba Nasar Aim of the study: Incisions through the abdominal wall are based on anatomical principles and Rectus abdominis muscle provides an excellent myocutaneous flap. The present work was proposed to identify variations in numbers and location of tendinous intersections of the Rectus Abdominis muscle in the cadavers as a guide to the surgical procedures. Materials and Methods: The study was conducted on 54 cadavers of North Indian origin allotted to undergraduate medical student for Anatomy dissection classes. Manual dissection was done to identify tendinous intersections of the Rectus Abdominis muscle with reference to number and location. R esults: In the present study one cadaver had five tendinous intersections (1.85%), one cadaver had four tendinous intersections (1.85%) and 52 cadavers had three tendinous intersections (96.29%). C onclusion: The present study is an effort to provide data about the anatomical variation in numbers and location of tendinous intersections of the Rectus Abdomini muscles. Rectus abdominis muscle provides an excellent myocutaneous flap because the muscle belly is separated from surrounding tissue within the rectus sheath. This study is representative of a small study of the human population and only serves to illustrate the variations in the anatomy of the tendinous intersections. More extensive studies are required to establish a definitive pattern among local populations to serve as a guide for surgical procedures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=AC10-AC12&id=6028 https://doi.org/10.7860/JCDR/2015/.6028 Comparison of Clinical Presentation and Risk Factors in Diabetic and Non-Diabetic Females with Urinary Tract Infection Assessed as Per the European Association of Urology Classification Vikas Garg, Abhishek Bose, Jyoti Jindal, Arvind Goyal Introduction: Diabetes has been known to cause severe complicated UTI as a result of its various changes in the genitourinary system. This study of UTI in diabetic females enables us to know the pattern of infections, their causative organisms and severity, particularly with reference to European Association of Urology (EUA) guidelines for UTI 2015. Materials and Methods: This is a prospective single centre study done over a period of one year at Dayanand Medical College and Hospital on a total of 151 diabetic (Group A) and non-diabetic (Group B) female patients with diagnosis of UTI. A thorough history of the patients was taken which included looking for the anatomical level of infections, host risk factors; extra urogenital risk factors and nephropathy disease were assessed. All patients were adequately investigated. The UTI was classified according to the EAU classification for UTI, and an effort was made to find out the frequent class of UTI in this study group. R esults: A total of 151 females which included 70 diabetic (Group A) and 81 non diabetic (Group B) females were studied. The most common symptom was fever in both the groups. UTI was classified as per the EAU grades of UTI. In group A, the number of patients having severity grade from 1 to 6 were 47, 9, 4, 2, 4, and 4 respectively. The most common clinical presentation in both the groups was cystitis followed by pyelonephritis and urosepsis. In group B, the number of patients having severity grade from 1 to 6 were 66, 4, 5, 5, 0 and 1 respectively. Most common organism was E-coli, which was susceptible to most of the antibiotics. C onclusion: UTI in diabetic and non-diabetic female patients have different patterns. Uncontrolled diabetes was more commonly associated with severe UTI like pyelonephritis and emphysematous pyelonephritis. E. coli was most common isolate in either group, followed by klebsiella and Pseudomonas. Candida was isolated only from the diabetic population. Therefore, the most common type of UTI as per the EAU classification in both diabetic and non diabetic female was CY-1R: E. coli (a): ‘simple cystitis but recurrent with susceptibility to standard antibiotics’, in our study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PC12-PC14&id=6029 https://doi.org/10.7860/JCDR/2015/.6029 A Comparative Analysis of Antimicrobial Property of Wine and Ozone with Calcium Hydroxide and Chlorhexidine Shenbaga Kuttalam Anand , A. V. Rajesh Ebenezar, Nirupa Anand, A.Vinita Mary, Bejoy Mony Background: The antibacterial properties of wine and ozone have been established but their antibacterial efficacies against endodontic pathogens are yet to be ascertained. Aim: The purpose of this study is to comparatively evaluate the antibacterial property of ozonated water, white wine (14%) and de-alcoholised white wine. Materials and Methods: S.mutans and E.faecalis were subcultured and inoculated in a nutrient broth for 24 hours. The following groups were formulated: Group 1A:2% Chlorhexidine (Control group); Group 1B:White wine; Group 1C:Dealcoholised white wine; Group 1D:Ozonated water; Group 2A: Ca(OH)2 + Chlorhexidine (Control group); Group 2B: White wine + Ca(OH)2; Group 2C:De-alcoholised White wine + Ca(OH)2 + chlorhexidine; Group 2D:White wine + Ca(OH)2 + chlorhexidine and group 2E: Dealcoholised white wine + Ca(OH)2 + chlorhexidine. The samples were allowed to diffuse into the culture medium for two hours, later the S. mutans were streaked on to the blood agar medium and the E. faecalis were streaked on to the Muller Hilton agar medium and incubated for 48 hours at 370C the zone of inhibition was measured after 48 hours. R esults: There was no growth of microorganisms seen with ozonated water. Chlorhexidine showed large zone of inhibition compared to the other groups. White wine has better antimicrobial property than de-alcoholised white wine, but when mixed with calcium hydroxide the dealcoholised white wine has better action against the microorganisms. C onclusion: Ozonated water has the best antibacterial property and the antibacterial action of Calcium hydroxide is enhanced when it is mixed with de-alcoholised white wine. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC04-ZC06&id=6030 https://doi.org/10.7860/JCDR/2015/.6030 Is Oral Health of the Sugar Mill Workers Being Compromised? Khushboo Singh, Venisha Pandita, Basavaraj Patthi, Ashish Singla, Swati Jain, Hansa Kundu, Ravneet Malhi, Vaibhav Vashishtha Introduction: Occupational environment has an immense influence on the general as well as oral health. The specific exposure to sugar and its byproducts might influence the dental health of sugar mill workers. Aim and Objectives: The present study was conducted to assess and compare the oral health status of production line workers and administration staff working in the sugar mills of Western Uttar Pradesh. Materials and Methods: A cross-sectional study was conducted in four Government aided and four Private sugar mills of West Uttar Pradesh, India among the production line workers and administration staff. Multistage random sampling methodology was employed to select total of 600 sugar mill factory workers (449 production line workers and 151 administration staff). The oral health status of the study subjects was assessed using the modified WHO Oral health survey Performa 1997. Statistical Analysis: SPSS 19 Version was used for statistical analysis. Mean, Standard Deviation and proportions were calculated for each clinical parameter. Student t-test and Chi-square analysis was done to analyse inter group comparison. R esults: Mean DMFT for production and non production line workers was 7.67± 2.99 and 0.15 ± 1.34 (p= 0.001) respectively. 80.17% of production line workers had maximum CPI score 2 in contrast to 63.57% of administration staff (p=0.324). C onclusion: The dental health was found to be debilitated among the production line workers of Sugar mill as compared to the Administrative staff. It is therefore recommended to raise the awareness among the sugar mill workers regarding the same. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC07-ZC10&id=6031 https://doi.org/10.7860/JCDR/2015/.6031 Giant Platelets in Platelet Donors – A Blessing in Disguise? Asitava Deb Roy, Nabajyoti Choudhury, Deepanjan Ray I ntroduction: Inherited thrombocytopenias, including inherited giant platelet disorders (IGPD) are relatively rare, but their prevalence is probably underestimated. Harris platelet syndrome, the most common IGPD reported from Indian subcontinent, mostly from eastern part, is characterised by a low platelet count, high mean platelet volume (MPV) and absence of bleeding. Aim: A short study was conducted to assess the prevalence of giant platelets in voluntary donors of single donor platelets (SDP) and analyse the effect of transfusion of such SDPs in patients. Materials and Methods: Voluntary donors of SDPs were screened as per standard guidelines prior to the procedure. A complete blood count (including MPV) along with a peripheral smear was done. A total of 45 donors were screened for plateletpheresis. Following plateletpheresis from these donors, a platelet count from the collection bag was done after one hour. The SDP was transfused as a single unit or divided into two and transfused to the same patient at two different occasions, as per clinical need. Platelet counts on pateints were done after one hour and the platelet recovery was noted. Results: Out of the 45 donors who were screened, 30 (66.67%) were found to have giant platelets. It was observed that the pre procedure platelet counts in donors having giant platelets were relatively low (1.5 -1.7 lacs) and so also the platelet yield (2.7-3x1011) compared to donors who did not, but the post transfusion platelet recovery was greater. Conclusion: Since presence of giant platelets has been seen to be common in the Eastern part of India, a peripheral smear examination should always be considered during screening of plateletpheresis donors to avoid rejecting donors with giant platelets whose platelet counts are given falsely low by autoanalysers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=EC01-EC03&id=6032 https://doi.org/10.7860/JCDR/2015/.6032 Evaluation of Fluoride Retention Due to Most Commonly Consumed Estuarine Fishes Among Fish Consuming Population of Andhra Pradesh as a Contributing Factor to Dental Fluorosis: A Cross-Sectional Study Shravani Ganta, Asif Yousuf, Anup Nagaraj, Sonia Pareek, Mohsin Sidiq, Kushpal Singh, Preeti Vishnani Background: Fluoride in drinking water is known for both beneficial and detrimental effects on health. The principal sources of fluoride include water, some species of vegetation, certain edible marine animals, dust and industrial processes. The purpose of this study was to evaluate the fluoride retention of most commonly consumed estuarine fishes among fish consuming population of Andhra Pradesh. Materials and Methods: A cross-sectional study was conducted to evaluate the amount of fluoride retention due to ten most commonly consumed estuarine fishes as a contributing factor to Fluorosis by SPADNS Spectrophotometric method. The presence and severity of dental fluorosis among fish consuming population was recorded using Community Fluorosis Index. Statistical analysis was done using MedCalc v12.2.1.0 software. Results: For Sea water fishes, the fluoride levels in bone were maximum in Indian Sardine (4.22 ppm). Amongst the river water fishes, the fluoride levels in bone were maximum in Catla (1.51 ppm). Also, the mean total fluoride concentrations of all the river fishes in skin, muscle and bone were less (0.86 ppm) as compared to the sea water fishes (2.59 ppm). It was unveiled that sea fishes accumulate relatively large amounts of Fluoride as compared to the river water fishes. The mean Community Fluorosis Index was found to be 1.06 amongst a sampled fish consuming population. Evaluation by Community Index for Dental fluorosis (CFI) suggested that fluorosis is of medium public health importance. Conclusion: It was analysed that bone tends to accumulate more amount of fluoride followed by muscle and skin which might be due to the increased permeability and chemical trapping of fluoride inside the tissues. The amount of fluoride present in the fishes is directly related to the severity of fluorosis amongst fish consuming population, suggesting fishes as a contributing factor to fluorosis depending upon the dietary consumption. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC11-ZC15&id=6035 https://doi.org/10.7860/JCDR/2015/.6035 Pelvic Floor Muscle Exercise for Paediatric Functional Constipation Fatemeh Farahmand, Aidin Abedi, Mohammad Reza Esmaeili-dooki, Rozita Jalilian, Sanaz Mehrabani Tabari Introduction: Functional constipation (FC) is one of the most common gastrointestinal problems among children. This study was designed to investigate the effectiveness of pelvic floor muscle exercise on treatment of FC. Materials and Methods: In this study which was conducted in Children’s Medical Center, children with a diagnosis of FC (aged 4-18 y) who did not respond to medical treatment, performed sessions of pelvic floor muscle exercise at home twice a day for 8 wk. Frequency of defecation, overall improvement of constipation, stool withholding, painful defecation and stool consistency were measured at the final week of the intervention compared to baseline. R esults: Forty children (16 males, 24 females mean age 5.6±1.03 y) completed the 8-wk exercise program. Subjective overall improvement of the symptoms was present in 36 patients (90%). The changes in stool frequency, stool diameter and consistency were statistically significant. However, there were no statistically significant differences in the stool withholding, fecal impaction, fecal incontinence and painful defecation. C onclusion: Pelvic floor muscle exercise is an effective non-pharmacologic treatment for Paediatric FC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=SC16-SC17&id=6036 https://doi.org/10.7860/JCDR/2015/.6036 Morphometrical Analysis of Developing Cochlear Ganglion Neurons: A Light Microscopic Fetal Study Madhu Sethi, Sabita Mishra, Neelam Vasudevava, J.M.Kaul Background and Aim: The cochlear or spiral ganglion neurons are the initial bridge between the external world of sound and its discernment in the brain. As the developing human fetal cochlea is known to start functioning in mid gestational period, its anatomical details when compared with adults could vary with each gestational age. The aim of current study was to assess morphometrical parameter of developing human fetal cochlear ganglion neurons and comparison of data in each gestational period. Materials and Methods: Ten aborted human fetuses from 14th to 28th weeks of gestation were procured from Department of Obstetrics and Gynaecology of associated hospital, after obtaining ethical clearance and were processed for studying under light microscope. Area of neurons from each gestational age was measured on histophotomicrographs using image Proplus software. Standard statistical method was used to calculate area range and percentage of small and large ganglion neurons. R esults: The neuronal area increased progressively in successively higher gestation age fetuses. In the fetus belonging to lowest gestational age the area ranged from 4-37µm2 while in highest gestational age fetus its range was 10-58.3µm2. The small ganglion neurons were higher in 14 weeks (65.5%) fetuses and 16-20 weeks (81.03%) fetuses, while in higher gestational age fetuses’ large ganglion neuronal population was higher (62-66%). C onclusion: A baseline morphometrical representation of fetal cochlear ganglion neurons could be of relevance in advanced human experimental studies on effect of neurotrophic factors in human fetuses with congenital deafness. It has been found that these factors directly influence neuronal maturation assessed by progressive increase in soma size and survival. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=AC01-AC04&id=5997 https://doi.org/10.7860/JCDR/2015/.5997 Risk Factors for Discontinuation of Exclusive Breastfeeding by One Month of Postnatal Age Among High Risk Newborns: An Institution Based Case Control Study Parul Chandrika, Bhanu Kiran Bhakhri, Geeta Gathwala, Varun Narwal, Abhishek Chaturvedi Background: Beyond one month of age, there is generally a drop in the proportion of mothers providing exclusive breastfeeding to their infants. Infants with morbidities during neonatal period have been observed to be at higher risk of discontinuation. Objective: To enumerate the prevalent factors behind discontinuation of breastfeeding among high risk newborns by first month of life. M aterials and Methods: A case control study conducted at high risk newborn followup clinic of a teaching medical institute in northern India between January and May 2013. Infants were divided on the basis of continuation (controls) or discontinuation (cases) of exclusive breastfeeding at one month of age. The socio-demographic factors along with maternal and neonatal medical factors were compared among groups. R esults: During the study period, 112 newborns were screened. Forty seven cases and thirty eight controls were enrolled and finally evaluated. Female gender of newborn, less educated mothers and large families were observed to be associated with discontinuation of exclusive breastfeeding during first month of life among high risk newborns. Requirement of parenteral fluids during hospital stay emerged as the only independent medical reason. C onclusion: As in healthy newborns, the socio-cultural factors overshadow the medical reasons for discontinuation of exclusive breastfeeding during first month of life among high risk newborns. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=SC01-SC03&id=5999 https://doi.org/10.7860/JCDR/2015/.5999 AGE-Related Differences of Novel Atherosclerotic Risk Factors and Angiographic Profile Among Gujarati Acute Coronary Syndrome Patients Jayesh Prajapati, Hasit Joshi, Sibasis Sahoo, Kapil Virpariya, Meena Parmar, Komal Shah Context: Although numerous risk factors have been established to predict the development of acute coronary syndrome (ACS), the risk factor profile may be different between the younger and older individuals. Aim: To analyse the frequency and pattern of atherogenic risk factors and angiographic profiles in age-stratified Gujarati patients with ACS. Materials and Methods: ACS patients undergoing coronary angiography at U.N. Mehta Institute of Cardiology and Research, Gujarat, India between January 2008 and December 2012 were classified in to two age groups with 40y as cut-off. Patients were assessed for conventional risk factors (diabetes mellitus, dyslipidaemia, hypertension, smoking, obesity), novel risk factors (high sensitivity C-reactive protein, lipoprotein (a), homocysteine), and angiographic profiles.The statistical difference between two age groups was determined by Student’s t-test for continuous variables and Chi-square or Fisher’s exact test for categorical variables. Results: A total of 200 patients, 100 patients =40 y of age and 100 patients >40 y of age, were evaluated. Older patients had higher frequency of hypertension (32 vs. 16%, p=0.008), while family history of coronary artery disease was more common among younger patients (19 vs. 9%, p=0.041). The incidence of diabetes, dyslipidaemia, smoking and tobacco chewing did not vary significantly between the two groups. Total cholesterol and low-density lipoprotein cholesterol levels were significantly higher in the younger group (p<0.05). Lipoprotein (a), homocysteine and high-sensitivity C reactive protein levels were comparable between two age groups. Multi-vessel coronary artery disease was more common among older group. The most commonly affected coronary artery was the left anterior descending artery among younger patients (44%) and the left circumflex artery among older patients (38.1%). Conclusion: Young patients with ACS had different atherosclerotic risk profile and less extensive coronary artery disease as compared to older counterparts. Emphasis should be given on diagnosis and management of major modifiable risk factors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OC05-OC09&id=6000 https://doi.org/10.7860/JCDR/2015/.6000 Efficacy of Collagen Particles in Chronic Non Healing Ulcers Karunakar Reddy Chalimidi, Yogesh Kumar, U. Anand Kini Introduction: Chronic foot ulcers will lead to a significant and prolonged stress to the patients. Pain and discomfort that may be acute or continuous is the usual complaint in chronic non healing ulcers that may even exacerbate with change of the dressings. The end process in any wound healing is wound contracture and scar formation. Collagen plays an important role in this stage of wound healing. Collagen particles were used in chronic non healing ulcer management to prove their efficacy when compared with conventional dressing in a study conducted by us. Objective: To compare the healing process in non healing ulcers using collagen particles with those of conventional method of dressing (betadine). Materials and Methods: It was a non randomized, prospective study conducted for a period of October 2012 to October 2014 in hospitals belonging to Kasturba medical college. Non concurrent pre and post comparative study; between collagen group and conventional dressing group. A total of 110 patients with chronic ulcers were included; each group comprising 55 patients. R esults: There was a significant decrease in wound size with a mean difference of 37.29 in experimental group when compared to 14.29 in control group. C onclusions: Collagen dressing is effective in management of chronic non healing ulcers when compared to conventional betadine dressing. It heals by forming an early granulation tissue and thus reducing the length of hospital stay. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PC01-PC03&id=6001 https://doi.org/10.7860/JCDR/2015/.6001 Spontaneous Resolution of Non Traumatic Chronic Subdural Haematoma Despite Continued Antiplatelet Therapy: A Case Report Ajeet Ramamani Tiwari, Shradha Maheshwari, Srikant Balasubra maniam, Tyagi Devendra, Hemantkumar Savant Spontaneous resolution of traumatic chronic subdural haematoma (CSDH) has been reported in literature. However, those with non traumatic CSDH are exceedingly rare and none reported with continued antiplatelet therapy where it itself is an aetiological agent for development of non traumatic CSDH. A 50-year-old male presented to us with a non haemorrhagic cerebellar infarct with a concomitant CSDH without history of any trauma. Patient’s PT/INR, Bleeding time and Clotting time were normal. Patient was started on antiplatelet therapy (Tablet Aspirin 150 mg OD) for the acute infarct. MR Brain at 1 month showed an increased size of CSDH. However patient denied surgical evacuation hence we continued conservative line of management, however we continued anti-platelet therapy with close neurological and coagulation profile monitoring that remained within normal range throughout the period of observation. CT at 5th month showed complete resolution of CSDH. Patient was on antiplatelet drugs throughout the period of observation. Our case argues about the role of antiplatelet therapy in patients with CSDH with contrary lesions requiring anticoagulation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PD01-PD02&id=6002 https://doi.org/10.7860/JCDR/2015/.6002 Clinical Profile of Diabetic Ketoacidosis: A Prospective Study in a Tertiary Care Hospital Pankaj Seth, Harpreet Kaur, Maneet Kaur Background: Diabetic ketoacidosis, a well-known and major acute metabolic complication classically occurs in young patients with type 1 diabetes. However, it may occur in patients with type 2 Diabetes Mellitus too. Objective: Aim of this study was to look into the clinical profile, precipitating factors and clinical outcome in the patients presenting with Diabetic ketoacidosis in the Emergency of a Tertiary care hospital. D esign: The study was a prospective study conducted over a period of two years in Kasturba Medical College, Manipal Karnataka, India. Materials and Methods: Clinical profile of 60 diabetic patients admitted in the Emergency with the diagnosis of Diabetic ketoacidosis were analysed. R esults: Out of 60 patients, 12 were of Type 1 and 48 were Type 2 Diabetes Mellitus. Mean duration of diabetes was 8.65 years. Only 14 (23.3%) patients were taking regular treatment for Diabetes Mellitus whereas 32 (53.33%) patients were on irregular treatment and eight (13.33%) were not on any treatment at all. Among 12 Type 1 Diabetic patients, six patients were freshly diagnosed to be diabetic when they presented with Diabetic ketoacidosis complication. Nausea and vomiting (63.33%) were the most common symptoms of these patients. Infections (73.33%) were the most common precipitating factor for Diabetic ketoacidosis. Mean fluid requirement on first day of therapy was 3.51 liters. Mortality of 10% was seen. C onclusion: Diabetic ketoacidosis is a fatal acute metabolic complication of Diabetes Mellitus with heterogeneous clinical presentation. Early diagnosis and treatment can avoid morbidity & mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OC01-OC04&id=5995 https://doi.org/10.7860/JCDR/2015/.5995 Root-Cause Analytical Survey for Measles Outbreak: Vaccination or Vaccine?- A Study From Madhepura District, Bihar, India Sudipta Basa, Rashmi Ranjan Das, (Late) Javed Akhtar Khan Introduction: Though measles is a vaccine preventable disease, outbreaks still continue to occur because of poor immunization coverage rate at the national level. Objective: To report the survey results of an outbreak of measles in Puraini village of Madhepura district in Bihar, India. M aterials and Methods: This cross-sectional survey was conducted among children aged 6 months to 12 years during an outbreak of measles in December 2008. WHO case definition criteria was used to define active measles cases. Demographic data, immunization status, and disease outcome among the cases was obtained by pre-structured questionnaires. Blood samples from 5 cases were sent for laboratory confirmation. R esults: A total of 52 cases and 8 deaths were reported with an attack rate of 28% and case fatality rate of 15.4%. Out of 35% cases of post-measles complications, dysentery with pneumonia was the most common. Anti-measles IgM antibody tested positive in all the 5 serum samples sent for confirmation. No child had received measles vaccination in the past, and the reasons were lack of awareness, lack of faith on vaccination, and unavailability of health workers. C onclusion: This survey calls for strengthening of disease surveillance and routine immunization coverage to achieve measles control in these communities. This has important public health implication for the whole country regarding measles elimination in near-future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=SC04-SC07&id=6004 https://doi.org/10.7860/JCDR/2015/.6004 Effect of Sub Maximal Dynamic and Static Exercises on QTc interval in Healthy Young Men Bharti Bhandari, Lokesh Kumar, Anjum Datta, Sabyasachi Sircar Introduction: The QTc interval depends largely on cardiac repolarization since the duration of cardiac depolarization is fairly constant in the normal heart. QTc at rest as well as during exercise has many clinical implications. In this study, we have compared the relative effects of dynamic and static exercise on QTc. Aim: To measure QTc interval in young men at rest and also assess how it is further modulated by submaximal dynamic and static exercises. Materials and Methods: This observational study was conducted in the Department of Physiology on 30 non-obese young men randomly selected from the students of our institute after obtaining the consent and institutional ethical clearance. Continuous blood pressure monitoring and ECG recording was done in the subjects. Baseline (pre-exercise), post submaximal dynamic (Harvard’s step test) and post submaximal static exercise (hand-grip exercise) recordings of ABP and ECG were taken for analysis. The measured QT interval was corrected for heart rate using the formula of Bazett et al., {QTc=QT/RR1/2}.Statistical analysis was done using Graph pad Prism 5 software (California, USA). The baseline and post-exercise data were compared using paired t-test. A p<0.05 was taken to be statistical significant. Results: There were statistically significant increases in HR, SBP, DBP and QTc interval after dynamic exercise in comparison to the baseline values (p<0.05). Significant increase in HR (p<0.05) with no significant change in QTc and other cardiovascular parameters were recorded following static exercise (p>0.05). Conclusion: Significant increase in QTc interval was observed after dynamic exercise, however, no change in QTc was observed following static exercise, and hence we conclude that static exercises may not be useful in assessing the cardiovascular status of an individual or in predicting cardiovascular events. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=CC01-CC04&id=6006 https://doi.org/10.7860/JCDR/2015/.6006 Fluid Administration Before Caesarean Delivery: Does Type and Timing Matter? Poonam Arora, Rupinder M Singh, Sandeep Kundra, Parshotam Lal Gautam Background: The effectiveness of fluid preloading is in doubt, so co-loading has been attempted to reduce the incidence of spinal anaesthesia induced hypotension in caesarean patients. Aim: To compare crystalloid preloading, colloid preloading and colloid co-loading for prevention of maternal hypotension in caesarean delivery. S ettings and Design: Study conducted in tertiary level hospital on 90 ASA I/II term parturients posted for elective caesarean section. Patients were randomly allocated to three Groups. Materials and Methods: Group A (n=30) was given 10 ml/kg of 6% hydroxyethyl starch (HES) 20 minutes prior to spinal anaesthesia, Group B (n=30) was given 10 ml/kg of 6% HES by rapid infusion in 10 minutes immediately after spinal anaesthesia and Group C (n=30) was given 10 ml/kg of Ringer’s Lactate 20 minutes prior to spinal anaesthesia. Intraoperatively, Heart rate, systolic, diastolic and mean arterial pressure were recorded every five minutes. Episodes of hypotension were recorded and treated with bolus of 5 mg of ephedrine and total amount of ephedrine was noted. Adverse effects, if any were recorded. S tatistical Analysis: ANNOVA for Quantitative Analysis and chi-Square test and Z-test for Qualitative Analysis. R esults: Baseline parameters were similar in all the three Groups. Heart rate decreased from the baseline in all the three Groups, however, mean heart rate was highest in Group C. Heart rate was statistically similar in Groups A and B. MAP decreased in all three Groups from baseline, however, highest fall was recorded in Group C whereas, MAP was statistically similar in Groups A and B. Incidence of hypotension was 66.66% in Group C as compared to 36.66% in Groups A and 40% in Group B respectively. Group C patients received 5.33±4.54 mg of ephedrine as compared to 2.00±2.82 mg in Group A and 2.33±3.14 mg in Group B. Thus, the incidence of hypotension and ephedrine consumption was significantly higher in Group C as compared to Groups A and B whereas, this difference was statistically not significant among Groups A and B. C onclusion: Colloid preloading and co-loading are equally effective and both are superior to crystalloid preloading for prevention of maternal hypotension in caesarean section patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=UC01-UC04&id=6008 https://doi.org/10.7860/JCDR/2015/.6008 Comparative Study of Prolene Hernia System and Lichtenstein Method for Open Inguinal Hernia Repair Mayank Badkur, Nitin Garg Background: Prolene Hernia System (PHS) is a bi-layered polypropylene mesh with a connector that combines the anterior and posterior inguinal hernia repair, but still not very popular in this part of the country. Hence a prospective & randomized comparative study was undertaken to compare PHS with the already popular Lichtenstein Hernia Repair (LHR) and determine the post-operative outcome. Materials and Methods: Total 67 inguinal hernia repairs were randomly assigned to either PHS or LHR method, and data was collected regarding various outcome measures like duration of surgery, post-operative pain, requirement of analgesia, return to normal activity, and early and late complications. Results: Mean duration of surgery was significantly higher for PHS group than LHR group (65.4 min vs 51.26 min, p-value < 0.0001). Significant difference was noted between the PHS and LHR group in terms of moderate to severe post-operative pain (15.15% vs 41.18%,p-value 0.018), time of requirement of analgesia (3.7 vs 4.6 days, p-value 0.024), and time to return to normal activity (2.7 vs 3.4 days, p-value 0.023), all in favour of the former technique. No intra-operative complication was noted in either of the groups. 5 patients had early complications in PHS group and 6 in LHR group, but this was statistically not significant. The average time of follow-up for the study was 7.8 month, ranging from 1 to 18 months. Chronic inguinal pain was noted in 1 and 2 patients respectively in PHS and LHR group, again statistically not significant. No recurrence was noted in both the groups till the time of follow-up. Conclusion: PHS is a safe and better alternative to the time honored Lichtenstein hernia repair with the added advantage of strengthening whole of myopectineal orifice, and virtually eliminating any risk of recurrence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PC04-PC07&id=6009 https://doi.org/10.7860/JCDR/2015/.6009 Body Donation after Death: The Mental Setup of Educated People Anubha Saha, Aniruddha Sarkar, Shyamash Mandal Introduction: Without dissection of cadavers teaching and learning of anatomy is nearly difficult; there remains a gap between the practical knowledge and the gathered theoretical knowledge. But there is a scarcity in the availability of the donated bodies for the sake of medical education. On the other hand a large number of people in our country are in waiting list for organ transplantation which could be overcome by deceased organ donation. Aim: Aim of the study was to evaluate the awareness regarding body donation after death. Materials and Methods: A cross-sectional study was conducted among medical students, engineering students and doctors in Indian population. Total 300 participants were answered the questionnaire providing information about the knowledge and attitude towards body and organ donation. R esult: 46.33% of entire study group had strongly positive attitude about cadaveric organ donation and 17% had no idea about this. 18% of total participants were unwilling for body donation after death. C onclusion: The present study has been done elaborately to find out the different barriers for body or organ donation. It is clear from the study that though there is high level of awareness, nobody has filled up the pledge form till now. It indicates that there is a gap between the knowledge and motivation for organ and body donation after death which has to be overcome by proper guidance and education. Media and other voluntary organisations could take an important role for this purpose. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=AC05-AC09&id=6011 https://doi.org/10.7860/JCDR/2015/.6011 Clinical Risk Index for Babies (CRIB II) Scoring System in Prediction of Mortality in Premature Babies Zahraa Mohamed Ezz-Eldin, Tamer A. Abdel Hamid, Meray Rene Labib Youssef, Hossam El-Din Nabil Background: Clinical Risk Index for Babies scoring system (CRIB II) score is a recently developed tool to predict initial risk of mortality amongst low birth weight babies, the utility of which is scarce in many developing countries. Objective: To assess the efficiency of CRIB II score as a tool to predict the risk for neonatal mortality among the LBW babies admitted to neonatal intensive care unit (NICU) at a tertiary care facility Kasr El-Aini paediatric hospital, Cairo, Egypt. M aterials and Methods: Prospective cohort study design where 113 neonates, admitted during the first 24 hours to the NICU of Kasr El-Aini Hospital, from November 2013 till May 2014 were included. On admission, history taking, neonatal examination, arterial blood gas analysis and variables of CRIB II score were done. Subjects were followed up from admission till discharge or death. R esults: Male to female ratio was 1.1:1. Gestational age ranged from 25-32 weeks, the birth weight ranged from 700-1500 gm with mean of 1134.5 (± 202). CRIB II score ranged from 1-19 with a mean of 9.9 (± 4.0). The total mortality in the included cohort was 34.5% (31/113). Significant positive correlations were found between gestational age, birth weight, temperature, excess base, CRIB II score and the occurrence of mortality and with progressive increase in mortality with increasing CRIB II score (p=0.001). CRIB II score = 11, gestational age = 28 and birth weight = 1100 were all found to be significantly associated with neonatal mortality. Area under ROC curve for CRIB II, gestational age and birth weight were found to be (0.968, 0.900 and 0.834) respectively. CRIB II score with cutoff point of = 11 was the most sensitive (94.9%) with the predictive value (74.0%) and specificity (82.4%) compared to birth weight and gestational age. CRIB II score showed good calibration to predict neonatal mortality as demonstrated with Hosmer-lemeshow goodness of fit test (p= 0.952). C onclusion: CRIB II score is a valid tool of initial risk assessment in LBW, predicting outcome more accurately than birth weight or gestational age alone. It is easily applicable and should replace the traditional models as predictor of neonatal outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=SC08-SC11&id=6012 https://doi.org/10.7860/JCDR/2015/.6012 Two Pelvic Digits on Same Side: Double Trouble? Kavin Khatri, Darsh Goyal, Rajesh Paul, H.S.Sandhu Pelvic digit is a rare congenital anomaly of pelvis usually discovered incidentally on plain radiography. It usually develops in the soft tissue adjacent to the normal skeletal tissue. Its importance lays in its differentiation from heterotopic ossification, osteochondroma, Fong’s disease and traumatic avulsion injuries of pelvis to avoid any unnecessary investigations and interventions. Here, we report a 32-year-old male presenting with complain of pain in right hip, was subjected to radiographic examination and two pelvic digits were noticed arising from the iliac bone in addition to features of osteoarthritis of hip joint. The symptomatology was attributed to osteoarthritis of hip after thorough physical examination and imaging investigations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=RD04-RD05&id=6013 https://doi.org/10.7860/JCDR/2015/.6013 Role of Perceptual Factors on Endurance Profiles on Treadmill Exercise N.S.V.M.Prabhakara Rao, Jampala Vasantha Kumar C ontext: It is common practice to unravel signs of possible cardiac ischemia by exposing the heart to graded degrees of exercise stress on treadmill under close monitoring and terminating it at safe limit. The safe limit of exercise duration and intensity is based on subjects who report a sense of exhaustion or appearance of any defined adverse sign whichever is earlier. Commonly, endurance is determined by subjective perception of distress leading to discontinuation of exercise. Aim: Scope of favourable manipulation of perception of stress was evaluated to extend the duration of exercise, and thereby the endurance. Materials and Methods: The indices of endurance such as duration of exercise, the distance covered and equivalents of O2 consumption (METs) as well as Cardiovascular adaptational changes of 30 young healthy male medical students are compared between two sets of conditions; {1} Routine treadmill exercise without intervention (Mode A) and later {2} same exercise repeated with individualized musical experience to favourably distract the perception of stress (Mode B). R esult: It has been conclusively demonstrated that perceptual modification of stress in Mode B caused significant improvement in endurance profiles, reflected by sustenance of longer duration of exercise, correspondingly greater cumulative distance covered and greater METs. Cardiovascular parameters of heart rate and blood pressure rise are comparatively less in Mode B, though not significant. The extent of cardiac stress evaluated by Rate-Pressure (R-P) product is also lesser spite of longer duration of exercise, pointing to better cardiovascular adaptational changes under states of perceptual modification (Mode B). C onclusion: Its relevance to day-to-day physical activities including exercise is obviously to make them enjoyable, rather than monotonous, for maximal benefit to health and endurance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=CC13-CC15&id=6063 https://doi.org/10.7860/JCDR/2015/.6063 Radiobiological Response of Cervical Cancer Cell Line in Low Dose Region: Evidence of Low Dose Hypersensitivity (HRS) and Induced Radioresistance (IRR) Saikat Das, Rabiraja Singh, Daicy George, T.S. Vijaykumar, Subhashini John Background: Purpose of the present study was to examine the response of cervical cancer cell line (HeLa cell line) to low dose radiation using clonogenic assay and mathematical modeling of the low dose response by Joiner’s induced repair model. Materials and Methods: Survival of HeLa cells following exposure to single and fractionated low doses of ? (gamma)-ray, 6 MV, and 15 MV photon was measured by clonogenic assay. Results: HeLa cell line demonstrated marked low dose response consisting of an area of HRS and IRR in the dose region of <1 Gy. The two gradients of the low dose region (as and ar) were distinctly different with a transition dose (Dc) of 0.28-0.40 cGy. Conclusion: HeLa cell line demonstrates marked HRS and IRR with distinct transition dose. This may form the biological basis of the clinical study to investigate the chemo potentiating effect of low dose radiation in cervical cancer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=XC05-XC08&id=6074 https://doi.org/10.7860/JCDR/2015/.6074 Preliminary Experience and Morbidity Analysis of Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CRS/Hipec ) from a Tertiary Cancer Center in India Naveen Padmanabhan, Barath Raj Kumar, Ans ar Pullampara Pookunju, Ayyapan Srinivasan, Vikash Mahajan <b>Background:</b> Peritoneal carcinomatosis (PC) can arise directly from peritoneum (primary) or from regional spread of gastrointestinal and gynecological malignancies. It is often considered a terminal event. CRS/HIPEC procedure provides encouraging outcomes in select sub-set of patients with PC. In this study we present our initial experience of this combined procedure from a tertiary cancer care center in India. <b>Materials and Methods:</b> Between January 2014 to January 2015, 13 patients underwent CRS + HIPEC procedure at our center. Preoperative assessment for cytoreduction was done using contrast CT-scan of the abdomen and staging laparoscopy. All procedures were performed by the same surgical team. After cytoreduction, HIPEC was performed by closed method. <b>Results:</b> Median patient age was 52 and median PCI was 13.5 (5-21). Ovarian cancers were commonest origin of PC in our series. All patients had a complete cytoreduction with a median operative time of 8.3 hours. Postoperative ileus was the commonest adverse event. In the immediate postoperative period, major complications were observed in 23% (3/13) of our patients (1. intra-abdominal abscess 2. Septicemia and liver function derangement 3. Bowel obstruction which required a re-operation. Median hospital stay was 12 days (range 9-45 days) and there was no perioperative mortality. <b>Conclusion:</b> Our initial results indicate that CRS + HIPEC procedure can be performed with acceptable morbidity and no mortality. Appropriate case selection by a multi-disciplinary team is vital to achieve complete cytoreduction and optimize outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=XC09-XC13&id=6075 https://doi.org/10.7860/JCDR/2015/.6075 Diagnosis of Salivary Gland Lesions By Fine Needle Aspiration Cytology and Its Histopathological Correlation in A Tertiary Care Center of Southern India Arul.P, Akshatha C, Suresh Masilamani, Srivani Jonathan <b>Background:</b> Salivary glands may enlarge either due to inflammation or neoplastic conditions and the diagnosis is possible by fine needle aspiration cytology (FNAC). Aim: The present study was undertaken to determine utility of FNAC in the diagnosis of salivary gland lesions. <b>Materials and Methods:</b> In this retrospective study, a total of 186 FNACs of salivary gland lesions were retrieved and evaluated. Of these, 146 cases had follow-up histopathological diagnosis. FNAC diagnoses were compared to histopathological diagnoses. <b>Results:</b> The parotid glands were more commonly involved than others. Among the various diagnostic categories used in FNAC reports, Non neoplastic category was seen in 24 (16.4%), benign category in 86 (58.9%) and malignant category in 30 (20.6%) and unsatisfactory category in 6 (4.1%) of 146 cases. The overall sensitivity, specificity, accuracy, positive predictive value and negative predictive value of FNAC in the diagnosis of salivary gland lesions were 86.6%, 94.6%, 93.6%, 88.3%, and 94.6% respectively. <b>Conclusion:</b> The present study concluded that FNAC in the diagnosis of salivary gland lesions is highly sensitive, specific and accurate method. Hence, FNAC is a useful, quick and reliable diagnostic tool. It also appears to be a safe, cost effective and minimally invasive procedure, which provides information for management of salivary gland lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=EC07-EC10&id=6076 https://doi.org/10.7860/JCDR/2015/.6076 Clinical and Radiological Outcome in Cases of Posterolateral Fusion with Instrumentation for Lumbar Spondylolisthesis Madhukar T Nayak, Raghavendra Bakki Sannegowda Introduction: Lumbar Spondylolisthesis as a cause of low back pain and lower limb radiculopathy has been treated using varied surgical options. The role of laminectomy for decompression of neural elements and stabilization using instrumentation in the form of pedicle screws and rod construct has been a well-established and time tested treatment modality. Aim and Objectives: This study analyses the role of laminectomy and instrumentation in obtaining clinical and radiologically favourable outcome. Materials and Methods: Data was analysed from the case records for the duration from January 2010 to March 2014. The study analyses the influence of lumbar decompression (laminectomy) and transpedicular instrumentation using titanium pedicle screws and intertransverse process iliac crest graft on patients with degenerative lumbar spondylolisthesis and spinal stenosis. C onclusion: Decompression primarily relieves radicular symptoms and neurogenic claudication whereas fusion primarily relieves back pain by elimination of instability. The addition of posterolateral instrumentation (pedicle screws) enhances the ability to obtain a solid arthrodesis. Posterolateral instrumentation enables improved functional outcome, better patient satisfaction and less back and lower limb symptomatology. This is irrespective of bony arthrodesis or pseudoarthrosis, at least in the short term follow-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PC17-PC21&id=6077 https://doi.org/10.7860/JCDR/2015/.6077 Clinical Assessment of Weight Gain with Atypical Antipsychotics - Blonanserin vs Amisulpride TS Deepak, BN Raveesh, BM Parashivamurthy, MS Narendra Kumar, Sumanth Mallikarjuna Majgi, HN Nagesh Background: Atypical antipsychotics appear to have the greatest potential to induce weight gain. Antipsychotic-induced weight gain is the one of main cause of non-compliance and discontinuation of treatment, often resulting in the relapse of psychosis. Objective: To compare the weight gain between amisulpride and blonanserin treatment, in persons with psychosis. Materials and Methods: Fifty six subjects with psychosis attending psychiatry department at KR Hospital, Mysore were randomized into two equal groups. After obtaining informed consent, subjects of group I received amisulpride tablets 200 mg BD, and group II received blonanserin tablets 4 mg BD, for eight weeks. Body weight, Body Mass Index (BMI) and Waist Hip Ratio (WHR) were measured at baseline, 4 weeks and 8 weeks. R esults: The mean weight gain with amisulpride at 4 weeks was 2.73 kg (5.21%) and at 8 weeks was 4.34 kg (8.28%) from the baseline. The mean weight gain with blonanserin at 4 weeks was 1.77 kg (3.46%) and at 8 weeks was 3.46 kg (6.75%) from the baseline. The mean BMI increase at 8 weeks with amisulpride was 1.66 ± 0.56 and with blonanserin was 1.34 ± 0.77. The mean WHR increase at 8 weeks with amisulpride was 0.036 ± 0.026 and with blonanserin was 0.029 ± 0.020. There was statistically significant increase in weight, BMI and WHR associated with both blonanserin and amisulpride at 8 weeks. But there was no statistically significant difference in those parameters between blonanserin and amisulpride, at eight weeks. C onclusion: Even though there was no significant difference in the weight gain caused by blonanserin, in comparison with amisulpride, both these drugs individually caused significant weight gain at 8 weeks, which is in contrast with the earlier studies, which needs to be further evaluated. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=FC07-FC10&id=6066 https://doi.org/10.7860/JCDR/2015/.6066 Is the Mean Platelet Volume in Patients with Acute Cholecystitis an Inflammatory Marker? Asli Tanrivermis Sayit, Pinar Hediye Gunbey, Yüksel Terzi Introduction: Acute cholecystitis is an inflammatory disease of the gallbladder. Ultrasonography (US) is the initial and the most valuable method in the diagnosis of acute cholecystitis. Also, laboratory findings are used to support the diagnosis. The aim of the present study was to evaluate the diagnostic value of mean platelet volume (MPV) and platelet (PLT) counts in patients with acute cholecystitis. Materials and Methods: From January to August 2014, the medical records of patients were reviewed for the diagnosis of acute cholecystitis. The study included 60 age-matched patients with acute cholecystitis and 60 healthy individuals as a control group. Patients with a chronic disease were excluded from the study. Over all, patients with acute cholecystitis and patients in the control group were evaluated for their MPV, PLT count, platelet distribution width (PDW), platelet crit (PCT) and erythrocyte sedimentation rate (ESR) in a complete blood count (CBC). R esults: The MPV values were found to be significantly lower in the acute cholecystitis group when compared to the control group. The PDW and PCT were found to be significantly higher in the acute cholecystitis group when compered to the control group. When a correlation test was performed, MPV was negatively correlated with PLT and PCT counts. C onclusion: US is the initial and the most important imaging method for diagnosing and evaluating the biliary system. Also, laboratory findings such as WBC, ESR and CRP support the diagnosis but may have some undesirable limitations. However, MPV is an acute phase reactant that does not require an additional cost because it is already worked in the CBC. Therefore, MPV can be used as a marker in diagnosing inflammatory diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=TC05-TC07&id=6061 https://doi.org/10.7860/JCDR/2015/.6061 Normal Bowel Pattern in Children and Dietary and Other Precipitating Factors in Functional Constipation Balamma Sujatha, Dhakshyani Raghavan Velayutham, Nirmala Deivamani, Sumathi Bavanandam Aim: To study the bowel pattern of children in general population and children with habit constipation with respect to food habits and regarding psychosocial aspect of toileting. Materials and Methods: A prospective descriptive study was done in the Institute of child health and hospital for children, Chennai, with two groups, Functional constipation group and Normal bowel pattern group. The functional group included the children with the age group of 2-12 years, of either sex who fulfilled the ROME III criteria for constipation. Normal bowel pattern group had school children of age group 6-12 years of age and 2-5-year-old children attending OPD for minor ailments. The demographic profile, socioeconomic status, complaints, psychosocial aspects affecting bowel pattern and diet chart were collected and recorded from the parents in proforma. Stool frequency and type of stool passed were recorded for a week, with Bristol stool chart. R esults: A total of 523 and 131 children were analysed for normal bowel pattern and functional constipation respectively. Data analysis done using SPSS version 15. The prevalence of functional constipation was noted in 13.5% with female preponderance and in the age group of 2-4 years. C onclusion: Constipation continues to be a problem, mostly under recognised in older population. Psychosocial factors had a significant effect on functional constipation. Skipping breakfast, early toilet training, low intake of vegetables and fruits were other factors of significance leading to constipation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=SC12-SC15&id=6025 https://doi.org/10.7860/JCDR/2015/.6025 Sinonasal Neoplasia – Clinicopathological Profile And Importance of Computed Tomography Jaiganesh Sivalingam, Radha Sarawagi, Sameer Raghuwanshi, Pankaj Kumar Yadav Background: Nasal cavity and Paranasal sinus malignancies are very rare, in which maxillary sinus is the commonest, followed by ethmoid, frontal and sphenoid sinus. Computed Tomography (CT) & Magnetic Resonance Imaging (MRI) play a key role in diagnosis, staging and management of paranasal sinuses and nasal pathologies. Multiplanar imaging in CT helps better imaging of critical anatomical areas. Aim of our study was to study the incidence, clinical features, CT features and its importance in the management of sinonasal neoplasms. Materials and Methods: This prospective study was carried out in a tertiary care hospital of MP, India. Consecutive 40 histologically proven cases of sinonasal neoplasia who visited the Department of Otorhinolaryngology and Radiotherapy are included in our study. Demography and clinical features were recorded. Cases of nasal and paranasal sinus masses diagnosed on CT attending ENT and Radiotherapy OPD or admitted in the Radiotherapy ward forms the material of this study. This included patients of both sexes and all ages. Histopathological examination was asked to confirm the diagnosis made on CT. R esults: There were total 40 cases of sinonasal neoplasia among which 24 were benign. Almost all the benign cases were seen in the age group <40 y with mean age of 20 y and most of the malignant cases were seen in the age group above 40 y with mean age of 55 y. In our study we found male preponderance with male female ratio of 4:1 in both benign and malignant conditions. The commonest presenting symptoms of the patients with sinonasal masses in our study was nasal obstruction (75%) and nasal discharge (67.5%) followed by nasal mass (65%), epistaxis (62.5%) and headache (60%). Angiofibroma and papilloma were the commonest benign lesions. Commonest malignant lesion was squamous cell carcinoma. Of the malignant Sinonasal tumours studied in our series, maxillary sinus was involved in 13, ethmoid sinuses and nasal cavity in 10 cases each, and frontal sinuses in 2 cases. Conclusion: Contrast enhanced computed tomography with multiplanar reconstruction is an excellent modality for imaging sinonasal masses. CT can define the character of the sinonasal mass, thus differentiating benign from malignant. CT helps better imaging of critical anatomical areas and helpful in planning treatment procedures such as surgery and radiotherapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=TC01-TC04&id=6026 https://doi.org/10.7860/JCDR/2015/.6026 Impact of Untreated Traumatic Injuries to Anterior Teeth on the Oral Health Related Quality of Life As Assessed By Video Based Smiling Patterns in Children Shruti Golai, Basavaraj Nimbeni, Sandya Devi Patil, Praveen Baali, Hemanth Kumar Introduction: The aim of the study was to assess the correlation between the oral health status, oral health related quality of life and the evaluations of their smiles as assessed by the children, their parents, and through measurements of the children’s videotaped smiles and compare the smiling patterns in children suffering from untreated traumatic injuries to anterior teeth and control group. M aterials and Methods: Fifty eight children of the age 5–15 years of both sexes were selected for the study and categorized into experimental group and control group. The experimental group consisted of 29 children with untreated trauma to one or more anterior teeth while the control group consisted of 29 children with good oral health. Oral examination of all children was done to include in study groups. Children and parents participating in the study responded to two separate Oral Health Related Quality of Life questionnaires for children and parents respectively. The children were asked to watch a funny cartoon show and a video was made while the children watched the show. The video was cropped into still images at 25 predetermined points. Width and openness of the children’s mouth and number of teeth shown were measured during the taped sessions to assess the children’s video–based smiling patterns. R esults: The children’s self evaluation scores had statistically significant correlation with their smiling patterns, the number of traumatized teeth and the parental assessment of their children’s oral health. Children with trauma to anterior teeth had more impacts on their smiling pattern compared to control group. C onclusion: Children suffering from trauma to anterior teeth had more effects on the emotions, the self confidence and social interaction than children without any traumatic injury. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC16-ZC19&id=6039 https://doi.org/10.7860/JCDR/2015/.6039 Helicobacter pylori Associated Gastritis in Northern Maharashtra, India: A Histopathological Study of Gastric Mucosal Biopsies Parvez Mujawar, Dhiraj B. Nikumbh, Kishor H.Suryawanshi, Poonam S. Pagare, Akshay Surana Introduction: Helicobacter pylori (H.pylori) are of major concern today because of its causal relationships with gastrointestinal diseases. It represents one of the most common and medically important infections worldwide. H.pylori plays a key role in the aetiology of chronic gastritis, duodenal ulcer, gastric carcinoma and MALT lymphoma. There is paucity of literature regarding the morphological changes in H.pylori associated gastritis. Aim: We undertake this study to find out the association and prevalence of H.pylori associated gastritis by histopathological methods in North Maharashtra, India. Materials and Methods: A total 310 patients with various upper gastrointestinal disorders were included in this study over the period of 19 months from July 2013 to January 2015. The detailed clinical history was taken and patients were subjected to video gastroscopy. Each biopsy was studied with Haematoxylin and Eosin/Giemsa method. R esults: The prevalence of H.pylori was high in third to fourth decades. Out of 310 patients of gastrocopy, 144 were H.pylori positive by Haematoxylin and Eosin/Giemsa method. Morphological changes specific for H.pylori was noted as atrophy and irregular gastric mucosa, lymphoid aggregates and reactive atypia. Male patient were outnumbered by female patients. C onclusion: Histopathological evaluation is the gold standard for diagnosing H.pylori infection. Prevalence of H.pylori in the present study was 46.5% in patients undergoing videogastroscopic biopsies for gastritis and vague upper gastrointestinal symptoms. Furthermore and large scale studies are required to establish the diagnostic modalities for H.pylori associated gastritis to prevent morbidity and mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=EC04-EC06&id=6040 https://doi.org/10.7860/JCDR/2015/.6040 Orthodontic Treatment Provided by General Dentists with Different Types of Appliances in Chattishgarh, India Ashok Kumar Dhanyasi, Yogesh Mahobia, Abhay Prem Prakash Agarwal, Akhil Gupta, Dilshad Quaraishi, Kishwar Zahoor Khan, Anil Agrawal Objective: The study was done to determine the quantity of orthodontics and the type of appliance used for orthodontic treatment by general dentist. M aterials and Methods: A total of 410 dentists completely participated in the study. The study included questions to know the positive effects of orthodontic treatment done by general dentists and their opinions and qualities regarding the provision of treatment. S tatistical Analysis: Statistical analysis was done using SPSS version of 16.0 was used at p = 0.05. R esults: One forty six (35.6%) dentists answered that they practice orthodontic treatment to their patients, of which most were providing removable appliances (39.5%). There was a significant difference between the groups toward the benefits of orthodontic treatment according to experience of service and locality. General dentist were providing this treatment mainly in the mixed dentition period i.e. 96(65.8%). Most of the participants gave positive response regarding expansion of their syllabus related to orthodontics. C onclusion: A significant difference in response to the benefits of the treatment were seen according to experience and are of practice and most of the participants showed positive response increasing their courses in orthodontics at undergraduate level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC20-ZC22&id=6042 https://doi.org/10.7860/JCDR/2015/.6042 Fungal Culture Positivity in Patients with Perforation Peritonitis Neerja Jindal, Shilpa Arora, Sumeet Pathania Background: Perforation peritonitis is the most common surgical emergency. A large number of microorganisms have been cultured from the abdominal fluid obtained from patients with gastrointestinal perforation peritonitis. The present study was undertaken to determine the frequency of positive fungal culture in perforation peritonitis as Candida co-infection is reported to be a bad prognostic factor in these patients. Materials and Methods: The intraoperative specimens of abdominal fluid collected during laparotomy from 140 consecutive patients of gastro-intestinal perforation were analysed by microbial culture for bacteria and fungi. Their antimicrobial susceptibility was also studied. R esults: The mean presenting age of the patients was 35 years and 120 (85.7%) of them were males. Aerobic Gram Negative Bacilli (AGNB) were observed in 82 (79.6%) of the culture positive abdominal fluid specimens, of which 58 (70.7%) were Escherichia coli. Gram negative bacteria were most frequently isolated from colorectal perforation (100%) while Gram positive bacteria were from upper gastrointestinal perforation (47.2%). Candida was cultured in as many as 68 of 140 (48.6%) specimens. Its prevalence was highest in patients with gastroduodenal perforation (70.5%) and was altogether absent in patients having appendicular perforation. C onclusion: High prevalence of fungal culture positivity of peritoneal fluid of patients of perforation peritonitis shows that along with the bacterial culture, fungal cultures should always be asked for in such patients. Adequate and timely antimicrobial treatment including treatment of fungal infection could help reduce mortality in this group of patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=DC01-DC03&id=6050 https://doi.org/10.7860/JCDR/2015/.6050 Assessment of Periodontal Status of Konda Reddy Tribe in Bhadrachalam, Khammam District, India Naheeda, Shaik Mohammed Asif, Madhavi Padma, Arpita paul Background: Though great strides have been taken globally in the fight against oral diseases, problems persist especially among poor, disadvantaged and socially marginalised communities like tribes. Konda Reddies are one of the most primitive tribes of Bhadrachalam who because of their isolation, inaccessibility to dental resources and lack of dental knowledge follow traditional methods of oral hygiene practices, which are found to be inadequate to maintain oral health. Aim and Objectives: To assess the periodontal status of Konda reddy tribes residing in Bhadrachalam of Khammam district, India. Materials and Methods: Based on availability and accessibility the tribes were gathered using convenient sampling method. The total study population consisted of 500 subjects. Using a preformed Performa the oral hygiene practices and periodontal status was recorded using CPI index. Results: The total study population was 500, comprising of 225 males and 275 females in the age group ranging from 20- >70 years. The mean number of sextants with healthy condition were 0.04±0.19; calculus 4.69±1.21; pockets 4-5 mm 0.91±0.91 and pockets >6mm 0.02±0.15. Conclusion: Poor oral hygiene and periodontal status was seen among the tribes. Under these circumstances, the implementation of a basic oral health care programme for these tribes is a high priority. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZC23-ZC25&id=6051 https://doi.org/10.7860/JCDR/2015/.6051 The Impact of High Surgical Volume on Outcomes From Laparoscopic (Totally Extra Peritoneal) Inguinal Hernia Repair A Aikoye, M Harilingam , A KHUSHAL Purpose: Laparoscopic hernia repair is characterised by a steep learning curve for the surgeon, and proficiency and outcomes are dependent on experience. The aim of this study was to compare laparoscopic totally extra peritoneal (TEP) inguinal hernia repair outcomes conducted by a single surgeon as experience changed over time. M aterials and Methods: Clinical records of 100 consecutive patients who underwent laparoscopic TEP inguinal hernia repair (n=113 hernias) at Kent and Canterbury Hospital by a single laparoscopic surgeon over a four-year period were reviewed for postoperative outcomes. Outcomes were compared with a previous cohort of patients undergoing TEP repair in the preceding three years. R esults: One patient experienced chronic postoperative pain, but there were no recurrences, wound infections, haematomas, or conversions compared to three recurrences, three conversions to open operations, one haematoma, and one episode of postoperative pain in the preceding period. C onclusions: Laparoscopic TEP inguinal hernia repair can be further improved with surgical proficiency and high surgical volumes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PC15-PC16&id=6057 https://doi.org/10.7860/JCDR/2015/.6057 The Clinical Utility of Vestibular Evoked Myogenic Potentials in Patients of Benign Paroxysmal Positional Vertigo Anuprasad Sreenivasan, Ganesan Sivaraman, Pradipta Kumar Parida, Arun Alexander, Sunil Kumar Saxena, Gopalakrishnan Suria C ontext: Vestibular Evoked Myogenic Potentials (VEMP) is an emerging tool to diagnose Benign Paroxysmal Positional Vertigo (BPPV). The clinical utility of VEMP has been reported only in small accord in Indian literature. Aim: To study the latency and amplitude of VEMP in patients with BPPV and compare it with that of normal subjects. S ettings and Design: The study included two groups. Group one (control group) were 18 normal subjects. Group two (test group) were 15 subjects with unilateral BPPV. Materials and Methods: Those subjects who fulfilled the selection criteria based on case history and audiological assessment were taken for the VEMP recording. The VEMP response consist of positive and negative successive waves (pI-nI), with latency values in adults about 13 and 23 milliseconds respectively. S tatistical Analysis: Data was analysed using Statistical Package for Social Sciences (SPSS) version 12 (Chicago, IL, USA). Unpaired t-test was employed to measure the statistical difference between control group and test group. R esults: The difference in n23 and the peak to peak amplitude between the ipsilateral and contralateral ears of the test group were statistically significant, whereas such a difference in the p13 latency turned out to be statistically insignificant. It should be noted that, out of 15 patients in the test group, five patients showed only artifact tracer recordings in both the ears which is considered as no response. The heterogeneity of the results extended from absence of VEMP to prolongation of both p13, n23; prolongation of p13 alone; and even side to side variations. C onclusion: Absent response from the ipsilateral ear, prolonged latency of n23 and decreased peak to peak amplitude (p13, n23), indicates the disease pathology. However, large sample size is required to draw further conclusions and to consolidate the usage of VEMP in the diagnosis of BPPV. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=MC01-MC03&id=6058 https://doi.org/10.7860/JCDR/2015/.6058 Association of Thyroid Function with Severity of Coronary Artery Disease in Euthyroid Patients Ravi Daswani, B. Jayaprakash, Ranjan Shetty, N.R. Rau Introduction: Thyroid hormone exerts multiple effects on the heart and vascular system. Variations of free T3 have been linked to coronary artery disease. We conducted a study to observe whether there is a relationship between the variation of the serum thyroid hormone levels (TSH, FT3 and FT4) and the presence and severity of CAD in the euthyroid patients. Aim: To study association of serum TSH, FT4 and FT3 levels within the normal range with presence and severity of coronary artery disease. Materials and Methods: A total of 100 euthyroid patients with stable angina, who underwent coronary angiography were enrolled in the study. Coronary artery disease was defined as >50% stenosis in the luminal diameter in at least one major epicardial coronary artery. The Gensini scoring system was used to define the severity of the CAD and serum TSH, FT3 and FT4 levels were measured by the chemiluminescence method. R esults: Single vessel disease was found in 23%, double vessel disease in 15% and triple vessel disease in 17% of patients. TSH and FT4 levels were also comparable between the groups. Normal coronary group had significantly higher mean FT3 values than triple vessel disease (p=0.004) and FT3 levels showed an inverse relation with Gensini score (Pearson’s correlation =- 0.30) (p =0.002). A level of FT3 = 2.7 predicted the severity of CAD with a 70% sensitivity and 60% specificity (area under curve (AUC): 0.755, p=0.001). C onclusion: In the absence of primary thyroid disease and acute coronary syndrome, the occurrence of CAD is associated with lower serum levels of FT3. FT3 and not the FT4 and TSH levels may be used as an indicator of increased risk for severe CAD. The present study clearly shows the existence of a strong association between the reduction of biologically active T3 and severity of coronary artery disease. However, low T3 state could be at first interpreted as just a biological risk factor of severe coronary artery disease; only the demonstration of beneficial effects on cardiovascular, end points of long term T3 replacement in CAD patients with low T3 state can answer this fundamental issue. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OC10-OC13&id=6059 https://doi.org/10.7860/JCDR/2015/.6059 OPN –Revisited Vijayanirmala Subramani, Muthukumar Thiyagarajan, N.Malathi, Sharada T. Rajan Osteopontin (OPN), a matrix extracellular glyco-phosphoprotein is found in various tissues such as epithelium lined tissues, kidney, bone and teeth .It is also detected in all body fluids including blood and breast milk. OPN plays role in a number of physiological and pathologic events such as cell adhesion, migration and cell survival, angiogenesis, apoptosis, inflammation and wound healing. This review summarizes the current data of the biological activities of OPN in the development of tumour, its progression and metastasis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZE10-ZE13&id=6111 https://doi.org/10.7860/JCDR/2015/.6111 Ebola Virus Disease (The Killer Virus): Another Threat to Humans and Bioterrorism: Brief Review and Recent Updates Deepak Passi, Sarang Sharma, Shubha Ranjan Dutta. Pooja Dudeja, Vivek Sharma Ebola virus disease (EVD) described as “one of the world’s most virulent diseases” by WHO was popularly known as Ebola haemorrhagic fever in the past. It is usually considered a severe and deadly illness when humans are concerned. EVD outbreaks have shown to have a very high fatality rate ranging from 50 - 90% with a reported occurrence primarily seen near the tropical rainforests of remote villages in Central and West Africa. The virus is transmitted to people from wild animals and within the human community through human-to-human contact. Natural host for Ebola virus is not yet conclusively identified but the most probable host appears to be the fruit bats of the Pteropodidae family. Five subspecies of Ebola virus are recognized till date, with Zaire Ebola virus being the most aggressive of all varieties and recording up to 90% mortality. All Ebola forms are highly contagious and hence have been classed as Category A Priority Pathogens by WHO. Severely ill patients warrant intensive support therapy. Medical workers working in affected areas need to undertake extensive measures to prevent contracting the disease. Till date, no particular anti-viral therapy has demonstrated effectiveness in Ebola virus infection. Also, no vaccine for use in humans is yet approved by the regulatory bodies. If Ebola was actually misused as a biological weapon, it could be a serious threat. Idea behind this article is to briefly review the history and present recent updates on Ebola virus, its pathogenesis and possible hopes for treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=LE01-LE08&id=6100 https://doi.org/10.7860/JCDR/2015/.6100 Flowable Resin Composites: A Systematic Review and Clinical Considerations Kusai Baroudi, Jean C. Rodrigues <b>Background:</b> Little is known about flowable composite materials. Most literature mentions conventional composite materials at large, giving minimal emphasis to flowables in particular. This paper briefly gives an in depth insight to the multiple facets of this versatile material. <b>Aim:</b> To exclusively review the most salient features of flowable composite materials in comparison to conventional composites and to give clinicians a detailed understanding of the advantages, drawbacks, indications and contraindications based on composition and physical/mechanical properties. <b>Methodology:</b> Data Sources: A thorough literature search from the year 1996 up to January 2015 was done on PubMed Central, The Cochrane Library, Science Direct, Wiley Online Library, and Google Scholar. Grey literature (pending patents, technical reports etc.) was also screened. The search terms used were “dental flowable resin composites”. <b>Search Strategy:</b> After omitting the duplicates/repetitions, a total of 491 full text articles were assessed. As including all articles were out of the scope of this paper. Only relevant articles that fulfilled the reviewer’s objectives {mentioning indications, contraindications, applications, assessment of physical/mechanical/biological properties (in vitro/ in vivo /ex vivo)} were considered. A total of 92 full text articles were selected. <b>Conclusion:</b> Flowable composites exhibit a variable composition and consequently variable mechanical/ physical properties. Clinicians must be aware of this aspect to make a proper material selection based on specific properties and indications of each material relevant to a particular clinical situation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZE18-ZE24&id=6129 https://doi.org/10.7860/JCDR/2015/.6129 Partial Edentulism and its Correlation to Age, Gender, Socio–economic Status and Incidence of Various Kennedy´s Classes– A Literature Review Vidhya Jeyapalan, Chitra Shankar Krishnan Partial edentulism, one or more teeth missing is an indication of healthy behaviour of dental practices in the society and attitude towards dental and oral care. The pattern of partial edentulism has been evaluated in many selected populations in different countries by different methods. Most of the studies have evaluated partial edentulism by surveying of Removable Partial Dentures (RPDs), patients visiting clinics, clinical records and population in particular locality. The objective of the study is to review the prevalence of partial edentulousness and its correlation to age,gender, arch predominance, socio economic factors and incidence of various Kennedy’s Classes. Key observations drawn from the review are as below. There is no gender correlation for partial edentulism.• Prevalence of partial edentulism is more common in mandibular arch than maxillary arch.• Younger adults have more Class III and IV RPDs. Elders have more distal extension RPDs Class I and II. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZE14-ZE17&id=6124 https://doi.org/10.7860/JCDR/2015/.6124 Tumour Angiogenesis and Angiogenic Inhibitors: A Review Lalita Yadav, Naveen Puri, Varun Rastogi, Pranali Satpute, Vandana Sharma Angiogenesis is a complex process depending on the coordination of many regulators and there by activating angiogenic switch. Recent advances in understanding of angiogenic mechanism have lead to the development of several anti-angiogenic and anti-metastatic agents that use the strategy of regulation of angiogenic switch. Antiangiogenic therapy is a form of treatment not cure for cancer and represents a highly effective strategy for destroying tumour because vascular supply is the fundamental requirement for growth of tumour. Because of the quiescent nature of normal adult vasculature, angiogenic inhibitors are expected to confer a degree of specificity when compared to nonspecific modalities of chemo and radiotherapy, so it has the advantage of less toxicities, does not induce drug resistance and deliver a relatively non toxic, long term treatment of tumour. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=XE01-XE05&id=6135 https://doi.org/10.7860/JCDR/2015/.6135 A Nonsyndromic Autosomal Dominant Oligodontia with A Novel Mutation of Pax 9-A Clinical and Genetic Report Umapathy Thimmegowda, Praveen Prasanna, Anantharaj Athimuthu, Prasanna Kumar Bhat, Yogish Puttashamachari Oligodontia is congenital absence of one or more teeth which has familial abnormality and attributable to various mutations or polymorphisms of genes often associated with malformative syndromes. The present case reports a rare case of non syndromic oligodontia in an 8-year-old girl with missing 14 permanent teeth excluding third molars in mixed dentition. It is a rare finding which has not been frequently documented in Indian children. Mutations in MSX1 and PAX9 have been described in families in which inherited oligodontia characteristically involves permanent incisors, lateral incisors, premolars and molars. Our study analysed one large family with dominantly inherited oligodontia clinically and genetically. This phonotype is distinct from oligodontia phenotypes associated with mutations in PAX9. Sequencing of the PAX9 revealed a novel mutation in the paired domain of the molecule. The multiple sequence alignment and SNP analysis of the PAX9 exon 2 revealed two mutations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD08-ZD10&id=6049 https://doi.org/10.7860/JCDR/2015/.6049 An Unusual Case of Foreign Body Aspiration Masquerading as Pulmonary Eosinophilia Nageswara Rao Gopathi, venu mandava, Prabahkar Rao P., Lakshmai kanth Kolaparthy Foreign body aspiration into the airways is a common occurrence in inebriated conditions, paediatric age group and or loss of cough reflex. Acute symptoms, often times are recognized and medical assistance is sought. Subtle aspirations, unrecognized and stationed for longer time in the abode of airways pose variegated clinical picture. The authors present herewith an unsuspected case of Areca nut in a middle-aged woman mimicking eosinophilic pneumonia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OD11-OD12&id=6081 https://doi.org/10.7860/JCDR/2015/.6081 Spontaneous Chest Wall Interstitial Emphysema Secondary to Chronic Empyema Thoracis Venkatraman S Bhat, Manjunath Poojaramuddanahalli, Natarajan Rajagopalan, Karthik Gadabanahalli Spontaneous extension of air from the pleural space to the chest wall, also referred to as pneumothorax necessitans (PN), is a rare occurrence. Few of such cases have been reported in the literature, some appear to have a pattern of extension from pleural cavity to chest wall. Clinical conditions known to predispose to this complication are pneumothorax, empyema thoracis and tuberculosis of the pleural space or rib. We report a case of PN arising as complication of postpneumonectomy empyema (PPE) secondary to broncho-pleural fistula. Imaging features are highlighted emphasizing the likely pattern of spread. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=TD05-TD06&id=6082 https://doi.org/10.7860/JCDR/2015/.6082 Grave Complication of Pharyngitis: Lemierre syndrome Suthar Pokhraj Prakashchandra, Ankit kumar B. Patel, Kimmyben Patel, Raj kumar Doshi P., Narottam A. Patel Fusobacterium necrophorum is the causative agent in the pharyngitis. After invasion of the oropharyngeal mucosa by the organism leads to the development of the grave complications like superficial thrombophlebitis of internal jugular vein, septic emboli in the lung and coagulopathy. A 23-year-old male presented with chief complaints of sore throat, headache and high grade fever with past history of upper respiratory tract infection one month ago. On examination, he had high grade fever, tachycardia, hypotension and tender cervical lymph nodes. Oropharyngeal mucosa appeared ooedematous and congested. Leucocytosis with raised ESR was present. Blood culture positive for Fusobacterium necrophorum. Dilated right IJV with the hypoechoic thrombosis seen on Ultrasonography & Doppler. Patient was diagnosed as a case of Lemierre syndrome secondary to oropharyngeal infection was made. He was treated with intravenous imipenem and metronidazole, and then shifted to oral amoxicillin. After completion of full course of the therapy of 6 weeks, patient was improved clinically and all routine blood investigations were normalized. Blood culture was negative for Fusobacterium necrophorum. No evidence of thrombosis within the right internal jugular vein on Doppler. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=TD03-TD04&id=6060 https://doi.org/10.7860/JCDR/2015/.6060 Surgical Management of a Non-healing Intra-alveolar Root Fracture Associated with Pulpal Calcification and Root Resorption: A Case Report Sonali Kapoor, Parul Bansal, Sarath Chandran, Vineet Agrawal Radicular fractures are very challenging to address due to various complications like periodontal communication, increased mobility, and continued pulpal infection leading to necrosis and its long term sequelae like root resorption and pulp canal obliteration. This paper present a case of a long standing horizontal mid root fracture with root resorption and pulp canal obliteration, which was preserved functionally and aesthetically by surgical approach using MTA (mineral trioxide aggregate) and PRF (platelet rich fibrin). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD03-ZD05&id=6046 https://doi.org/10.7860/JCDR/2015/.6046 Retrieval of Iatrogenically Pushed Pulp Stone From Middle Third of Root Canal in Permanent Maxillary Central Incisor: A Case Report Kanika Gupta Verma, Suruchi juneja, Sohajpreet Randhawa, Tejal Malay Dhebar, Anupama Raheja The pulp stones are the discrete nodular calcified masses commonly existing in coronal and occasionally in radicular pulp, placed freely, attached or embedded into the dentine. The present case report revealed the iatrogenic pushing of pulp stone and blockage of root canal that caused endodontic failure. The case enlightens the proper use of ultrasonic instruments with irrigating solutions to manage the calcifications in root canal for successful endodontic therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD06-ZD07&id=6047 https://doi.org/10.7860/JCDR/2015/.6047 Oral Cysticercosis- A Diagnostic Dilemma Pavan G kulkarni, Pavan Palakurthy, Keerthi Muddana, Rateesh kumar Nandan Cysticercosis, a helminthic disease commonly seen in India, Latin America, Eastern Europe and Southern Africa, results from extraintestinal encystation of the larval form of Taenia solium. It is a condition in which man acts as intermediate host instead of definitive host. The most frequent sites of cysticercosis are subcutaneous layers, brain, muscles, heart, liver, lungs, and peritoneum. Oral cysticercosis is considered rare and cause cystic swellings or nodules in the mouth and a precise clinical diagnosis is not usually established. Here, we report a case of oral cysticercosis in a 32-year-old female occurring in the mentalis muscle presenting as asymptomatic nodule. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD01-ZD02&id=6044 https://doi.org/10.7860/JCDR/2015/.6044 Intramuscular Hibernoma: A Rare Tumour in Buttock Reena Naik, Kishori Moni Panda, Anil Ku Kushwaha, P.C.Agrawal Hibernomas are benign tumours of brown fat that does not recur after complete excision. These tumours are found most often in adults and most commonly in thigh. Four morphologic variants of hibernoma are identified: typical, myxoid, spindle cell, and lipoma-like. The most common histologic type is typical variant. In this report, we present the clinical, morphological features and discuss the differential diagnosis of a typical variant of intramuscular hibernoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ED01-ED02&id=6041 https://doi.org/10.7860/JCDR/2015/.6041 Aberrant Dual Origin of the Dorsal Scapular Nerve and Its Communication with Long Thoracic Nerve: An Unusual Variation of the Brachial Plexus Poonam Shilal, Rohit kumar Sarda, Kalpapana Chhetri, Polly Lama, Binod kumar Tamang Pre and post-fixed variations at roots of the brachial plexus have been well documented, however little is known about the variations that exist in the branches which arise from the brachial plexus. In this paper, we describe about one such rare variation related to the dorsal scapular and the long thoracic nerve, which are the branches arising from the roots of the brachial plexus. The variation was found during routine dissection. The dorsal scapular nerve, which routinely arises from the fifth cervical nerve root (C5), was seen to receive contributions from C5 as well as sixth cervical nerve (C6), while the long thoracic nerve arose from C6 and seventh cervical nerves (C7) only. Furthermore along with variations in origin of the dorsal scapular and long thoracic nerves, the brachial plexus was seen to exist as a prefixed plexus receiving a contribution from C4 nerve root. An aberrant communicating branch between the dorsal scapular and long thoracic nerve was also identified. Knowledge about the course and anatomy of such variations can be vital for understanding the aetiology of various conditions such as winging of scapula, interscapular pain, administration of cervical nerve blocks, surgeries and for effective management of regions and muscles supplied by dorsal scapular and long thoracic nerve. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=AD01-AD02&id=6027 https://doi.org/10.7860/JCDR/2015/.6027 Polymorphous Low Grade Adenocarcinoma of Retromolar Region - A Rare Case Report with Distinct Clinical Manifestations T. Radhika, Nadeem Jeddy, K.Kamal Kannadasan, R.Aarthi,Ramachandra Prabakar Polymorphous low grade adenocarcinoma (PLGA) is a rare, low-grade malignancy of minor salivary glands accounting for 2% of salivary gland tumours. The most common sites are palate (60%), lip, buccal mucosa, alveolar ridge and base of the tongue with retromolar region being very rare (0.5%). It is considered to be a low grade malignancy with indolent nature. Very few cases with metastatic spread to lymph nodes and lung have been reported in literature. This report of PLGA is a rare case presenting in an uncommon location (retromolar area) with suspected lymph node and lung metastases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD11-ZD13&id=6054 https://doi.org/10.7860/JCDR/2015/.6054 Jumbo Cutter for Removal of A Bent Femoral Interlocking Nail: A Cost Effective Method Manjeet Singh Dhanda, Harnam Singh Madan, Sansar C Sharma, Nadeem Ali, Abedullah Bhat Closed diaphyseal femoral shaft fractures can be treated with multiple surgical options. It is more challenging to remove a bent nail than a broken one because it is difficult to retrieve the bent nail through the intramedullary canal. Various authors have published their techniques for removal of bent femoral interlocking nail. This article describes a simple technique using Jumbo cutter for sectioning and removal of bent interlocking nail. This technique will help orthopaedic surgeons to remove bent nail without using any specialised metal cutting instruments. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=RD06-RD07&id=6055 https://doi.org/10.7860/JCDR/2015/.6055 Acute Pulmonary Oedema: A Post-Operative Complication Due to Neostigmine and Post Obstructive Pulmonary Oedema in a Case of Tonsillectomy Preeti G. More, Shubhada R. Durve Acute pulmonary oedema has been described in relation to perioperative period. The aetiology may be multifactorial and its management poses a challenge to the anaesthesiologist. Its occurrence in a normal healthy person with no other medical history makes the diagnosis difficult. The causes of pulmonary oedema are cardiac failure, fluid overload, airway obstruction, acid aspiration, gas embolism, anaesthetic drugs, sepsis, anaphylactic reaction and reaction to blood & blood products. Early detection, prompt management by an anaesthesiologist will help to prevent further postoperative complications. We report a case of 9-year-old male child, posted for tonsillectomy under general anaesthesia, who developed acute pulmonary oedema following extubation after reversal with neostigmine and how we managed it successfully. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=UD05-UD06&id=6067 https://doi.org/10.7860/JCDR/2015/.6067 Unusual Presentation of Dengue Fever-Cerebral Venous Thrombosis Natarajan vasanthi, Pradhosh M vairamon, Thiruvengadam gowtham, Ashok kumar das Dengue infection can present as febrile illness with thrombocytopenia, dengue shock syndrome and dengue haemorrhagic fever. Neurological manifestation of dengue infection is more predominant in endemic region. Here, we report a case with unusual neurological presentation of dengue infection. A 16-year-old boy presented with fever for two week duration, headache and double vision involving left eye for two days. He had multiple erythematous rashes all over the body on 3rd day and treated conservatively. On examination he had bilateral papilloedema, left eye restricted abduction. His investigation revealed thrombocytopenia and positive dengue serology. His MRI brain with venogram showed bilateral transverse sinus thrombosis. Hence he was diagnosed as cerebral venous thrombosis due to dehydration with underlying dengue infection. He was hydrated and managed conservatively. On 3rd day his double vision started improving. His repeat MR Venogram was done after two week duration, which revealed recanalisation of bilateral transverse sinus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OD09-OD10&id=6068 https://doi.org/10.7860/JCDR/2015/.6068 An Unusual Traumatic Lamellar Laceration of Cornea Rakesh K Barot, Amar Karkhanis, Satish C Shitole Lamellar laceration of the cornea may occur following ocular trauma. The management of lamellar laceration will depend on whether the lacerated corneal flaps are displaced or undisplaced. We hereby report an unusual case of large traumatic lamellar corneal laceration in right eye in a 14-year-old girl presenting with diminution of vision. Slit lamp biomicroscopic examination showed partial thickness corneal flap of 11.5mm X 7mm from 11o’clock to 6 o’clock position with 3 mm superonasal displacement associated with stromal folds and shifting of inferior limbus and conjunctiva. Surgery was the appropriate option which included visualization of inferior limbus by incising conjunctiva, repositioning of displaced corneal flap and securing it with sutures. Immediate examination and proper surgical management of lamellar corneal injuries results in good visual outcome and prevention of complications like fibrous ingrowth and infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ND01-ND02&id=6069 https://doi.org/10.7860/JCDR/2015/.6069 Non Functional Unilateral Adrenal Myelolipoma, A Case Report Anita B Sajjanar, Vidisha s. Athanikar, U S Dinesh, Bhuvnesh nanjappa, Preetam b. Patil Adrenal myelolipoma is characterized by presence within the adrenal gland of mature adipose tissue and active bone marrow elements. Owing to their non functional nature most cases are incidental, either at autopsy or through computer tomography scan. Occasionally the lesions attain a large size to become clinically apparent. We present a case of a 58-year-old female with mass per abdomen. Preoperative computer tomography scan of abdomen, hormonal and urine analysis showed features of non functional adrenal myelolipoma. Gross specimen consists of unilateral ovoid mass, external surface having capsule with adherent fat and areas of congestion. Microscopic examination showed well encapsulated tumour tissue composed of mature adipose tissue with major blood forming elements like myeloid, erythroid and megakaryocytic series. The diagnosis was confirmed by histopathological examination of right sided adrenalectomy specimen. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ED03-ED04&id=6070 https://doi.org/10.7860/JCDR/2015/.6070 Ewing’s Sarcoma Multifocal Metastases to Temporal and Occipital Bone: A Rare Presentation Kanika Rana, Vikram Wadhwa, Eishaan Kamta. Bhargava, Vasun Batra, Shramana Mandal Ewing’s sarcoma (ES) is a common malignant bone tumour seen to involve long bones, flat pelvic bones and ribs and vertebrae in majority of cases. Here, we present a rare case of aggressive primary ES of pelvic bones with multifocal metastases to temporal bone and occipital bone. The patient presented with facial palsy and an occipital swelling and was referred for chemotherapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=MD04-MD05&id=6071 https://doi.org/10.7860/JCDR/2015/.6071 Tuberculosis and Acute Deep Vein Thrombosis in a Paediatric Case Jayesh Sangani, Satarupa Mukherjee, Soumyadeep Biswas, Tarun Chaudhuri, Gautam Ghosh Deep vein thrombosis (DVT) may be associated with tuberculosis infection. DVT in tuberculosis (TB) is implicated to the release of inflammatory cytokines, decrease synthesis of anti-coagulant proteins and increased fibrinogen levels. Drugs may also predispose to the hyper-coaguability. DVT may correlate with the severity of mycobacterium infection. We report a case of DVT in an 11-year-old child with sputum positive pulmonary tuberculosis. The patient was put on low molecular weight heparin after Doppler documentation of thrombosis of left femoral vein. She was then put on oral warfarin with complete resolution of the thrombosis. A clinician should be aware of this rare but dangerous association of tuberculosis and must not delay in early diagnosis and intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=SD01-SD02&id=6078 https://doi.org/10.7860/JCDR/2015/.6078 An Unusual Complication with Use of Lignocaine: A Case Report Vikas S. Meshram, Priyatama V. Meshram, Pravin N. Lambade, Manish S. Tiwari Allergic responses to lignocaine (amide local anaesthesia) used in dentistry is extremely rare. It is widely used by Oral Maxillofacial surgeons to carry out various procedures safely, comfortably and efficiently. It is important for the practitioners to be aware that allergic reactions though very rare, can occur after injection of lignocaine intradermally for allergy testing. A proper diagnosis and management of such allergic reaction is very essential to avoid undesired consequences. We report a case of a 50-year-old male who suffered itching and generalized skin reaction within 5 minutes after administration of test dose of lignocaine intradermally for allergy testing. Clinical presentation, Diagnosis & management of such allergic reaction are discussed. As local anaesthetic agents are commonly used drugs in day to day practice clinicians are encouraged to be familiar with the presentation of various allergic reactions and there management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZD14-ZD15&id=6064 https://doi.org/10.7860/JCDR/2015/.6064 Nasal Foreign Body, Dislodged and Lost – Can the Adenoids Help? Arijit Jotdar, Mainak Dutta, Subrataataata Mukhopadhyay Foreign body in the nasal cavity is one of the most common paediatric otolaryngology emergencies and needs to be promptly addressed. The incidence of nasal foreign body getting dislodged secondary to unsuccessful attempts to take it out is quite high and can be potentially dangerous as it might cause fatal airway compromise. The chances of it getting impacted and retained in the nasopharynx are practical, although such cases are seldom encountered for primarily nasal foreign bodies. Nevertheless, the nasopharynx should always be looked for as a site of impaction of hidden foreign objects. Presence of enlarged adenoids could be of help as it may prevent accidental lodgement of displaced foreign body in the airway, but might also result in difficulty in locating and retrieving the foreign body because it acts as an anchor-pad with its grooves and crevasses. This report presents a rare, interesting case of a child with enlarged adenoids anchoring a metallic ring and describes the clinical presentations and relevant management of a nasal foreign body dislodged and lost in the nasopharynx. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=MD06-MD07&id=6073 https://doi.org/10.7860/JCDR/2015/.6073 Necrotizing Fasciitis of Hand By Methicillin Resistant Staphylococcus aureus (Mrsa ) – A Sinister Harendra Chauhan, Saiprasad Patil, Anoop Hajare, K Krishnaprasad, Amit Bhargava Necrotizing fasciitis (NF) is an aggressive and life-threatening infection of skin and soft tissue characterized by widespread fascial necrosis, leads to gross morbidity and mortality if left untreated. Although MRSA has become a common isolate associated with skin and soft tissue infections globally over the past few years, monomicrobial MRSA NF has been reported only in a few studies. Our case represents the development of NF followed by trivial trauma salvaged with daptomycin and amputation of the affected limb. Prompt diagnosis and surgical management with empiric MRSA cover in areas where community acquired MRSA (CA-MRSA) is endemic for suspected cases of necrotizing fasciitis can prevent the dreaded consequences. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=DD01-DD02&id=6014 https://doi.org/10.7860/JCDR/2015/.6014 A Challenging Diagnosis of Fluctuating Dyspnea: Myasthenia Gravis Rohan Mandaliya, Kandan Kulandaivel, Nicholas Nowotarski, Kajalben Buddhdev, Rajesh Patel Isolated respiratory muscles weakness is an unusual presentation of Myasthenia Gravis (MG). We present a case of 49-year-old male with undiagnosed MG who presented with fluctuating dyspnea on exertion and at rest. There was no peripheral muscle involvement, diagnostic tests and standard electromyography was normal, and the serologic tests were negative. The repetitive nerve stimulation and Single Fiber Electromyography revealed the diagnosis of MG. Interestingly the patient did not have sufficient therapeutic response on first line agents and required immunoglobulins and corticosteroids due to respiratory muscle involvement. Since skeletal muscle weakness is a cardinal feature of MG, dyspnea may be fluctuating as in our patient causing further difficulty in diagnosis as the pulmonary function tests performed during remission may be normal. This presentation highlights the need to consider MG in the differential diagnosis of unexplained dyspnea on exertion/rest. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OD06-OD08&id=6015 https://doi.org/10.7860/JCDR/2015/.6015 A Rare SOL of the Liver: Diagnostic and Management Dilemma Sudeepta Kumar Swain, Tirupporur Govindaswamy Balachandar, Diwaker Sahu, Anand Ramamurthy, Prasanna Kumar Reddy Aetiology and clinical presentation of space occupying lesions (SOL) of liver are varied. It can be solid, cystic or heterogenous. Usually liver abscess presents as a symptomatic cystic SOL in a sick patient. Here, we are reporting a case of giant liver abscess presenting as simple benign cyst with corroborative image findings of simple cyst. He had significant co-morbid illness and jaundice on clinical evaluation. Liver abscess was not a differential diagnosis from clinical history. None of the haematological and biochemical parameters were suggestive of liver abscess. It was an intra-operative surprise to find such a huge liver abscess with 2 liters of pus, which was drained. We report this case because of its unusual presentation and associated findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=PD03-PD04&id=6010 https://doi.org/10.7860/JCDR/2015/.6010 Uranium-Toxicity and Uranium-Induced Osteosarcoma Using A New Regimen and Surgery : A First-Time Experience Tejbir Singh Pannu, Sukhmani, Karamjit Singh Gill Uranium isotopes have always been problematic to mankind since many centuries. Different studies all over the world have been unable to reveal causal relationship between uranium and its toxic effects on kidneys, bone and lungs. In this case report, we present a rare association of uranium toxicity with renal dysfunction and possibility of induction of osteosarcoma by an unknown mechanism. The presentation of the 12-year-old patient was reduction in urine output along with joint pains, seemed like that of diabetes mellitus, as he was already on insulin. The patient later diagnosed to have uranium toxicity. This case is an instance of strong association between medicine and public health. With complete history, physical examination and required investigations, all common causes like NSAID toxicity, aminoglycoside toxicity and exacerbation of diabetes were ruled out. Uranium investigations were done lastly based on the toxicology report of drinking water (South African toxicologist, Caron Smith). In the management strategy, the new regimen CBMIDA, supported by studies in Europe, was used. However, to our surprise, joint symptoms tracked their way to a diagnosis of osteosarcoma, which was later operated upon by our orthopaedic surgery team. Histopathologically, it was found to be a chondroblastic type of osteosarcoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=RD01-RD03&id=6007 https://doi.org/10.7860/JCDR/2015/.6007 Multiple Amoebic Liver Abscess As Initial Manifestation in Hiv Sero-Positive Male Subrata Chakrabarti Amoebic liver abscess is the most frequent extra-intestinal manifestation of Entamoeba histolytica infection. Immunosuppression is known to predispose to amoebic liver abscess. Although amoebic liver abscess is seen more commonly in patients of Human-Immunodeficiency virus (HIV), first presentation of HIV sero-positive patient as multiple liver abscess is quite uncommon.The author reports an unusual case of multiple liver abscesses in an HIV seropositive patient. This middle aged male with history of multiple unprotected sexual encounters presented with spasmodic abdominal pain, fever, diarrhoea and weight loss along with generalised ill-health and painful liver enlargement. HIV-1 serology was found to be reactive. Imaging revealed an enlarged liver with multiple, irregular, hypoechoic foci characteristic of abscesses. Amoebic aetiology was later confirmed by percutaneous aspiration and microscopy. Administration of appropriate chemotherapeutics along with institution of antiretroviral therapy led to both clinical resolution as well as disappearance of lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OD04-OD05&id=6005 https://doi.org/10.7860/JCDR/2015/.6005 Spontaneous Tracheal Rupture in a Case of Interstitial Lung Disease (ILD): A Case ReportNon Saurabh Kumar, Sandeep Goel, Ashu Seith Bhalla Spontaneous tracheal rupture is one of the rare life threatening conditions. Tracheal lacerations are generally secondary to cervical or chest trauma or occurring as a complication of endotracheal intubation. Only two cases of spontaneous tracheal rupture are reported, in adults, one due to acquired tracheobronchomalacia and other due to long term steroid use. We hereby report a very rare case of spontaneous tracheal rupture in young male patient of interstitial lung disease (ILD) who was on steroids for two months and developed spontaneous subcutaneous emphysema and pneumomediastinum. Tracheal rupture was diagnosed on unenhanced computed tomography (CT) and reconstructed virtual bronchoscopic images. Patient subsequently died due to cardiac arrest. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=TD01-TD02&id=5996 https://doi.org/10.7860/JCDR/2015/.5996 Retinal Hemorrhages in Severe Non-cerebral Plasmodium vivax Malaria in an Adult Manoj Lakhotia, Jagdish Singh, Hans Raj Pahadiya, Harish Kumar, Prakash K. Choudhary Malaria is the most important parasitic diseases of humans and one of the leading causes of morbidity and mortality in tropical countries. Earlier Plasmodium vivax was considered as a benign infection, but now it is recognized as a cause of severe malarial disease. It causes severe malarial disease similar to those as Plasmodium falciparum including cerebral malaria, severe anaemia, severe thrombocytopenia, hepatic dysfunction, shock, acute respiratory distress syndrome (ARDS), acute renal failure, and pulmonary oedema. Malarial retinopathy includes retinal whitening, vessel changes, retinal hemorrhages and papilledema. However, retinal hemorrhages are very rare in Plasmodium vivax infestation. Hereby, we report a case of 30-year-old man, who presented with fever with chills and diminution of vision. He was found to have Plasmodium vivax infection with retinal hemorrhages. He was treated successfully with artisunate, primaquine and doxycycline, completely recovered after one month. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OD01-OD03&id=6003 https://doi.org/10.7860/JCDR/2015/.6003 The Ossified Bifid Superior Transverse Scapular Ligament Causing a Double Suprascapular Foramen: A Case Report Praisy Joy, Manisha B. Sinha, Bikash Chandra Satapathy Ossified bifid superior transverse scapular ligament causing a double suprascapular foramen is a very rare finding. This ossified ligament reduces the suprascapular space by half of its original size. It is one of the precipitating factors of suprascapular nerve entrapment. Here we describe a double suprascapular foramen in a dry left scapula of Indian origin. There were two bony bars bridging the suprascapular notch thereby making two foramina. The bony bars were ‘V’ shaped with its apex attached to the lateral side of the suprascapular notch. The upper foramen was large and triangular whereas the lower foramen was small and oval. Considering the shape of the foramen and the ‘V’ shaped attachment of the bony bars, we conclude it to be due to the ossification of bifid superior transverse scapular ligament. A double suprascapular foramen should always be kept in mind while diagnosing and treating suprascapular nerve entrapment. Knowledge about the double suprascapular foramen would be useful to orthopaedic surgeons who perform decompression for suprascapular nerve entrapment through arthroscopy and open procedures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=AD03-AD04&id=6037 https://doi.org/10.7860/JCDR/2015/.6037 Anaesthesia for a “Scalped” Patient M.M. Rizvi, Raj Bahadur singh, Arindam Sarkar, Sanjay Choubey Trichilemmal carcinoma of scalp is a rare malignant tumour of scalp. A 52-year-old female presented with an extensive ulcerative lesion of the scalp. As the location of the tumour was in the occipital region and there was loss of bony skull in the region, this case became challenging. This patient was managed in the left lateral which was a difficult situation for even the experienced Anaesthesiologist. Intravenous access was acquired, central venous catheter (CVC) was placed in the right internal jugular vein under ultrasonography (USG) guidance and intubation was carried out in the lateral position. After the procedure, patient was again returned to the left lateral position. The trachea was extubated in the lateral position once the patient was awake, after thorough reversal of neuromuscular blockade. Patient had an uneventful postoperative period. This case report highlights the management of an unusual case of Trichilemmal carcinoma of the scalp. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=UD03-UD04&id=6038 https://doi.org/10.7860/JCDR/2015/.6038 The Incidence of Severe Diarrhea with Transdermal Fentanyl Patch: An Uncommon Event Karim Hemati, Poupakpak Rahim Zadeh Cancer pain is a major problem for the health care providers. One of the most important aspects of cancer pain is palliative care management. Recently, different research finding shows the efficacy of opioid analgesics such as fentanyl transdermal patch in chronic pain management. Transdermal Fentanyl patches may cause side effects such as drowsiness, dizziness, itching, life-threatening or serious breathing difficulties and diarrhea, mainly during the first 72 h of patient’s treatment initiation and any time when the drug’s dose is increased. We report three case reports of severe diarrhea without most common side effects associated with Fentanyl patches during first 72 h of patient’s treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=UD01-UD02&id=6024 https://doi.org/10.7860/JCDR/2015/.6024 Clinico-radiological Approach to a Rare Case of Early Clavicle Tuberculosis: A Case Discussion Based Review of Differential Diagnosis Mohammad Nasim Akhtar, Sharat Agarwal, Rizwan Athar A patient of 41 years of age presented with insidious onset atraumatic swelling arising from medial end of right clavicle with apparently normal radiograph. Initial computed tomography ascribed it to benign bony pathology requiring no specific treatment but patient did not respond to symptomatic management. FNAC done elsewhere was inconclusive, with no bacteria on Gram’s staining and negative bacterial culture and AFB smear examinations. Patient had possible exposure to tuberculosis and Mantoux skin test done which showed significant induration. Possible differential diagnoses related to clavicle including infective, neoplastic, rheumatological, degenerative and idiopathic conditions considered. Magnetic resonance imaging (MRI) showed focal periosteal reaction with marrow signal changes with sparing of sternoclavicular joint. Correlation between patient’s history, clinical findings and investigations done and diagnosis of isolated clavicle tuberculosis was made. Patient showed good response to anti-tubercular chemotherapy. Repeat MRI showed resolution of initial imaging findings. At the end of 2 years patient was completely symptom free. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=RE01-RE05&id=6079 https://doi.org/10.7860/JCDR/2015/.6079 Human Papilloma Virus (HPV) Induced Head & Neck Squamous Cell Carcinoma: A Comprehensive Retrospect Roquaiya Nishat, Shyam Sundar Behura, Sujatha Ramachandra, Harish Kumar, Alokenath Bandyopadhyay Head and Neck Squamous Cell Carcinoma accounts for the sixth most common malignancy occurring worldwide with tobacco and alcohol being the two well established risk factors. In the recent years, substantial evidence has been obtained that Human Papilloma Virus (HPV) associated head and neck cancers are on the rise. This article provides an insight into the structure of HPV genome, molecular pathogenesis, detection methods and clinical implications of HPV positive Head and Neck Squamous Cell Carcinoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZE01-ZE04&id=6056 https://doi.org/10.7860/JCDR/2015/.6056 Mitigation of Fluorosis - A Review Mahesh R. Khairnar, Arun S. Dodamani, Harish C. Jadhav, Rahul G. Naik, Manjiri A. Deshmukh Fluoride is required for normal development and growth of the body. It is found in plentiful quantity in environment and fluoride content in drinking water is largest contributor to the daily fluoride intake. The behaviour of fluoride ions in the human organism can be regarded as that of “double-edged sword”. Fluoride is beneficial in small amounts but toxic in large amounts. Excessive consumption of fluorides in various forms leads to development of fluorosis. Fluorosis is major health problem in 24 countries, including India, which lies in the geographical fluoride belt. Various technologies are being used to remove fluoride from water but still the problem has not been rooted out. The purpose of this paper is to review the available treatment modalities for fluorosis, available technologies for fluoride removal from water and ongoing fluorosis mitigation programs based on literature survey. Medline was the primary database used in the literature search. Other databases included: PubMed, Web of Science, Google Scholar, WHO, Ebscohost, Science Direct, Google Search Engine, etc. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZE05-ZE09&id=6085 https://doi.org/10.7860/JCDR/2015/.6085 Use of the Open Coil Space Regainer for Tooth Movement Prior to Prosthodontic Treatment Godwin Clovis Da Costa, Paul Chalakkal, Meena Ajay Aras, Vidya Chitre https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZJ03-ZJ04&id=6045 https://doi.org/10.7860/JCDR/2015/.6045 Oral Squamous Cell Carcinoma Metastases to the Kidneys: Is It Common? Binit Sureka, Kalpana Bansal, Nitesh Agrawal, Dipanjan Panda, Ankur Arora https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=TJ01-TJ02&id=6048 https://doi.org/10.7860/JCDR/2015/.6048 Bilateral Paramolar Tubercles on the Distobuccal Surfaces of Mandibular Primary First Molars: A Rare Occurrence Jaya Agali Ramachandra, Miloni S. Vora, Nidhi K. Nihal, Umapathy Thimmegowda https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZJ05-&id=6052 https://doi.org/10.7860/JCDR/2015/.6052 Which one is Worse? Acute Myocarditis and Co-existing Non-compaction Cardiomyopathy in the Same Patient Oguz Karaca, Beytullah Cakal, Sinem Deniz Cakal,Gamze Babur Guler, Ekrem Guler https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=OJ01-&id=6033 https://doi.org/10.7860/JCDR/2015/.6033 A Rare Case of Low Flow Vascular Malformation of Head and Neck Region Presenting with Multiple Phleboliths Sujoy Ghosh, Khushboo Singh, Anju Garg, Priya Kumar, Sunita Gupta https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZJ01-ZJ02&id=6034 https://doi.org/10.7860/JCDR/2015/.6034 Antifungal Breakpoints of Non-albicans Candida Clinical Isolates in Vitek-2 Compact Arunava Kali, Kunigal Srinivasaiah Seetha, Sreenivasan Srirangaraj https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=DL01-&id=6043 https://doi.org/10.7860/JCDR/2015/.6043 Shear Bond Strength - New Reports Jacek Matys https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=ZL01-&id=6062 https://doi.org/10.7860/JCDR/2015/.6062 Biofilm Production Correlating with Multidrug Resistance Among Clinical Isolates of Acinetobacter baumannii Venkataramana Kandi https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&month=June&volume=9&issue=6&page=DJ02-&id=6084 https://doi.org/10.7860/JCDR/2015/.6084