Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR A Rare Cause of Anaemia in HIV/AIDS Samarth Virmani, Rama Bhat, Raghavendra Rao, Ruchee Khanna, Lipisha Agarwal Patients living with HIV are commonly diagnosed with anaemia which can have various aetiologies. However, one of the rare causes of anaemia in such patients is Auto Immune Haemolytic Anaemia (AIHA), which is difficult to diagnose due to the absence of reticulocytosis in HIV patients. Such patients can be treated with corticosteroids which can gradually be tapered off over a period of time. The following is a case of a 52-year-old male living with HIV who was diagnosed to have AIHA and was successfully treated with steroids. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OD01-OD02&id=10338 https://doi.org/10.7860/JCDR/2017/28560.10338 Pure Villous Adenoma of the Vesicoureteric Junction Presenting as Pyonephrosis Gwendolyn Fernandes, Shital Munde, Amey Rojekar Villous adenomas of the urinary tract are uncommon neoplasms which share similar morphological features with gastrointestinal villous adenomas. Only two case series and around 20 scattered case reports of villous adenoma in the urinary tract have been published in English literature till date. They have been identified mainly in the urinary bladder, urethra, prostate and urachus, but the occurrence of villous adenomas at the vesicoureteric junction has not been described. We present a case of villous adenoma of the vesicoureteric junction which completely occluded the lumen and led to gross pyonephrosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ED04-ED05&id=10356 https://doi.org/10.7860/JCDR/2017/29670.10356 Sacrococcygeal Teratoma in a Seven-Day-Old Child with Pulmonary Differentiation Barkha Gupta, Surekha Yadav, Nita Khurana, Prince Raj Sacrococcygeal Teratoma (SCT) showing pulmonary differentiation has been rarely reported in the literature. Till date, only eight cases have been reported, out of which six belong to teratomas arising from female genital tract. Spinal teratomas showing pulmonary differentiation are rarer and only two cases have been reported so far in the literature both of which had associated congenital spinal anomaly. We present a rare case of seven day old infant with sacrococcygeal teratoma showing mature lung differentiation as one of its components. The infant was otherwise asymptomatic and had no associated spinal anomaly. This case has been presented for its rarity. Extensive review of the literature along with the possible pathogenesis is also included for better understanding. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=SD01-SD02&id=10357 https://doi.org/10.7860/JCDR/2017/27273.10357 Unusual Presentation of Gonadal Vein Aneurysm - Thrombosis and Hydronephrosis: A Rare Case Report Shivraj Bharath Kumar, Velmurugan Palaniyandi, Sriram Krishnamoorthy, Kumaresan Natarajan , Venkat Ramanan Gonadal vein aneurysm is a very rare anomaly and the aetiology is often unknown. Many factors have been said as contributory such as multiple pregnancies, multiple pelvic surgeries, pelvic tumours or pelvic congestion, but none of them have been strongly or closely associated with the lesion. Here, we present a case of left gonadal vein aneurysm in a female with its management. A 72-year-old, diabetic and hypertensive female presented with complaints of left loin pain. She is multiparous with four normal vaginal deliveries. On evaluation, she was diagnosed to have 4 cm left gonadal vein aneurysmal mass with internal thrombus causing hydronephrosis due to mass compression and perilesional adhesions. She underwent left gonadal vein aneurysm excision. Many treatment options are available such as endovascular– embolization/sclerotherapy. In the presence of thrombus and dense adhesions, as noted in our case, it is best to do open surgery for safety of the patient and obtain a good outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PD01-PD02&id=10358 https://doi.org/10.7860/JCDR/2017/25188.10358 Neglected Necrotizing Fasciitis - A Rare Complication of Spinal Anaesthesia Karikal Chakaravarthi, Ashish Gupta, Lileswar Kaman Necrotizing Fasciitis (NF) is a rare, rapidly progressive severe bacterial soft tissue infection with a high mortality rate. NF classically involves the trunk, groin/perineum, lower limbs, and postoperative wound sites. NF secondary to spinal anaesthesia in a young postpartum female is extremely rare. Here we are describing a young postpartum female who underwent cesarean section for the delivery of child but developed NF of the back starting from the site of spinal needle insertion. She was referred to our center after 21 days of surgery with extensive NF. She underwent serial debridement but succumbed to septic shock secondary to gram negative and fungal sepsis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PD03-PD04&id=10359 https://doi.org/10.7860/JCDR/2017/26929.10359 Thyrolingual Trunk Arising from Common Carotid Artery- A Case Report Santhosh Kumar Nochikattil, TP Sajith Babu, Sudheesh Manoharan Superior Thyroid Artery (STA) usually arises from the ventral surface of the External Carotid Artery (ECA) just below the level of tip of greater cornu of hyoid bone and it runs anteriorly, downwards and medially. Lingual artery arises at the level of tip of greater cornu of hyoid bone and it runs anteriorly, upwards and medially. Rarely, both STA and lingual artery may originate as a common trunk called thyrolingual trunk. But a thyrolingual trunk arising from Common Carotid Artery (CCA) is very rare. We report a case of patient diagnosed to have carcinoma of right lower alveolus with nodal recurrence; with thyrolingual trunk arising from the medial aspect of CCA, which was detected incidentally during neck dissection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=AD01-AD02&id=10365 https://doi.org/10.7860/JCDR/2017/23144.10365 Duplicated and Hypoplastic V4 Segment of Vertebral Artery along with Duplication of Anterior Inferior Cerebellar Artery: A Case Report S. S. S. N Rajasekhar, k. Aravindhan, Dharmaraj Wamanrao Tamgire Variations of V3 and V4 segments of Vertebral Artery (VA) are very rare. We report an extremely rare case of hypoplastic and duplicated V4 segment of right VA along with variant origin of right Anterior Inferior Cerebellar artery (AICA) from right Posterior Inferior Cerebellar artery (PICA). AICA was duplicated, with one vessel arising from PICA and another arising from distal Hypoplastic Vertebral Artery (HVA). HVA should be considered for the diagnosis of acute stroke of brainstem and cerebellum. Knowledge about VA variations is important to prevent iatrogenic injuries during surgeries involving posterior cranial fossa. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=AD03-AD05&id=10366 https://doi.org/10.7860/JCDR/2017/29157.10366 A Rare Case of Primary Plasma Cell Leukaemia with Monosomy X Smita Surendra Masamatti, Aparna Narasimha, Archana C Shetty, C Vijaya Primary Plasma Cell Leukaemia (pPCL) is a very rare and aggressive subtype of plasma cell dyscrasias with a very poor outcome and characterized by presence of >2x109/l circulating plasma cells. Overall incidence being 1%-2% of all malignant plasma cell diseases and 0.9% of all acute leukaemias. Patients with primary and secondary PCL have similar clinical features but differences do exist. Here we report a rare and interesting case diagnosed as primary PCL in a 44-year-old female with unusual clinical presentation and complex karyotyping. Her serum electrophoresis showed a monoclonal IgG component and immunohistochemistry of bone marrow plasma cells showed CD 38 positive and CD 20 negative. The patient initially responded partially for combination chemotherapy, but succumbed after 20 days of diagnosis. We are presenting this case to highlight the importance of early diagnosis of such haematological malignancies in settings where treatment options like stem cell transplantation are limited. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ED06-ED07&id=10367 https://doi.org/10.7860/JCDR/2017/28512.10367 Amelanotic Signet Ring Cell Melanoma Presenting as Breast Lump- A Diagnostic Conundrum Prasath Sathiah, Debasis Gochhait, Subathra Adithan, Sandhya Umamahesweran, Priyadarshini Dehuri Amelanotic signet ring cell melanoma is one of the rare variants of malignant melanoma. Here we are presenting a case of a 58-year-old female with chief complaints of swelling in the left sternal region/breast, and right cervical region. Contrast Enhanced CT scan showed the two well circumscribed lobular mass lesions with central necrosis in the left breast. The radiologist opined the lesions as intramammary nodes. Biopsy from the larger breast mass lesion showed a tumour with cells arranged in discohesive pattern less with hetrogenos morphology. These tumour cells had a predominantly signet ring morphology along with markedly pleomorphic tumour cells and giant cells. These tumour cells were negative for pan CK and positive for S100, HMB45. So the case was diagnosed as metastatic amelanotic malignant melanoma with signet ring morphology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ED08-ED10&id=10368 https://doi.org/10.7860/JCDR/2017/28774.10368 Simultaneous Bilateral Anterior and Posterior Lenticonus in Alport Syndrome Ravi Kant Bamotra, Meenakshi, Prem Chandra Kesarwani, Shazia Qayum Alport syndrome is an inherited disease characterized by progressive renal failure, hearing loss, and ocular abnormalities like anterior lenticonus, corneal opacities, cataract, central perimacular and peripheral coalescing fleck retinopathies, and temporal retinal thinning. Although anterior lenticonus is common in Alport syndrome, simultaneous anterior and posterior lenticonus is a rare presentation. We report a case of a 22-year-old female with simultaneous anterior and posterior lenticonus presentation in which ocular examination lead to the detection of Alport syndrome. The patient had sensorineural deafness as well as microscopic haematuria. Clear lens extraction was performed in both eyes to eliminate lenticular irregular astigmatism for visual rehabilitation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ND01-ND02&id=10369 https://doi.org/10.7860/JCDR/2017/25521.10369 Spontaneous Enterocutaneous Fistula Resulting from Richter’s Hernia Ranendra Hajong, Donkupar Khongwar, Ojing Komut, Narang Naku, Kappa Baru Richter’s hernia is due to the entrapment of a part of circumference of the bowel wall. As the bowel continuity is maintained, the patients usually do not have intestinal obstruction. Some patients with Richter’s hernia may present with enterocutaneous fistula either spontaneous or due to surgical intervention mistaking the obstructed hernia to be inguinal abscess. This is more so in developing countries due to lack of awareness among the masses or due to the delay in seeking medical attention. Presenting here is a case of a 53-year-old male patient with enterocutaneous fistula which occurred spontaneously and sought medical attention only after about three years of repeated discharge of yellowish fluid from the left inguinal region. Magnetic resonance fistulogram confirmed the diagnosis of enterocutaneous fistula. Laparotomy with resection and primary anastomosis of the fistulous bowel was done. Patient recovered uneventfully without any complications or recurrence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PD05-PD06&id=10370 https://doi.org/10.7860/JCDR/2017/27789.10370 International Depository Authority and its Role in Microorganism’s Deposition Goutam Bera, Zeenat Ara, Moumita Sengupta, Uttara Chatterjee, Madhumita Mukhopadhyay Wilms’ tumour, a renal malignancy, primarily occurs in children with a peak incidence between 2 to 5 years age group and accounts for approximately 95% of childhood renal malignancies. Though rarely, it may also occur in adults with an incidence rate of less than 0.2 per million per year. Microscopically, there is no difference between Wilms’ tumour of paediatric and adult age groups. But the prognosis for adults with Wilms’ tumour is thought to be worse than that for children possibly due to more aggressive clinical course in case of adult Wilms’ tumour. They are often associated with higher tumour stage at the time of presentation and outcome is often worse than paediatric age group possibly due to difficulty in diagnosis, inappropriate staging, and lack of standard treatment protocol. We report a case of 28-year-old lady presented with flank pain and abdominal lump. Abdominal CT scan showed a right renal mass suggestive of malignancy. A provisional diagnosis of renal cell carcinoma was made based on clinical and radiological findings. Nephrectomy was performed and a final morphological diagnosis of Wilms’ tumour was given. Immunohistochemical study showed strong Wilms’ Tumour 1(WT1) positivity in both blastemal and epithelial components confirming the morphological diagnosis. In view of its diagnostic difficulty and rare occurrence in adults, this case is being reported. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ED11-ED12&id=10383 https://doi.org/10.7860/JCDR/2017/22957.10383 Primary Endometrial Squamous Cell Carcinoma in-situ with Extensive Icthyosis Uteri: A Rare Case Report Manjula Jain, Anamika Kashyap, Ratna Biswas Primary squamous cell carcinoma of the endometrium is a rare entity with primary endometrial squamous cell carcinoma in-situ being more uncommon. We report a 60-year-old multiparous post-menopausal woman who presented with a lower abdominal swelling alongwith difficulty in urination since five months. Total abdominal hysterectomy with bilateral salpingo-oophorectomy showed an enlarged uterus with pyometra. A diagnosis of primary squamous cell carcinoma in-situ of the endometrium was made on histopathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ED13-ED14&id=10384 https://doi.org/10.7860/JCDR/2017/29967.10384 Advancing Cholesteatoma Secondary to Acquired Atresia of the External Auditory Canal: Clinical Perspectives Arijit Jotdar, Mainak Dutta, Sohag Kundu, Subrata Mukhopadhyay Acquired atresia of External Auditory Canal (EAC) is seldom encountered in routine otolaryngology practice. Apart from resulting in moderate-to-severe conductive hearing impairment, it is a potentially dreaded condition which might lead to canal cholesteatoma. Suspected to develop as a consequence of a pre-existing chronic otitis externa/media, the EAC atresia leads to proximal (medial) accumulation of desquamated epithelium and denatured keratin (the canal cholesteatoma) that further leads to aggravation of the chronic otitis, thereby initiating a vicious cycle. The canal cholesteatoma might progress unhindered into the middle ear and mastoid cavity, with its characteristic bone-eroding property, producing complications. A high index of clinical suspicion along with proper imaging are therefore essential to apprehend the disease progression in a patient presenting with an apparently innocuous EAC stenosis/atresia. In this report, we illustrate the clinical details of a young girl with unilateral acquired EAC atresia where canal cholesteatoma had turned extensive, invaded the middle ear cleft, and produced a post-aural fistula, thereby establishing one of the extreme outcomes of chronic otitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=MD01-MD03&id=10385 https://doi.org/10.7860/JCDR/2017/29458.10385 A Rare Surprising Cause of Acute Severe Pancreatitis Cyriac Abby Philips, Philip Augustine, George Joseph, Lijesh Kumar, Pushpa Mahadevan A 39-year-old woman was admitted with clinical, biochemical and imaging features suggestive of acute pancreatitis. Conservative and guideline based management failed to improve her condition. Repeate the imaging, utilizing contrast revealed the progression of extra-pancreatic signs in the absence of pancreatic necrosis, the absence of intra-abdominal fluid collections, enhancing omental and peritoneal deposits and obstructive pancreatitis. A biopsy and histopathological evaluation of the omentum revealed rare anaplastic large cell lymphoma causing obstructive pancreatitis. In patients who present with pancreatitis not responding to conventional treatment and with an atypical disease course, the diagnostic possibility of rare causes of pancreatitis such as obstructive/infiltrative pathology must be thought of. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OD03-OD04&id=10386 https://doi.org/10.7860/JCDR/2017/27421.10386 Meropenem Induced Hypokalemia T V Anuhya, Raviraj Acharya, Sharath Madhyastha, Ram Bhat, Veena Nayak Meropenam, a beta-lactam antibiotic has been used for severe infections of skin, tissue, intra- abdominal and urogenital infections in hospitalized patients. The common adverse effects reported are diarrhoea, vomiting, rashes and hypersensitivity reactions. Here we report two cases of meropenam induced hypokalemia, wherein, meropenam was prescribed for cellulitis and urinary tract infection in the first and second case respectively. Hypokalemia can manifest as muscular weakness, fatigue, muscle cramps, constipation, ileus, flaccid paralysis, hyporeflexia, hypercapnia, tetany, rhabdomyolysis or respiratory failure. Hence, it is necessary to make physicians aware of such an adverse effect which can develop with meropenam. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OD05-OD06&id=10387 https://doi.org/10.7860/JCDR/2017/27584.10387 An Unusual Case of Giant Arterio-Venous Malformation of Anterior Abdominal Wall PS Aravinda, Hirdaya Hulas Nag, Vitha l Kumar M. Betigeri, Puja Sakhuja, Ashok Sharma Arterio-Venous Malformations (AVMs) are high flow vascular anomalies, commonly seen in head, neck and extremities. AVMs represent a direct connection between the arterial and the venous systems.They are congenital, often asymptomatic and rarely manifest before adolescence. Depending on the site,size and symptoms, treatment options varies from conservative management to surgical resection. Here, we report a case of 20-year-old male patient with long standing lump in the anterior abdominal wall with no typical clinical features of vascular lesions. However, imaging findings were suggestive of vascular malformation, and final histopathological examination revealed arterio-venous malformation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PD07-PD08&id=10388 https://doi.org/10.7860/JCDR/2017/27706.10388 Unusual Clinical Presentations in Early-Onset Childhood Sarcoidosis: A Correlation or Coincidence? Priyadarshini Sahu, Sudhanshu Sharma, Nidhi Sharma, Sarika Sharma, Shilpa Garg Sarcoidosis is a multisystem granulomatous disease which frequently affects young adults. Because of its rarity, the exact incidence and prevalence of childhood sarcoidosis is not known. It mostly affects children of older age group i.e., 13–15 years. Early onset sarcoidosis (<5 years) is characterized by a triad of arthritis, uveitis and rash. Late onset sarcoidosis present with a multisystem disease similar to adults, with frequent pulmonary infiltrations and lymphadenopathy. Herein, we report a case of early-onset childhood sarcoidosis in a four-year-old female along with uncommon clinical features like cutaneous ulceration, onycholysis and geographical tongue and its rarity in the literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=WD01-WD03&id=10389 https://doi.org/10.7860/JCDR/2017/27841.10389 Unusual Branching Pattern of the Portal Vein: Its Importance Sreedhara B Cheluvashetty, Vamsidhar Rachapalli Portal vein anatomy and its branching pattern are of utmost importance for surgical planning of complex liver resections, living donor liver transplant and radiological procedures. The division of the vein at the porta hepatis, into the right and left branches is the most common branching pattern. Various branching variations have been described. We report a previously undescribed branching pattern of the right portal vein, where the segment VII vein arises directly from the left portal vein. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=TD01-TD02&id=10390 https://doi.org/10.7860/JCDR/2017/29011.10390 A Rare Case of Pulmonary Lymphangitic Carcinomatosis in a Young Adult with Carcinoma Stomach Prasanta Kumar Bhattacharya, Md. Jamil, Yookarin Khonglah, Aakash Roy, Murti V. Subrahmanya Pulmonary Lymphangitic Carcinomatosis (PLC) occurs in about 6-8% of patients with lung metastasis and may rarely develop in the course of gastric cancer representing a complication due to diffuse metastasis in the lymphatics of the lungs. A 29-year-old female, admitted with difficulty in breathing and productive cough for one week, was initially evaluated for respiratory tract infection. During evaluation of associated anaemia an upper gastrointestinal endoscopy showed large ulcerative growth in the lesser curvature of the stomach suggestive of carcinoma. A High Resolution Computed Tomographic (HRCT) scan of the lungs was done for evaluation of the pulmonary opacities on chest x-ray which showed nodular thickening of interlobular septa with peribronchial cuffing and fissural thickening. The biopsy of the gastric ulcer was suggestive of poorly differentiated malignancy. With the cumulative results of the investigations a diagnosis of poorly differentiated carcinoma of stomach with pulmonary metastasis as lymphangitic carcinomatosis was made. PLC is an extremely rare manifestation of metastatic gastric cancer. Though associated with an extremely poor prognosis, advanced gastric cancer in younger patients presenting with symptoms and signs of respiratory disease should alert the physician of a possible diagnosis of PLC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OD07-OD09&id=10397 https://doi.org/10.7860/JCDR/2017/27352.10397 Gastroduodenal Intussusception due to Gastrointestinal Stromal Tumour (GIST) Abdul Rehman Abdul Jameel, Durairaj Segamalai, Gnanasekaran Murugaiyan, Rajendran Shanmugasundaram, Naganath Babu Obla Gastroduodenal intussusception is the rarest forms of adult intussusception. We present a case of gastroduodenal intussusception due to a gastric Gastrointestinal Stromal Tumour (GIST). The patient was a 65-year-old female who clinically presented as acute gastric outlet obstruction. The patient was managed by gentle reduction of the intussusception, followed by wedge resection of the tumour. She was relieved of her symptoms and recurrence free for past one year. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PD09-PD10&id=10398 https://doi.org/10.7860/JCDR/2017/26292.10398 Unfolding of a Clinically Suspected Case of Pulmonary Tuberculosis Savitha Thirouvengadame, Swapna Muthusamy, Vignesh Kanna Balaji, Joshy Maducolil Easow Pulmonary nocardiosis caused by Nocardia mimics pulmonary tuberculosis in many aspects. Here, we report a case of suspected pulmonary tuberculosis turning into pulmonary nocardiosis following microbiological evaluation. Sputum sample of the patient grew Nocardia otitidiscaviarum. Identification was done by conventional methods and matrix assisted laser desorption ionization-time of flight. He was given co-trimoxazole based on susceptibility reports. Even though Nocardia is a rare entity, pulmonary nocardiosis should be ruled out before starting antitubercular treatment to avoid unnecessary burden to the patient and community. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DD01-DD03&id=10404 https://doi.org/10.7860/JCDR/2017/25788.10404 Pleomorphic Hyalinizing Angiectatic Tumour: A Rare Case Report and Discussion of Differential Diagnosis Ambica Chalmeti, Surekha U Arakeri, Anita P Javalgi, Shefali Goyal Pleomorphic Hyalinizing Angiectatic Tumour (PHAT) is one of the rare soft tissue tumour which is non-metastasizing. The origin of this tumour is yet uncertain. It occurs in adults as a slow growing subcutaneous mass mimicking clinically and histologically to various benign and malignant soft tissue tumours such as schwannoma, haemangioma and malignant fibrous histiocytoma. The microscopic features of this tumour include clusters of ectatic, fibrin containing, hyalinized blood vessels with pleomorphic and spindle shaped tumour cells showing intranuclear inclusions, stromal haemosiderin pigment and a variable inflammatory infiltrate. Despite marked pleomorphism, the lesion behaves as a low grade neoplasm, with frequent recurrences, but no metastases. The incidence of this tumour is very rare with less than 100 cases being published. Hence, awareness of this entity is must for proper management of the patient and to avoid misdiagnosis of the lesion. We report a case of pleomorphic hyalinizing angiectatic tumour in a 50-year-old man who presented with a slow growing mass in the left calf region since two years. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ED15-ED16&id=10405 https://doi.org/10.7860/JCDR/2017/27396.10405 Isolated sixth Cranial Nerve Palsy in a Case Of Severe Pre Eclampsia Presenting as Postpartum Diplopia Aarti Yevale, Akhila Vasudeva, Anjali Mundkur, Pratap Kumar, Arvind Prabhu Visual symptoms in pregnancy are ominous. The spectrum of ocular symptoms seen in pre eclampsia includes blurring of vision, scotoma, hemianopia and even total cortical blindness. Diplopia, though rare has also been reported in cases of pre eclampsia and occurs due to pathological changes affecting the 6th cranial nerve. Ocular symptoms of pre eclampsia usually regress after delivery but occasionally may present in the postpartum period. We present a case of a 34-year-old lady with severe pre eclampsia at 31 weeks of gestation with diplopia presenting seven days post caesarean section. No identifiable pathology was found and the condition recovered spontaneously once blood pressure control was achieved. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QD01-QD02&id=10407 https://doi.org/10.7860/JCDR/2017/28903.10407 Chondroid Lipoma in Left Thigh –A Rare Case Report Sachin Shivaji Kapse, Surekha U. Arakeri, Anita P. Javalgi Chondroid lipoma is a rare variant of lipoma and often confused with chondroid tumours such as soft tissue chondroma, extraskeletal chondrosarcoma and myxoid chondrosarcoma. It consists of two components – adipose tissue and cartilaginous tissue. Differentiating chondroid lipoma from its malignant variant such as extraskeletal chondrosarcoma and myxoid chondrosarcoma is necessary as the treatment modality is more intense and aggressive for latter. Here we are presenting histopathological features and differential diagnosis in an unusual case of chondroid lipoma in a 40-year-old female. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ED17-ED18&id=10432 https://doi.org/10.7860/JCDR/2017/29853.10432 Insulin Injection Site Adverse Effect in a Type 1 Diabetes Patient: An Unusual Presentation Ranjana Ajit Sahasrabudhe, Tejas Yashwant Limaye, Vidya Sanjay Gokhale Insulin is an integral part of Type 1 diabetes management. Patient education is of utmost importance to ensure proper injection technique for getting appropriate glycaemic control as well as to avoid injection site adverse effects. Commonest injection site adverse effect is lipodystrophy, attributable to localized manifestation of the pharmacological action of insulin. However, we present a case where incorrect injection technique led to an unusual presentation of injection site adverse effect. Apart from the abnormal skin changes, the incorrect technique also adversely affected the glycaemic control. Though less prominent, some marks are still evident one and a half years after correction of the injection technique. However, the glycaemic control has substantially improved. This emphasizes the need of proper patient education regarding insulin injection technique. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OD10-OD11&id=10433 https://doi.org/10.7860/JCDR/2017/28919.10433 Crossed Fused Ectopic Kidney: A Case Report Rohit Bhattar, Anuradha Maheshwari, Vinay Tomar, SherSingh Yadav Crossed fused ectopic kidney is an unusual congenital malformation of the urinary tract. This condition is usually identified in the autopsy specimen rather than in general clinical scenario. In this condition, both kidneys are located on one side of the midline and are fused with each other. This condition is generally asymptomatic and usually diagnosed as incidental finding. We came across a case of crossed fused left to right ectopia with inferior infusion with nephroptosis. Generally, in cases of crossed fused renal ectopia, one kidney is lower than the other one but in our report, both kidneys were present at the same level. Initially it was thought as cake kidney, but on careful inspection diagnosis of crossed fused left to right ectopia with inferior infusion was made. During workup of abdominal pain, this finding was detected with no gross abnormality except for a tiny calculus. After detailed discussion with the patient, regular follow up was done without any active intervention and during that period he remained clinically and radiologically stable. So in these conditions active intervention is not always mandatory and patient may remain asymptomatic without any intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PD11-PD12&id=10434 https://doi.org/10.7860/JCDR/2017/26944.10434 Spontaneous Subcapsular Renal Haematoma : A Case Report Varinder Singh, Sreenivas Jayaram, Dhananjaya BR Kumar Spontaneous subcapsular renal haematoma is a rare condition with wide range of presentation; it poses a dilemma for diagnosis and management. We present a case of 38-year-old female who presented with right flank pain (continuous, dull aching) for a week with right renal angle tenderness and high blood pressure (though she was not known hypertensive). On imaging, there was right renal subcapsular collection. She did not respond to conservative management except that her blood pressure was controlled with single drug Angiotensin Converting Enzyme (ACE) inhibitor. Right double J stent was placed (in view of urinoma) and patient was followed for six weeks. Repeat computed tomography scan showed persistence of right renal subcapsular collection but the cause was not found. Except hypertension, no definitive cause for the condition could be found. Patient was intervened surgically with right subcostal exploration and subcapsular haematoma was found and drained. Patient was asymptomatic thereafter. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PD13-PD14&id=10435 https://doi.org/10.7860/JCDR/2017/27901.10435 A Huge Ovarian Dermoid Cyst: Successful Laparoscopic Total Excision Hacer Uyanikoglu, Abdurrahim Dusak Giant ovarian cysts, =15 cm in diameter, are quite rare in women of reproductive age. Here, we present a case of ovarian cyst with unusual presentation treated by laparoscopic surgery. On histology, mass was found to be mature cystic teratoma. The diagnostic and management challenges posed by this huge ovarian cyst were discussed in the light of the literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QD03-QD05&id=10436 https://doi.org/10.7860/JCDR/2017/29262.10436 Esthesioneuroblastoma Presenting with Bilateral Proptosis and Blindness in a Child: A Case Report Mahdi Shahriari, Nader Shakibazad, Mehrpour Moradi Esthesioneuroblastoma is a rare malignant tumour of the olfactory epithelium. The most common symptom is related to unilateral nasal obstruction. It rarely presents with bilateral proptosis and blindness. We report a 21-month-old girl with esthesioneuroblastoma in sphenoid and ethmoid sinus in a child presenting with bilateral proptosis, blindness, and irritability. The diagnosis was confirmed by histopathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=XD01-XD02&id=10437 https://doi.org/10.7860/JCDR/2017/26309.10437 Mediastinal Teratoma with Pulmonary Parenchyma Fistula: A Rare Diagnostic Endeavor Dharma Ram, Deepak Kumar Sharma, LM Darlong, Suhas K Rajappa, Yogendra Singh Bhakuni Teratoma is the most frequent mediastinal germ cell tumour amongst young population. They are often detected due to pressure symptoms or as an incidental finding on chest X-ray done for any other reason. Mediastinal teratoma is usually benign and rarely possesses diagnostic or therapeutic challenge unless they rupture into surrounding viscera. In such scenario, they may lead to acute life threatening condition and need prompt diagnosis and surgical extirpation. Here, we are reporting our experience of managing a young lady, who presented with short duration breathing difficulty and cough, and was diagnosed with ruptured mediastinal teratoma on imaging, which was further confirmed intraoperatively and histopathologically. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=XD03-XD04&id=10438 https://doi.org/10.7860/JCDR/2017/28238.10438 Ghost Cell Odontogenic Carcinoma Arising Denovo with Distant Metastasis: A Case Report and Review of Literature Madhurya namana, Sumit majumdar, Divya Uppala, Aditya Avv, Ayyagari kameswara Rao Ghost Cell Odontogenic Carcinoma (GCOC) is a rare malignant odontogenic tumour of epithelial origin accounting about 0.37% to 2.1% of all odontogenic tumours. They are characterized by the presence of ameloblastic islands along with ghost cells representing aberrant keratinization. The aim of this case report is to present a rare case that was diagnosed in a 37-year-old male patient and to describe the behavior of the tumour. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZD01-ZD03&id=10445 https://doi.org/10.7860/JCDR/2017/28143.10445 Adult Survival in Ellis–van Creveld Syndrome with Common Atrium – A Rare Case Report Mugula Sudhakar Rao, Devavrata Sahu, Hashir Kareem, Tom Devasia, Kishor Kumar Shetty Ellis-van Creveld syndrome is a rare genetic disorder, characterized by chondral dysplasia, ectodermal dysplasia, polydactyly and congenital heart defects. Patients with this syndrome rarely survive into adulthood. The syndrome has also been rarely reported in the Indian population. We present the case of a 56 year old female who presented with post-menopausal bleeding, and was diagnosed with Ellis van Creveld syndrome, with a common atrium and common atrioventricular valve. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OD12-OD13&id=10454 https://doi.org/10.7860/JCDR/2017/25126.10454 Remote Cerebellar Haemorrhage Occurring after Transcranial Pituitary Surgery Numan Karaarslan, Mehmet Sabri Gürbüz, Tezcan Caliskan, Tamer Tunckale Post supratentorial and spinal surgeries, in rare cases, Remote Cerebellar Haemorrhage (RCH) develops as a complication. Although the exact aetiology of RCH remains uncertain, excessive drainage of the Cerebrospinal Fluid (CSF) is accepted as the most possible cause. It has been suggested that overdrainage of CSF leads to stretching and resultantly tearing of the cerebellar veins. Early diagnosis and appropriate management decrease mortality and morbidity significantly. In this report, we present a case of RCH encountered on the third postoperative day of transcranial pituitary surgery and discuss the possible causative factors. Excessive loss of CSF is considered to be the major cause of RCH. To our knowledge this is the first case of RCH seen after transcranial macroadenoma surgery reported in the literature so far. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PD15-PD16&id=10465 https://doi.org/10.7860/JCDR/2017/29152.10465 Decreased Foetal Movements Secondary to Uterine Septum: A Case Report and Proposed Algorithm of Management. Eram Ali, Tamkin Khan, Deeba Khanam Congenital uterine anomaly has been well established as cause of infertility and recurrent pregnancy loss. However, only few studies have reported the association of mullerian anomalies and adverse pregnancy outcome in third trimester. We are hereby reporting a case of 25-year- old female second gravida who presented at 36 weeks six days pregnancy with complaint of decreased foetal movements for the past two weeks. The female had previous history of multiple admissions on account of decreased foetal movements in the third trimester. Ultrasonography for biophysical profile and cardiotocography were done on each admission which revealed normal findings. Decision to terminate the pregnancy was taken because of persistent decreased foetal movements. She was induced with dinoprostone gel 0.5 mg intracervically; however she underwent lower segment caesarean section on account of non reassuring cardiotocography. Peroperative findings confirmed the presence of partial uterine septum. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QD06-QD07&id=10466 https://doi.org/10.7860/JCDR/2017/25833.10466 Tamoxifen Induced Pancreatitis: An Unusual Complication of Commonly used Drug Pritam Suresh Chandra Kataria, Pradip Piraji Kendre, Apurva Ashok Patel, Murtaza Zoher Bohra, Nahush Tahiliani Tamoxifen is a selective oestrogen receptor modulator used for the treatment of oestrogen/progesterone receptor positive breast cancer. It possess antagonistic or agonistic activity depending on the tissue location i.e., antagonistic action on breast but agonist action on endometrium and bones. The side effects of tamoxifen include hot flushes, gynaecologic symptoms (vaginal dryness, vaginal discharge), depression, forgetfulness, sleep alterations, weight gain, alteration of lipoprotein metabolism, thromboembolic disorder. Tamoxifen, like oestrogens, increases the plasma level of triglycerides and liver secretion of Very Low Density Lipoprotein (VLDL). Moreover, it inhibits the key enzymes of triglyceride metabolism. However, there are few cases of severe tamoxifen induced hypertriglyceridemia and pancreatitis. Hypertriglyceridemia is one of the risk factor for acute pancreatitis. Here we present a case of tamoxifen-induced hypertriglyceridemia and acute pancreatitis in a 50-year-old female without any comorbidity. She was treated with supportive antibiotics and supportive therapy. About one week after discharge, patient was started on letrozole 2.5 mg once a day. Clinicians must be aware of this rare side effect of tamoxifen, so baseline and periodic testing of triglyceride level must be done to avoid such complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=XD05-XD06&id=10467 https://doi.org/10.7860/JCDR/2017/27440.10467 Neglected Type I Monteggia Fracture Dislocation in Adult Archit Agarwal, Inder Pawar Neglected Monteggia fracture dislocation is one of the challenging case and it becomes more of a therapeutic dilemma especially in adults. Several surgical techniques are described and in spite of this complication rate following surgery is high. This report concerns with management of three-month-old monteggia fracture dislocation in a 30-year-old male. Patient presented with complete loss of movement at elbow. Patient was managed surgically, with internal fixation of ulna and reduction of radial head with radio-capitellar Kirschner wires. Postoperatively at six months, ulna united and patient has achieved flexion from 50 to 115 degrees at elbow and supination pronation arc of 120 degrees. We do not see any indication for procedures directed at the reconstruction of annular ligament. The dilemma remains whether radial head preservation or excision gives better functional range of motion in adult neglected monteggia fracture dislocation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=RD01-RD02&id=10468 https://doi.org/10.7860/JCDR/2017/28250.10468 Bilateral Double Maxillary Paramolars: A Rare Case Report Aydin Ozkan, Hakan Dag, Hasan Ayberk Altug, Metin Sencimen Paramolars are rare supernumerary molars occurring buccally or lingually/palatally near the molar row. They may cause complications such as caries, periodontal disease and delay or prevention eruption of permanent teeth. Reports of bilateral entity are rarely found in the dental literature. The present article reports a rare case of bilateral double paramolars in the maxillary molar region in 21-year-old male patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZD04-ZD05&id=10484 https://doi.org/10.7860/JCDR/2017/27393.10484 Femoral Hypoplasia with Unusual Facies Syndrome Sreekanth R Shenoy, Dipankar Mondal, Manas Ranjan Upadhyay,Bhupendra Kumar Gupta, Jatadhari Mahar Femoral facial syndrome is a rare clinical entity characterized by unilateral or bilateral femoral hypoplasia along with various malformations of face. Only few cases have been detected by antenatal ultrasonography so far. We present the case of one-day-old, male child, born to a primi gravida with oligohydramnios and severe growth restriction. The child had unusual facies with posterior cleft palate, non-communicating hydrocephalus and complete absences of left femur, hypoplasia of right femur, bilateral club foot and bilateral undescended testis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=SD03-SD04&id=10481 https://doi.org/10.7860/JCDR/2017/27632.10481 A Rare Case of Giant Solitary Neurofibroma of Abdominal Wall Masked by Pregnancy Madhumita Patel, Kumari Usha Rani, Manjula Sharma, Amar Bhatnagar Various types of neurogenic tumours can involve the abdomen. Retroperitonial space is most commonly affected but other sites can also be involved. Mostly younger age group is affected and malignant transformation is rare. CT and MRI are helpful in making diagnosis and planning surgery. Complete surgical excision is treatment of choice. Final diagnosis is made by histopathology and immunohistochemistry report. We report a rare case of giant solitary benign neurofibroma of anterior abdominal wall in 25-year-old multiparous women reported on day 15 of vaginal delivery with large abdominal mass which was masked before because of pregnancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QD08-QD09&id=10482 https://doi.org/10.7860/JCDR/2017/25629.10482 Disseminated Burkitt’s Lymphoma with a Pancreatic Mass in a HIV Positive Woman Diagnosed by Axillary Lymph Node Biopsy Godfrey Mutashambara Rwegerera, Yordanka Pina Rivera, Feng Zhou, Kudra Jumanne Chobanga, Sheikh Omar Sesay Burkitt’s Lymphoma (BL) is a highly aggressive B cell lymphoma of non-Hodgkin’s type usually presenting in extranodal sites for endemic and sporadic types of the disease. Like other non-Hodgkin’s Lymphomas (NHL), HIV positive associated BL is associated with peripheral lymphadenopathy. We present a case of 22-year-old newly diagnosed HIV positive female patient who presented with generalized peripheral lymphadenopathy and obstructive jaundice. Initial work up was suggestive of acute pancreatitis with further evaluation revealing a pancreatic head mass. BL was confirmed both by axillary lymph node biopsy and immunohistochemistry, highlighting the importance of high index of suspicion and prompt histopathological diagnosis to enable treatment of this fatal disease that is potentially curable. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OD14-OD16&id=10493 https://doi.org/10.7860/JCDR/2017/27456.10493 Cauda Equina Syndrome in a Lactating Mother - A Safe Treatment Approach Ajay Kothari, Ketan Khurjekar, Shailesh Hadgaonkar, Himanshu Kulkarni, Parag Sancheti Cauda equina syndrome is widely considered as a surgical emergency. The cause of cauda equina syndrome usually is a large central lumbar disc herniation, prolapse or sequestration. Decompression at the earliest has been suggested by many authors but the planning of surgical management becomes challenging when the patient is a breastfeeding mother. Fear of harmful effects of the drugs (administered in the mother) on the infant, always confuses clinicians regarding the treatment approach. So the multidisciplinary approach is necessary with involvement of anaesthetist, paediatrician and also a gynaecologist if necessary. Thorough knowledge of the safety of drugs to be used in operative and post operative period becomes a necessity keeping the baby into consideration. We present a case of one month postpartum female with cauda equina syndrome and present a stepwise multidisciplinary approach, which involves active contributions from surgeon, for safety of the mother and the infant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=RD03-RD05&id=10494 https://doi.org/10.7860/JCDR/2017/27064.10494 Hepatitis B Core Antibody Negativity in a Chronic Hepatitis B Infected Patient: Report of an Unusual Serological Pattern Vijeta Bajpai, Ekta Gupta, Naveen Kundu, Shvetank Sharma, SM Shashtry Diagnosis of Hepatitis B Virus (HBV) infection is established by the presence of various hepatitis B serological and molecular markers. Expression of these serological markers may vary in natural course of HBV infection. We report a case of an unusual HBV serological pattern in a Chronic Hepatitis B (CHB) infected patient demonstrating absence of Hepatitis B core Antibody (Anti-HBc) in spite of presence of Hepatitis B surface Antigen (HBsAg) and HBV DNA. Since, anti-HBc represents a reliable serological marker for past exposure of HBV infection, therefore we emphasize on the presence of such unusual serological pattern which could lead to doubts in the interpretation of results. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DD04-DD06&id=10498 https://doi.org/10.7860/JCDR/2017/26821.10498 Azathioprine in Chronic Recalcitrant Erythema Nodosum Leprosum: A Case Report Singh Shailendra Vikram Jitendra, Romita Bachaspatimayum, A. Subhalakshmi Devi, S. Rita Erythema Nodosum Leprosum (ENL) may have a chronic course which may be recalcitrant to treatment. Preferred treatment modalities are systemic corticosteroids and thalidomide. Azathioprine, methotrexate and cyclosporine are immunosuppressants which may also be used as a steroid sparing agent. We report the case of a 48-year-old male diagnosed as lepromatous leprosy that developed ENL after four months of Multibacillary Multi-Drug Therapy (MB-MDT). He was treated with oral prednisolone (1 mg/kg/day) which was gradually tapered upto a dose of 7.5 mg/day. He developed recurrences on and off once the dose reached the said level and this continued for three years. Oral clofazamine (300 mg/day x 6 months; then 100 mg/day x 6 months) was also added in the second year. Thalidomide (200 mg/day) was also given but withdrawn due to adverse effect after 10 days. Azathioprine was started at a dose of 100 mg/day following which there was resolution of symptoms by one week and no recurrences by 10 weeks; it was given for eight months after which the dose was tapered to 50 mg/day for another four months. Complete withdrawal of oral prednisolone after gradual tapering was possible by 12 months of azathioprine therapy. The patient is still on regular follow-up with no recurrences so far till the last check-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=FD01-FD02&id=10499 https://doi.org/10.7860/JCDR/2017/26536.10499 Scrub Typhus in a New Born Mamta Jajoo, Dipti Kumar, Sameeksha Manchanda Scrub typhus is an acute febrile mite-born rickettsial infection caused by Orientia tsutsugamushi (formely called Rickettsia tsutsugamushi). This infection is very uncommon in neonates. We report a case of 19-day-old newborn presenting with clinical features mimicking severe sepsis but was subsequently diagnosed with primary scrub typhus infection. The timely treatment resulted in dramatic response and complete recovery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=SD05-SD06&id=10500 https://doi.org/10.7860/JCDR/2017/26607.10500 Microfilariae of Wuchereria bancrofti in Testicular Aspirate Anil Kumar Verma, Ashok Kumar Kapoor, Manish Singh Present study deals with results of fine needle aspiration of both the testes in a patient with azoospermia. Surprisingly, aspiration of right testis revealed large number of microfilariae in the smears. Conversely, left testicular aspirate showed few spermatogonia. However, microfilariae were not detected in venous blood smears. Findings of this study suggested possible role of Wuchereria bancrofti in causation of azoospermia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ED19-&id=10505 https://doi.org/10.7860/JCDR/2017/30532.10505 Giant Pyonephrosis Due to Ureteropelvic Junction Obstruction: A Case Report Rupesh Gupta, Sweta Gupta, Arpan Choudhary, Supriya Basu Pyonephrosis is a suppurative infection of upper urinary tract due to obstruction of the ureter. It is usually associated with suppurative damage of renal parenchyma and renal function loss. Patients are mostly symptomatic but may remain asymptomatic in 15% of cases. Severe infection in pyonephrosis may lead to urosepsis and may endangered life, if timely not treated with surgical intervention. We hereby report a rare case of Giant Pyonephrosis (GP), contained 11 liters of pus, due to Ureteropelvic Junction (UPJ) obstruction presented with haematuria. The patient was treated with open nephrectomy. The aetiology, clinical features, diagnosis and management of pyonephrosis with the review of literature of GP in the background of a rare case report have been discussed here. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PD17-PD18&id=10506 https://doi.org/10.7860/JCDR/2017/26103.10506 Hemiscrotal Agenesis: A Rare Congenital Anomaly Alexandros Psarris, Anastasia Dimopoulou, Emmanouil Iakomidis, Nikolaos Zavras, Georgios Vaos Hemiscrotal Agenesis (HSA) is the rarest developmental malformation of the scrotum. It is characterized by the absence of either half of the scrotal rugae with an intact midline raphe. We report the case of a 16-month-old boy with HSA, with an island of scrotal tissue in the pubic tubercle region and ipsilateral cryptorchidism. To our knowledge, this is the first case of HSA with heterotopic development of scrotal tissue. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PD19-PD20&id=10507 https://doi.org/10.7860/JCDR/2017/28605.10507 Perilunate Dislocation – Case Report and Review of Literature Karthik Subramanian, Bakul Arora, Abhinav Bhatnagar, Imran Jan Perilunate dislocations are rare injuries comprising of less than 10% of all wrist injuries. These usually occur after high-energy trauma to the wrist. One-fourth (25%) of perilunate dislocations are missed at the initial presentation. We report a case of perilunate dislocation in a patient who presented late, about two months after trauma. He underwent open reduction through a single dorsal approach and internal fixation with K-wires. Aggressive physiotherapy exercises were started after removal of K-wires. He regained near normal full range of motions at the wrist by the end of four months and showed no recurrence of the dislocation. In conclusion, perilunate dislocations should be considered as one of the important differential diagnosis in patients with history of high-energy trauma to the wrist. Early diagnosis and treatment is necessary to prevent the potential risk of avascular necrosis of lunate and scaphoid and secondary osteoarthritis. The best results can be obtained with open reduction and internal fixation with K-wires via a single dorsal approach. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=RD06-RD08&id=10509 https://doi.org/10.7860/JCDR/2017/29750.10509 Expander Eye Prosthesis Assisting Ocular Rehabilitation in Child with Eye Loss Daniela Micheline Dos Santos, Agda Marobo Andreotti, Bruno Garib Iyda, Stefan Fiuza De Carvalho Dekon, Marcelo Coelho Goiato This clinical report describes the ocular rehabilitation of a child, initially using an acrylic expander and subsequently the conventional prosthesis. A two-month-old anophthalmic female patient was referred to Araçatuba Dental School, for rehabilitation with ocular prosthesis. The treatment chosen was the manufacturing of expander prostheses changed periodically until the socket reached an adequate size, so that a definitive ocular prosthesis could be installed. The acrylic expander remained in patient’s anophthalmic socket for 60 days in order to restore its volume. After this period, ocular prosthesis was installed and replaced according to facial growth. It can be observed that the expander prostheses increased the anophthalmic cavity and provided patient’s adaptation for using an ocular prosthesis. The ocular prosthesis set the face aesthetic balance which eventually reflects positively on psychological and social development of the child. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZD06-ZD08&id=10511 https://doi.org/10.7860/JCDR/2017/26859.10511 Primary Intestinal Lymphangiectasia (Waldmann’s Disease) Presenting with Chylous Effusions in a 15-Year-Old Vijay Surampalli, Srinath Ramaswamy, Deepanjali Surendran,Chanaveerappa Bammigatti, Rathinam Palamalai Swaminathan Primary Intestinal Lymphangiectasia (PIL) is a rare disease of unknown aetiology which presents in the paediatric age group with anasarca, diarrhoea, hypoproteinaemia, lymphoedema and chylous effusions. Tuberculosis, filariasis, chest trauma, malignancies and haematological disorders usually contribute to most cases of secondary lymphangiectasia and chylous effusions. We hereby describe a case of PIL presenting with chylous effusions which remained undiagnosed for eight years. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OD17-OD18&id=10522 https://doi.org/10.7860/JCDR/2017/29055.10522 A Rare Case Report of Caesarean Scar Ectopic Pregnancy Deepika, Taru Gupta, Sonika Wahi Caesarean scar ectopic is one of the rarest of all ectopic pregnancies. It is defined as when a blastocyst implants on a previous Caesarean scar. The incidence Caesarean scar ectopic increased due to increase in number of Caesarean deliveries. Early diagnosis of this can be done using sonography. It is very important because a delay can lead to increased maternal morbidity and mortality. Early diagnosis leads to prompt management and improves outcomes by allowing preservation of future fertility. Magnetic Resonance Imaging (MRI) has important role when sonography is equivocal or inconclusive before therapy or intervention. We are reporting a rare case report of G3P2l2 with previous two Caesarean deliveries and diagnosed as Caesarean scar ectopic pregnancy with the help of sonography and MRI. She underwent laparotomy and on histopathological examination Caesarean scar pregnancy confirmed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QD10-QD11&id=10523 https://doi.org/10.7860/JCDR/2017/24611.10523 Giving Birth After Fertility Sparing Treatment for a Yolk Sac Tumour: Case Report Georgios-Marios Makris, Alexandros Fotiou, Georgios Chrelias, Marco-Johannes Battista, Charalampos Chrelias Yolk Sac Tumours (YSTs) of the ovary, also called Endodermal Sinus Tumours (ESTs), are the second most common Malignant Ovarian Germ Cell Tumours (MOGCTs), after dysgerminomas. YSTs occur primarily in children and young women. We present a case report of a 20-year-old woman who had been diagnosed with YST (tumour diameter of 29 cm). The patient underwent fertility sparing surgery and was subsequently treated with adjuvant chemotherapy (four cycles of bleomycin, etoposide and cisplatin). Two years after the diagnosis of YST, she successfully gave birth to a healthy girl (birth weight 3,500 g, Apgar score of 9-10 and a spontaneous vaginal delivery). During pregnancy, she had microscopic hematuria and bilateral nephrolithiasis was ultrasonographically diagnosed. The conception after fertility sparing treatment of YST is possible and the birth of a healthy child is feasible. There are no current guidelines for surveillance of such patients during pregnancy; however, structured pregnancy surveillance in such survivors seems necessary. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QD12-QD13&id=10524 https://doi.org/10.7860/JCDR/2017/25820.10524 Pregnancy Outcomes in Isolated Oligohydramnios during Second Trimester: A Case Series Ashima Taneja, Kamaldeep Arora, Isha Chopra, Sushree Samiksha Naik Oligohydramnios is associated with increased maternal and foetal morbidities. However, some of the recent studies have shown no adverse effect of isolated oligohydramnios on perinatal outcome and recommends continuation of pregnancy. Pregnancies between 18-28 weeks with isolated Oligohydramnios were included. History and physical examination was recorded in a pre-designed proforma. All the cases received care as per the protocol. A total of seven patients were recruited of which one was a twin pregnancy with Oligohydramnios in both sacs. The mean age at presentation was 30 years. Three patients went into spontaneous explusion at an average gestational age of 22-24 weeks. One patient with twins delivered vaginally at 32 weeks. Rest were delivered by caesarean section between 34-35 weeks (indication in majority of the cases was foetal distress and cord compression). None of the babies suffered any complication and were discharged in good condition. Isolated oligohydramnios during second trimester does not increase adverse perinatal outcome significantly (but increases the caesarean section rate) and therefore, should not be an indication for termination of pregnancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QR01-QR02&id=10502 https://doi.org/10.7860/JCDR/2017/27722.10502 Three-Dimensional Control on Lingually Rolled in Molars using a 3D Lingual Arch Sunil Sunny, Denny P Joseph, Neethu Mathew, Roshini Sara Rajan, Eldo Kurian The fixed lingual arches that are used for mandibular molar uprighting works in two dimensions, whereas the 3D lingual arch works in all the three dimensions. The 3D lingual arch was fabricated from a 0.028 “round S.S wire with parts consisting of an adaptor, activator, friction lock and extender. The friction lock was inserted into the vertical stubs welded on the molar bands of the lingually tipped molar. They provided greater stability and anchorage to the molars. Up righting of the lingually tipped mandibular molars was attained within one month after insertion of the Wilson’s 3D lingual arch. Correction was attained in all three dimensions with a buccal crown torque and lingual root torque. Levelling and alignment of the anterior segment was also attained by this multipurpose modular appliance. The 3D lingual arch enabled the clinician to set up a more positive anchorage for a greater variety of treatment applications than earlier lingual arches. Quality treatment results were attained with less span of time and were cost effective. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZR01-ZR03&id=10503 https://doi.org/10.7860/JCDR/2017/28742.10503 Patients with Congenital Limb Anomaly Show Short Telomere, Shutdown of Telomerase and Deregulated Expression of Various Telomere-Associated Proteins in Peripheral Blood Mononuclear Cells- A Case Series Jayitri Mazumdar, Priyanka Chowdhury, Tunisha Bhattacharya, Badal Chandra Mondal, Utpal Ghosh Congenital limb anomalies are outcome of improper bone formation during embryonic development when cells divide, differentiate with high rate. So, telomerase activity is essential to maintain telomere length for such highly dividing cells. Here, we report four cases of congenital limb anomalies with detailed structures of limbs along with other clinical manifestations of age less than two years. We compared telomere length, expression of telomerase and telomere-associated genes of Peripheral Blood Mononuclear Cells (PBMC) in patient and four age-matched normal individual. Patient-1 was diagnosed with congenital limb hypogenesis ectrodactyly sequence, an autosomal dominant disorder, showing absence of digits and fibula in upper and lower limb respectively. Both mother and grandmother of Patient-1 showed similar hypogenesis of limbs. Patient-2 showed bilateral clenched hand with arthrogryposis, microcephaly and holoprosencephaly. Both Patient-3 and Patient-4 has no radius in upper limb. Additionally, Paient-3 showed right sided orbital Space Occupying Lesion (SOL) and Paranasal Sinuses (PNS) whereas Patient-4 showed fused kidney with fanconi anaemia. Furthermore, all the patients showed shorter telomere length, inactive telomerase and de-regulated expression of telomere-associated proteins in PBMC compared with age-matched control group. So, we can conclude that congenital limb anomalies may be linked with telomeropathy and a study with large number of samples is required to firmly establish such association. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=GR01-GR05&id=10516 https://doi.org/10.7860/JCDR/2017/26960.10516 Super-Refractory Status Epilepticus: A Therapeutic Challenge in Paediatrics Shrikiran Aroor, Kanaparthi Shravan, Suneel C Mundkur, C Jayakrishnan, Sai Sripad Rao A status epilepticus which persists for 24 hours or more after starting treatment with anaesthesia or has recurred inspite of general anaesthesia is known as Super-Refractory Status Epilepticus (SRSE). It includes cases where status epilepticus recurs on reduction or withdrawal of anaesthesia. SRSE, though infrequently seen, constitutes a medical emergency due to the associated high morbidity and mortality. No clear cut guidelines are available till date for the management of SRSE. Most of the published literature was case reports and expert opinion. We hereby reported three cases of super refractory seizures as they posed a therapeutic challenge. All three children were aged 6-7 years with prior normal developmental history and no medical illness. Viral meningoencephalitis, fever induced refractory status epilepticus, and auto-immune encephalitis was the probable aetiology in the cases studied. Midazolam, pentobarbital, and ketamine are the most commonly used anaesthetic agents. Phenytoin, phenobarbitone, valproate and levetiracetam are the most commonly used antiepileptic agents. All three cases had residual neurological deficits and morbidities like pneumonia and sepsis. SRSE is associated with high rates of mortality and morbidity necessitating immediate treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=SR01-SR04&id=10485 https://doi.org/10.7860/JCDR/2017/25811.10485 Metaplastic Carcinoma Breast: A Clinical Analysis of Nine Cases Manashi Ghosh, A Muneer, Vinita Trivedi, Kaustav Mandal, Santosh Shubham Metaplastic Breast Carcinoma (MBC) is a rare heterogeneous group of primary breast malignancies with different subgroups; exhibits a variety of histopathologic patterns and appears to be both epithelial and mesenchymal in origin. The ideal treatment for MBC remains unknown, due to its low incidence and pathological variability. Owing to its rarity, MBC has been treated as a variant of Invasive Duct Carcinoma (IDC). But it has poorer prognosis as compared to IDC. This is a case series to evaluate clinicopathologic characteristics and the multi-disciplinary treatment of nine MBC patients treated in a single institute. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=XR01-XR03&id=10472 https://doi.org/10.7860/JCDR/2017/27977.10472 A Case Series on Superior Mesenteric Artery Syndrome Surgical Management, Single Institution Experience Gopakumar Valiathan, Majid Wani, Juneed Lanker, Prasanna Kumar Reddy Compression of duodenum by Superior Mesenteric Artery (SMA) causing proximal intestinal obstruction is an uncommon condition. Treatment of this condition involves conservative management initially followed by surgical management in those patients who have persistent symptoms. This case series evaluates surgical management and outcome of six patients after one year, who presented with SMA syndrome and describes a brief review of literature. Three patients underwent open duodenojejunostomy and the rest three underwent laparoscopic duodenojejunostomy. All patients had uneventful postoperative recovery. Postoperative requirement of analgesics was less in laparoscopic group versus open group. All the three patients in laparoscopic group could be mobilised out of bed on the day of the surgery itself. Mean duration of hospital stay was seven days for open surgery group and three days for the laparoscopy group. Outcome in terms of resolution of abdomen pain and vomiting was similar in both the groups. Four patients were asymptomatic after one year of follow up. A high index of clinical suspicion is needed for the diagnosis of SMA syndrome. Laparoscopic approach is feasible, safe, less morbid and effective as compared to open surgery. In the presence of facilities and surgical expertise, laparoscopic duodenojejunostomy should be considered the procedure of choice for SMA syndrome. Majority of patients remain symptom free at one year follow up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PR01-PR03&id=10402 https://doi.org/10.7860/JCDR/2017/20248.10402 Intracarotid Sodium Nitroprusside on Fifth Post Ischemic Stroke Day in Middle Cerebral Artery Occlusion Rat Model Vinod Kumar Tewari, Vivek Bhosale, Rakesh Shukla, Hari Kishan Das Gupta, Sheeba <b>Introduction:</b> Ischemic stroke at later stages (>4.5 hour) have very few treatment options left. In those cases Nitric Oxide (NO) may provide promising results. NO is active in signaling pathways. Sodium Nitroprusside (SNP), a NO donor was tested earlier in rat Middle Cerebral Artery Occlusion (MCAO) model in early stages (5-60 minutes) and found useful but in delayed stroke cases (60-120 minutes) found useless. This was due to local inducible Nitric Oxide Synthase Enzyme (iNOS) and superoxide (causes destructive effect) formation which was skipped. <b>Aim:</b> To evaluate the effect of Intracarotid Sodium Nitroprusside (ICSNP) in MCAO rat model of ischemic stroke (I/R model) fifth post ischemic stroke day. <b>Materials and Methods: </b>A total of 24 Sprague Dawley rats, weighing 250 gm to 280 gm, at CDRI-Lucknow, India were used. Rats were divided in three groups. Group A (n=4) were taken as sham with standard procedure but without any injection on fifth day, Group B (n=8) as control with injection of saline on fifth day and Group C (n=12) received SNP at dose of 3 mcg/kg/minute given directly in internal carotid artery via External Carotid Artery (ECA) with a modified intraluminal stump technique as Ischemia/Reperfusion (I/R) in ipsilateral MCAO at intracarotid artery region as a single dose therapy on fifth day and then wound was closed. Waited for full recovery for two hours, then neurobehavioural assessment scores were noted. Thereafter, the brains were quickly removed and sliced at 2 mm intervals. Animals showing no sign of neurological deficit, were excluded from the study. Tested animals were compared with control animals for neurological deficit, percentage of infarction by 2,3,5-Triphenyl Tetrazolium Chloride (TTC) staining, nNOS expression and scores were summed up. The statistical analysis was done by Newman–Keuls test, Graph Pad prism (version.5.0) and p<0.05 was considered statistically significant. <b>Results:</b> ICSNP group (Group C) showed a good reduction in the cerebral infarction of 53.42% as compared to control (Group B). Group A mean change in Newman–Keuls test and Graph Pad prism (version.5.0) was showing increase of 1.44 points/6.55%, compared to Group B decrease of 0.7 points. A 60% decrease in ischemic zone noted in Group A. <b>Conclusion:</b> The use of single dose ICSNP is beneficial (53.42%) in fifth post stroke day. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=AF01-AF04&id=10504 https://doi.org/10.7860/JCDR/2017/28085.10504 Management of Severely Dilacerated Mandibular Third Molar Ambar W. Raut, Vijay Mantri, Shubham Kala, Harshank Lakhera https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZJ05-ZJ06&id=10471 https://doi.org/10.7860/JCDR/2017/30403.10471 Management of Double Lip Amitabh Srivastava, Shweta Chaudhri, Atul Kumar, Sunita Srivastava https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZJ07-ZJ08&id=10492 https://doi.org/10.7860/JCDR/2017/28816.10492 A Rare Case of Osteopetrosis with Unusual Feature as Microcephaly Parul Bhati, P C Goyal https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=SJ01-SJ02&id=10406 https://doi.org/10.7860/JCDR/2017/27256.10406 Use of Impella 2.5 in Patient with Multi-Vessel Percutaneous Coronary Intervention and Cardiogenic Shock Rajkumar Doshi, Rajiv Jauhar, Perwaiz Meraj https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OJ01-OJ02&id=10413 https://doi.org/10.7860/JCDR/2017/30784.10413 Rare Metastases from a Papillary Thyroid Carcinoma Deepak Rathinam, Nayha Handa, Manisha Jana https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=TJ01-&id=10448 https://doi.org/10.7860/JCDR/2017/26095.10448 Spontaneous Intracranial Hypotension Ankit Balani, Sandhya Shantilal Sarjare, Amit Kumar Dey, Anjani D Kumar, Sapna S Marda https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=TJ02-&id=10455 https://doi.org/10.7860/JCDR/2017/29360.10455 Pleomorphic Adenoma Masquerading as Odontogenic Lesion in the Maxilla Lavanya Mallika, Dominic Augustine, Parimala Sagar, Kavitha prasad, Roopa S Rao https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZJ01-ZJ02&id=10342 https://doi.org/10.7860/JCDR/2017/28993.10342 Giant Sialolith of the Submandibular Gland Toshinori Iwai, Toshiharu Izumi, Takashi Ohya, Senri Oguri, Iwai Tohnai https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZJ03-ZJ04&id=10391 https://doi.org/10.7860/JCDR/2017/29383.10391 Chronic Gastric Volvulus –Diagnosed on Endoscopy Vinoth Boopathy, Padhmini Balasubramanian https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PJ01-&id=10392 https://doi.org/10.7860/JCDR/2017/28547.10392 Challenges, Issues and Warnings from CLSI and EUCAST Working Group on Polymyxin Susceptibility Testing Yamuna Devi Bakthavatchalam, Balaji Veeraraghavan https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DL03-DL04&id=10375 https://doi.org/10.7860/JCDR/2017/27182.10375 Decline of Nosocomial Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infections in an Indian Tertiary Hospital: Hope for the Future Rojaleen Das, Sujeesh Sebastian, Arti Kapil, Benu Dhawan https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DL01-DL02&id=10344 https://doi.org/10.7860/JCDR/2017/27677.10344 Group B Streptococcus: An Unusual Cause for Urinary Tract Infection Bichitrananda Swain, Anindita Rakshit, Kundan Kumar Sahu, Nalinee Sahoo, Sarita Otta https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DL05-DL06&id=10449 https://doi.org/10.7860/JCDR/2017/26025.10449 Correspondence: Hordeum Vulgare in Neonatal Jaundice Anirban Mandal, Amitabh Singh, Puneet Kaur Sahi https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=SL01-SL02&id=10414 https://doi.org/10.7860/JCDR/2017/28385.10414 Correspondence: Knowledge Attitude and Perception of Sex Education among School Going Adolescents in Ambala District, Haryana, India: A Cross-Sectional Study Himel Mondal, Shaikat Mondal https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=IL01-IL02&id=10363 https://doi.org/10.7860/JCDR/2017/27304.10363 Correspondence: Knowledge, Attitude and Practice of Healthcare Managers to Medical Waste Management and Occupational Safety Practices: Findings from Southeast Nigeria Puneet Anand https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=IL03-&id=10364 https://doi.org/10.7860/JCDR/2017/27928.10364 Association between Style of Living and General Health in Suburban Women: A Cross-sectional Study in South East of Iran Samira Khayat, Mahrokh Dolatian, Ali Navidian, Amir Kasaeian, Zohreh Mahmoodi <b>Introduction:</b> In developing countries, suburban population is increasing. However, their health issues are rarely considered in studies. Socioeconomic and environmental factors in their neighbourhood can affect their lifestyle and health. Compared to men, women have fewer social resources and are more susceptible to an unfavourable environment, in general. <b>Aim:</b>To investigate the association between lifestyle and general health status in suburban women. <b>Materials and Methods:</b> This correlation, cross-sectional study assessed the lifestyle and general health, among suburban women living in Shirabad neighbourhood, Zahedan, Iran. Randomized one stage cluster sampling was used and 132 people participated in the study. Lifestyle Questionnaire (LSQ) and General Health Questionnaire-28 (GHQ-28) were used for data collection. For data analysis, descriptive statistical methods, Pearson’s correlation coefficient and multivariate regression analysis were performed. <b>Results:</b> Mean score of LSQ was 100.23±20.45 and mean GHQ-28 score was 28.46±16.41. There was a significant negative relationship between lifestyle and GHQ-28 total score (r=-0.619, p=0.01). Multivariate regression analysis showed that among predictor variables, education, sports and fitness and psychological health components had a significant relationship with GHQ-28 (p<0.001, p=0.01, p=0.002 respectively). <b>Conclusion:</b> This study demonstrated that suburban women have poor lifestyle and health status. Also, it showed a significant relationship between education, sports and fitness and psychological health components and health. As a result, implementation of programs to modify lifestyle especially in the field of sports and improving the educational level could be useful in promoting womens health. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=LC09-LC13&id=10403 https://doi.org/10.7860/JCDR/2017/28109.10403 Sonographic Estimation of Umbilical Cord Cross-section Area and its Reference Value in Normal Pregnancy Khizer Hussain Afroze, Subhash Lakshmi Prabha, V Chandrakala, M Deepak <b>Introduction:</b> The routine antenatal sonographic investigations of the umbilical cord are limited for assessment of number of umbilical vessels and doppler evaluation of umbilical blood flow. With the advancements of the sonographic techniques it is now possible to have more detailed evaluation of umbilical cord. There exist only few literatures on assessment of umbilical cord cross-sectional area during pregnancy to provide a baseline reference value. <b>Aim:</b> To establish the reference intervals of cross-sectional area of the umbilical cord during gestation and to find the correlation of umbilical cord cross-sectional area with the foetal anthropometric measurements. <b>Materials and Methods:</b> This study was conducted among 214 normal pregnant women who underwent a routine antenatal sonogram during gestational age ranging from 24-39 weeks in the Department of Radiodiagnosis. The umbilical cord cross-sectional area was calculated at a plane immediately close to the umbilical cord insertion to the foetal abdomen. The following foetal parameters were studied: Biparietal Diameters (BPD), Head Circumference (HC), Abdominal Circumference (AC), Femur Length (FL), and Estimated Foetal weight (EFW). The relationship between foetal anthropometric measurements and umbilical cord cross sectional area was assessed using spearman rank correlation. The 5th, 10th, 50th, 90th and 95th percentiles of umbilical cord cross-sectional area were calculated for each gestational groups using polynomial regression analysis. <b>Results:</b> A statistically significant correlation was observed between cross-sectional area of umbilical cord with both gestational age and foetal anthropometric parameters. The mean age of study population was 25.08±3.5 years and the mean gestational age was 34.42±2.5 weeks. We observed a strong correlation between head circumference and umbilical cord cross-sectional area. <b>Conclusion:</b> The mean umbilical cord cross-section area increases steadily with gestational age for up to 34 weeks and then it declines. Umbilical cord cross-sectional area can be easily measured and hence it can be included in routine antenatal sonographic evaluations to predict the perinatal outcome. Careful monitoring of the pregnancy is needed in case of abnormal cross-sectional area measurements. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=AC04-AC06&id=10415 https://doi.org/10.7860/JCDR/2017/30251.10415 Molecular and Phenotypic Identification and Speciation of Malassezia Yeasts Isolated from Egyptian Patients with Pityriasis Versicolor Walaa Othman Elshabrawy, Niveen Saudy, Manar Sallam <b>Introduction:</b> Pityriasis Versicolor (PV) is a common health problem caused by genus Malassezia, a lipophilic fungi found as a part of the normal flora of skin. Although PV is common in Egypt, there is little information regarding the Malassezia species distribution in PV patients to date. <b>Aim:</b> To spot a light on the distribution and clinico-epidemiological features of the Malassezia species in PV patients and healthy individuals that were established by conventional phenotypic and molecular techniques. <b>Materials and Methods:</b> A cross-sectional study including 167 individuals; 137 clinically suspected PV patients attending Mansoura University Hospitals, Egypt and 30 healthy control individuals, was carried out. Characterization of Malassezia species was performed phenotypically by conventional, culture-based methods and biochemical tests. Genomic DNA was extracted from isolated colonies for PCR amplification of the highly conserved 26S rDNA region with further species level identification by Restriction Fragment Length Polymorphism (RFLP) using Hha1 and BstC1 enzymes. The association of Malassezia species with epidemiological profile and clinical characteristics was studied. <b>Results:</b> A 94.2% of PV samples and 13.3% of control samples were positive by Potassium Hydroxide (KOH) while 71.5% of PV samples and 16.7% of control samples yielded growth in culture with high statistically significant differences (p=0.0001, for both methods). By phenotypic methods, only 75.5% of isolates from patients were identified as: M. furfur (51.4%), M. globosa, (29.7%), M. restricta (13.5%) and M. pachydermatis (5.4%) while by RFLP technique, six species were revealed: M. furfur (44.9%), M. globosa (24.5%), M. sympodialis (12.2 %), M. restricta (10.2%), M. obtusa (4.1%) and M. pachydermatis (4.1%). Most species were isolated from hypopigmented lesions of PV patients aged between 20-29 years. Neck and back were the most common affected sites. Only M. furfur (10%) and M. globosa (6.7%) were identified in healthy controls. <b>Conclusion:</b> M. furfur and M. globosa are the commonly encountered species in both healthy and diseased human skin although other species were identified in PV patients. PCR-RFLP method represents a considerably accurate technique in identification of different Malassezia species for better understanding of their effect on the clinico-epidemiological characterization of PV patients in Egypt. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DC12-DC17&id=10416 https://doi.org/10.7860/JCDR/2017/27747.10416 Comparative Study on the Vaginal Flora and Incidence of Asymptomatic Vaginosis among Healthy Women and in Women with Infertility Problems of Reproductive Age Geethavani Babu, Balamuru ganvelu Singaravelu, R Srikumar, Sreenivasalu V Reddy, Afraa kokan <b>Introduction:</b> The normal vaginal flora is highly complex, dominated by lactobacilli of doderlein that plays a vital role in maintaining the women’s health and inhibits other pathogenic microorganisms. Fluctuation in local environment or exposure to any exogenous and endogenous sources changes the vaginal flora over a period of time. Disruption of the vaginal ecosystem changes the microflora of the healthy vagina, altering the pH and predisposing to lower reproductive tract infections. The change in the microflora of the female genital tract by pathogenic organisms may ascend from vagina to upper genital tract and may cause infertility. Although several studies demonstrate a higher prevalence of bacterial vaginosis in infertile population. The role of vaginal microbiome in infertility is not clear and need to be explored further. <b>Aim:</b> To compare the vaginal flora and analyse the incidence of asymptomatic vaginosis among healthy women and in women with infertility problems. <b>Materials and Methods:</b> A cross-sectional study was conducted over a period of six months at Sri Lakshmi Narayana Medical College and Hospital Puducherry, India. A total of 200 high vaginal swabs were collected from Group 1 which included 84 healthy women with regular menstrual cycles without any gynaecological disorder and from Group 2, 116 women with infertility problems attending fertility clinic within the age group of 18 to 45 years. All swabs were subjected to routine aerobic, anaerobic and fungal culture. Saline wet mount was performed for the detection of clue cells and Trichomonas vaginalis, 10% KOH was performed for demonstration of budding yeast cells and pseudo hyphae, Gram’s staining to determine the presence of yeast cells, leucocytes and bacterial morphotypes. The smear was also graded using Nugent scoring system. <b>Results:</b> The vaginal flora of Group 1 was dominated by Lactobacillus (40, 27.8 %) followed by Micrococcus (22, 15.3 %), Enterococcus (16, 11.1%), Coagulase negative Staphylococcus spp. (12, 8.3%). Whereas in Group 2, the most dominant flora was Candida spp. (30, 26.5 %), Enterococcus (26, 23%) followed by Gram negative bacilli such as E. coli (16, 14.1 %). The percentage of Lactobacillus in Group 2 women with infertility problems was relatively low (4, 3.5%). Asymptomatic vaginosis was present in 32 (27.6 %) of Group 2 women compared to Group 1 women were only 6 (7.1%) had asymptomatic vaginosis. <b>Conclusion: </b>Women with infertility problems showed higher prevalence of asymptomatic vaginosis and abundance of Bacterial Vaginosis (BV) associated bacteria compared to healthy women. Hence, this study recommends the screening of vaginal flora as a routine for all women, especially in women undergoing infertility treatment and also suggests the importance of vaginal culture and sensitivity in routine practice. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DC18-DC22&id=10417 https://doi.org/10.7860/JCDR/2017/28296.10417 Patterns of Thyroid Cancers in Southeastern Nigeria: A 15 Year Histopathologic Review (2000-2014) Francis Ikechukwu Ukekwe, Daniel Bankole Olusina, Philip C.N. Okere <b> Introduction:</b> Thyroid Cancer (TC) continues to be the most common endocrine cancer with a worldwide increase in incidence over the last three decades. This trend has been reported in all continents except Africa, where detection is adjudged to be insufficient, making it imperative for us to re-evaluate the patterns in our environment. <b> Aim:</b> To determine the patterns of TCs in Southeastern Nigeria. <b> Materials and Methods:</b> This was a 15-year retrospective review of all thyroidectomy specimens received at the Department of Morbid Anatomy, University of Nigeria, Enugu Campus, Enugu, Nigeria. The age, sex and histologic subtypes of diagnosed TCs were analysed using Predictive Analytics Software (PASW) Statistics for Windows, Version 18 (Chicago: SPSS Inc.) and the results were expressed in descriptive statistics. <b> Results:</b> Sixty one cases of TCs were identified in this study constituting 10.8% of thyroid biopsies received at our centre during the period under review. There were 51 (83.6%) females and 10 (16.4%) males giving a ratio of 5.1:1, and a mean age of 45.9 years. The commonest histologic type was Papillary Thyroid Carcinoma (PTC) (42.6%), followed by; follicular thyroid carcinoma (37.7%), medullary thyroid carcinoma (4.9%), anaplastic carcinomas (3.3%), Non-Hodgkin lymphoma (1.6%) and metastatic squamous cell carcinoma (3.3%). Mixed papillary/ follicular carcinoma (4.9%) and mixed papillary/ anaplastic carcinoma (1.6%) were also identified. <b> Conclusion: </b>TC continues to predominate amongst females, occurring mainly in early middle age group in Southeastern Nigeria. PTC is now the commonest histologic type. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EC16-EC19&id=10418 https://doi.org/10.7860/JCDR/2017/26971.10418 Sutureless, Glue-less Conjunctival Autograft versus Conjunctival Autograft with Sutures for Primary, Advanced Pterygia: An Interventional Pilot study Tanie Natung, Avonuo Keditsu, Wakaru Shullai, Prasanta Kumar Goswami <b>Introduction:</b> Conjunctival Autograft (CAG) in pterygium surgery can be attached by sutures or fibrin glue or autologous in situ blood coagulum. Recurrence rate and other parameters related to pterygium surgery between CAG with sutures and autologous in situ blood coagulum have not been compared uniformly in advanced pterygia alone. <b>Aim:</b> To compare and evaluate the outcome of sutureless, glue-less CAG with autologous in situ blood coagulum versus CAG with sutures for primary, advanced pterygium. <b>Materials and Methods:</b> Thirty eyes of 30 patients with primary, nasal, advanced, Grade 3 pterygia (as per Tan et al’s., classification) were randomized into Group 1 (n=15) (sutureless, glue-less CAG with autologous in situ blood coagulum) and Group 2 (n=15) (conjunctival autograft with 8-0 vicryl sutures) as a pilot study. The outcome parameters evaluated were graft stability and symptoms of pain, foreign body sensation and watering at day 1, day 7, day 14, one month, three months and six months and recurrence at six months. <b>Results:</b> The mean age in the study was 44.77±13.74 years. Overall, Group 1 had better scores in symptom parameters than Group 2 (p<0.05). Graft stability was better in Group 2 (p<0.05). In Group 1, 3 (20%) patients had one side displacement and 3 (20%) patients had full displacement of graft. At six months, 4 (26.6%) patients in Group 1 had recurrence whereas in Group 2, 5 patients (33.3%) had recurrence (p=0.446). <b>Conclusion: </b>In primary, advanced pterygia, sutureless, glue-less pterygium surgery with autologous in situ blood coagulum was better in symptom scores but graft stability was better in the suture group. Sutureless, glue-less pterygium surgery with autologous in situ blood coagulum was unpredictable in graft stability. There was no statistically significant difference in the recurrence rate between the two groups. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=NC04-NC07&id=10419 https://doi.org/10.7860/JCDR/2017/23839.10419 Comparison of Central Corneal Thickness using Anterior Segment Optical Coherence Tomography Versus Ultrasound Pachymetry Prasanna Venkatesh Ramesh, Kirti Nath Jha, Krishnagopal Srikanth <b>Introduction:</b> Corneal thickness is an important and sensitive indicator of corneal health. It is useful in monitoring corneal diseases such as corneal oedema and keratoconus, and selecting patients for refractive surgery. Central Corneal Thickness (CCT) is a risk factor for Primary Open-Angle Glaucoma (POAG). <b>Aim: </b>To compare CCT using ultrasound pachymetry and Anterior Segment Optical Coherence Tomography (AS-OCT), and also to find out the reproducibility of AS–OCT readings for both central and pericentral corneal areas. <b>Materials and Methods: </b>This prospective cross-sectional study was conducted on 120 patients above 40 years of age, and with clinically normal corneas, who underwent CCT measurements by both ultrasound and AS-OCT. Both the eyes were analysed. Two measurements by AS-OCT and 25 measurements by ultrasound pachymetry were taken. The readings were averaged and compared by paired t-test. Repeatability of the OCT pachymetry map sector averages, was assessed by pooled standard deviation, obtained from the two measurements taken from each eye. <b>Results:</b> The CCT in right eye by OCT and ultrasound was 516.28±29.76 µm and 532.42±29.71 µm, respectively. The CCT in left eye by OCT and ultrasound was 515.82±29.88 µm and 532.36±29.83 µm, respectively. The difference in CCT measurement by AS-OCT and ultrasound was statistically significant (p<0.001); mean ultrasound CCT being 16.14 µm and 16.54 µm greater than the mean AS-OCT, CCT in right eye and left eye respectively. For AS-OCT, intra-session repeatability was measured. Repeatability of the OCT mapping was 0.01 µm to 1.6 µm and 0.01 µm to 1.9 µm in the right eye and left eye respectively. <b>Conclusion:</b> The CCT measurement by ultrasound pachymetry gives higher values compared to AS-OCT measurement. Hence, they cannot be interchangeably used in clinical practice. The AS-OCT provides highly repeatable pachymetry map measurements both centrally and pericentrally. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=NC08-NC11&id=10420 https://doi.org/10.7860/JCDR/2017/25595.10420 Eye Donation Awareness and Conversion Rate in Hospital Cornea Retrieval Programme in a Tertiary Hospital of Central India Bhavana Sharma, Ulka Shrivastava, Kavita Kumar, Rajendra Baghel, Farhana Khan, Shridhar Kulkarni <b>Introduction: </b>Corneal blindness accounts for 6–8 million blinds in the world. In India, it is estimated that there are approximately 6.8 million people who have vision less than 6/60 in at least one eye due to corneal diseases. <b>Aim:</b> This study was done to assess the awareness about eye donation amongst attendants of critically ill and deceased patients, their willingness to donate eyes, the efficacy of grief counselling by Eye Donation Counsellors (EDC), its impact on the conversion rate and the reasons for poor donation rate. <b>Materials and Methods:</b> This prospective hospital based study was done in 554 participants (guardians of critically ill and deceased subjects) to understand the awareness of eye donation. Factors related to willingness for eye donation that influenced conversion to actual donation were evaluated. Data was analysed with tests for statistical significance: Chi square test; p<0.05 at 95% confidence interval was set as significant. <b>Results:</b> Awareness index particularly in males <40 years, was found to be statistically more. In participants who were partially/fully aware of eye-donation, time taken for motivation remained less than 12 hours, which was statistically significant (Chi square=106. p<0.001). Subject who were aware, willing for donation in comparison to those who were unaware in a ratio of 2:1. Grief counsellors (57.5%) had the most influence among the causes that were facilitators of donation. <b>Conclusion:</b> Utilizing the services of eye donation counsellors is a promising way to motivate the guardians of deceased. Increasing the awareness in society, rendering simple assistances to next of kin and speeding the medico legal formalities can go a long way in increasing the conversion rate and hence actual donation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=NC12-NC15&id=10421 https://doi.org/10.7860/JCDR/2017/27287.10421 Role of Mid-Upper Arm Circumference for Determining Overweight and Obesity in Children and Adolescents Madhur Jaiswal, Rajesh Bansal, Ashok Agarwal <b>Introduction:</b> The prevalence of obesity in adolescents and children has risen to alarming levels globally and this has led to serious public health consequences. <b>Aim:</b> To assess the use of Mid-Upper Arm Circumference (MUAC) in the identification of overweight and obesity in North Indian children and adolescents. <b>Materials and Methods:</b> The study was conducted in Bareilly district of Uttar Pradesh, India, from October 2014 to November 2015. Anthropometric data (weight, height and MUAC) was collected from a cross-sectional sample of 875 children aged 5–14 year old. Receiver Operating Characteristic (ROC) curve analysis determined the validity of MUAC as a proxy for determining overweight and obesity. <b>Results: </b>Area Under the Curve (AUC) results were generally high (0.92 – 0.98). The accuracy level of MUAC for identifying obesity was high in both sexes and across age groups (overall AUC of 0.95, sensitivity of 95% and specificity of 90%). The MUAC cut-off to identify BMI defined obesity was 18.8 cm and 19.4 cm for boys and girls of 5-9 age group; 23 cm and 23.3 cm for boys and girls of 10-14 age group. <b>Conclusion:</b> MUAC may have potential for clinical and surveillance applications as an accurate yet simple and widely available indicator of overweight and obesity in children and adolescents in resourcepoor settings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=SC05-SC08&id=10422 https://doi.org/10.7860/JCDR/2017/27442.10422 Prevention of Parent to Child Transmission of HIV: Single Centre Experience of 14 years at Tertiary Care Hospital in Delhi, India AG Radhika, Sonia Chawla, Sruthi Bhaskaran <b>Introduction:</b> Prevention of Parent To Child Transmission (PPTCT) of HIV/AIDS is an integral component of AIDS control programme. PPTCT is an ongoing programme since last 15 years. <b>Aim:</b> The aim of the study was to evaluate the reduction in the burden of disease in newborn and infants by prevention of parents to child transmission of HIV/AIDS. <b>Materials and Methods:</b> This retrospective study was conducted at Department of Obstetrics and Gynecology in a tertiary care hospital of Delhi from May 2002 to May 2015. The data was collected from records of maternal details registered at PPTCT clinic as well as list of infants undergoing Early Infant Diagnosis (EID) recorded in the standard format as per instructions from National AIDS Control Organization (NACO) of India. The Programme performance was assessed against performance indicators stated by NACO, India. <b>Results:</b> Evaluation was done by dividing study period into two halves of seven years each. Out of 2,52,447 new antenatal case registration, overall, 43% received pretest of which, 91% were tested. Antenatal seropositivity rate varied from 0.1%-0.25%. Of 243 seropositive antenatal women 187 partners tested positive. While 25 women opted for MTP, 15 had still births. There were 17 neonatal deaths at 3-12 months attributable to respiratory infections and diarrheal diseases. Operative delivery rates declined from 50% to 31% over the years. Most women opted for breast feeding. The lost to follow up rate of newborns was quite high with details of only 43.5% being available at 18 months of infant’s age. A total of three infants tested HIV positive at 18 months of age. <b>Conclusion: </b>The study highlights the practical aspects of policy implementation and operational issues involved in low resource country. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QC04-QC07&id=10423 https://doi.org/10.7860/JCDR/2017/26432.10423 Effect of Ondansetron on Prevention of Ventilator Associated Pneumonia in Intensive Care Unit Patients in Kashani Hospital in 2013 Hossein Madineh, Omolbanin Rahimi, MohamadReza Abedin Zadeh, Majid Kabiri <b>Introduction:</b> Ventilator Associated Pneumonia (VAP) is the second most common infection with high mortality (24-50%). Ondansetron is a reliable and safe drug and it is currently used in the prevention of nausea and vomiting and has no side effects. </b>Aim:</b> The aim of the present study was to examine the effect of ondansetron on prevention of VAP in Intensive Care Unit (ICU) patients. <b>Materials and Methods: </b>The present study was a randomized clinical trial study (IRCT201406156480N6), carried out at Kashani Hospital, Iran, in 2013 on 80 patients aged from 15-65 years. The patients were randomly allocated to two groups: Case group (n=40) and Control group (n=40). The patients in first group were injected with 4 mg ondansetron, twice daily for five days. The patients of other group were injected with distilled water as placebo. The presence of VAP was assessed in the two groups. The collected data were analysed by SPSS software through Fisher-exact test. <b>Results:</b> Eleven (13.8%) patients were diagnosed with VAP. Among them, 9 (81.8%) patients were male and 2 (18.2%) patients were female. The incidence of VAP in Case group was 5 (12.5%) patients and in Control group was 6 (15%) patients (p>0.05). Results showed that VAP in Case group was less prevalent than that in the Control group, but this difference was not significant. <b>Conclusion:</b> The study did not find an association between ondansetron administration and reduction in VAP incidence; vomiting alone may not be leading to VAP, instead silent micro aspirations may be the cause of it. None of the factor such as age, sex, weight, smoking, drug addiction was found significantly related to VAP. Only variable found related was comorbidity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=UC05-UC08&id=10424 https://doi.org/10.7860/JCDR/2017/25859.10424 Alterations in the Reactive Oxygen Species in Peripheral Blood of Chronic Myeloid Leukaemia Patients from Northern India Sunita Jetly, Neha Verma, Kumar Naidu, Muneeb Ahmad Faiq, Tulika Seth, Daman Saluja <b> Introduction:</b> There is a significant difference in the Reactive Oxygen Species (ROS) levels of Chronic Myeloid Leukaemia (CML) patients before and during treatment with Tyrosine Kinase Inhibitors (TKIs). This is because high ROS levels support oncogenic phenotype of CML by inducing proliferation pathway and accumulation of further genetic mutations. Often the measurement is done on WBC or serum for ascertaining one type of ROS species, but measurement of global ROS in fresh whole blood will give more accurate estimation of ROS. <b> Aim:</b> To measure global ROS in peripheral blood of CML patients. <b> Materials and Methods:</b> A first case control study was undertaken to measure ROS in peripheral blood of CML patients from Northern India. CML patients on TKIs (n=40 on imatinib herein called treated) and untreated (n=17, who were not on any TKIs or alternative medicine, called as treatment naive) and 52 healthy controls were also enrolled. Chemiluminescent assay was carried out using luminol as signal enhancer in 400 µl of blood to measure ROS. The chemiluminescence was measured as Relative Light Units (RLU)/sec/104 WBC. Data was presented in terms of mean±SE or geometric mean (95% Confidence Interval) for continuous variables and percentage for categorical variables. Groups were compared using two sample t-test for continuous variables and chi-square test for categorical variables. <b> Results:</b> The WBC profile and ROS levels of patients taking TKIs were quite similar and showed no significant difference (p<0.999) compared to healthy controls. In contrast, significant increase was observed in the ROS levels of CML patients not on TKIs (untreated) compared to patients under treatment (p<0.029) and healthy controls (p<0.007). We also observed that the absolute ROS values and WBC counts were higher in untreated patients compared to patients on TKIs and healthy controls, even though mean ROS value was less. <b> Conclusion: </b> To ascertain the alterations in ROS levels of CML patients before and during treatment with TKIs, it is better to measure global ROS in fresh whole blood by chemiluminescent method using luminol. Luminol assay is a quick, easy and inexpensive method to measure global ROS. Patient under treatment with TKIs show significant decrease in ROS levels almost similar to the levels measured in healthy controls yet the mechanisms by which this decrease occurs needs to be elucidated. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=XC01-XC05&id=10425 https://doi.org/10.7860/JCDR/2017/28565.10425 Role of Functional Magnetic Resonance Imaging Derived Parameters as Imaging Biomarkers and Correlation with Clinicopathological Features in Carcinoma of Uterine Cervix Ramireddy Jeba Karunya, Putta Tharani, Subhashini John, Ramani Manoj Kumar, Saikat Das <b> Introduction:</b> Magnetic Resonance Imaging (MRI) is emerging as a powerful tool in the evaluation and management of cervical cancer. The role of Diffusion Weighted Imaging (DWI) with Apparent Diffusion Coefficient (ADC) as a non-invasive imaging biomarker is promising in characterization of the tumour and prediction of response. <b> Aim:</b> The aim of this study was to evaluate the role of conventional MRI and diffusion weighted MRI in predicting clinicopathological prognostic factors. <b> Materials and Methods:</b> This was a retrospective study. The data of 100 cervical cancer patients who had MRI with DWI was retrieved from the database and analysed. Clinico pathological details were collected from the computerized hospital information system. SPSS version 15.0 was used for statistical analysis. <b> Results: </b> The mean tumour dimensions on MRI in x, y and z axes were 43.04 mm (±13.93, range: 17-85), 37.05mm (±11.83, range: 9-80) and 39.63 mm (±14.81, range: 14 –76). The mean T2W MRI based tumour volume (TV) was 48.18 (±34.3, range: 7–206) and on DWI images was 36.68(±33.72, range: 2.5–200). The mean ADC value in patients with squamous cell carcinoma was 0.694 (±0.125, n=88), adenocarcinoma was 0.989 (±0.309, n=6), adenosquamous was 0.894 (±0.324, n=4). There was statistical significant difference in mean ADC between squamous vs. non squamous histology (p = 0.02). The mean ADC values of well differentiated, moderately differentiated, and poorly differentiated tumours were 0.841(±0.227, n= 26), 0.729 (±0.125, n=28), 0.648 (±0.099, n=46) respectively. There was significant statistical difference of mean ADC between well differentiated, moderately differentiated (p=0.020) and poorly differentiated tumours (p=0.0001). Difference between the mean ADC values between the node positive and node negative disease was statistically significant (p=0.0001). There was no correlation between the tumour volumes on T2W and DWI images and ADC values. Sixteen patients had residual/recurrent disease at a median follow up of 12 months (range: 3-59 months). The mean ADC values in this group was 0.71 (n=16) and was not significantly different from the disease free group (mean ADC =0.72, n=74). <b> Conclusion:</b> Higher ADC values are associated with favourable histology and differentiation. Adenocarcinomas have higher ADC values followed by adenosquamous followed by squamous cell carcinomas. Well differentiated tumours had higher ADC values than moderately followed by poorly differentiated tumours. DWI with ADC have a potential role as an imaging biomarker for prognostication and needs further studies for routine clinical applications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=XC06-XC11&id=10426 https://doi.org/10.7860/JCDR/2017/29165.10426 Clinicopathological Study of Eosinophilic Cholecystitis: Five Year Single Institution Experience Sabina Khan, Mohammad Jaseem Hassan, Zeeba Shamim Jairajpuri, Sujata Jetley, Musharraf Husain <b> Introduction:</b> Gallbladder diseases are very common in Northern India, most common of which is Chronic Cholecystitis. Rarely, histopathological diagnosis of Eosinophilic Cholecystitis (EC) is given when transmural cellular infiltrate consists of more than 90% eosinophils. <b> Aim:</b> To determine the prevalence and clinicopathological profile of eosinophilic cholecystitis at a tertiary care hospital of New Delhi. <b> Materials and Methods:</b> This was a retrospective clinicopathological study done on twenty two cases of eosinophilic cholecystitis over a period of five years from January 2011- December 2015. In cases diagnosed histopathologically as eosinophilic cholecystitis, clinical details were obtained from hospital records and slides were retrieved. Various histologic features, pattern of the inflammatory infiltrate and association of EC with other medical diseases, drugs and allergic states were evaluated. <b> Results:</b> Out of a total of 1370 cholecystectomy specimens received during five year period, Eosinophilic cholecystitis was diagnosed in 22 (1.6%) of the specimens. Clinically, seven of these patients had a clinical diagnosis of acute cholecystitis. Patient’s age ranged from 25-64 years and male to female ratio was 1:2.7. Most common symptom reported was abdominal pain. Most of the cases showed gallstones radiologically (90%) while only two cases showed peripheral eosinophilia (9%). Histologically, mucosal and muscular eosinophilic infiltrate was seen in 72.6% of the cases. No association with drug therapy, allergies or other pre-existing medical conditions was noted. <b> Conclusion:</b> EC is a relatively uncommon entity in which histopathology remains the main stay of diagnosis. Although the presentation may be similar to general cholecystitis, if a postoperative histopathological diagnosis of EC is made, then the patient must be investigated thoroughly to rule out other associated disease conditions, which may have a worse prognosis than cholecystitis itself. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EC20-EC23&id=10427 https://doi.org/10.7860/JCDR/2017/27886.10427 Anti-Alzheimer Properties of Probiotic, Lactobacillus plantarum MTCC 1325 in Alzheimer’s Disease induced Albino Rats Mallikarjuna Nimgampalle, Yellamma Kuna <b> Introduction:</b> Alzheimer’s disease is a type of dementia, and till now there is no suitable drug available for the complete cure of this disease. Now-a-days Probiotics, Lactobacillus strains play a therapeutic role in cognitive disorders through Gut-Brain Axis communication. <b> Aim:</b> The present study was aimed to evaluate the anti-Alzheimer properties of Lactobacillus plantarum MTCC1325 against D-Galactose-induced Alzheimer’s disease in albino rats. <b> Materials and Methods:</b> Healthy rats (48) of wistar strain were divided into four groups viz., Group-I: control rats received saline, Group-II: rats received intraperitoneal injection of D-Galactose (120 mg/kg body weight) throughout experiment, Group-III: initially animals were subjected to D-Galactose injection for six weeks, then followed by simultaneously received both D-Galactose and L. plantarum MTCC1325 (12×108 CFU/ml; 10 ml/kg body weight) for 60 days and Group-IV: rats which were orally administered only with Lactobacillus plantarum MTCC1325 for 60 days. During the experimentation, both morphometric and behavioural aspects were studied. Later we have examined histopathological changes and estimated cholinergic levels in selected brain regions of all experimental groups of rats including control on selected days. <b> Results:</b> Morphometric, behavioural changes, ACh levels were significantly decreased and pathological hallmarks such as amyloid plaques and tangles were also observed in AD model group. Treatment of AD-group with L. plantarum MTCC1325 for 60 days, not only ameliorated cognition deficits but also restored ACh and the histopathological features to control group. However, no significant effects have been observed in the group treated with L. plantarum alone. <b> Conclusion: </b>The study revealed that, L. plantarum MTCC1325 might have anti-Alzheimer properties against D-Galactose induced Alzheimer’s disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=KC01-KC05&id=10428 https://doi.org/10.7860/JCDR/2017/26106.10428 Quality of Life, Mental Health and Educational Stress of High School Students in the Northeast of Thailand Supat Assana, Wongsa Laohasiriwong, Poonsri Rangseekajee <b>Introduction:</b> Majority of high school students in Thailand aim to study at universities. Therefore, they spend a lot of time studying in both classrooms and tutorial classes, that could cause stress, health problems and deteriorate their Quality Of Life (QOL). However, there has been no study on these issues in Thai context. <b>Aim:</b> To describe the status of QOL, mental health, educational stress, well-being and determine factors associated with QOL among high school students in the Northeast of Thailand. <b>Materials and Methods:</b> This cross-sectional study was conducted in the Northeast of Thailand among 1,112 students of grade 10th, 11th and 12th. Multistage random sampling was used to select high schools in 5 provinces. A self-administered questionnaire was used to assess QOL, educational stress, anxiety, depression and well-being. The association between the covariates was observed by using Generalized Linear Mixed (logistic regression) Model (GLMM). <b>Results:</b> The prevalence of high level of QOL was 36% (95%CI: 32.30 to 41.69); whereas, 26.18% (95% CI: 16.72 to 35.63) had high level of educational stress and 16.41% (95% CI: 2.20 to 30.71) had severe anxiety. Prevalence of depression was 18.55% (95%CI: 9.86 to 27.23) and low level of well-being was 13.41% (95% CI: 0.18 to 27.14). The factors significantly associated with high QOL were; not having depression (Adj. OR= 3.07; 95%CI: (2.23 to 4.22); p<0.001), had high level of general well-being (Adj. OR=3.19; 95% CI:1.99 to 5.09; p<0.001) and had low to moderate level of anxiety (OR=1.60; 95%CI:1.01 to 2.67). <b>Conclusion: </b>Most of the high school students had low to moderate levels of QOL, educational stress and anxiety. Depression, anxiety and general well-being had influences on QOL of high school students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=VC01-VC06&id=10429 https://doi.org/10.7860/JCDR/2017/29209.10429 Burden of Proteinuria and Risk Factors of Chronic Kidney Disease among Adult Population in Urban Puducherry, India Manan Jhawar, Venkatachalam Jayaseelan, Ramya Selvaraj <b>Introduction:</b> In the recent times, Chronic Kidney Diseases (CKDs) are emerging as a serious problem all over the world along with diabetes mellitus and hypertension. The presence of proteinuria is considered as an indicator of increased risk of progressive kidney diseases. <b>Aim:</b> To determine the prevalence of proteinuria among an adult population of a tertiary care institute of Puducherry, India. <b>Materials and Methods:</b> A cross-sectional study was carried out in the field practice areas of an urban health centre of a tertiary care institute, in Puducherry, India. A total of 215 study respondents were selected by systematic random sampling. All adults aged above 18 years who were residing for at least a year in Puducherry were included in the study. The study period was from July 2015 to October 2015. All the categorical variables were described as proportions. Chi square test was done to compare between two proportions. Univariate analysis was done to estimate the Odds Ratio (OR) with 95% CI. <b>Results:</b> The mean age of the study participants was 38.5±12.8 years. Majority, 145 (67.4%) of the study participants were females. The prevalence of proteinuria was found to be 9.3%. While 4.7% and 11.2% of participants used tobacco and alcohol respectively, 13.5% and 27.9% had diabetes mellitus and hypertension respectively. Elderly age, diabetes mellitus and hypertension were found to be statistically significant predictors for proteinuria. <b>Conclusion:</b> The prevalence of proteinuria was high in our study population (9.3%) and hypertension and diabetes mellitus were also found to be risk factors for CKD. Routine screening among the general population for proteinuria in community-based settings might be an effective step to bring down the rate of progression of CKD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=LC14-LC16&id=10430 https://doi.org/10.7860/JCDR/2017/24492.10430 A Functional Scoring System Based on Salivary Gland Scintigraphy for Evaluating Salivary Gland Dysfunction Secondary to 131I therapy in Patients with Differentiated Thyroid Carcinoma Yasuhiro Maruoka, Shingo Baba, Takuro Isoda, Yoshiyuki Kitamura,Koichiro Abe, Masayuki Sasaki, Horoshi Honda <b>Introduction:</b> Radioiodine therapy with 131I (131I therapy) after total or near-total thyroidectomy has been established as an effective treatment for Differentiated Thyroid Carcinoma (DTC), but can induce dry mouth symptoms by salivary gland damage and impair the patients’ quality of life. <b>Aim:</b> To propose a functional scoring system based on Salivary Gland Scintigraphy (SGS) findings that evaluates development of salivary gland dysfunction secondary to 131I therapy in patients with DTC. <b>Materials and Methods:</b> This retrospective study evaluated the records of 279 DTC patients who underwent SGS after one or more round(s) of 131I therapy, using 370 MBqof 99mTc-pertechnetate. The SGS results were assessed using a novel functional scoring system in the Parotid Glands (PGs) and Submandibular Glands (SMGs) according to visual evaluations based on a three-point uptake score, Washout Rate (%WR) score after lemon-juice stimulation, and functional score. The scores were compared among pre treatment, low-dose (<10 GBq), and high-dose (>10 GBq) groups and among pre treatment, symptom-positive, and symptom-negative groups. Risk factors for dry mouth were analyzed by univariate and multivariate logistic regression analyses. <b>Results:</b> Dry mouth symptoms developed in 15.4% of the DTC patients after 131I therapy. The three-point uptake, %WR, and functional scores in both the PG and SMG were statistically significant between low-dose and high-dose groups, and between symptom-positive and symptom-negative groups. The PG/SMG functional scores were independent risk factors for dry mouth (odds ratio, 0.03 and 0.0007 respectively). <b>Conclusion: </b>SGS-based PG and SMG functional scores were effective biomarkers to objectively evaluate salivary gland dysfunction, with the high strength of association with dry mouth symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=TC23-TC28&id=10431 https://doi.org/10.7860/JCDR/2017/27340.10431 Haemostatic Profile of Patients with Chronic Liver Disease- its Correlation with Severity and Outcome Varnika Rai, Neeraj Dhameja, Sandip Kumar, Jyoti Shukla, Rajeev Singh, Vinod Kumar Dixit <b>Introduction:</b> The liver plays an important role in the haemostatic system as it synthesizes the majority of coagulation factors and fibrinolytic proteins. <b>Aim:</b> The present study was planned to determine the range of haemostatic defects in patients of chronic liver diseases. <b>Materials and Methods: </b>Test performed included Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), Thrombin Time (TT), Fibrinogen, Protein C, D Dimer and platelet count. Comparisons between groups frequencies and groups means were made using Chi-square test and Student’s t-test, respectively. <b>Results:</b> In cirrhosis group PT, aPTT, TT and D Dimer level were significantly increased compared to Chronic Hepatitis (CH) and control group (p<0.001 for all comparisons). Serum fibrinogen, Protein C and platelet count were significantly reduced in cirrhosis patients compared to CH and control group. (p<0.001 for all comparisons). All studied coagulation parameters were within normal limit in CH group. However, statistically significant difference was found in protein C and mean platelet count in CH group compared to control (p=0.03 and p<0.001 respectively). No evidence of bleeding or thrombosis was present in study group. <b>Conclusion:</b> In cirrhosis patients severe derangement in both anti and procoagulant factors occurs. Haemostatic profile in chronic hepatitis patient remains within normal limits. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EC24-EC26&id=10451 https://doi.org/10.7860/JCDR/2017/24975.10451 Nurses' Awareness about Principles of Airway Suctioning Mohammad Heidari, Sara Shahbazi <b>Introduction:</b> Airway suctioning is one of the most common interventions for patients with respiratory disorders and having adequate knowledge in implementing this technique is quite crucial for nurses. <b>Aim:</b> To assess the nurses' awareness about principles of airway suctioning. <b>Materials and Methods:</b> This study was a cross-sectional study done on 85 staff nurses’ in Vali-Asr hospital. Sampling was based on census data collection. A researcher made questionnaire was used for assessment of nurses' awareness about the principles of airway suctioning. The validity and reliability (Cronbach's alpha=0.78) of the questionnaire have been examined and proved. The level of nurses’ awareness about airway suctioning was measured based on the questionnaire that includes demographic and specialty information in the form of eight questions of 3-selection-item. The maximum and minimum score of knowledge ranged between 0-8. The data obtained was statistically analysed using SPSS software Version 16.0 and was analysed using descriptive statistics and Pearson correlation coefficient. <b>Results:</b> The results reveal that the nurses' awareness about principles of airway suctioning was average. There was a significant association between knowledge and gender of nurses (p<0.05) which reveals that the awareness of women about the principles of airway suctioning was more than men. <b>Conclusion:</b> The results indicate that nurses' awareness of airway suctioning technique was in an average state. Considering the importance of this technique and the effects this technique has on the patients' haemodynamic status, we recommend in-service courses. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=LC17-LC19&id=10452 https://doi.org/10.7860/JCDR/2017/25550.10452 Single Loading Low Dose MgSo4 Regimen: A Simple, Safe and Effective Alternative to Pritchard’s Regimen for Indian Women Tripti Nagaria, Subarna Mitra, Sashi Prabha Banjare <b>Introduction:</b> Magnesium sulphate is the anticonvulsant of choice in prevention and control of eclamptic convulsions. Pritchard’s regimen is the most popular time-tested regimen used. However, owing to concerns of toxicity, several low dose regimens have been introduced considering the lower body mass index of Asian women. <b>Aim: </b>To compare the efficacy and safety of a single loading low dose MgSo4 regimen with the Pritchard’s regimen. <b>Materials and Methods:</b> Seventy cases of eclampsia and imminent eclampsia were allocated to the control and study groups each. The former received the Pritchard’s regimen while the latter was treated with single loading low dose of magnesium sulphate. Recurrent convulsion rates, maternal and perinatal outcomes of both regimens were evaluated and compared using unpaired t-test and Chi-square test for continuous and categorical variables, respectively. <b>Results:</b> The mean serum magnesium levels were significantly lower in the study group at 30 minutes and 4 hours of initiation of therapy. The single loading low dose regimen was equally efficacious in prevention (96.6% vs 100%, p = 0.934) and control (97.6% vs 97.8%, p = 0.358) of eclamptic fits as compared to the Pritchard’s regimen. The feto-maternal outcomes were also comparable. <b>Conclusion:</b> The single loading low dose MgSo4 regimen is an effective and safe alternative to the Pritchard’s regimen, especially tailored to the small built Indian women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QC08-QC12&id=10453 https://doi.org/10.7860/JCDR/2017/26635.10453 Oxidative Stress Markers in Tuberculosis and HIV/TB Co-Infection Shreewardhan Haribhau Rajopadhye, Sandeepan R. Mukherjee, Abhay S. Chowdhary, Sucheta P. Dandekar <b>Introduction:</b> Dysfunction of redox homeostasis has been implicated in many pathological conditions. An imbalance of pro- and anti-oxidants have been observed in Tuberculosis (TB) and its co-morbidities especially HIV/AIDS. The pro inflammatory milieu in either condition aggravates the physiological balance of the redox mechanisms. The present study therefore focuses on assessing the redox status of patients suffering from TB and HIV-TB co-infection. <b>Aim:</b> To assess the oxidative stress markers in the HIV-TB and TB study cohort. <b>Materials and Methods:</b> The current prospective study was conducted in Haffkine Institute, Parel, Maharashtra, India, during January 2013 to December 2015. Blood samples from 50 patients each suffering from active TB and HIV-TB co-infection were collected from Seth G.S.Medical College and KEM Hospital Mumbai and Group of Tuberculosis Hospital, Sewree Mumbai. Samples were processed and the experiments were carried out at the Department of Biochemistry, Haffkine Institute. Samples from 50 healthy volunteers were used as controls. Serum was assessed for pro-oxidant markers such as Nitric Oxide (NO), Thiobarbituric Acid Reactive Species (TBARS), C-Reactive Protein (CRP), superoxide anion. Antioxidant markers such as catalase and Superoxide Dismutase (SOD) were assessed. Total serum protein, was also assessed. <b>Results:</b> Among the pro-oxidants, serum NO levels were decreased in TB group while no change was seen in HIV-TB group. TBARS and CRP levels showed significant increase in both groups; superoxide anion increased significantly in HIV-TB group. Catalase levels showed decreased activities in TB group. SOD activity significantly increased in HIV-TB but not in TB group. The total serum proteins were significantly increased in HIV-TB and TB groups. The values of Control cohort were with the normal reference ranges. <b>Conclusion:</b> In the present study, we found the presence of oxidative stress to be profound in the TB and HIV-TB co-infection population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=BC24-BC28&id=10473 https://doi.org/10.7860/JCDR/2017/28478.10473 Linezolid and Vancomycin Resistant Enterococci: A Therapeutic Problem Garima Yadav, Bhaskar Thakuria, Molly Madan, Vivek Agwan, Anita Pandey <b>Introduction:</b> Enterococci are recognized as opportunistic pathogens, as well as commensals in both humans and animals. They are an important cause of nosocomial infections, difficult to treat, as the organism have intrinsic and acquired resistance to many antibiotics. <b>Aim: </b>To isolate and identify clinically relevant Enterococcus up to species level from all the clinical samples processed in the microbiology laboratory and also to study their resistance pattern. <b>Materials and Methods: </b>A prospective study was carried out for a period of one year from May 2014 to April 2015 at the Department of Microbiology, Subharti Medical College, Meerut, Uttar Pradesh, India. A total of 200 isolates of Enterococcus species from 15342 clinical samples obtained from IPD/OPD patients irrespective of age, having suspicion of bacterial infection were processed in the microbiology laboratory. Identification was done with standard biochemical methods. Antibiotic susceptibility testing was done on Muller Hilton agar plate by Kirby Bauer disc diffusion method. High-Level Gentamycin Resistance (HLGR) and High-Level Streptomycin Resistance (HLSR) were further confirmed by Agar dilution method and Broth microdilution method. Vancomycin and linezolid resistance was further confirmed by Agar dilution method and MIC was calculated by using VITEK 2, Biomerieux. All methodology was followed as per Clinical and Laboratory Standards Institute (CLSI) M100-S 24, 2014 guidelines. <b>Results:</b> E. faecalis (n=169, 84.5%) was the predominant species isolated, followed by E. faecium (n=27, 13.5%) and E. casseliflavus (n=4, 2%). A total of 25 (12.5%) isolates were HLGR, 13 (6.5%) isolates were HLSR and 62 (31%) isolates were HLGR+HLSR. Vancomycin resistance was found in 14 (7%) isolates of which 11 (78.5%) were Van A and 3 (21.4%) were Van B, detected phenotypically as per relative MIC of vancomycin and teicoplanin. Linezolid resistance was seen in 4 (2%) of isolates which were vancomycin as well as high-level gentamycin and high-level streptomycin resistant. <b>Conclusion:</b> Isolation of Enterococcus species resistant to most of the higher antibiotics like vancomycin and linezolid, with high prevalence of High-Level Aminoglycoside Resistance (HLAR), from hospitalized patients is a major concern as such isolates have limited or no therapeutic option. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=GC07-GC11&id=10474 https://doi.org/10.7860/JCDR/2017/27260.10474 Immunohistochemical Study of ER, PR, Ki67 and p53 in Endometrial Hyperplasias and Endometrial Carcinomas Nayar Musfera Abdul Masjeed, Siddhi Gaurish Sinai Khandeparkar, Avinash R Joshi, Maithili Mandar Kulkarni, Nidhi Pandya <b>Introduction:</b> Endometrial carcinoma is the second most common gynecologic malignancy in the developing countries. Endometrial Hyperplasia (EH) is a precursor to Endometrioid Adenocarcinoma (EMAC). A 23% of Atypical Hyperplasias (AEH) progress to EMAC. <b>Aim:</b> This study was undertaken to analyse ER, PR, p53 and Ki67 in EH and endometrial carcinomas and attempt correlation with clinical and histopathological findings. <b>Materials and Methods:</b> The present study was conducted over a period of seven years. A manual tissue array technique was employed for cases subjected to IHC. Analysis of the expression of IHC markers (ER, PR, p53, Ki67) in EH and endometrial carcinoma was attempted. Results were subjected to statistical analysis. The results were considered to be significant when the p-value <0.05. <b>Results:</b> A total of 85 cases of EH and 28 cases of endometrial carcinoma were included in the study. EH (75.22%) was more common than endometrial carcinoma (24.78%). Among 28 cases of endometrial carcinomas, EMAC was most common (78.57%) followed by Clear Cell Carcinoma (CCC) (14.28%), and Uterine Serous Carcinoma (USC) (7.14%). ER and PR expression decreased as lesion progressed from EH to EMAC. ER and PR expression was negative in USC and CCC. The p53 expression and mean Ki67 labelling index increased as the severity of lesion increased from EH to endometrial carcinoma. <b>Conclusion: </b>The ER, PR, p53, Ki67 IHC markers may be included in every case of endometrial carcinoma to understand the tumour biological behavior which in turn could help individual treatment strategies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EC31-EC34&id=10475 https://doi.org/10.7860/JCDR/2017/28750.10475 Prevalence of Refractive Errors and Number Needed to Screen among Rural High School Children in Southern India: A Cross-sectional Study Deepika Dorothy John, Padma Paul, Evon Selina Kujur, Sarada David, Smitha Jasper, Jayaprakash Muliyil <b> Introduction:</b> Avoidable blindness is mainly due to uncorrected refractive errors (URE). School Eye Screening (SES) can be used as an initiative to address this issue. <b> Aim: </b> To determine prevalence of URE and Number Needed to Screen (NNS) to find one child with low vision or blindness from URE among rural school children. <b> Materials and Methods:</b> A cross-sectional study was performed in 22 government schools with sixth to ninth grades in Kaniyambadi block of Vellore District of Tamil Nadu, India. There were 4739 children on the rolls. Among children present, all those identified to have a visual deficit in either eye, using a single line 20/40 Snellen’s optotype E chart at 6 m, were referred to the hospital for confirmatory evaluation. Blindness (uncorrected) was defined as inability to see 20/200 in the better eye. In two of these schools, visual deficits were validated through a second school based examination by a clinician. <b> Results: </b> Of the 4739 children on rolls, 601 were absent; all 4138 (87.3%) who were present underwent screening; 2.3% (98) {95% Confidence Interval (CI) 1.8 to 2.8} failed the screening test in at least one eye and were referred for examination. Only 28 (28.6%) of 98 children who were referred came for examination to the hospital. In the 2 of the 22 schools where the visual deficit was validated, there were no false positives. The prevalence of refractive error in these two schools was 2.2% (95% CI 1.7 – 2.7). NNS to detect one child with low vision or blindness from URE was 147. <b> Conclusion:</b> Magnitude of refractive error, low NNS, low response to referral necessitates complete care at school and hence a relook at the current SES program. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=NC16-NC19&id=10476 https://doi.org/10.7860/JCDR/2017/25388.10476 Does Selection and Management of Patients with Chronic Kidney Disease In Government Run and Private Hospitals Differ? Anoop Gowda, Aswini Raghavendra Dutt, Shobith Bangera <b>Introduction:</b> Globally, incidence of Chronic Kidney Disease (CKD) is rapidly rising with huge burden on the life expectancy of the patients. Regular haemodialysis improves the quality of life in these patients. They get treatment at either government run or private sector hospitals. A difference in disease pattern, comorbidity, patient management and number of access failures can be observed in these set ups. <b>Aim:</b> The present study was carried out to find out selection, management and disease pattern of CKD patients admitted for dialysis in government run and private hospital. <b>Materials and Methods:</b> A cross-sectional study on patients (18–90 years) admitted and undergoing dialysis at government run (N=129) and private hospital (N=182) was undertaken in Karnataka, India. Parameters like comorbidity (diabetes), number of dialysis per week, number of access failures, and follow up visits were compared between these patients. Chi-squared test was used to compare the data. All tests were two-tailed and p< 0.05 was considered as significant. <b>Results:</b> More number of younger patients and associated comorbidity, were seen in patients admitted in government run hospital (p<0.001), with no gender bias in selection of patients for dialysis between the two hospitals. Similarly, follow-ups with nephrologist, number of dialysis done per week and erythropoietin supplements administered were significantly more among private hospital patients (p<0.001). Number of dialysis sessions and mean haemoglobin level was less in government run hospital patients, as compared to those in private hospital. No statistical difference was seen with access failure in both these setups. <b>Conclusion:</b> No bias in management of CKD patient was seen among the two sets of hospitals though available facilities seemed to vary. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OC25-OC28&id=10477 https://doi.org/10.7860/JCDR/2017/29071.10477 Comparing Early Outcomes using Non Absorbable Polypropylene Mesh and Partially Absorbable Composite Mesh through Laparoscopic Transabdominal Preperitoneal Repair of Inguinal Hernia Tarun Kalra, Rajesh Kumar Soni, Ajit Sinha <b> Introduction:</b> Laparoscopic hernia repair is in vogue in the present era. Both the operating surgeon and the patient are concerned about the postoperative inguinodynia which has now replaced recurrence as the predominant factor affecting quality of life. <b> Aim:</b> Our study aimed to compare early postoperative outcomes with the standard non absorbablepolypropylene and the newer partially absorbable composite meshes. <b> Materials and Methods: </b> A total of 60 patients with unilateral uncomplicated inguinal hernia were included in the study and randomly divided into two groups, one each for one kind of mesh. Patients underwent Transabdominal Preperitoneal (TAPP) repair of hernia after taking written informed consent. Follow up was done in the immediate postoperative period and at three months. Patients were compared for inguinodynia, sensation of heaviness, seroma/haematoma formation and return to work activities. Standard statistical tests were applied and a p-value <0.05 was taken as significant. <b> Results:</b> Patients in the composite group complain of significantly less pain as compared to those with the non absorbable mesh at three months (p-value 0.003). They also report less sensation of heaviness over the groin area. However, incidence of seroma formation was higher in the composite group (20%) when compared to the non absorbable group (6.67%). An earlier return to work was seen in the patients with composite mesh. <b> Conclusion:</b> Use of composite mesh in TAPP is associated with better patient outcomes in terms of less postoperative pain and an earlier return to work https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PC13-PC16&id=10478 https://doi.org/10.7860/JCDR/2017/27982.10478 Postpartum Depression in Women: A Risk Factor Analysis Farheen Zaidi, Aruna Nigam, Ruby Anjum, Rashmi Agarwalla <b>Introduction:</b> Postpartum Depression (PPD) is a known entity affecting not only the women but the whole family. It affects women more harshly and chronically due to their increased stress sensitivity, maladaptive coping strategies and multiple social roles in the community. <b>Aim:</b> To estimate the commonly associated risk factors of PPD among the women coming to a tertiary hospital in New Delhi, India. <b>Materials and Methods:</b> It was a longitudinal study conducted at the antenatal clinic for a period of one year. Total 260 women were screened at > 36 weeks of gestation, of which 149 postnatal women completed the questionnaire for PPD at six weeks of their delivery. The inform consent, demographical data and obstetrical details from each participant was taken before commencing the screening. Various risk factors and their association were determined by odds-ratio and significant association was accepted at < 5% level of error. In order to identify the most important confounding variables, logistic regression analysis was used. <b>Results: </b>PPD is a common mental health problem seen among the postnatal women as it was found in 12.75% (19 out of 149) of subjects at six weeks of their delivery. Moreover, it has significant association with the young maternal age (p-value=0.040), birth of the female child (p-value=0.015), previous stressful life events (p-value= 0.003), low self-esteem and feeling of loneliness (p-value=0.007). <b>Conclusion: </b>This study provides important information regarding the risk factors associated with development of PPD in this region of India. Female sex of the new born and the younger age play an important role in the development of PPD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QC13-QC16&id=10479 https://doi.org/10.7860/JCDR/2017/25480.10479 Therapeutic Plasma Exchange - An Emerging Treatment Modality in Patients with Neurologic and Non-Neurologic Diseases Shreedevi S Bobati, Karkal Ravishankar Naik <b>Introduction:</b> Therapeutic Plasma Exchange (TPE) is a procedure in which the patient’s blood is passed through an apheresis machine, where the filtered plasma is removed and discarded with reinfusion of red blood cells along with replacement fluid such as plasma or albumin in to the patient. We present our experience with TPE in treatment of various neurologic and non-neurologic diseases. <b>Aim:</b> To evaluate TPE as primary therapy or as a first-line adjunct to other initial therapies as mentioned by American Society for Apheresis (ASFA). <b>Materials and Methods:</b> A retrospective analysis of TPE procedures was done for a period of nine years, from January 2007 to May 2016 in a tertiary care teaching hospital. A total of 584 TPE procedures were performed in 161 patients between 2 to 75 years of age. Clinical and laboratory investigations like ECG, chest X-ray, cardiorespiratory status and serology were carried out before the TPE procedure. <b>Results:</b> A total of 161 patients were enrolled in the present study. Guillain-Barre Syndrome (GBS) (67.7%, n=109) was the main indication for TPE, followed by Myasthenia Gravis (MG) (13.04%, n=21). Overall incidence of adverse reactions was 9.93%, inadequate vascular access was a common complication encountered in paediatric age group. <b>Conclusion:</b> Our results show that TPE is not only safe and effective treatment alternative to Intravenous Immunoglobulin (IVIG), it also strongly holds evidence in the improvement of neurological disorders compared to non-neurological disorders. There is need of further detail evaluation on large number of cases for proper evidence based practice. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EC35-EC37&id=10480 https://doi.org/10.7860/JCDR/2017/27073.10480 Hypertension, C Reactive Protein and Metabolic Profile: What is the Scenario in Patients Undergoing Arteriography? Ricardo Jose Tofano, Sandra Maria Barbalho, Marcelo Dib Bechara, Karina Quesada, Claudemir Gregorio Mendes, Marie Oshiiwa <b>Introduction:</b> High Blood Pressure (HBP), Diabetes Mellitus (DM), Metabolic Syndrome (MS) and Cardiovascular Diseases (CVD) are among the main causes of death worldwide and HBP is one of the most common chronic health problem representing an important and modifiable risk factor for vascular events and mortality. <b>Aim:</b> To study the association among high sensitivity CRP levels, and the biochemical, and anthropometric profile in hypertensive and non-hypertensive patients who underwent arteriography. <b>Materials and Methods:</b> This research was performed at the Haemodynamic Laboratory of the University Hospital in the city of Marilia - state of São Paulo, Brazil. Ninety-five subjects who underwent arteriography were included. Anthropometric (body mass index and waist circumference) and biochemical parameters (glycaemia, total cholesterol, HDL-c, LDL-c, triglycerides, and high sensitivity C reactive protein), were evaluated. Variables pertaining to blood pressure, atherogenic indices, diagnosis of metabolic syndrome and catheterization details were collected. Statistical analysis was performed with Chi-square test, Fisher, Student t-test and ANOVA complemented by Tukey test. <b>Results:</b> Our results showed that 78.95% of the patients who underwent arteriography were suffering from HBP. Hypertensive individuals had significantly higher glycaemia (124.14±45.33 mg/dL) or DM, higher values of triglycerides (195.27±74.52 mg/dL), waist circumference (98.52±12.52 cm), body mass index (29.99±1.41 kg/m2) and hs-CRP (0.53±0.44 mg/dL). Most of the hypertensive patients (93.33%) presented with MS and were related to the presence of more severe lesions in the arteries and had passed through more invasive procedures like angioplasty and surgery. <b>Conclusion:</b> Our findings indicate that blood pressure control is of paramount importance to ensure better quality of life and life expectancy as it is associated with several risk factors that increase the morbidity and mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=BC19-BC23&id=10456 https://doi.org/10.7860/JCDR/2017/26595.10456 Prevalence of Specific Helicobacter Pylori cagA, vacA, iceA, ureC Genotypes and its Clinical Relevance in the Patients with Acid-Peptic Diseases Himani Bhardwaj Pandya, Harihar Hardas Agravat, Jagdish Shantilal patel <b>Introduction:</b> Virulent markers of H. pylori, the vacuolating cytotoxin (vacA), cytotoxin-associated gene A (cagA), induced by contact with epithelium factor antigen (iceA gene) and the urease C gene (ureC) may plays a major role in determining the clinical outcome of Helicobacter infections. <b>Aim:</b> To detect the prevalence of the cagA, vacA, ureC and iceA genotypes of H. pylori from antral biopsy specimens of patients and to associate its role in specific disease. <b>Materials and Methods:</b> The study was conducted at Department of Microbiology of Shree P.M. Patel College of Paramedical Sciences, Anand, Gujarat, India. Seventy one antral biopsies of symptomatic patients referred for endoscopy from October 2012 to September 2013 were subjected to Multiplex PCR. DNA isolation from 71 biopsy samples was done by using “QIAamp DNA mini kit” from QIAGEN (GmbH, Hilden, Germany). Data was analysed using Chi square (?2) test and p-value<0.05 was considered significant. <b>Results:</b> Out of the 71 biopsies screened, 22(31%) samples were positive for H. pylori by PCR, with high proportion of cagA positive (17/22 specimen; 77.27%), followed by ureC positive (4/22 specimen; 18.18%) and vacA positive (1/22 specimen; 4.54%) strains. Significant association was found between cagA and female gender (p-value=0.042). Out of 17 cagA positive strains, 9(52.94%) were found in patients with gastritis, 5(29.41%) in reflux oesophagitis and 3(17.64%) in patients with diodenal ulcer. We found 0% prevalence of iceA gene; conversely we had three peptic ulcer patients with only cagA positivity. <b>Conclusion: </b>The cagA positive strain mainly affects the patients with gastritis specifically of female gender and iceA genotype is not a useful marker associated with peptic ulcer disease. Patients should be screened for cagA genotype when reported to be a case of gastritis for early treatment to prevent further complications such as cancer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DC23-DC26&id=10457 https://doi.org/10.7860/JCDR/2017/27812.10457 Gestational Trophoblastic Disease - Clinicopathological Study at Tertiary Care Hospital Sunil Vitthalrao Jagtap, VidhyaAher, SuchiGadhiya, SwatiSunil Jagtap <b> Introduction:</b>Gestational Trophoblastic Disease (GTD) is a term used for a group of pregnancy-related tumours. These consist of various tumours and tumour like lesions characterized by proliferation of trophoblastic tissue. Amongst GTD, hydatidiform moles are the most common form. These lesions sometimes may develop into invasive moles, or, in rare cases, into choriocarcinoma. <b> Aim: </b>To study the clinicopathologic characteristics and prevalence of different forms of gestational trophoblastic disease in a tertiary care hospital. <b> Materials and Methods:</b> The present study was descriptive, observational, analytical type done in Department of Pathology at tertiary care hospital from May 2012 to April 2016. All cases clinically suspected of GTD were included and confirmation was done by histopathological study on H&E stained slides. The cases of GTD were classified according to WHO classification. Detailed histomorphological features and beta human Chorionic Gonadotropin (hCG) levels were correlated. <b> Results:</b> During study period, 18345 deliveries were reported; out of which 77 cases were diagnosed as GTD. Almost 97.40% cases were of hydatidiform moles, 1.30% cases of choriocarcinoma and 1.30% cases of Placental Site Trophoblastic Tumour (PSTT). Among the cases of hydatidiform mole 57.34% were complete mole and 41.33% cases were of partial mole. The common clinical presentation was per vaginal bleeding and amenorrhea. The blood group A was most commonly observed in patient (49.35%). In majority of cases beta hCG levels were between 50,000 to 100000 mIU/ml. The correlation between beta hCG level and GTD were done. <b> Conclusion:</b> Pregnant females clinically presenting with abnormal vaginal bleeding must be evaluated for GTD. Histopathological examination is helpful for confirmatory diagnosis. Follow up of such patients is essential for early detection of malignant trophoblastic tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EC27-EC30&id=10458 https://doi.org/10.7860/JCDR/2017/27232.10458 Association of Serum Lipids with Hepatic Steatosis, Stage of Liver Fibrosis and Viral Load in Chronic Hepatitis C Ivan Valkov, Radina Ivanova, Assen Alexiev, Krasimir Antonov, Lyudmila Mateva <b> Introduction: </b> Hepatitis C Virus (HCV) relies on host lipids for its life cycle contributing to lipid abnormalities and hepatic steatosis. Disease progression is influenced by viral factors interacting with host immune and metabolic pathways. The significance of serum lipids for Chronic Hepatitis C (CHC) assessment is not clearly established yet. <b> Aim:</b> Our aim was to investigate serum lipids’ association with stage of liver fibrosis, steatosis and genotypes in patients with CHC. <b> Materials and Methods:</b> A total of 112 CHC patients (54 male, 58 female, aged 48.6±13.7 years) were studied - 98 genotype 1 (G1) and 14 genotype 3 (G3). Liver cirrhosis (F4) was diagnosed in 31 cases. Steatosis was present in 75 of all patients on ultrasound. Liver biopsy was done in 65 patients and histology showed steatosis in 28, stages of fibrosis (F1-F3) in 56 and F4 in 9 patients (METAVIR). Laboratory panel included complete blood count, liver tests and serum lipid levels (mmol/l) with Friedewald equation estimations. Indirect noninvasive fibrosis scores FIB-4, Aspartate aminotransferase to Platelet Ratio Index (APRI) and Forns index were calculated. HCV RNA was quantified by RT-PCR. Statistical analysis included Spearman’s rho, Mann-Whitney U test, Receiver Operating Characteristic (ROC) curve. <b> Results:</b> Total Cholesterol (TCh) (p=0.002) and Low-Density Lipoprotein (LDL) (p=0.003) in G1 patients were higher when steatosis was present. TCh (p<0.001), High-Density Lipoprotein (HDL) (p=0.018) and LDL (p=0.003) were lower in G1 F4 compared with F1-F3 patients. Triglyceride (TG) levels correlated with FIB-4 (r=0.364, p=0.029), APRI (r=0.333, p=0.047) and Forns index (r=0.423, p=0.010) in G1 patients without steatosis. TG to LDL ratio (TG/LDL) (p=0.001) was higher in F4 than in F1-F3 patients. TG/LDL ratio predicted the presence of F4 in G1 patients without steatosis by an area under the ROC curve 0.900 (p<0.001). TG/LDL ratio > 0.52 was highly specific for F4 without steatosis. Specificity dropped to 76% when steatosis was present. TG/LDL < 0.32 negatively predicted liver cirrhosis. HCV RNA correlated with TG levels (r=0.330, p=0.009) in G1 patients with steatosis and with histological percent of fatty hepatocytes (r=0.585, p=0.028) in G3 patients. <b> Conclusion:</b> Lipid levels in CHC G1 patients depend on the presence of steatosis and cirrhosis. HCV RNA is associated with TG levels in G1 patients with steatosis, but not in G3 patients. In cirrhotic CHC G1 patients cholesterol is low with relatively increased TG. TG/LDL ratio is a potential marker of liver cirrhosis in CHC G1 patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OC15-OC20&id=10459 https://doi.org/10.7860/JCDR/2017/28609.10459 An Evaluation of the Numbers and Locations of Coronary Artery Disease with Some of the Major Atherosclerotic Risk Factors in Patients with Coronary Artery Disease Behshad Naghshtabrizi, Abbas Moradi, Jalaleddin Amiri, Sepide Aarabi , Zahra Sanaei <b>Introduction: </b>Despite definite recognition of major atherosclerotic risk factors, the relationship between the pattern of coronary artery disease and these risk factors is unknown. <b>Aim:</b> The aim of this study was to identify the relationship between some of the major atherosclerotic risk factors and the number and pattern of coronary artery disease in patients with coronary artery disease who presented to Farshchian Heart University Hospital, Hamadan, Iran. <b>Materials and Methods:</b> In this descriptive cross-sectional study, we investigated some of the major atherosclerotic risk factors and their relationships with the type of coronary artery disease in terms of number and location of disease. A total of 1100 patients were enrolled with coronary artery disease confirmed by selective coronary angiography from 2010-2014. A p-value<0.05 was considered statistically significant. <b>Results:</b> A total of 1100 patients enrolled in this study. The patient population consisted of 743 (67.5%) males and 357 (32.5%) females. A meaningful relationship existed between ageing, diabetes mellitus, hypertension and 3-Vessel Disease (3VD, p<0.001) as well as between hyperlipidemia and Single Vessel Disease (SVD, p<0.001). Patients diagnosed with diabetes mellitus, hypertension, and hyperlipidemia showed greater potential to develop coronary artery disease at the proximal section of the coronary arteries. <b>Conclusion:</b> Based on the relationship between some of the major risk factors and the pattern of coronary artery disease in the current study, prospective studies should investigate other risk factors. We recommend that a plan should be developed to reduce adjustable risk factors such as diabetes mellitus, hypertension and hyperlipidemia in order to decrease coronary artery disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OC21-OC24&id=10460 https://doi.org/10.7860/JCDR/2017/29104.10460 Evaluation of Percutaneous Vertebroplasty for Management of Symptomatic Osteoporotic Compression Fracture Arnab Karmakar, Suchi Acharya, Dibyendu Biswas, Arkaprabha Sau <b>Introduction:</b> Osteoporotic vertebral compression fractures are a leading cause of disability and associated morbidities among Indian population. Worldwide, approximately 20% of elderly population above 70 years and 16% of postmenopausal women are suffering from it. Vertebral compression fractures should be aggressively treated with minimally invasive techniques such as Percutaneous Vertebroplasty (PVP) or Percutaneous Kyphoplasty (PKP) to minimize pain and disability associated with it. <b>Aim: </b>To evaluate the PVP in terms of pain reduction and restoration of functional abilities among the patients suffering from symptomatic osteoporotic vertebral compression fracture. <b>Materials and Methods:</b> PVP using polymethyl methacrylate bone cement was performed between 2011 to 2013, on 25 patients admitted for symptomatic osteoporotic vertebral compression fracture in the Department of Orthopaedics, Institute of Post Graduate Medical Education and Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India. All of them were followed up for one year. Pain and disability were evaluated with Visual Analogue Scale (VAS) and Oswestry Disability Questionnaire (ODQ) score respectively. Repeated measures ANOVA with Bonferroni post-hoc test was applied for significance testing. <b>Results:</b> Reduction in pain was reported by 56% of patients within 10 minutes of operation. Mean VAS score at presentation was 8.24 (±1.16). It reduced to 6.31 (±1.21) and 2.38 (±0.08) at immediate postoperative period and after 12 months respectively. There was significant reduction (p<0.05) in pain, as measured by VAS score, started at immediate postoperative period to end of follow up period up to one year. Disability, measured by ODQ score, significantly decrease (p<0.05) over time from one week to 12-month postoperatively. At presentation, ODQ score was 93.01 (±4.54). It reduced to 76.84 (±3.76), one week after operation and 16.23 (±1.17), one year after operation. <b>Conclusion: </b>The PVP with polymethayl methacrylate bone cement is still a justified treatment procedure for osteoporotic vertebral compression fractures as it provides excellent pain relief, internal stability to the fractured vertebra thus preventing further collapse and progression of kyphosis, allowing the patients to regain normal activity at the earliest, and at a very reasonable cost with minimal complication. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=RC07-RC10&id=10461 https://doi.org/10.7860/JCDR/2017/25886.10461 Development of a Trans-disciplinary Intervention Module for Adolescent Girls on Self-awareness Jasmine Mary John, Janardhan Navneetham, H R Nagendra <b>Introduction:</b> Mental health promotion among adolescents has been a key area of intervention for professionals working with children and adolescents. The opinions of experts in the field of mental health have taken to frame a trans-disciplinary intervention for adolescent girls on self awareness. <b>Aim:</b> To discuss the development and validation of a structured intervention by combining the knowledge from different disciplines in helping adolescents enhancing self awareness. <b>Materials and Methods: </b>Both qualitative and quantitative methodologies were followed for the development and validation of the module. First phase of the development of intervention module was the framing of intervention module after conducting in-depth interviews with experts in both mental health and yoga fields. Six experts each from mental health and yoga field were chosen for interview through convenient sampling. Validated interview guides were used for the process. The framed intervention module was given to six mental health experts and six yoga experts for content validation. The experts rated the usefulness of the intervention on a scale 0-4 (4=extremely helpful). <b>Results:</b> The themes derived in the interviews were importance of self awareness, autonomy of self, physical level of self understanding, self regulation of emotions and self monitoring. The interviews were consolidated to frame the intervention module consisting of eight sessions having two parts in each session. Part one of each session is activities and interactions on mental health and part two is guided instructions for body focused meditation. Sessions were finalized with rating and suggestions from the experts. The final version of the module was pilot tested and had found to have enhanced self awareness among adolescent girls. <b>Conclusion:</b> Integration of multiple disciplines brought in novel perspectives in intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=VC07-VC10&id=10462 https://doi.org/10.7860/JCDR/2017/25765.10462 Comparison of the Effect of Fluoride Varnish, Chlorhexidine Varnish and Casein Phosphopeptide- Amorphous Calcium Phosphate (CPP-ACP) Varnish on Salivary Streptococcus mutans Level: A Six Month Clinical Study Punit Manish Patel, Shivayogi M Hugar, Seema Halikerimath, Chandrashekhar M Badakar, Niraj S Gokhale, Prachi J Thakkar, Divyata Kohli, Shreyas Shah <b>Introduction:</b> Dental caries is the most widespread disease which has a multi factorial origin. Streptococcus mutans is considered to be the chief pathogen in its development. Different varnishes are available which can be used for the prevention of the carious process. <b>Aim:</b> To compare the effect of fluoride varnish, chlorhexidine varnish and fluoride varnish containing Casein Phosphopeptide – Amorphous Calcium Phosphate (CPP-ACP) on salivary Streptococcus mutans count in children with mixed dentition over a period of six months. <b>Materials and Methods:</b> Seventy two children of age 6-12 years with mixed dentition were selected fulfilling inclusion and exclusion criteria and divided into three groups: Group I– Fluoride varnish group; Group II– Chlorhexidine varnish group; Group III– MI varnish (fluoride varnish containing CPPACP) group. After thorough oral prophylaxis and restorative treatment the varnishes were applied to the teeth once a week for four consecutive weeks in the respective groups. Salivary Streptococcus mutans count (CFU/ml of saliva) was estimated at baseline, 1 month, 3 months and 6 months after varnish application. Bonferroni post-hoc test and paired t-test for inter group and intra group comparison was used in the study. <b>Results:</b> A statistically significant reduction in salivary S. mutans colony count was seen with all three groups at all the different time intervals. Maximum reduction was noted in chlorhexidine varnish group at all the intervals after varnish application. <b>Conclusion:</b> Prevention of dental caries plays a vital role in paediatric dental practice. The use of dental varnish has proved to be effective in reducing the dental caries. Chlorhexidine varnish was found to show maximum reduction in salivary S. mutans count for six month period, when compared to MI varnish and fluoride varnish. Thus, chlorhexidine varnish can be used as potent caries inhibiting agent and promote good oral health. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC53-ZC59&id=10409 https://doi.org/10.7860/JCDR/2017/26541.10409 The Relation Between Dermatoglyphics And Mesiodistal Width Of The Deciduous Second Molar And Permanent First Molar Naveen Kumar Ramagoni, Vinod Kumar, Hamsini Adusumilli, KM Parveen Reddy, NH Praveen Kumar <b>Introduction:</b> Dermatoglyphics is one of the important diagnostic tools used in the recent days for identification of an individual. Dermatoglyphics is the study of type of patterns present on digits, palms and foot. The mesiodistal diameter of the tooth is an important factor which reveals the tooth-bone discrepancy. Deciduous second molar and permanent first molar exhibit least degree of variation. Both the dermal ridges and the enamel layer of the tooth originate from ectodermal layer and during the same period of intrauterine life. <b>Aim:</b> To determine and compare the dermatoglyphics with the mesiodistal width of the deciduous second molar and permanent first molar. <b>Materials and Methods:</b> A sample of 120 child ranaged between 6-12 years were included in the study whose digital and palmer traits were recorded using ink method and the mesiodistal widths of the deciduous second molar and permanent first molar were recorded using a vernier caliper.The data was subjected to statistical analysis using unpaired t test. <b>Results:</b> The ‘ATD’ angle was found in the range of 40°-50°. The loop patterns were more common followed by whorls and arch patterns. Girls expressed a greater mesiodistal diameter of deciduous second molar than boys. No significant correlation was found in between the dermatoglyphics and tooth size. <b>Conclusion:</b> There was no significant correlation between the finger print patterns, ‘ATD’ angle and the mesiodistal diameter of the deciduous second molar and the permanent first molar. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC60-ZC63&id=10410 https://doi.org/10.7860/JCDR/2017/26938.10410 Effect of Different Composite Restorations on the Cuspal Deflection of Premolars Restored with Different Insertion Techniques- An In vitro Study Sakshi Singhal, Anuraag Gurtu, Anurag Singhal, Rashmi Bansal, Sumit Mohan <b>Introduction:</b> This study was conducted to assess the effect of different composite materials on the cuspal deflection of premolars restored with bulk placement of resin composite in comparison to horizontal incremental placement and modified tangential incremental placement. <b>Aim:</b> The aim of this study was to evaluate the cuspal deflection caused by different composite materials when different insertion techniques were used. <b>Materials and Methods:</b> Two different composite materials were used that is Tetric N Ceram (Ivoclar Vivadent marketing, India) and SonicFillTM (Kerr Sybron Dental). Forty standardized Mesio-Occluso-Distal (MOD) preparations were prepared on maxillary first premolars. Each group was divided according to composite insertion technique (n=10), as follows: Group I – bulk insertion using Tetric N Ceram, Group II - Horizontal incremental insertion technique using Tetric N Ceram, Group III- Modified tangential incremental technique using Tetric N Ceram, and Group IV- bulk insertion using SonicFillTM. Preparations were acid-etched, and bonded with adhesive resin to provide micro mechanical attachment before restoration using a uniform etching and bonding protocol in all the groups. All groups received the same total photo-polymerization time. Cuspal deflection was measured during the restorative procedure using customized digital micrometer assembly. One-way ANOVA test was applied for the analysis of significant difference between the groups, p-value less than 0.05 was considered statistically significant. <b>Results:</b> The average cuspal deflections for the different groups were as follows: Group I 0.045±0.018, Group II 0.029±0.009, Group III 0.018±0.005 and Group IV 0.017±0.004. The intergroup comparison revealed statistically significant difference. <b>Conclusion:</b> A measurable amount of cuspal deflection was present in all the four studied groups. In general, bulkfill restoration technique with conventional composite showed significantly highest cusp deflection. There were no significant differences in cuspal deflection among sonicFillTM and modified tangential incremental insertion techniques. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC67-ZC70&id=10440 https://doi.org/10.7860/JCDR/2017/20159.10440 Expressional Analysis of MSX1 (Human) Revealed its Role in Sagittal Jaw Relationship Prateek Gupta, Thakur Prasad Chaturvedi, Vipul Sharma <b>Introduction:</b> Abnormal skeletal jaw relationships is an important factor causing difficulty in speech, mastication, sleep and social interaction, thus affect the overall well being of an individual. <b>Aim:</b> The present study was an attempt to decipher the role of human MSX1 in terms of sagittal jaw relationship by employing Polymerase Chain Reaction (PCR) based analysis. <b>Materials and Methods:</b> Ninety-eight case subjects belonging to North India with skeletal Class II and Class III jaw relationships were selected. Further, thirty-five control subjects of the same region having Class I skeletal and dental relationships (normal Jaw relationships) with good alignment of all teeth were enrolled. MSX1 gene sequencing was performed using the subjects’ blood samples. Multiple sequence alignment was performed to find Single Nucleotide Polymorphisms (SNP’s). Nine SNP’s were obtained of which seven were reported and two novels. Statistical analysis was performed using Chi square test to compare genotype differences between case and control groups. <b>Results:</b> SNP rs186861426 was found to be significantly associated in Class I subjects (p-value=0.02). The sequencing results suggested that individuals having changes from G (guanosine) with A (adenine) genotype had approximately seven times low risk for developing Class II division 1 malocclusion as compared to those alleles having GG genotype and therefore, allele ‘A’ position on chromosome 4 (rs186861426) seems to have a protective role. <b>Conclusion:</b> The study unfolds an important relationship between MSX1 gene and Class II division 1 malocclusion and Class I normal skeletal relationships. The study tried to interpret the role of human MSX1 and extend the gene pool responsible for the skeletal anomalies related to development of abnormal upper and lower jaws. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC71-ZC77&id=10441 https://doi.org/10.7860/JCDR/2017/26755.10441 Assessing Quality of Life using the Oral Health Impact Profile (OHIP-14) in Subjects with and without Orthodontic Treatment need in Chennai, Tamil Nadu, India A. Vinita Mary, Jaideep Mahendra, Joseph John, Joyson Moses, A.V. Rajesh Ebenezar, R. Kesavan <b>Introduction:</b> Dental ailments like malocclusion affect not only the functional ability and aesthetic appearance of the person but also the psychological aspect of the individual. <b>Aim:</b> The aim of the present study was to the find relationship between quality of life and dental malocclusion among school going adolescents in Tamil Nadu, India. <b>Materials and Methods:</b> A cross-sectional study was conducted among 342 subjects of age range 14-19 years. Oral health status was assessed using WHO basic oral health survey (2013), orthodontic treatment needs according to Index of Orthodontic Treatment Needs (IOTN) and oral health quality of life using Oral Health Impact Profile-14 (OHIP-14). <b>Results:</b> A total of 342 subjects were interviewed and examined. The mean DMFT score was 1.86±2.77. A 203 (59.4%) did not require any orthodontic treatment while 139 (40.6%) had orthodontic treatment need ranging from mild to very severe. It was seen that malocclusion affected some aspects of OHIP-14 significantly namely functional limitation, psychological discomfort and psychological disability. The comparison of OHIP-14 scores between treatment needed and treatment not needed was highly significant (p<0.001). <b>Conclusion:</b> Hence, it is stated that there is an urgent need to educate the school children and in turn their parents regarding the malocclusion for its treatment to prevent any effect on quality of life of the young adults. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC78-ZC81&id=10442 https://doi.org/10.7860/JCDR/2017/27309.10442 Root Conditioning with Citric Acid and Ethylenediaminetetraacetic Acid and their Effect on Fibrin Clot Adhesion to Dentin-A Scanning Electron Microscopic Study Sangeetha Subramanian , Devapriya Appukuttan , Anupama Tadepalli ,Prakash Ponnudurai Samuel Gnana , Rajagopal Thennukonda Athmarao <b>Introduction:</b> Root biomodifiers are used to remove the smear layer formed on the roots as a result of mechanical debridement and also to expose collagen fibers making the root surfaces biologically acceptable. Further, the blood element linkage to demineralized roots and clot stabilization by collagen fibres are vital for the wound healing and success of periodontal surgery. <b>Aim:</b> The aim of this study was to evaluate and compare the distribution of fibrin network to dentin surfaces conditioned with citric acid and Ethylenediaminetetraacetic Acid (EDTA) using Scanning Electron Microscope (SEM). <b>Materials and Methods:</b> Thirty human dentin blocks (4 mm x 3 mm x 1 mm) were prepared and equally divided into three groups. The control Group A specimens were treated with Phosphate Buffered Saline (PBS). The study Group B and C specimens were treated with citric Acid and EDTA respectively. After conditioning, a drop of fresh human whole blood was placed on the dentin specimens and was allowed to clot. The specimens were then processed using standardized protocol for SEM. The dentin surfaces were then analysed for fibrin network linkage under SEM and scored according to the degree of fibrin linkage to the dentin surface. Statistical analysis was done using Kruskal Wallis test to compare the score values between the study groups. Pairwise comparison between the study groups was done using Mann Whitney U test with Bonferroni correction. <b>Results: </b>The fibrin network formed on the dentin network were analysed and scores were given. Kruskal Wallis test and Mann Whitney U test with Bonferroni correction were used for statistical analysis. It was found that most of the dentin specimens conditioned with citric acid and covered with human blood exhibited dense fibrin network compared to EDTA. However, statistical analysis showed that there were no significant differences found between the groups (p=0.35). <b>Conclusion: </b>Citric acid and EDTA has almost comparable effect in promoting the adhesion of fibrin network onto the dentin surface which may further enhance connective tissue attachment to the root surface. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC82-ZC85&id=10443 https://doi.org/10.7860/JCDR/2017/27768.10443 Comparative Evaluation of the Depth of Cure and Degree of Conversion of Two Bulk Fill Flowable Composites CA Anand Yokesh, P Hemalatha, M Muthalagu, M Robert Justin <b> Introduction:</b> Since the development of resin based composites, several improvements have been made to improve their physical and chemical properties. In an attempt to fasten and simplify the restoration process, a new class of resin based composite materials, called the bulk fill resin based composites have been introduced, which has been claimed to achieve a depth of cure of 4 mm without affecting the properties of the material. <b> Aim:</b> To comparatively evaluate the depth of cure of two different bulk fill flowable composite resins by ISO 4049 method and to evaluate the degree of conversion of the same composite resins with Fourier Transform Infrared (FTIR) spectroscopy method. <b> Materials and Methods: </b> Composite resin specimens (n=10) per group were prepared with bulk fill flowable composites, Surefil SDR flow (Dentsply Caulk, Milford, DE, USA) designated as Group A and Filtek bulk fill (3M ESPE, St.Paul, MN, USA) designated as Group B. Depth of cure was determined according to “ISO 4049; Depth of Cure” method, and FTIR spectroscopy method was used to estimate the degree of conversion of both the bulk fill flowable composites. The degree of conversion of monomer to polymer was estimated individually in coronal half (Group A1 and B1) and pulpal half (Group A2 and Group B2) by dividing each specimens into two halves. The data were analysed using Student’s unpaired t-test at 5% level of significance. <b> Results:</b> The mean depth of cure of Group A was 3.89 mm (±0.103) and for Group B was 3.54 mm (±0.129). The degree of conversion percentage for Group A1=78.51 (±47.8), Group A2= 31.9 (±22.4), Group B1=39.8 (±5.2), Group B2=37.4 (±6.4). Statistical analysis revealed significant difference in the depth of cure between the two bulk fill flowable composites with Group A higher than Group B. The degree of conversion of the coronal half of Group A1 was significantly higher when compared to Group B1. <b> Conclusion: </b> Surefil SDR bulk fill resin has better depth of cure and degree of conversion compared to Filtek bulk fill composites. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC86-ZC89&id=10444 https://doi.org/10.7860/JCDR/2017/28004.10444 Variations of Adipokines and Insulin Resistance in Primary Hypothyroidism Kaushik Kar, Satwika Sinha <b>Introduction:</b> Hypothyroidism is a common concern in endocrinology practice, which plays a significant role in metabolic and development processes. Obesity, hyperlipidaemia and hypertension may complicate hypothyroidism. Recent studies have shown that cytokines like leptin and adiponectin, secreted by adipose tissue and exert their endocrinal functions by modulating appetite, obesity and insulin sensitivity in conjunction with thyroid hormones. Interrelation between thyroid hormone, insulin resistance and adipokines are not yet clear. <b>Aim:</b> To estimate serum leptin, adiponectin and insulin resistance in patients with hypothyroidism and to compare with control subjects and measure the relation between the mean value of one variable with others. <b>Materials and Methods:</b> Forty primary hypothyroidism patients and forty age and sex matched controls were selected for the study with informed consent. Fasting serum Thyroid Stimulating Hormone (TSH), leptin, adiponectin, glucose and insulin were estimated. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) was evaluated from fasting plasma glucose and serum insulin levels. Statistical analysis was carried out using SPSS version 17.0. Unpaired t-test and regression analysis were used to compare and determine the dependence, p<0.05 was considered significant. <b>Results: </b>Serum TSH, leptin, adiponectin HOMA-IR were significantly higher (p<0.05) in patients with hypothyroidism (10.37±4.10, 10.97±0.60, 31.09±4.07, 3.64±0.40) than controls (2.41±2.09, 10.37±0.12, 33.32±1.44, 2.36±0.35). Regression analysis showed that leptin was significantly (p=0.054) dependent on adiponectin but not on others. <b>Conclusion:</b> Increased oxidative stress by hypothyroid mediated leptin secretion and increased insulin resistance can down- regulate the adiponectin secretion and future complications. Serum estimation and correction of imbalance of adipokines in hypothyroidism can prevent severe consequences. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=BC07-BC09&id=10345 https://doi.org/10.7860/JCDR/2017/26666.10345 Spectrum of Parasitic Infections in Patients with Diarrhea Attending a Tertiary Care Hospital in Western Rajasthan, India Kumar Saurabh, Vijaya Lakshmi Nag, Saroj Dash, Anand Kumar Maurya, Vivek Hada, Richa Agrawal, Himanshu Narula, Anuradha Sharma <b>Introduction: </b>Owing to the poor socioeconomic conditions and lack of sanitary hygiene, a large number of population in developing countries remain under constant threat of different parasitic infections causing severe morbidity and mortality. Enough measures to prevent and reduce the disease burden are still to be undertaken. <b>Aim: </b>Aim of the study was to determine the spectrum of parasitic infections in patients with complaints of diarrhoea and other gastrointestinal symptoms attending a tertiary care hospital in Western Rajasthan, India. <b>Materials and Methods:</b> It is a retrospective study conducted in the Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, India, between the period of September 2014 and April 2016. The records of routine stool examination carried out during the study period, were analyzed. A total of 968 stool samples from the same number of patients complaining of diarrhoea and other gastrointestinal symptoms such as nausea, vomiting, flatulence, and pain abdomen were received from different outdoor and indoor wards of the hospital. Microscopic examination was performed after the concentration of stool samples by formol-ether concentration technique and their wet mount preparations. Modified Ziehl-Neelsen (ZN) staining was performed on 17 samples for the detection of coccidian parasites. <b>Results:</b> Out of 968 cases, 158 (16.3%) were found to be infected with either a parasite or a commensal or both. A maximum number of isolates (21.1%) were from the age group of 31-40 years. Overall, protozoans (95.38%) were detected in excess of helminths (4.62%). The most common protozoa isolated was Entamoeba histolytica (37.57%) followed by Giardia lamblia (23.12%), and the most common helminth isolated was Hymenolepis nana (2.9%) followed by Ascaris lumbricoides (1.15%). Out of 17 stool samples, where modified ZN staining was performed, Cryptosporidium spp., Isospora belli, and Cyclospora spp. were detected in one sample each. <b>Conclusion:</b> Intestinal protozoal infections are more prevalent as compared to helminthic infections in this study group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DC01-DC04&id=10346 https://doi.org/10.7860/JCDR/2017/29001.10346 Antimicrobial Activity of Honey with Special Reference to Methicillin Resistant Staphylococcus aureus (MRSA) and Methicillin Sensitive Staphylococcus aureus (MSSA) Guruvu Neeraja Rani, Radhika Budumuru, Narasinga Rao Bandaru <b>Introduction:</b> Antimicrobial agents are essentially important in reducing the global burden of infectious diseases. With the irrational and excessive use of antibiotics in underdeveloped and developing countries, there may be chances to develop and spread resistant pathogens in the community. As a result, the effectiveness of the antibiotics is diminishing. Therefore, the need for novel alternative antimicrobial strategies has renewed interest in natural products like turmeric, honey, ginger and others exhibiting antibacterial properties. This situation has led to a re-evaluation of the therapeutic use of ancient remedies like honey as no other studies are available in the state of Andhra Pradesh with the locally available honey. <b>Aim:</b> To find out the efficacy of antibacterial activity of locally available honey against Methicillin Resistant Staphylococcus aureus (MRSA) and Methicillin Sensitive Staphylococcus aureus (MSSA) isolates. <b>Materials and Methods:</b> A prospective study on the antibacterial activity of Bharat multi floral pasteurised honey which was locally available in the state of Andhra Pradesh, further it was conducted and evaluated against the bacterial strains of Methicillin Resistant Staphylococcus aureus and Methicillin Sensitive Staphylococcus aureus. Their antibacterial sensitivity pattern was tested using Kirby-Bauer disc diffusion susceptibility testing technique of CLSI along with other commonly used antimicrobials. <b>Results:</b> Both MRSA and MSSA isolates were sensitive to honey. But MRSA were resistant to all antimicrobials tested except linezolid where as MSSA were sensitive to all except penicillin. <b>Conclusion:</b> It is definitely worthy to consider honey as a promising future antimicrobial to be tested and studied. Honey, may be elaborately used in future with some more molecular studies on its method of action as an antimicrobial agent. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DC05-DC08&id=10347 https://doi.org/10.7860/JCDR/2017/30085.10347 Association of Metabolic Syndrome in Chronic Plaque Psoriasis Patients and their Correlation with Disease Severity, Duration and Age: A Case Control Study from Western Maharashtra Aarti Sudam Salunke, Mahendra Vinayak Nagargoje, Vasudha Abhijit Belgaumkar, Su¬nil Narayan Tolat, Ravindranath Brahmadev Chavan <b>Introduction:</b> Psoriasis is a chronic systemic inflammatory disease where the skin and the joints are the primary targets. Despite the fact that psoriasis carries minimal risk of mortality, it is associated with significant morbidity which may have a significant impact on quality of life of patients. Globally, psoriasis has been reported to be associated with Metabolic Syndrome (MS) including obesity, dyslipidemia, diabetes and hypertension. Association of MS and its various components with psoriasis has been consistently reported in various studies, but there is a paucity of data on this association from the Indian subcontinent. <b>Aim:</b> To compare the prevalence of MS in patients with psoriasis and controls and to determine association of MS with age of patient, severity and duration of psoriasis. <b>Materials and Methods:</b> A hospital based case control study on 95 psoriasis patients and 95 age and sex matched controls. MS was diagnosed by the presence of three or more of the South Asian Modified National Cholesterol Education Programs Adult Panel III SAM-NCEP criteria. Clinical, biometric and necessary laboratory evaluations were performed. Statistical analysis was performed by using Statistical Package for the Social Sciences (SPSS version 16.0). Data was compared between cases and controls using unpaired t-test and chi-square test and odds ratio with 95% confidence interval. <b>Results:</b> MS was significantly more common in psoriatic patients than in controls (38.9%vs 21.05%, odds ratio 2.39, 95% confidence interval, 1.26-4.55; p-value=0.007). Psoriatic patients had higher prevalence of hypertriglyceridemia (45.2%vs.11.5%), decreased HDL cholesterol (27.3%vs.4.2%), abdominal obesity (32.6% vs.15.7%) and elevated blood pressure (18.9%vs.5.2%) whereas no association observed for elevated blood sugar level (12.6%vs.5.2%). MS was present in psoriasis cohort irrespective of severity and duration of psoriasis. (p-value 0.123, 0.596 respectively). MS was more prevalent in elderly individuals with psoriasis (51.1%vs.28% p-value=0.008; Odds ratio 3.12, 95% confidence interval 1.32-7.35). <b>Conclusion:</b> Significant association between psoriasis and MS was noted and it was independent of disease duration and severity. Elderly psoriatic patients were more prone for developing MS. We suggest that all patients of psoriasis, irrespective of disease, duration and severity, should be screened for MS to prevent significant morbidity and mortality associated with it. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=WC06-WC10&id=10348 https://doi.org/10.7860/JCDR/2017/24390.10348 Patch Test Results from an Occupational and Contact Dermatitis Clinic in a Tertiary Care Hospital of Southern India: A Retrospective Study Kumaravel Sadagopan, Deepa Kalappan, Nirmala Sivaprakasam, Vinoth <b>Introduction: </b>Occupational contact dermatitis, accounting for 95% of cases of occupational dermatoses, is the most common occupational skin disease. <b>Aim: </b>To find out the various allergens in different occupational and environmental settings causing contact allergy, from our patients presented with contact dermatitis. <b>Materials and Methods:</b> It was a retrospective study from the data in hospital outpatient register over one year period, which includes patients with age ranging from 11 years to 73 years. Patch test was done with total of 24 allergens from Indian standard battery and Indian standard series and with materials suspected to cause contact allergy. Result was expressed in terms of percentage. <b>Results: </b>Contact dermatitis constitutes about 0.75% of total dermatological cases in our Dermatology Outpatient Department. A total of 358 contact dermatitis were included in this study with M:F ratio 2.25:1 and majority of the cases in the age group of 26-55 years. Out of 358 cases, 157 cases were positive to at least one allergen. Building construction workers constitute about 35.75% (128 cases) of total contact dermatitis cases, among which potassium dichromate (39 out of 57) is the most common allergen, followed by nickel (31) and cobalt (28). In other occupations, contact allergy to parthenium, hair dye, foot wear, paint, kum-kum, turmeric, detergents and cosmetics were also present in significant number and none was positive for vegetables, dettol, kerosene and native medication. <b>Conclusion:</b> This study gives an idea about the common occupation and population who are prone to develop contact dermatitis in our environmental setting and also about the most common sensitizers involved in various occupation and environment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=WC11-WC14&id=10349 https://doi.org/10.7860/JCDR/2017/26391.10349 Gene Scanning for Microdeletions in the Azoospermia Factor Region of Y-Chromosome in Infertile Men of Gujarat, India Mili Nailwal, Jenabhai B Chauhan <b>Introduction:</b> Azoospermia Factor (AZF) microdeletions in Yq chromosome is one of the most frequent genetic cause associated with failure of spermatogenesis in males with infertility. <b>Aim:</b> To figure out the Yq chromosome microdeletions frequency in infertile men from Gujarat region of India. <b>Materials and Methods:</b> In this study, 141 infertile men with azoospermia (n=41) and oligozoospermia (n=100) were examined along with 159 normozoospermic men. Eleven different markers spanning the azoospermia factor region of human Yq chromosome, amplified by sequence-tagged site Polymerase Chain Reaction (PCR) to detect the microdeletions. Sperm morphological analysis was done using papanicolau staining method. <b>Results:</b> Thirty four infertile men out of 141 presented Yq chromosome microdeletions. The frequency of AZF microdeletions was 31.71% in azoospermia and 21% in oligozoospermia patients. Only two oligozoospermia patients showed morphological defects. <b>Conclusion:</b> Due to the presence of high frequency of Yq chromosome microdeletions in Gujarati infertile men, it is imperative to implement the AZF microdeletion screening in such patients as it results in male spermatogenesis dysfunctioning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=GC01-GC06&id=10350 https://doi.org/10.7860/JCDR/2017/26750.10350 Cross Pinning Versus Lateral Pinning in the Management of Type III Supracondylar Humerus Fractures in Children Lokesh Gudda Naik, Gaurav Mahesh Sharma, Krishna Sudhakar Badgire, Faisal Qureshi, Chaitanya Waghchoure, Vikas Jain <b>Introduction:</b> Closed reduction of supracondylar humerus fractures with K-wires has become the standard line of management with different opinions regarding the technique that is utilized. <b>Aim:</b> To compare the functional and radiological outcomes of lateral and cross pinning technique in supracondylar fractures of humerus in children. <b>Materials and Methods:</b> A prospective study with 57 cases of displaced fracture supracondylar humerus, treated by lateral (Group A n=28) and cross pinning (Group B n=29), was conducted between May 2013 and May 2015. Independent sample student’s t-test was done to assess the parameters like age, follow-up and duration of surgery. The results were expressed as mean with standard deviation and p<0.05 was considered as statistically significant. <b>Results:</b> As per the Gartland classification system, 46 (80.7%) patients had Type IIIA and 11 (19.2%) patients had Type IIIB fracture. The average surgical time was 28.3±1.6 minutes in Group A and 30±3.6 minutes in Group B (p=0.02). About, 3.5% patients in Group A had pin loosening. As per the Flynn criteria, 78.6% in Group A and 79.3% in Group B had excellent results. <b>Conclusion:</b> No significant difference in terms of functional and radiological outcome was observed between both the techniques. Thus, both the techniques have equal results. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=RC01-RC03&id=10351 https://doi.org/10.7860/JCDR/2017/28481.10351 Comparative Study of Ultrasonographic and Anthropometric Measurements of Regional Adiposity in Metabolic Syndrome Rudresh Hiremath, Jebin Ibrahim, Krishna Prasanthi, Harish T Reddy, Rushit Sandeep Shah, CH Haritha <b>Introduction:</b> Metabolic syndrome is complex disorder unifying dyslipidemia, insulin resistance and hyper insulinemia. Rising global epidemic of obesity has tremendous impact on metabolic syndrome. Ultrasound is becoming widely utilized modality for measuring the visceral adiposity. <b>Aim:</b> To determine the usefulness of ultrasonographic measurements in the estimation of regional adiposity and to compare them with anthropometric measurements and to correlate ultrasonographic measurements of regional adiposity and metabolic syndrome. <b>Materials and Methods:</b> A cross-sectional study was conducted to compare anthropometry and ultrasonography in assessing the regional adiposity in metabolic syndrome. A total of 105 consecutive participants were included in the study after scrutinizing them for various definable factors of metabolic syndrome. Body Mass Index (BMI) of all participants was calculated and their available serological investigations were gathered. Primarily participants were subjected for anthropometric measurements like waist circumference and hip circumference, further waist/hip ratio was calculated. Following which all participants underwent sonological examination and sonographic indices like intraabdominal fat thickness, preperitoneal fat thickness, minimum and maximum subcutaneous fat thicknesses were measured. Abdominal wall fat index was calculated as ratio of maximum preperitoneal fat thickness to minimum subcutaneous fat thickness. Statistical analysis was performed using SPSS (Statistical Package Social Science, version-10.0.5) software. A p-value was calculated and values <0.05 were considered as statistically significant. <b>Results:</b> Significant correlation was established between the BMI and waist and hip circumferences. Mild positive correlation was obtained between BMI and sonographic indices like IAF, SCF and PPF with Pearson correlation (r) values of 0.324, 0.585 and 0.211 respectively. Anthropometric measurements showed higher r-values (WC- 0.624 and HC- 0.825) than sonographic indices; indicating anthropometry is better in assessing the regional adiposity than the sonography. <b>Conclusion:</b> Sonography can be considered as one of the reliable imaging modality for assessing the regional adiposity but not as better as waist or hip circumferences. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=TC01-TC05&id=10352 https://doi.org/10.7860/JCDR/2017/26386.10352 Evaluation of IOTA Simple Ultrasound Rules to Distinguish Benign and Malignant Ovarian Tumours Sugandha Garg, Amarjit Kaur, Jaswinder kaur Mohi, Preet Kanwal Sibia, Navkiran kaur <b>Introduction:</b> IOTA stands for International Ovarian Tumour Analysis group. Ovarian cancer is one of the common cancers in women and is diagnosed at later stage in majority. The limiting factor for early diagnosis is lack of standardized terms and procedures in gynaecological sonography. Introduction of IOTA rules has provided some consistency in defining morphological features of ovarian masses through a standardized examination technique. <b>Aim:</b> To evaluate the efficacy of IOTA simple ultrasound rules in distinguishing benign and malignant ovarian tumours and establishing their use as a tool in early diagnosis of ovarian malignancy. <b>Materials and Methods:</b> A hospital based case control prospective study was conducted. Patients with suspected ovarian pathology were evaluated using IOTA ultrasound rules and designated as benign or malignant. Findings were correlated with histopathological findings. Collected data was statistically analysed using chi-square test and kappa statistical method. <b>Results:</b> Out of initial 55 patients, 50 patients were included in the final analysis who underwent surgery. IOTA simple rules were applicable in 45 out of these 50 patients (90%). The sensitivity for the detection of malignancy in cases where IOTA simple rules were applicable was 91.66% and the specificity was 84.84%. Accuracy was 86.66%. Classifying inconclusive cases as malignant, the sensitivity and specificity was 93% and 80% respectively. High level of agreement was found between USG and histopathological diagnosis with Kappa value as 0.323. <b>Conclusion:</b> IOTA simple ultrasound rules were highly sensitive and specific in predicting ovarian malignancy preoperatively yet being reproducible, easy to train and use. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=TC06-TC09&id=10353 https://doi.org/10.7860/JCDR/2017/26790.10353 A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center Viral Patel, Geetika Sindhwani, Monica Gupta, Sweta Arora, Arpita Mishra, Jayesh Bhatt, Manali Arora, Anisha Gehani <b>Introduction:</b> An organization’s transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. <b>Aim:</b> To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. <b>Materials and Methods:</b> To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP’s), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. <b>Results: </b>A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. <b>Conclusion:</b> Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=TC10-TC16&id=10354 https://doi.org/10.7860/JCDR/2017/29545.10354 Fine-Needle Aspiration of De Quervain's Thyroiditis (Subacute Granulomatous Thyroiditis): A Cytological Review of 20 Cases Rachna Lamichaney, Mingma Sherpa, Deepak Das, Chumila Thinley Bhutia, Sabina Laishram <b>Introduction:</b> De Quervain’s Thyroiditis (DQT) is a self limiting inflammatory disease of the thyroid gland that presents with pain and sore throat. Although the diagnosis is usually made clinically, Fine Needle Aspiration (FNA) may provide assistance, particularly in excluding other thyroid lesions. <b>Aim:</b> The objective of this study was to reveal the cytological characteristics of DQT. <b>Materials and Methods:</b> We retrospectively reviewed the clinical and FNAC findings of 20 cases of DQT to find the most reliable features for a confident cytological diagnosis. <b>Results:</b> Among the cases reviewed, the common cytological features present in all 20 cases were follicular epithelial cells with degenerative changes and dirty background comprising of cellular debris and mixed inflammatory cells (lymphocytes and macrophages and occasional polymorphs). The next common finding observed was Multinucleated Giant Cells (MNGCs) seen in 19 cases followed by epithelioid cell clusters in 15 and colloid in 13 cases. <b>Conclusion:</b> Presence of follicular epithelial cells, large MNGCs and dirty background of cellular debris, mixed inflammatory cells with predominance of lymphocytes and macrophages were the most striking and consistent features for diagnosis of DQT in cytological smears. The above findings in consideration with the clinical history will help us reach a definitive diagnosis. FNA also proves to be a useful tool in excluding other thyroid lesions with similar clinical presentations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EC09-EC11&id=10355 https://doi.org/10.7860/JCDR/2017/26054.10355 Dentinal Tubule Occluding Effect of Potassium Nitrate in Varied Forms, Frequencies and Duration: An In vitro SEM Analysis Jesline Merly James, Manjunath P Puranik, Kr Sowmya <b> Introduction:</b> Dentinal hypersensitivity is an exaggerated response to non-noxious sensory stimuli (osmotic, thermal or mechanical changes). An inverse relationship between occluding open tubules and the intensity of sensitivity has been reported. Studies on the efficacy of potassium nitrate used in different forms and frequencies to occlude dentinal tubules are scarce. <b>Aim:</b> To evaluate, in vitro the dentinal tubule occluding effect of potassium nitrate which differ in form, frequency and duration of application. <b> Materials and Methods:</b> In an in vitro study, 45 extracted human maxillary and mandibular premolars were sectioned using diamond disc to obtain 90 samples which were treated with 6% citric acid and were randomly assigned to three groups: Group 1 was treated with potassium nitrate toothpaste (once and twice daily for two minutes); Group 2 with potassium nitrate mouthwash (once and twice daily for two minutes) and Group 3 served as control (distilled water). Post-treatment, the samples were immersed in distilled water. The samples were subjected to Scanning Electron Microscopy (SEM) at the end of 3, 7 and 14 days. SEM photographs were analysed based on extent of tubular occlusion. Chi-square test was applied to assess the significant difference between the groups. <b> Results:</b> There was detectable difference in the dentinal tubule occlusion at the end of 3rd, 7th and 14th day between three groups. When compared to the mouthwash, toothpaste yielded better results. Twice daily application for a period of two minutes each was better when compared to once daily for two minutes. <b> Conclusion:</b> Potassium nitrate is effective in occluding dentinal tubules when applied twice daily in toothpaste form than mouthwash form. However, randomised control trials are needed to confirm its efficacy in human subjects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC06-ZC08&id=10340 https://doi.org/10.7860/JCDR/2017/26442.10340 Morphometric Analysis of Odontometric Parameters for Gender Determination Dilpreet singh Grewal, rajbir kaur Khangura, keya sircar, krishan kumar tyagi, gurkirat kaur, simon david <b> Introduction:</b> In contemporary human population, males exhibit larger size of dentition as compared to females. Additionally, these odontometric parameters show variation in members of same species and also show regional variation. <b> Aim:</b> To evaluate sexual dimorphism of four maxillary odontometric parameters such as Intercanine Width (ICW), Interpremolar Width (IPW), Arch Length (AL) and Combined Width (CW) of six maxillary anterior teeth, to determine percentage of sexual dimorphism of all four odontometric parameters singly or in combination and also to determine sensitivity, specificity and overall accuracy of odontometric parameters for sex determination. <b> Materials and Methods:</b> This cross-sectional study was conducted on 200 subjects (100 males, 100 females). Four odontometric parameters ICW, IPW, AL and CW were measured directly on the subject and the data thus collected was subjected to statistical analysis. <b> Results:</b> Discriminant statistical analysis (d square test) revealed that all the four odontometric maxillary parameters exhibited greater mean values in males as compared to females. The difference was found to be statistically highly significant (p<0.001) for ICW and IPW for sexual dimorphism. Also, combination of parameters such as ICW, IPW further improved assessment. <b> Conclusion:</b> The study concluded that linear odonotometric parameters ICW, IPW along with AL, CW show significant sexual dimorphism. Hence, odontometric parameters offer simple, reliable and cost-effective way of determining sex in any forensic investigation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC09-ZC13&id=10341 https://doi.org/10.7860/JCDR/2017/26680.10341 Role of Cathepsin B as a Marker of Malignant Transformation in Oral Lichen Planus: An Immunohistochemical Study Krishnanand Prakash Satelur , Shiny Bopaiah , Radhika Manoj Bavle , Prashant Ramachandra <b>Introduction:</b> Malignant transformation of Oral Lichen Planus (OLP) remains a much discussed but very less understood realm. Various hypotheses and theories have been put forward to explain the same. Malignant transformation is a complex interplay of epithelial mesenchymal factors acting in tandem. This study tries to identify and asses the stromal changes that pave the way for epithelial migration using Cathepsin B (CB) a cysteine protease belonging to the Cathepsin family. Various studies have been done to study its role in human cancers which have proven that CB helps mark and identify tissue digestion. <b>Aim:</b> The purpose of this study was to evaluate the expression of CB, in OLP and examine its possible role in malignant transformation. <b>Materials and Methods: </b>Immunohistochemical analysis of CB expression was done in 50 OLP tissues along with 10 normal mucosa tissue and 10 Oral Squamous Cell Carcinoma (OSCC) cases (control groups). Evaluation was done on the basis of intensity of staining. The intensity was graded in all the cases by assigning values of 0 to 4 in ascending order. Two other observers evaluated the staining and intensity independently and the average of the observations was taken. <b>Results:</b> A variable staining pattern in both the stroma and the cytoplasm of the epithelial cells was noticed. The staining intensity was clearly increased in OLP tissues when compared to normal control tissue and OSCC which served as our positive control. The staining patterns in tissues of OLP and OSCC to Cathepsin B were similar. The staining intensity of Cathepsin B was observed to be increased in both these groups of tissues. <b>Conclusion: </b>This study demonstrated a significantly increased expression of CB in OLP. This may be correlated to a possible indicator for its eventual malignant transformation. This overexpression of CB amounts to an array of stromal changes that take place and different mechanisms that get activated underneath the epithelium leading to the formation of what is known as a tumour microenvironment, a well proven entity. We hypothesize that it is this which felicitates the invasion of the overlying epithelial cells https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=7&page=ZC29-ZC32&id=10274 https://doi.org/10.7860/JCDR/2017/30740.10274 Clinical Outcome of Probing in Infants with Acute Dacryocystitis – A Prospective Study Bhawesh chandra saha, Rashmi kumari, Bibhuti Prasanna Sinha <b>Introduction: </b>Acute dacryocystitis is an uncommon but serious condition in infants and needs immediate treatment. Although, medical management with systemic antibiotics remains the mainstay of initial treatment, there are recent studies justifying simultaneous Naso Lacrimal Duct (NLD) probing with acceptable success rate. <b>Aim:</b> To assess the success rate of probing in the management of infantile acute dacryocystitis and to analyse the factors affecting it. <b>Materials and Methods:</b> A prospective interventional study was designed and infants presenting with acute dacryocystitis with or without complications like dacryocystopyocele/ lacrimal abscess/preseptal cellulitis at a Tertiary Eye Care Centre from May 2014 to April 2016 were enrolled. Demographic details and baseline clinical characteristics were noted. Intravenous antibiotics were started and probing under general anaesthesia was done. Follow up was done after one month. Success was defined as subsidence of acute attack and resolution of epiphora at final follow up of one month. <b>Results:</b> A total 20 eyes of 18 patients were included with male: female ratio 10:8. Mean age of patients was 6.5 months and the mean duration of symptoms was 5.6 days. Dacryocystitis with lacrimal swelling was present in five eyes, preseptal cellulitis was present in two eyes while the rest 13 eyes presented with simple inflammation over the lacrimal sac. After one month, 85% (17eyes) had complete resolution of symptoms.Recurrence of epiphora was seen in 15% (three eyes) after initial improvement. <b>Conclusion:</b> Medical management with simultaneous probing of nasolacrimal duct has fairly good success rate in infantile dacryocystitis. Presence of dacryopyocele or dacryocystocele can lead to failure of probing owing to presence of intranasal cysts. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=NC01-NC03&id=10295 https://doi.org/10.7860/JCDR/2017/29033.10295 Challenges in Learning Preclinical Prosthodontics: A Survey of Perceptions of Dental Undergraduates and Teaching Faculty at an Indian Dental School Kamal Shigli, S Jyotsna, G Rajesh, Umesh Wadgave, Banashree Sankeshwari, Sushma S Nayak, Rashmi Vyas <b>Introduction: </b>Preclinical dental education promotes development of competency and expertise before students work on patients, but this phase is devoid of exposure to real patients leading to challenges in teaching-learning. <b> Aim: </b>The aim of this study was to explore the challenges faced by students during the process of learning preclinical prosthodontics. <b> Materials and Methods:</b> Two Focus Group Discussions (FGDs) were conducted with two different groups of students and one FGD was held with prosthodontics faculty. The FGDs explored the students' and faculty perceptions on the topics which were difficult for the students to understand and their suggestions on how these topics can be made easier to understand. The discussions were audio taped with prior consent and transcribed. <b> Results:</b> The students and the faculty felt that the subject of prosthodontics is vast, difficult to visualize and also difficult to correlate theory with practical aspects. Lack of clinical exposure coupled with use of conventional methods of teaching were identified as reasons for difficulty in understanding the subject. Both students and faculty members suggested that use of simulation, demonstrations, and videos could augment the learning process for the students. Early clinical exposure will help solve many problems encountered during learning and contribute to a better understanding. <b> Conclusion: </b> The students and faculty expressed a "need" for early clinical exposure to enhance the learner’s understanding of the preclinical aspects of the subject. The present study highlights the need for change in instruction methods to enhance the learning experiences in preclinical prosthodontics of dental undergraduate students in India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC01-ZC05&id=10301 https://doi.org/10.7860/JCDR/2017/27710.10301 Evaluation of Serum Zinc and Antioxidant Vitamins in Adolescent Homozygous Sickle Cell Patients in Wardha, District of Central India Rina Raibhan Wasnik, Nilkanth Ramji Akarte <b>Introduction:</b> Sickle cell anaemia is a condition characterized by haemolytic and vaso-occlusive crisis. Previous studies in different part of the world have reported deficiency of zinc, vitamin C and E but the role of their supplementation in sickle cell disease remains question. Nutritional factors may contribute to clinical manifestation in rural population of developing countries specially in adolescent age group. Thus, the present study was designed in rural population of Wardha district of Maharashtra in adolescent sickle cell homozygous patients in view to evaluate serum zinc and antioxidant vitamins C and E. <b>Aim:</b> To evaluate the serum zinc and antioxidant vitamins C and E in cases of adolescent homozygous sickle cell disease. <b>Materials and Methods:</b> The study includes adolescent (between 10-20 years) individuals in two groups of 33 each. Group A included confirmed cases of Sickle Cell Disease (SCD) and Group B included age and sex matched normal healthy controls. Serum zinc, vitamins C and E were analysed in all the subjects of both the groups. Data were expressed as Mean±SD; unpaired t-test was used to compare the two groups. Statistical significance was decided by calculating the p-value. <b>Results:</b> Serum levels of zinc and antioxidant vitamins E and C were significantly low in sickle cell anaemia patients when compared to normal health controls (p-value<0.001). <b>Conclusion:</b> Our study shows that the adolescent patients with SCD have significant low levels of zinc and significantly low antioxidant vitamins C and E, which may contribute to some of the manifestations of sickle cell disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=BC01-BC03&id=10320 https://doi.org/10.7860/JCDR/2017/30855.10320 Histogenesis of Muscularis Mucosa and Muscularis Externa of Stomach: A Human Foetal Study Babita Pangtey, Jagat Mohini Kaul, Sabita Mishra <b>Introduction:</b> The histological and developmental knowledge of musculature of stomach wall is vital for the assessment and management of various associated congenital abnormalities like hypertrophy of pyloric musculature and pathologies of nerve terminals and ganglia. <b>Aim:</b> To study the development of muscularis mucosa and muscularis externa in human foetal stomach. <b>Materials and Methods: </b>The study was conducted on 22 aborted human foetuses of varying gestational ages ranging from 10-26 weeks. The foetuses were procured after obtaining Institutional Ethical Clearance and informed consent of parents of the aborted foetuses. Stomach was dissected and immersed fixed in 10% formalin and then sectioned and stained with Haematoxylin and Eosin and Masson’s Trichrome. <b>Results: </b>The muscularis mucosa appeared as a thin layer of smooth muscle strands at 14 weeks of gestation and later developed as a continuous and well developed layer by 22 weeks. Muscularis externa was composed of only two layers in early gestational ages from 10-15 weeks with predominant circular and discrete outer longitudinal muscle coat. The innermost layer of oblique muscle developed later at 16 weeks of gestation. <b>Conclusion: </b>The gastric muscularis mucosa and muscularis externa developed and differentiated sequentially in the human foetuses. The musculature in pyloric region of stomach was more developed and thick than the body and fundus of stomach in all foetuses at all gestational ages. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=AC01-AC03&id=10323 https://doi.org/10.7860/JCDR/2017/26219.10323 Effects of Sleep Deprivation on the Cognitive Performance of Nurses Working in Shift Deepalakshmi Kaliyaperumal, Yaal Elango, Murali Alagesan, Iswarya Santhanakrishanan <b>Introduction:</b> Sleep deprivation and altered circadian rhythm affects the cognitive performance of an individual. Quality of sleep is compromised in those who are frequently involved in extended working hours and shift work which is found to be more common among nurses. Cognitive impairment leads to fatigability, decline in attention and efficiency in their workplace which puts their health and patients’ health at risk. <b>Aim:</b> To find out the prevalence of sleep deprivation and its impact on cognition among shift working nurses. <b>Materials and Methods:</b> Sleep deprivation among 97 female and three male healthy nurses of age 20–50 years was assessed by Epworth sleepiness scale (ESS). Cognition was assessed by Montreal Cognitive Assessment (MoCA) questionnaire. Mobile applications were used to test their vigilance, reaction time, photographic memory and numerical cognition. The above said parameters were assessed during end of day shift and 3-4 days after start of night shift. <b>Results:</b>Poor sleep quality was observed among 69% of shift working nurses according to ESS scores. The cognitive performance was analysed using Wilcoxon signed rank test. The MoCA score was found to be lesser among 66% of nurses during night (25.72) than day (26.81). During the night, 32% made more mathematical errors. It was also found that, 71%, 83% and 68% of the nurses scored lesser during night in the Stroop’s colour test, vigilance test and memory tests respectively. Thus, impairment in cognitive performance was statistically significant (p<0.001) among shift working nurses. <b>Conclusion:</b> Cognitive performance was found to be impaired among shift working nurses, due to poor sleep quality and decreased alertness during wake state. Thus, shift work poses significant cognitive risks in work performance of nurses. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=CC01-CC03&id=10324 https://doi.org/10.7860/JCDR/2017/26029.10324 Prevalence of Iron Deficiency and Iron Deficiency Anaemia in Adolescent Girls in a Tertiary Care Hospital Rekha Kumari, Raushan Kumar Bharti, Kalpana Singh, Archana Sinha, Sudhir Kumar, Anand Saran, Uday Kumar <b>Introduction:</b> Iron Deficiency Anaemia (IDA) is a global health problem. It involves population of all age group and sex. But adolescent girls are more vulnerable to it. The reasons may be increased iron demand, menstrual blood loss, infection, worm infestation etc. <b>Aim: </b>To find the prevalence of iron deficiency and IDA in adolescent girls in a Tertiary Care Hospital. <b>Materials and Methods:</b> This cross-sectional study was done in the biochemistry clinical laboratory of Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India for a period of six months (April 2015-October 2015). Haemoglobin estimation was done by Sahli’s method. Total iron and Total Iron Binding Capacity (TIBC) estimation was done by Ferrozine method on fully automated chemistry analyzer Olympus AU 400 with the reagent kit available in the market. Ferritin estimation was done by chemiluminesence immunoassay method, using Access 2 (Beckman Coulter). <b>Results: </b>Out of 200 girls, 50% adolescent girls were found to be anaemic. Of the total, 43.3% were mildly, 3.3% were moderately and 3.3% were severely affected by anaemia. <b>Conclusion: </b>As prevalence of anaemia is 50%, it needs intervention for its prevention and control. This study will help in planning and implementation of the policy for prevention of iron deficiency and IDA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=BC04-BC06&id=10325 https://doi.org/10.7860/JCDR/2017/26163.10325 Histomorphologic Spectrum in Hyaline Vascular Variant of Castleman Disease Chaithra Gowthuvalli Venkataramana, Hema Kini, Debarshi Saha, Sharada Rai, Deepa Sowkur Anandarama Adiga, Ranjitha Rao, Cheryl sarah philipose <b>Introduction:</b> Castleman Disease (CD) is a rare lymphoproliferative disorder with heterogenous clinical and pathological features. It is a rare disease with mention in the rare disease data of the orphanet. It can present as unicentric or multicentric disease. Hyaline vascular variant and plasma cell variant are the two pathological subtypes. Hyaline vascular variant accounts for nearly 80% to 90% of unicentric cases. Hyaline vascular subtype variant has follicular and stroma rich subtype. <b>Aim:</b> To study the histomorphologic spectrum of hyaline vascular variant of CD. <b>Materials and Methods:</b> Retrospective cross-sectional, observational study was undertaken from the archival data between January 2009 and April 2015. Only ten cases of hyaline vascular CD were identified after studying the histomorphological characteristics. Both follicular and interfollicular changes were studied in detail. <b>Results:</b> The age of presentation ranged from 17 years to 59 years. Seven out of 10 cases were female. Site of presentation included cervical, inguinal, retroperitoneal, intra-abdominal and axillary. Six cases showed predominant follicular change. Two cases were sclerotic subtype. Two cases showed both follicular and interfollicular changes in equal proportion. Distribution of follicles throughout the lymphnode was seen in eight cases. Uniform sized follicles seen in seven out of ten cases. Small germinal centre with lymphocyte depletion was one of the uniform features seen in all 10 cases. Numerous high endothelial vessels were seen in nine cases. Twinning of germinal centre was seen in two cases. All ten cases showed concentric rings of small lymphocytes. Lollipop pattern was relatively rare feature seen in only two cases. <b>Conclusion:</b> Hyaline vascular variant of CD has considerable morphologic variation with few consistent features seen in most of the cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EC01-EC04&id=10326 https://doi.org/10.7860/JCDR/2017/29415.10326 Prognostic Significance of Epidermal Growth Factor Receptor in Patients of Glioblastoma Multiforme Kalpalata Tripathy, Bidyutprava Das, Ajit Kumar Singh, Aparajita Misra, Sanjib Misra, Sudhansu Sekhar Misra <b>Introduction:</b> Glioblastoma Multiforme (GBM) is the most aggressive glial tumour with hallmark characteristics of rampant proliferation of glial cells along with high pleomorphism, necrosis, endothelial proliferation and high MIB-1 labeling index (cell proliferation marker). These tumours are managed by surgery followed by Radiotherapy (RT), Chemotherapy (CT) and adjuvant CT Temozolomide (TMZ). <b>Aim:</b> To evaluate Epidermal Growth Factor Receptor (EGFR) protein expression in GBM patients. <b>Materials and Methods:</b> The study comprised of 52 cases of GBM diagnosed by histomorphology from biopsy specimens. Ancillary techniques like Immunohistochemistry (IHC) for Glial Fibrillary Acidic Protein (GFAP), cell proliferation marker (MIB-1 labeling index, P53 expressions) were done in all cases. EGFR protein expression was assessed by IHC as the percentage of positive tumour cells in hot spots (10 high power fields). Response to therapy was assessed at three months post therapy by using World Health Organization (WHO) Response Evaluation Criteria In Solid Tumours (RECIST) guideline. Statistical analysis was performed by using IBM-Statistical Package for Social Sciences (SPSS) software, version 20. The p-value of = 0.05 was considered significant. The mean survival of the patients was calculated using unpaired t-test and ANOVA (analysis of variance) test. <b>Results:</b> Out of 52 cases, thirty cases was EGFR positive and 22 cases were EGFR negative. Response to therapy was evident in 33 (63.5%) cases and 19 cases (36.5%) were non responders. The responders with EGFR negative were 86.4% and EGFR positive were 46.7% with a p-value of 0.003. The mean survival among EGFR positive and negative GBM were 315.73±257.54 and 657.91±305.88 days respectively with a significant p-value of 0.001. <b>Conclusion:</b> EGFR negative patients respond better to therapy along with longer duration of survival as compared to EGFR positive patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EC05-EC08&id=10327 https://doi.org/10.7860/JCDR/2017/30138.10327 Pattern of Allergen Sensitivity among Patients with Bronchial Asthma and/or Allergic Rhinosinusitis in a Tertiary Care Centre of Southern India Bharti Chogtu, Neha Magaji, Rahul Magazine, Preetamtam R Acharya <b>Introduction:</b> The distribution of aeroallergens varies among various geographical areas of India and the knowledge of allergen sensitivity pattern in this part of Southern Indian (Karnataka) is limited. This data can provide clinically useful information and better understanding of common allergies prevalent in this area. <b>Aim:</b> To study the pattern of allergen sensitivity among patients with bronchial asthma and/or allergic rhinosinusitis. <b>Materials and Methods:</b> In this retrospective study, patients diagnosed with bronchial asthma and/or allergic rhinitis who underwent skin prick testing, were included in the study. Patients who had taken drugs that could affect the test results, within one week prior to testing were excluded. Also, patients on long-acting oral antihistamines within four weeks of testing and pregnant women were excluded. A total of 64 antigens were used which included eight types of pollens, eight types of dusts, six types of fungi, eight types of insects, two types of danders, wool and 31 types of food items. Skin prick testing was done as per standard protocol. <b>Results:</b> Out of 2219 patients, 1193 (53.8%) were males and 1026 (46.2%) were females. The mean age of the subjects was 41.47 (±14) years. There were 740 (33.3%) patients diagnosed with bronchial asthma, 357 (16.1%) allergic rhinitis and 1122 (50.6%) had both bronchial asthma and allergic rhinitis. Overall the highest percentage of skin-prick test positivity was found among insect allergens (24.45%) followed by dust (24.21%), grass and tree pollen (20.57%), fungus (13.92%) and food allergens (9.28%), in that order. Among the individual allergens, the highest percentage of skin-prick test positivity was present in rice grain dust allergen (33.30%) and the least common was chicken allergen (4.40%). <b>Conclusion:</b> Among the allergen groups, insects and dusts elicited the highest percentage of skin-prick test positive results. Whereas, among all the individual allergens rice grain dust elicited highest percentage of positives. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OC01-OC04&id=10328 https://doi.org/10.7860/JCDR/2017/26973.10328 Prevalence and Severity of Depression in a Pakistani Population with at least One Major Chronic Disease Ansab Godil, Muhammad Saad Ali Mallick, Arsalan Majeed Adam, Amna Haq, Akash Khetpal, Razna Afzal, Maliha Salim, Naureen Shahid <b>Introduction:</b> Diabetes, anaemia, hypertension and asthma are major contributors to morbidity in our society. Depression is the commonest psychological malady diagnosed in hospital settings. There tends to be some overlap between certain chronic systemic illnesses and depressive disorders, this point towards the need to determine relationships between them, if any. <b>Aim:</b> To determine the prevalence and compare the severity of depression among individuals diagnosed with four of the most common chronic diseases in our community. <b>Materials and Methods: </b>This cross-sectional study was carried out among patients with chronic diseases visiting a tertiary care hospital in Karachi, Pakistan from August 2015 to August 2016. The Beck Depression Inventory-II*, a 21-item self-report instrument was used to assess the severity of depression. Categorical variables were compared using Chi-square test while intergroup comparisons were performed using one way ANOVA test. Logistic regression was employed to estimate the odds of Category B depression (moderate and severe levels of depression) in chronic diseases. <b>Results:</b> The prevalence of anaemia, hypertension, diabetes and asthma was 90%, 47%, 26% and 23% respectively. Predictors of Category B depression were anaemia (OR=4.21, 95% CI: 1.30-13.56) and diabetes (OR=2.03, 95% CI: 1.09-3.77). Asthma predicted Category B depression in males (OR=1.26, 95% CI: 0.29-5.42) but not in females (OR=0.77, 95% CI: 0.39-1.52). Individuals with hypertension were less likely to report Category B depression than non-hypertensive (OR=0.72, 95% CI 0.43-1.21). Female gender had a greater influence to develop Category B depression than males (OR= 2.96, 95% CI: 1.93-4.55). <b>Conclusion:</b> Our study points towards a strong correlation between depression and chronic diseases especially anaemia and diabetes. This cautions medical practitioners against treatment of depressive disorders and chronic diseases as separate, independent entities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OC05-OC10&id=10329 https://doi.org/10.7860/JCDR/2017/27519.10329 Visceral Adiposity Index and the Degree of Hepatic Fibrosis and Inflammation in Egyptian Patients with Chronic Hepatitis C Zainab ahmed ali-eldin, fatma ahmed ali-eldin, inas elkhedr mohamed <b>Introduction:</b> Many clinical studies suggest a direct association between hepatic fat content and visceral adiposity and the progression of fibrosis. <b>Aim:</b> This work aims to clarify the relation between the Visceral Adiposity Index (VAI) and severity of necroinflammatory activity and liver fibrosis in Egyptian patients with chronic Hepatitis C Virus (HCV) infection. <b>Materials and Methods:</b> A cross-sectional study, over a period of six months, was performed on 50 chronic HCV patients subjected to routine laboratory investigations, abdominal ultrasonography, measurement of Waist Circumference (WC), calculation of Body Mass Index (BMI) and VAI, ultrasound guided liver biopsy and assessment of hepatic fibrosis by METAVIR staging. <b>Results:</b> A total of 50 HCV positive patients, 29 (58%) males and 21 (42%) females were included in the study. Age ranged from 29-60 years (44.4±8.4). BMI was ranged from 20.3 to 41.4 kg/m2 (31.7±5.5). VAI for males was 0.4±0.2 and for females was 0.5±0.3. There were significant positive correlations between VAI and BMI, Triglycerides (TG), fibrosis stages, grades of liver inflammation and FIB-4 Fibrosis-4 score. There were significant negative correlations between VAI and high density lipoprotein, platelets and haemoglobin. <b>Conclusion:</b> There is an association between visceral obesity represented by VAI and the severity of hepatic inflammatory response in chronic hepatitis C patients. Other studies are recommended to measure the clinical implication of visceral obesity on the response to the novel directly acting antivirals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=OC11-OC14&id=10330 https://doi.org/10.7860/JCDR/2017/28381.10330 Predictive Regression Equations of Flowmetric and Spirometric Peak Expiratory Flow in Healthy Moroccan Children Khalid Bouti, Jouda Benamor, Jamal Eddine Bourkadi <b>Introduction:</b> Peak Expiratory Flow (PEF) has never been characterised among healthy Moroccan school children. <b>Aim: </b>To study the relationship between PEF and anthropometric parameters (sex, age, height and weight) in healthy Moroccan school children, to establish predictive equations of PEF; and to compare flowmetric and spirometric PEF with Forced Expiratory Volume in 1 second (FEV1). <b>Materials and Methods: </b>This cross-sectional study was conducted between April, 2016 and May, 2016. It involved 222 (122 boys and 100 girls) healthy school children living in Ksar el-Kebir, Morocco. We used mobile equipments for realisation of spirometry and peak expiratory flow measurements. SPSS (Version 22.0) was used to calculate Students t–test, Pearsons correlation coefficient and linear regression. <b>Results:</b> Significant linear correlation was seen between PEF, age and height in boys and girls. The equation for prediction of flowmetric PEF in boys was calculated as ‘F-PEF = -187+ 24.4 Age + 1.61 Height’ (p-value<0.001, r=0.86), and for girls as ‘F-PEF = -151 + 17Age + 1.59Height’ (p-value<0.001, r=0.86). The equation for prediction of spirometric PEF in boys was calculated as ‘S-PEF = -199+ 9.8Age + 2.67Height (p-value<0.05, r=0.77), and for girls as ‘S-PEF = -181 + 8.5Age + 2.5Height’ (p-value<0.001, r=0.83). The boys had higher values than the girls. The performance of the Mini Wright Peak Flow Meter was lower than that of a spirometer. <b>Conclusion: </b>Our study established PEF predictive equations in Moroccan children. Our results appeared to be reliable, as evident by the high correlation coefficient in this sample. PEF can be an alternative of FEV1 in centers without spirometry. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=SC01-SC04&id=10331 https://doi.org/10.7860/JCDR/2017/27619.10331 Groin Flap in Paediatric Age Group to Salvage Hand after Electric Contact Burn: Challenges and Experience Pradeep Gupta, Rakesh Singh Tawar, Manohar Malviya <b>Introduction:</b> Electric contact burn is characterised by multiple wounds produced by entrance and exit of the current. Hand is most commonly involved in the same and children are particularly susceptible to such accidents. <b>Aim:</b> To document effectiveness and challenges associated with the use of groin flap as an initial definitive treatment of electric contact burn in paediatric age group. <b>Materials and Methods:</b> From January 2015 to December 2016, 25 children up to 12 years of age, who were admitted at SMS Medical College, Jaipur, Rajasthan, India, after electric burn injury with hand defect and who were treated by pedicled groin flap at the Department of Plastic and Reconstructive Surgery, were included in the study. Details related to gender, age, type of voltage injury, sites of injury and postoperative complications were recorded. The groin flap was used in these children for coverage of hand and finger defect with exposed bone and tendon. <b>Results:</b> Normal functional results were seen in all children treated with pedicled groin flap and all were able to perform activities of daily living. All the children had satisfactory aesthetic result. <b>Conclusion: </b>Although, groin flap was an uncomfortable procedure due to limb position that was particularly difficult for children, it was found to be a useful method to salvage hand and it resulted in favourable functional and aesthetic outcome in each case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PC01-PC03&id=10332 https://doi.org/10.7860/JCDR/2017/29124.10332 Gestational Urinary Incontinence in Nulliparous Pregnancy- A Pilot Study Alp Tuna Beksac, Emine Aydin, Ceren Orhan, Ergun Karaagaoglu, Turkan Akbayrak <b>Introduction:</b> Urinary Incontinence (UI) in pregnancy is more than a disease; it is a social problem that necessitates special care and management. The exact rationales and biological facts behind urinary incontinence during pregnancy are unclear and multivariate. <b>Aim:</b> This pilot study was designed to examine the direct effect of gestational factors (e.g., physical and metabolic/hormonal) on the presence of Gestational Urinary Incontinence (GUI), in nulliparous pregnant women. <b>Materials and Methods: </b>This was a questionnaire-based study comprising of 61 nulliparous pregnant woman who had not experienced any Urinary Incontinence (UI) before their pregnancies. Patients were examined during their pregnancies within the framework of the antenatal care program continued at the Division of Perinatology, Hacettepe University, Ankara, Turkey, between January 2015 and December 2016. A ‘urinary incontinence questionnaire’ was used three times during different periods of gestation (11–14, ~24 and ~37 gestational weeks) for each patient. Statistical analysis was performed using the SPSS software version 20.0. The Chi-Square test or Fisher’s-exact test was used to compare proportions in groups. <b>Results:</b> The prevalence of total urinary incontinence (stress urinary incontinence, urge urinary incontinence and mixed urinary incontinence) in nulliparous pregnant women was 4.9% (n=3), 9.8% (n=6) and 26.2% (n=16) at 11–14, ~24 and ~37 gestational weeks, respectively. Stress urinary incontinence was found to be 3.3% (n=2), 6.6% (n=4) and 16.4% (n=10) at 11–14, ~24 and ~37 gestational weeks, respectively. Urge urinary incontinence frequency was found to be 1.6% (n=1), 3.3% (n=2), 6.6% (n=4), and mixed urinary incontinence frequency was 0% (n=0), 0% (n=0), 3.3% (n=2) at 11–14, ~24 and ~37 gestational weeks, respectively. Maternal age, birth weight of the neonate and gestational age at birth had no statistically significant effect on GUI. <b>Conclusion:</b> Urinary incontinence is an important issue during pregnancy and related symptoms are more common in third trimester. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QC01-QC03&id=10333 https://doi.org/10.7860/JCDR/2017/25572.10333 Primary Cutaneous Amyloidosis: A Clinical, Histopathological and Immunofluorescence Study Krati Mehrotra, Rupali Dewan, Jagannath V Kumar, Abhinav Dewan <b> Introduction:</b> Primary Localized Cutaneous Amyloidosis (PLCA) is a relatively rare chronic condition characterized by amyloid deposition in dermis without associated deposits in internal organs. Histopathology of cutaneous amyloidosis using Haematoxylin and Eosin (H&E) stain shows eosinophilic hyaline material in papillary dermis, which can be further confirmed by Congo Red (CR) staining or Direct Immunofluorescence (DIF) Test or immunohistochemistry. <b> Aim:</b> To assess the concordance between the clinical, histopathological and DIF findings in various subtypes of (PLCA). <b> Materials and Methods:</b> Data was collected from patients attending the Outpatient Department (OPD) at a tertiary care centre in Karnataka, India, over a period of one and half years. A total of 50 patients with clinical features suggestive of cutaneous amyloidosis were subjected to histopathological examination with H&E, CR stain and immunofluorescence. <b> Results:</b> Among 50 clinically suspected patients, the most common subtype was macular amyloidosis (70%) and lichen amyloidosis seen only in 16%. A biphasic pattern comprising of both macular and lichen amyloidosis was seen in 14% cases. Extensor aspect of the arm was the most frequently (76%) involved area. All the cases had multiple site involvement. Immunofluorescence positivity was 88% as compared to 86% on histopathology using CR stain. Amyloid deposits were detected in 80% of clinically diagnosed macular amyloidosis cases by histopathology using CR stain and in 85.7% by DIF, whereas in 5.7% cases, it was not detectable by both CR stain and DIF. Both immunofluorescence and CR staining were able to detect amyloid in all the cases of lichen amyloidosis. In biphasic amyloidosis, amyloid was detected in 100% cases on histopathology versus 85.7% cases on immunofluorescence. <b> Conclusion:</b> CR stain and DIF are complimentary to each other for detection of macular amyloidosis. In case of lichen and biphasic amyloidosis, both CR and DIF are comparable modalities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=WC01-WC05&id=10334 https://doi.org/10.7860/JCDR/2017/24273.10334 Efficacy of Task Oriented Exercise Program Based on Ergonomics on Cobb’s Angle and Pulmonary Function Improvement in Adolescent Idiopathic Scoliosis- A Randomized Control Trial Arvind Kumar, Santosh Kumar, Vineet Sharma, R.N.Srivastava, Anil Kumar Gupta, Anit Paparihar,Vikas Varma, Dileep Kumar <b> Introduction:</b> Scoliosis is lateral curvature of the spine greater than 100 accompanied by vertebral rotation. The prime risk factors for curve progression are a large curve magnitude, skeletal immaturity and female gender. The curve progression can be recorded by measuring the curve magnitude using the Cobb method on radiographs. <b> Aim:</b> To assess the effect of task oriented exercises based on ergonomics on Cobb’s angle and pulmonary functions on one year outcome of Adolescent Idiopathic Scoliosis(AIS) (defined as curves < 150 for thoracolumbar region and < 200 for thoracic region). <b> Materials and Methods:</b> A total of 36 patients were enrolled in the study and 18 patients in each group (experimental and control group) were allocated randomly. The subjects in control group underwent spinal strengthening exercises, active self-correction and breathing exercises, whereas subjects in the experimental group followed task oriented exercises based on ergonomics in addition to exercises for conventional group for one year. Chi square test was used to compare the categorical/dichotomous variables between the groups. Unpaired t-test was used to compare continuous variables between the groups at pre and post intervention. Paired t-test was used to compare the changes in continuous variables from pre to post intervention within the group. <b> Results:</b> FVC was found to be significantly (p=0.001) higher in experimental group (2.68±0.37) than control group (2.20±0.41) at post-intervention. FEV1 (p=0.01) and VC (p=0.002) were also found to be significantly higher in experimental group compared to control group at postintervention. Also, there was significant (p=0.001) mean reduction in Cobb’s angle from pre to post intervention in both the groups being higher in Experimental group than control group. <b> Conclusion:</b> The task oriented exercise protocol benefited patients with AIS which had a significant improvement of their pulmonary functions and Cobb’s angle. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=YC01-YC04&id=10335 https://doi.org/10.7860/JCDR/2017/27497.10335 Prevalence of Cardio-metabolic Risk Factors: A Cross-sectional Study among Employed Adults in Urban Delhi, India Deepa Shokeen, Bani Tamber Aeri <b>Introduction:</b> Many studies have shown increasing prevalence of Cardiovascular Diseases (CVD) among employed adults. Metabolic Syndrome (MS) which is a predictor of increasing CVD is a cluster of risk factors like central obesity, dyslipidemia, hyperglycaemia and hypertension. Heredity, poor dietary choice, unhealthy lifestyle, job stress are some of the causes responsible for increased prevalence of cardiovascular risk among employed adults. <b>Aim: </b>To measure the prevalence of cardio-metabolic risk factors among employed adults in urban Delhi, India. <b>Materials and Methods:</b> Study design was cross-sectional with purposive sampling of 200 apparently healthy adults (both males and females) working in urban Delhi, India. Sociodemographic profile, anthropometric measurements (height, weight and waist circumference) and biochemical measurements (lipid profile and fasting glucose) and blood pressure were documented. Physical activity pattern was assessed using WHO Global Physical Activity Questionnaire (GPAQ). Univariate and multivariate regression analysis for associating cardio-metabolic risk factors among adults were performed using the SPSS 18.0 software. <b>Results:</b> High prevalence of metabolic syndrome among males (66.6%) and females (57.2%) of 25 to 45 years of age was reported. Overall prevalence of MS was 62% among the study population. Central obesity (50.5%, p<0.04), low HDL (62%, p<0.05), hypertriglyceridemia (56.5%, p<0.00), hypertension (39%, p<0.00) and high fasting glucose (10.5%, p<0.76) were the most common abnormalities among males and females. Incidence of high BMI (54.5%, p<0.05) was positively correlated with MS risk factors. Associated cardio-metabolic risk factors besides MS were family history (43.5%, p<0.72), smoking (17.6%, p<0.001), drinking (18%, p<0.001) and physical inactivity. It was found that 32.8% of the subjects had low, 60.4% had moderate and only 7.0% had high physical activity. <b>Conclusion: </b>Employed adults in urban Delhi, India are at high risk of developing CVD due to high prevalence of MS and high Body Mass Index (BMI). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=LC01-LC04&id=10336 https://doi.org/10.7860/JCDR/2017/29087.10336 Prospective Evaluation of Psychosocial Impact after One Year of Orthodontic Treatment Using PIDAQ Adapted for Indian Population Kanika Garg, Tulika Tripathi, Priyank Rai, Nandini Sharma, Anup Kanase <b>Introduction:</b> The impact of dental appearance, malocclusion and treatment for the same on psychological and functional well-being has drawn increasing attention over the past decade. Various psychometric instruments alongside normative indices have been used to predict orthodontic concerns. Evaluating the patients’ experience during the orthodontic treatment can help us understand the true benefits and advantages of orthodontic therapy. <b>Aim:</b> The aim of the present study was to evaluate the change in the psychosocial impact of malocclusion using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) adapted for the Indian population after one year of fixed orthodontic treatment. <b>Materials and Methods:</b> This interventional study was conducted on 93 patients requiring fixed orthodontic treatment. Brazilian, Chinese, Spanish, Nepali and Moroccan versions of the PIDAQ have been published but the questionnaire is not available in Hindi. In the present study, the original PIDAQ was translated into Hindi language to adapt it for the Indian population and was validated by back translation and pretest. All the subjects answered the Hindi version of the questionnaire at pretreatment (T1) and at one year of orthodontic treatment (T2). Additionally, the Index of Orthodontic Treatment Need (IOTN) was applied to measure the severity and self-perception of malocclusion. The data were analysed using paired t-test, Wilcoxon signed rank test and Kruskal-Wallis test. <b>Results:</b> Significant reduction was found in the total PIDAQ score and each factor’s score (p<0.001) after one year of orthodontic treatment. There was a positive association of the psychosocial impact of malocclusion with the IOTN-AC (IOTN-Aesthetic Component). Adolescent females were found to be most concerned with their dentofacial appearance. <b>Conclusion:</b> Results showed significant improvement in the psychosocial impact of malocclusion with a reduction in the self-perceived needs of patients with orthodontic treatment. The psychometric instrument used may be recommended as an Oral Health Related Quality of Life (OHRQoL) assessment tool for the population in India for further research. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC44-ZC48&id=10376 https://doi.org/10.7860/JCDR/2017/28720.10376 Citral, A Monoterpene Protect Against High Glucose Induced Oxidative Injury in HepG2 Cell In Vitro-An Experimental Study Sri Devi Subramaniyan, Ashok kumar Natarajan <b>Introduction:</b> Diabetes mellitus, a major metabolic disorder associated with hyperglycaemia is one of the leading cause of death in many developed countries. However, use of natural phytochemicals have been proved to have a protective effect against oxidative damage. <b>Aim:</b> To investigate the effect of citral, a monoterpene on high glucose induced cytotoxicity and oxidative stress in human hepatocellular liver carcinoma (Hep G2) cell line. <b>Materials and Methods:</b> Cells were treated with 50 mM concentration of glucose for 24 hours incubation following citral (30 µM) was added to confluent HepG2 cells. Cell viability, Reactive Oxygen Species (ROS) generation, DNA damage, lipid peroxidation, antioxidants and Mitogen Activated Protein Kinases (MAPKs) signaling were assessed in citral and/or high glucose induced HepG2 cells. <b>Results:</b> Cells treated with glucose (50 mM), resulted in increased cytotoxicity, ROS generation, DNA damage, lipid peroxidation and depletion of enzymatic and non enzymatic antioxidants. In contrast, treatment with citral (30 µM) significantly decreased cell cytotoxicity, ROS generation, DNA damage, lipid peroxidation and increased antioxidants enzymes in high glucose induced HepG2 cells. In addition, the present study highlighted that high glucose treated cells showed increased expression of Extracellular Signal Regulated Protein Kinase-1 (ERK-1), c-Jun N-terminal Kinase (JNK) and p38 in HepG2 cells. On the other hand treatment with citral significantly suppressed the expression of ERK-1, JNK and p38 in high glucose induced HepG2 cells. <b>Conclusion:</b> Citral protects against high glucose induced oxidative stress through inhibiting ROS activated MAPK signaling pathway in HepG2 cells. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=BC10-BC15&id=10377 https://doi.org/10.7860/JCDR/2017/28470.10377 Pre-analytical Errors at the Chemical Pathology Laboratory of a Teaching Hospital Marlene A Tapper, James C Pethick, Lowell L Dilworth, Donovan A McGrowder <b>Introduction:</b> The Chemical Pathology Laboratory at the University Hospital of the West Indies (UHWI) processes specimens received from inpatients, the outpatient department and other medical facilities in Jamaica. Specific rejection criteria are used to determine samples unsuitable for analysis. It has been noted that despite efforts to reduce the number of unacceptable samples received in the laboratory, the problem persists. <b>Aim:</b> The study seeks to provide empirical evidence of the inadequacies from which improvements can be formulated. <b>Materials and Methods:</b> Errors recorded in the rejection log in the Chemical Pathology laboratory at the University Hospital of the West Indies for the period were assessed. The types and frequency of errors were determined manually. The yearly rejection ratios over a four-year period were evaluated. <b>Results:</b> The most common causes for rejection were unlabelled samples (37%), incorrectly labelled specimens (23%), samples submitted in an inappropriate tube (14%) and incomplete or inaccurately completed requisition forms (14%). The rejection ratio for 2015-2016 was 2.1%. <b>Conclusion:</b> The laboratory must initiate programmes directed at improving the preanalytical process in order to ensure patient safety. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=BC16-BC18&id=10378 https://doi.org/10.7860/JCDR/2017/30159.10378 CD44 Expression in Meningioma and its Correlation with Proliferation Indices Rasha Ramadan Mostafa, Rasha Ahmed Khairy <b>Introduction:</b> CD44 is a cell adhesion molecule assumed to be related to tumour invasion and metastatic ability and is expressed in variety of tumours including meningiomas. <b>Aim:</b> To evaluate the immunohistochemical expression of CD44 in variable grades and variants of meningioma and to correlate the results with Ki-67 proliferation index and available clinicopathologic variables. <b>Materials and Methods:</b> A total of 40 meningioma cases were studied for immunohistochemical expression of CD44 and Ki-67 and correlated with different clinicopathologic variables. A p-value less than 0.05 was considered statistically significant. <b>Results:</b> CD44 was markedly expressed in high grade (II and III) meningioma (81.8%) compared to grade I (18.2%) and that was statistically significant (p<0.001). Ki-67 proliferation activity was significantly correlated with meningioma grade (p<0.001) and brain invasiveness (p=0.033). Moreover, statistically positive correlation (p=0.01) was reported between CD44 and Ki-67 proliferative activity. No statistically significant correlation was detected between CD44 or Ki-67 expression and patients’ age, sex, and tumour recurrence rate (p>0.05). <b>Conclusion:</b>We concluded that CD44 is a marker of aggressiveness in meningioma as it was significantly highly expressed in grade II and III meningioma and was, positively correlated with higher Ki-67 proliferation indices. Therefore, researches should be carried out to identify the role of CD44 targeted therapy in atypical and anaplastic meningiomas as done in other tumours e.g., breast cancer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EC12-EC15&id=10379 https://doi.org/10.7860/JCDR/2017/28438.10379 An Attempt to Make Platelet Rich Fibrin from Bone Marrow Aspirate Soh Nishimoto, Kazutoshi Fujita, Toshihiro Fujiwara, Yohei Sotsuka, Maki Tonooka, Hisako Ishise, Kenichiro Kawai, Masao Kakibuchi <b>Introduction:</b> Platelet Rich Fibrin (PRF) was developed as a new generation of platelet concentration from peripheral blood. Method to make PRF is simple. It is easy to handle with its moderate firmness. Histologically, platelets and nucleated cells are packed along the yellow-red border. Bone marrow aspirate contains bone marrow cells that potentially work for tissue regeneration, and platelets which contain growth factors. The specific gravities of them are comparable. It implies that, if it is possible to make PRF from bone marrow aspirate, then high concentration of platelets and bone marrow cells can be obtained simultaneously by taking out yellow-red interface of it. <b>Aim:</b> To find out a method to make PRF from bone marrow aspirate. <b>Materials and Methods:</b> Iliac crest of rabbits were punctured and aspirated with or without anti-coagulant, under general anaesthesia. The bone marrow aspirate was centrifuged in glass tubes. For the bone marrow aspirate taken with anti-coagulant, calcium chloride was added just before centrifugation. Products were taken out and observed grossly. The products were fixed with formaldehyde and observed histologically. <b>Results:</b> Coagulated gels with two-toned colour were obtained by all methods. In the gels without anti-coagulant, interfaces between two colours were obscure. Histologically, platelets and nucleated cells scattered as clusters. Filtering caused haemolysis and reduced the yield of the product. With the aspirate taken with anti-coagulant, platelets and nucleated cells formed a band along the interface. <b>Conclusion:</b> PRF can be made from bone marrow aspirate by adding anti-coagulant in aspiration and reversed with calcium chloride just before centrifugation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PC04-PC07&id=10380 https://doi.org/10.7860/JCDR/2017/27006.10380 Effect of Different Dosages of Intravenous Midazolam Premedication on Patients Undergoing Head and Neck Surgeries- A Double Blinded Randomized Controlled Study Roshni Gupta, Neeta Santha, Madhusudan Upadya, Jesni Joseph Manissery <b>Introduction:</b> Benzodiazepines primarily acts on the central nervous system. Most patients are extremely anxious in the pre-operative period. Excessive anxiety adversely influences anaesthetic induction and often leads to functional impairment and poor recovery after surgery. <b>Aim:</b> To determine whether amnesia, anxiety, sedation and cardio respiratory symptoms are affected while administering two different doses of intravenous midazolam (0.02 mg/kg & 0.06 mg/kg). <b>Materials and Methods:</b> Two forty patients posted for head and neck surgeries were involved in this double blinded prospective randomised controlled trial. The patients were randomized into two main groups, Group 1 receiving 0.02 mg/kg and Group 2 receiving 0.06 mg/kg midazolam intravenously as premedication. Visual recognition and recall were tested using eight laminated A4 size posters pre-operatively and four further images were shown at the postoperative interview. Anxiety was evaluated by a Visual Analogue Scale (VAS) and sedation depth was determined by the Observer’s Assessment of Alertness/Sedation Scale (OAAS) scale. Vital signs including heart rate, respiratory rate, mean blood pressure and arterial oxygen saturation (SpO2) were monitored. Statistical analysis was done using paired Student's t-test and Chi-square test. <b>Results:</b> VAS scores were lower in Group 2 (0.06 mg/kg) than in Group 1 (0.02 mg/kg) at T15 (15 minutes after the injection of midazolam). Comparison of OAAS scores among Group 1 and Group 2 showed that more patients in Group 1 were alert at T15 compared to Group 2. Recall of events was significantly lower in Group 2 compared to Group 1. There was no significant statistical variation in haemodynamic parameters between the groups except for decreased diastolic blood pressure and room air saturation in Group 2. <b>Conclusion:</b> A higher dosage of midazolam improves the quality of anxiolysis and sedation with lesser rates of intraoperative recall and maintains haemodynamic stability. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=UC01-UC04&id=10381 https://doi.org/10.7860/JCDR/2017/26414.10381 Closed External Fixation for Failing or Failed Femoral Shaft Plating in a Developing Country Adil Aliakbar, Ibrahim Witwit, Alaa A. Hussein Al-Algawy <b>Introduction:</b> Femoral shaft fractures are one of the common injuries that is treated by open reduction, with internal fixation by plate and screws or intramedullary nailing, which can achieve a high union rate. <b>Aim: </b>To evaluate the outcome of using closed external fixation to augment a failing plate; with signs of screw loosening and increasing bone/plate gap; a failed plate; broken plate; screws completely out of bone with redisplacement of fracture. <b>Materials and Methods: </b>A retrospective study on 18 patients, aged between 17-42 years, who presented between 6-18 weeks after initial surgical fixation, with pain, difficulty in limb function, deformity and abnormal movement at fracture site, was done. X-Rays showed plating failure with acceptable amount of callus, which unfortunately had refractured. Cases associated with infection and no radiological evidence of callus formation were excluded from this study. Closed reduction was done by manipulation, then fracture fixation by AO external fixator. The patients were encouraged for full weight bearing as early as possible with dynamization later on. <b>Results:</b> Of the 18 patients who underwent external fixation after close reduction, 15 cases showed bone healing in a period between 11-18 weeks (mean of 14.27 weeks) with good alignment (Radiologically). Removal of external fixator was done followed by physical therapy thereafter. <b>Conclusion:</b> Closed external fixation for treatment of failing or failed femoral plating, achieves good success rate and has less complications, is a short time procedure, especially in a hospital with limited resources. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=RC04-RC06&id=10382 https://doi.org/10.7860/JCDR/2017/27437.10382 An Insight into Spiritual Health and Coping Tactics among Dental Students; A Gain or Blight: A Cross-sectional Study Kuldeep Dhama, Ritu Gupta, Ashish Singla, Basavaraj Patthi, Irfan Ali, Lav Kumar Niraj, Jishnu Krishna Kumar, Monika Prasad <b>Introduction:</b> Spiritual health is the youngest dimension of health which affects the coping skills of the individual and may help the dental students who are the caregivers of the future, to overcome crisis situation with time. <b>Aim:</b> To measure the association between spiritual health and coping skills among the dental students of private dental college. <b>Materials and Methods:</b> A questionnaire based cross-sectional study was conducted to assess the spiritual health status using Spiritual Health Assessment Scale (SHAS) and coping skills using Adolescent Coping Orientation for Problem Experiences (ACOPE) scale among the 389 dental students of different academic years in a private dental college. The data obtained was subjected to descriptive statistics and means were compared using independent t-test and one-way ANOVA. <b>Results:</b> The mean age of the study participants was 22.8±3.17 years. Majority of the students had fair spiritual health score (74.55%). Of the coping strategies dimension, highest mean score was observed in seeking diversions (3.60±1.40) and the least mean score was observed in engaging in demanding activities (2.67±1.41). Statistically significant association was seen between dimension of coping behaviour and spiritual health (p= 0.05). <b>Conclusion:</b> The present study highlights that spiritual health plays a central role and influences the coping strategies in human health. The spiritual health can continuously compensate with other health like mental, physical and social well-being. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC33-ZC38&id=10371 https://doi.org/10.7860/JCDR/2017/25358.10371 Evaluation of Effect of Zirconia Surface Treatment, Using Plasma of Argon and Silane, on the Shear Bond Strength of Two Composite Resin Cements Aswathy Kaimal, Poojya Ramdev, C S Shruthi <b>Introduction:</b> Yttria stabilised tetragonal zirconia opens new vistas for all ceramic restoration by the mechanism of transformation toughening, making it much stronger compared to all other ceramic materials. Currently, it is the most recent core material for all ceramic fixed partial dentures due to its ability to withstand high simulated masticatory loads. Problems which have been reported with zirconia restorations involve the core cement interface leading to loss of retention of the prosthesis. Different reasons which have been reported for the same include the lack of adhesion between zirconia and commonly used cements due to absence of silica phase which makes zirconia not etchable. In addition, the hydrophobic nature of zirconia causes low wettability of zirconia surface by the adhesive cements which are commonly used. <b>Aim:</b> The purpose of this in vitro study was to compare and evaluate the effect of two pre-treatments of zirconia, using plasma of argon and silane, on the shear bond strength values of two composite resin cements to zirconia and to evaluate the failure pattern of the debonded areas using stereomicroscopic analysis. <b>Materials And Methods:</b> Sixty zirconia discs (10 mm×2 mm) were randomly divided into three groups (n=20), following surface treatment, with airborne particle abrasion, using 110 µm Al2O3: Group I (control), Group II (plasma of argon cleaning), and Group III (application of silane primer). Each group had two subgroups based on the type of resin cement used for bonding: subgroup A; Rely X Ultimate (3M ESPE) and subgroup B; Panavia F (Kuraray). In subgroup A, Rely X universal silane primer and in subgroup B Clearfil ceramic primer was used. Shear bond strengths were determined after water storage for one day and thermocycling for 5000 cycles. Data (megapascal) were analyzed using ANOVA and Bonferroni test. Specimens were subjected to stereomicroscopic analysis, for evaluation of failure pattern. <b>Results:</b> Group III produced the highest shear bond strength followed by Group II and Group I. Subgroup A showed higher shear bond strength than Subgroup B. Stereomicroscopic analysis showed cohesive failure in Group III, while in Group I adhesive failure was seen. <b>Conclusion:</b> Silane primer application caused maximum increase in shear bond strength due to increased wettability. Argon plasma treatment was less effective in comparison to silane treatment. Air abrasion when used alone resulted in lower bond strength values, thereby making it necessary to use a combination of surface treatments. Rely X Ultimate cement was superior to Panavia F in terms of adhesive bonding to zirconia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC39-ZC43&id=10372 https://doi.org/10.7860/JCDR/2017/27426.10372 Magnetic Resonance Imaging in Paediatric Spinal Dysraphism with Comparative Usefulness of Various Magnetic Resonance Sequences Deepakkumar Vinodray Mehta <b>Introduction:</b> Spinal dysraphism occurs due to failure of fusion of parts along dorsal aspect of midline structures lying along spinal axis from skin to vertebrae and spinal cord. Congenital spinal anomalies may be minimal and asymptomatic like spinal bifida occulta, or severe with marked neurological deficits like Arnold-Chiari malformation or caudal regression syndrome. Magnetic Resonance Imaging (MRI) is the modality of choice to diagnose mild to severe spinal dysraphism. <b>Aim:</b> To diagnose type and extent of clinically suspected spinal anomalies by MRI scan and to compare various sequences for identifying neural tissue and fatty tissue in anomalies. <b>Materials and Methods:</b> Fifty paediatric patients referred with clinical suspicion of spinal anomalies for MRI scan to radiodiagnosis department and diagnosed as having spinal dysraphism on 1.5 Tesla MRI Scan, were included in this observational analytic study. Various MRI sequences were taken in multiple planes. MRI findings of spinal dysraphism were compared with detailed clinical examination or surgical findings. Osseous anomalies like spina bifida occulta were confirmed by radiographs or CT scan. <b>Results:</b> Out of 50 patients, type II Arnold-Chiari Malformation (34%), Spina Bifida Occulta (22%) and Diastematomyelia (18%) were common anomalies. MRI findings were well correlated with surgical findings in 20 operated cases. Nerve roots with/ without neural placode in thecal sac/outpouching were detected in combination of 3D HASTE myelographic sequence with SE/TSE T1W sequence in 24 cases; which was significantly high as compared to combinations of SE/TSE T1W sequence with TSE T2W, with STIR and with Single Shot Myelographic sequence {p-value 0.002, < 0.001 and 0.008 respectively}. Fatty component was present in dysraphism in five cases, commonly as isolated anomaly; which was detected by combination of STIR and SE/TSE T1W sequences in all five cases. <b>Conclusion:</b> Paediatric spinal dysraphism and associated malformations are accurately diagnosed on MRI scan. MR myelographic 3D-HASTE and STIR sequences should be a part of protocol to evaluate spinal dysraphism. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=TC17-TC22&id=10393 https://doi.org/10.7860/JCDR/2017/30134.10393 Isolation and Speciation of Candida in Type II Diabetic Patients using CHROM Agar: A Microbial Study Usha Sharma, Krupa Patel, Vandana Shah, Surabhi Sinha, Vishnu Pratap Singh Rathore <b>Introduction:</b> Newer Candida species are now becoming increasingly predominant commensal in the oral cavity. <b>Aim:</b>Aim of the study was to identify and compare different Candida species in the oral cavity of Type II diabetic individuals. <b>Materials and Methods:</b> The present microbial study was carried out for the duration of three months. Sixty participants were included in the study and divided into two groups of 30 individual each. Group I consisted of patients with Type II diabetes while Group II consisted of healthy individuals without diabetes or any other systemic disease. A total of 3 ml of unstimulated whole saliva was collected from them and centrifuged at 5000 rpm for fives minutes. This pellet was plated onto CHROM agar medium plates and incubated at 37°C for at least 3-4 days. CHROM agar plates were visualized daily at 24 hours, 72 hours and followed up to seven days to check for growth. Candida speciation was done by counting the different coloured creamy colonies. Comparison of Candida spp. between two groups was done by applying the Student’s t-test. A p-value<0.05 was considered as statistically significant. <b> Results:</b> All the species of Candida, namely, Candida albicans, Candida glabrata, Candida dubliniensis, Candida krusei, Candida parapsilosis except for Candida tropicalis showed a significantly higher (p<0.001) occurrence in the diabetic group compared to the healthy group. The highest identified species is C. parapsilosis, second being C. albicans in both the groups. <b> Conclusion: </b>C. parapsilosis is now considered as one of the significant causes of Candida infection in the oral cavity. This increased virulence will affect the global burden of Candidiasis as few treatment options are available for this new pathogen. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DC09-DC11&id=10394 https://doi.org/10.7860/JCDR/2017/24864.10394 Patient Demographic and Clinician Factors in Antibiotic Prescribing for Upper Respiratory Tract Infections in the Australian Capital Territory from 2006-2015 Hannah Glenn, Justin Friedman, Alexander A. Borecki, Camilla Bradshaw, Nicolas Grandjean-Thomsen, Harrison Pickup, Michelle Yue Yin, Catherine Jun, Mohamed E. Adel-Latif <b>Introduction:</b> National antibiotic stewardship programs aim to mitigate rising antimicrobial resistance and associated healthcare costs by promoting safe and appropriate antibiotic prescribing. <b>Aim:</b> This study aimed to analyse patient and clinician demographic factors that may influence antibiotic prescribing for Upper Respiratory Tract Infections (URTIs). Trends in antibiotic prescribing patterns were also analysed over the study period. <b>Materials and Methods:</b> This retrospective cross-sectional study analysed data from the Australian National University Medical School Clinical Audit Project database, comprising data collected by students during patient encounters over a two week period each April-May between 2006 and 2015 (excluding 2013). Data was collected via standardised survey in multiple healthcare settings and locations in the Australian Capital Territory (ACT) and Southeast New South Wales. (NSW) URTI diagnosis and symptomatology were defined using the International Classification of Disease (ICD-10) and International Classification of Primary Care, version 2 PLUS (ICPC-2+) criteria. <b>Results:</b> URTI accounted for 5.6% (n=698) of total patient encounters (n=12,468), and of these, 42.7% (n=289) were prescribed an antibiotic intervention. Antibiotics were significantly more likely to be prescribed in the hospital setting (44.2%; n=237) compared to community GP (32.1%; n=52; p<0.05) and for patients presenting with localised symptoms (65.9%; n=109) compared to generalised symptoms (33.7%; n=122; p<0.01). No significant association was observed for age, rurality, patient gender, clinical gender or Indigenous status. The most frequently prescribed antibiotic was penicillin (67.8%; n=196). Over the decade of study, antibiotic prescribing for URTIs showed decreasing trend both overall (R2=0.204) and with respect to all demographic factors assessed. <b>Conclusion: </b>This study supports the effectiveness to-date of antibiotic stewardship programs in Australia. While continued efforts are required to further mitigate antibiotic resistance, this study suggests target areas may include improving clinician resistance to patient demand for antibiotics and increasing confidence in prescribing for special populations such as Indigenous peoples and the extremes of age. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=FC01-FC05&id=10395 https://doi.org/10.7860/JCDR/2017/25539.10395 Effect of 2% Nasal Mupirocin Ointment on Decreasing Complications of Nasotracheal Intubation: A Randomized Controlled Trial Kourosh Taheri Talesh , Reza Movassaghi Gargary , Seyed Ahmad Arta , Javad Yazdani , Monireh Roshandel , Milad Ghanizadeh , Hossein Samadi Kafil , Mir Naser Seyyed Mousavi <b>Introduction:</b> In oral and maxillofacial surgeries, nasotracheal intubation is carried out to increase the surgeon’s access to the oral cavity. During nasotracheal intubation the risk of trauma is higher than that in orotracheal intubation as there is passage of the tube through the mucosa of the nasal tract due to which bacteria might get transported into the trachea. <b>Aim:</b> To evaluate the effect of 2% nasal mupirocin ointment before and after nasotracheal intubation on decreasing the complications of intubation for oral and maxillofacial surgeries. <b>Materials and Methods:</b> In the present single blinded randomised controlled clinical trial, 44 patients were randomly assigned to two equal groups. A sterile swab was used, eight to 10 hours before nasotracheal intubation, to take a sample for culturing from the vestibule of nostrils and the anterior septum of the patients. In Group 1, 2% nasal mupirocin ointment was applied to the vestibules of both nostrils and the anterior septum. In Group 2, no intervention was carried out. After general anaesthesia and extubation, microbial cultures were prepared from the 4 cm distal end of the tube and antibiogram test was carried out. Also, the patients were compared in terms of the severity of nasal bleeding, the ease of breathing through the nose after nasotracheal intubation. Data were analysed with suitable statistical tests. <b>Results:</b> In the mupirocin group, 27.2% of the subjects were carriers of Staphylococcus aureus in the nasal cavity but no S. aureus was detected at the distal end of nasotracheal tube after extubation. In the control group, 18.2% of the subjects were carriers of Staphylococcus aureus in the nasal cavity but there was no change in the number of S. aureus counts at the distal end of nasotracheal tube (p-value<0.001). After extubation, in the mupirocin and control groups, 18.2% and 22.7% of the subjects, respectively, exhibited severe bleeding (p-value=0.001). In the mupirocin and control groups, 86.4% and 59.1% of the subjects had easy extubation, respectively (p-value=0.044). In the mupirocin and control groups, 9.1% and 63.7% of the subjects immediately after regaining consciousness and 9.1% and 54.6% three hours after extubation had difficulty in breathing, respectively (p-value=0.001). <b>Conclusion:</b> Use of mupirocin before nasotracheal intubation decreased the complications of nasal intubation in addition to decreasing the risk of colonization of S. aureus and other gram-negative bacteria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PC08-PC12&id=10396 https://doi.org/10.7860/JCDR/2017/29575.10396 Patient Reported Outcome Assessment of Periodontal Therapy: A Systematic Review R.M. Baiju, Elbe Peter , N.O. Varghese, P Anju <b>Introduction:</b> Patient Reported Outcomes (PROs) are now regarded as a fundamental measure of therapeutic success. Patient’s opinion regarding the impact of disease and its treatment is assessed using scales such as Oral Health Related Quality Of Life (OHRQoL) tools. Patient centred outcome assessment is now being considered as a primary outcome measure in clinical trials. <b>Aim:</b> To evaluate whether treatment of periodontal disease could influence OHRQoL based on available literature. <b>Materials and Methods: </b>An electronic search was done in Google, Google Scholar and Pubmed for articles in English language using the terms Quality of Life or ORHQoL or PROs or patient centered outcome and periodontal therapy. The search commenced on 1st September 2016 and ended on 15th December 2016. Studies that employed one or more than one multi-item OHRQoL instrument to assess PROs related to either non-surgical or surgical periodontal therapy were reviewed. <b>Results:</b> Initially 423 relevant articles were obtained, from which based on screening titles and abstracts 396 were excluded. Full text of remaining 27 articles were retrieved. Nineteen clinical studies with 1345 participants and 2 systematic reviews were included after the full text review. <b>Conclusion:</b> Both surgical and Non-surgical Periodontal Therapy (NSPT) significantly influenced the OHRQoL scores. However the change in scores after surgical therapy when compared to nonsurgical therapy was not statistically significant. There is a need for a specific PRO scale that could potentially tap the entire dimension of the change in patients perception brought about by periodontal therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC14-ZC19&id=10343 https://doi.org/10.7860/JCDR/2017/28505.10343 An In vitro Comparative Evaluation of Flexural Strength of Monolithic Zirconia after Surface Alteration Utilising Two Different Techniques Ketaki Janardhan Chougule, Arti Prabodh Wadkar <b>Introduction:</b> Chairside surface alteration like grinding is often done by clinicians for adjustment of zirconia restorations. To restore the surface of the prostheses, either polishing or glazing is done. However, there is a controversy which of the surface restoration technique helps regain strength of the restoration. <b>Aim:</b> This study was conducted to evaluate the effects of chairside surface alteration on flexural strength of Monolithic zirconia. <b>Materials and Methods:</b> Rectangular zirconia samples (n=30) were prepared by CAD-CAM and divided into three groups. One was control group with no alteration (n=10), second was ground and polished (n=10) and third was ground and reglazed (n=10). Flexural strength testing was performed with a three-point bend test on a universal testing machine. The collected data was statistically analysed for normal distribution using D'Agostino and Pearson omnibus normality test, one-way ANOVA and Tukeys multiple comparison test (p<0.05). <b>Results:</b> The mean flexural strength of the reglazed group was significantly higher (648.7 MPa) as compared to the control (507 MPa) or the polished groups (588.5 MPa). <b>Conclusion:</b> Statistically, reglazing increased the flexural strength as compared to polishing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC20-ZC23&id=10361 https://doi.org/10.7860/JCDR/2017/25177.10361 Comparative Evaluation of Platelet Rich Fibrin and Dehydrated Amniotic Membrane for the Treatment of Gingival Recession- A Clinical Study Ankita Jain, Gagan Rajesh Jaiswal, Kanteshwari Kumathalli, Rajesh Kumar, Alisha Singh, Aakrti Sarwan <b>Introduction:</b> The main objective of any therapeutic intervention aimed at root coverage is to restore the tissue margin to the cemento-enamel junction and to regenerate the lost periodontium. <b>Aim:</b> To compare the effectiveness of Platelet Rich Fibrin (PRF) and Amniotic Membrane (AM) in the treatment of gingival recession by Coronally Advanced Flap (CAF) Technique. <b>Materials and Methods:</b> Thirty systemically healthy patients who met inclusion-exclusion criteria were selected. After Phase-I therapy, patients were randomly allocated to one of the groups; PRF (Group-A) and Amnion Group (Group-B). Clinical parameters like Plaque Index (PI), Recession Depth (RD) and Width of Keratinized Gingiva (WKG) were measured on the baseline day, three months and six months postoperatively. Mann-Whitney test and Wilcoxon signed ranks test were applied for intergroup and intragroup comparisons respectively. <b>Results:</b> Intergroup comparison between platelet rich fibrin and amniotic membrane showed statistically insignificant difference in the recession depth and width of keratinized gingiva at three and six months postoperatively. <b>Conclusion:</b> Both the membranes were equally effective in terms of recession coverage and increase in width of keratinized gingiva. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC24-ZC28&id=10362 https://doi.org/10.7860/JCDR/2017/29599.10362 Evaluating the Correlation between Anteroposterior and Mediolateral Compensatory Curves and their Influence on Dentoskeletal Morphology-An In vitro CBCT Study K Suresh Babu, A Nanda Kumar, Pradeep Babu Kommi, P Hari Krishnan, M Senthil Kumar, R Senkutvan Sabapathy, V Vijay Kumar <b>Introduction: </b>To date, many orthodontist corrects malocclusion based on patients aesthetic concern and fails to correct the compensatory curves. This scenario is due to less insight on understanding relationship of compensatory curves and its correlation in treatment prognosis. <b>Aim:</b> The purpose of this study was to evaluate the correlation between the curve of Spee, curve of Monson and curve of Wilson, their influence on dentoskeletal morphology and their contribution to occlusal stability. <b>Materials and Methods:</b> This study included 104 non-orthodontic models. The study casts were subdivided into two groups, Group-I consist 52 non- orthodontic models with Class-I molar relationship and Group-II consist of 52 non- orthodontic models with Class-II molar relationship. Curve of Spee was measured with digital vernier caliper, curve of Monson estimated using specially made sphere (7”inch, 8” inch and 9”inch) and curve of Wilson was evaluated using Cone Beam Computed Technology (CBCT). <b>Results:</b> Mean value for curve of Spee obtained for Group I and Group II is 1.844 mm and 3.188 mm. For curve of Monson, the mean value obtained for Group I and Group-II is 7.65 inches and 7.40 inches. The mean degree obtained for the curve of Wilson for Group I and Group-II is 12.05 and 16.49. The result showed positive correlation between curve of Spee and curve of Wilson and no correlation between curve of Monson and curve of Wilson and no correlation between curve of Spee and curve of Monson. The Pearson correlation coefficient analysis from the study confirmed these results. <b>Conclusion:</b> The results showed positive correlation between curve of spee and curve of Wilson. The data found in this study can be applied clinically for Class I and Class II malocclusion patients on diagnosis and treatment planning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC49-ZC52&id=10400 https://doi.org/10.7860/JCDR/2017/28670.10400 Home Based Care as an Approach to Improve the Efficiency of treatment for MDR Tuberculosis: A Quasi-Experimental Pilot Study Neha Taneja, Vinoth Gnana Chellaiyan, Shailaja Daral, Mrinmoy Adhikary, Timiresh Kumar Das <b>Introduction:</b> Multi Drug Resistant Tuberculosis (MDR TB) has emerged as a significant public health problem in India. The prolonged treatment duration in MDR TB is a challenge in achieving treatment completion and poses a threat to TB control in the country. Home based care is an approach accepted by patients because it helps in ameliorating their understanding of TB, improving the compliance and reducing stigma in the community. <b>Aim:</b> To assess the outcome of Home-Based Care (HC) versus No Home-Based Care (NHC) on the treatment of MDR TB patients registered at two chest clinics in Eastern Delhi. <b>Materials and Methods:</b> A quasi-experimental study was done among diagnosed MDR TB patients receiving Category IV regimen under Revised National Tuberculosis Control Programme (RNTCP) from two government chest clinics in Eastern Delhi during May 2014 to May 2016. In the control arm, 50 MDR TB patients at one of the chest clinics were offered the standard Category IV regimen under RNTCP; while in the intervention arm, 50 MDR TB patients at the second chest clinic were provided home based care (counselling, support for completion of treatment, rehabilitation, and nutritional support) along with the standard treatment. The primary outcome assessed was outcome of treatment, while secondary outcomes included stigma faced due to the disease, and impact of disease on family and community life. <b>Results:</b> The primary outcome data was available for 32 (64%) participants in the intervention arm, and 38 (76%) participants in control arm. The treatment was significantly more successful in the intervention arm (p<0.03). The data on secondary outcomes was available for all participants. Stigma due to disease was significantly lower in the intervention arm (p<0.01); also rejection faced by participants from family and community due to disease was significantly lower among the HC group (p<0.05). <b>Conclusion:</b> Home-based care in MDR TB treatment holds potential in improving treatment outcomes of patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=LC05-LC08&id=10401 https://doi.org/10.7860/JCDR/2017/27594.10401 Effect of Denture Cleansers on Surface Roughness and Flexural Strength of Heat Cure Denture Base Resin-An In vitro Study Prabal Sharma, Sandeep Garg, Nidhi Mangtani Kalra <b>Introduction:</b> Denture cleansing is essential for maintaining the prosthesis and oral health, so choosing an appropriate cleanser which is not only efficient but also not adversely affects the properties of denture base resin itself with prolonged use is important. Hence, the present study was undertaken. <b>Aim:</b> To evaluate the effect of different chemical cleansers on surface roughness and flexural strength of heat cure denture base resin when used daily for three months. <b>Materials and Methods:</b> A total of 40 rectangular specimens (65 mm x 10 mm x 2.5 mm) and 32 disc shaped specimens (10 mm x 2 mm) were fabricated from heat cure denture base resin (DPI Heat Cure) for evaluation of flexural strength and surface roughness respectively. The specimens not subjected to cleansing served as control whereas other specimens were subjected to daily cleansing with one of the three cleansers (1% sodium hypochlorite, fittydent tablets, 100% vinegar) daily and stored in distilled water for three months. Surface analyser (Surftest SJ-210, Mitutoyo, USA) was used to evaluate change in surface roughness of the specimens (?Ra) before and after cleansing. Also, flexural strength (S) of specimens after cleansing was evaluated by subjecting the specimens to load of 50 kgf at a crosshead speed of 5 mm/min in universal testing machine (INSTRON). Data obtained by testing was compiled and analysed using statistical software SPSS version 17.5. ANOVA and Post-hoc Tukey’s tests were used and p-value <0.05 was considered significant in all tests. <b>Results:</b> Results showed that the surface roughness of the specimens was significantly increased and flexural strength significantly decreased after immersion in 1% sodium hypochlorite solution for three months (p<0.05). No statistically significant difference were observed in flexural strength and surface roughness of the specimens cleaned with fittydent and 100% vinegar for three months (p>0.05). <b>Conclusion:</b> Within the limitations of this in vitro study, it was concluded that immersion in 1% sodium hypochlorite solutions for three months influences the surface roughness and flexural strength of heat cure denture base resin; hence it should be used with caution when used for long period. Fittydent and 100% vinegar can be recommended as a routine chemical cleansing agent for long term use. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC94-ZC97&id=10483 https://doi.org/10.7860/JCDR/2017/27307.10483 Iranians’ Self-Report Knowledge and Practice about Arbitrary Use of Antibiotics Kazem Hosseinzadeh, Jalil Azimian <b>Introduction:</b> Scientific studies revealed a high prevalence rate of self-medication among Iranians, nevertheless there are few studies exploring the factors affecting on. <b>Aim: </b>This study was conducted to detect the knowledge and behaviour of individuals who take antibiotics arbitrarily. <b>Materials and Methods:</b> The research population included all Iranian men and women between 20 and 60 years. The sample size based on previous studies and after applying the correction factor 1.6. Total of 950 subjects were involved in this cross-sectional study. Face and content validity (qualitative) tool was confirmed by expert faculty members. It was estimated based on Cronbachs alpha reliability 0.73. After coding, all data were entered into SPSS and analyzed. <b>Results:</b> The mean and SD of knowledge was 4.58±0.65. Sore throat (80%) and runny nose (70%) were the most common causes of antibiotic consumption in the participants. The most common reason for antibiotic use was its availability. More than 68% of participants said they never read the brochure of antibiotics. More than 51% of them were unable to understand the content of the brochure. There was a positive relation between participants’ knowledge and performance. More than 60% of them had a history of dosage change. <b>Conclusion:</b> Results of present study revealed that the study population did not possess the requisite knowledge about the appropriate behaviour in the use of antibiotics. It is recommended to do some educational program in order to improve their knowledge and behaviour. Further studies with larger sample in this regard are recommended. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=FC06-FC09&id=10495 https://doi.org/10.7860/JCDR/2017/25368.10495 Pattern of Ocular Morbidity in the Elderly Population of Northern India Vibha Florence Baldev, Rupali Chopra, Nitin Batra, Shavinder Singh <b>Introduction:</b> The frequency of eye diseases has been suggested to start increasing around 40 years of age, with an even steeper increase beginning around 60 years of age. Health promotions and curative and rehabilitative services for the visually impaired elderly population should therefore be a priority in the coming years especially in low and middle income countries. <b>Aim:</b> To examine the changing pattern of ocular morbidity in the elderly population of Northern India and to determine the socioeconomic status in relation to ocular morbidities. <b>Materials and Methods:</b> A team from the Department of Ophthalmology and Department of Community Medicine, conducted house visits and did a complete eye examination of 450 elderly subjects. They were selected by systematic random sampling from the data base available in the Department of Community Medicine. <b>Results:</b> A total of 900 eyes were examined. Visual impairment and blindness was seen in 135 (30%) and 36 (8%) individuals respectively. The most common cause of blindness was cataract, followed by corneal opacity, glaucoma, refractive error, diabetic retinopathy, macular scar, age related macular degeneration, retinal detachment, retinitis pigmentosa. Visual impairment was more in individuals with low socioeconomic status. <b>Conclusion:</b> The results of this study suggest that though cataract remains the main cause of blindness, there is an increase in blindness and visual impairment due to corneal diseases and glaucoma which was not seen earlier. The availability and accessibility to eye care facilities particularly for corneal diseases and glaucoma should be increased to reduce blindness in Northern India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=NC20-NC23&id=10496 https://doi.org/10.7860/JCDR/2017/27056.10496 Evaluation of Use of Adipose Cells in Various Procedures of Plastic Surgery and its Volumetric Quantification using High Resolution Ultrasound Somashekar Gejje, Arun K Singh, P.K Srivastava, Madhumati Goel, Vijay Kumar, Amrita Hongal <b>Introduction:</b> Autologous fat transfer is based on one of the principles of plastic surgery, replace like with like. It is used in wide variety of aesthetic procedures such as lip, facial augmentation and reconstructive procedures such as involutional disorders, post traumatic defects etc. <b>Aim:</b> We intend to study the use of adipose cells in various procedures of plastic surgery, the role of high resolution ultrasound in estimating the volume of the grafted fat, comparison of the results based on the different donor sites of the harvested fat and comparison of the effectiveness of grafted fat in extremities and craniofacial region. <b>Materials and Methods:</b> In this prospective study a total of 34 patients underwent fat grafting procedure at various sites of the body from May 2012 till November 2013. After noting the details of the patient, details of the defect, laboratory and radiological investigations, the consent for the fat grafting procedure was taken. Clinical photographs and High Resolution Ultrasound (HRUS) volume estimation was done on a regular basis as per the protocol. <b>Results:</b> Out of 34 patients, 29 patients underwent free fat grafting and five patients underwent derma fat grafting. HRUS at six months revealed a mean 73.5% and 63.5% of the injected fat remained in contour deformity in extremities and craniofacial region respectively. HRUS at one year revealed a mean 57.4% and 41.4% of the injected fat remained in contour deformity in extremities and craniofacial region respectively. <b>Conclusion:</b> HRUS is an excellent handy modality for serial volume estimation, cost-effective, non-invasive, multi planar modality, does not require any preparation, and easily done outdoor procedure. Follow up is a practical proposition. Autologous fat grafting is a safe procedure with no significant complications other than fat reabsorption and it can be done under local anaesthesia in contour deformity of smaller areas. Disadvantage of autologous fat grafting is the fat reabsorption needing multiple sittings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PC17-PC21&id=10497 https://doi.org/10.7860/JCDR/2017/25116.10497 Prevalence of Helicobacter Pylori Infection and Stress, Anxiety or Depression in Functional Dyspepsia and Outcome after Appropriate Intervention Kirti Katherine Kabeer, Nilakanthan Ananthakrishnan, Chetan Anand, Sivaprakash Balasundaram <b>Introduction:</b> The association between psychological factors and non-ulcer dyspepsia remains controversial. <b>Aim:</b> To determine the prevalence of Helicobacter pylori (HP) and Stress/Anxiety/Depression (SAD) in patients with Functional Dyspepsia (FD) and assess the outcome at three months after appropriate intervention. <b>Materials and Methods: </b>This prospective non-randomized interventional study was conducted on 120 patients with FD. Initial workup included upper gastrointestinal endoscopy to confirm HP infection with either of two tests, the urease test or histopathology. Patient Health Questionnaire-9 scale (PHQ-9) was used to assess depression, General Anxiety Disorder-7 scale (GAD-7) for anxiety and Perceived Stress Scale (PSS) for stress. Patients were considered positive when they had significant scores on one or more of the questionnaires (SAD+). The subjects were then classified into four groups: Group A (positive for HP and SAD, n=35), Group B (positive for HP and negative for SAD, n=31), Group C (negative for HP and positive for SAD, n=33) and Group D (negative for HP and SAD, n=21). The groups were then treated as follows: Group A: HP eradication plus psychiatric intervention, Group B: HP eradication alone, Group C: psychiatric intervention alone and Group D: proton pump inhibitors. Modified Glasgow Dyspepsia Symptom Score (Mod. GDSS) was used to assess the severity of dyspepsia at baseline and to monitor the change in score over three months. Statistical analysis was done using the Statistical Package for the Social Sciences version 16.0. Non-parametric data like proportions of response in different groups to treatment was analysed using the Chi square test and quantitative data using ANOVA. Gender wise distribution and response to treatment was calculated using the z-test and unpaired t-test. <b>Results:</b> Overall 120 patients were recruited across four groups. A 55% of the subjects were positive for HP and 56.7% for SAD and 29.2% for both. In all three groups with psychiatric comorbidity, females exceeded males in a proportion of 3:1. Mod. GDSS was not significantly different at baseline between HP+ and HP- patients (p=0.1278) except when HP positivity was also associated with SAD (p<0.001), whereas SAD positivity alone significantly increased the baseline Mod. GDSS (p=0.006). Mod. GDSS declined in all four groups at three months. When a fall of four or more was considered as an indicator of significant response to intervention, it was seen that overall 74.2% responded to intervention with the best response in Group B and the poorest was in Group C. <b>Conclusion: </b>There is a significant prevalence of HP and SAD in FD. Appropriate intervention is beneficial except in those who are HP negative and SAD positive. This latter group requires further investigation and or drug intervention for SAD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=VC11-VC15&id=10486 https://doi.org/10.7860/JCDR/2017/26745.10486 Measles Outbreak in the Adolescent Population - Matter of Concern? Priya Rathi, Varun Narendra, Vivek Sathiya, Sanjay Kini, Avinash Kumar, Noore Sana, Rohini, Veena G Kamath <b> Introduction:</b> Measles is a disease predominantly seen in young children and infants. It is an unusual occurrence of the disease in the adolescent population warranting an investigation. This would help understand the possible cause-effect relation, changing epidemiology of the disease and immunity gaps to initiate targeted interventional strategies. <b> Aim:</b> To determine the time, place and person distribution of an outbreak and calculate the attack rates and vaccine efficacy. <b> Materials and Methods:</b> Investigation of an outbreak was conducted by an emergency rapid response team following the report of a case of measles on 18th November 2013, in and around the campus of the study university in search of suspects and undetected cases. W.H.O developed standard outbreak investigation formats, were used for obtaining the data. The subjects were chosen by purposive sampling. All the contacts of the cases were approached along with a house to house survey in the surrounding residential area for active case finding. Measles was clinically diagnosed based on the standard case definition of measles as per the WHO guidelines and confirmed through measurement of measles specific IgM antibody levels in the serum of suspected/clinically confirmed cases. <b> Results:</b> The outbreak lasted for duration of six weeks during which a total of 20 laboratory confirmed cases were found. Most of the cases were in the age group of 21-25 years. The overall attack rate was 3.5% and vaccine efficacy was calculated to be 75%. <b> Conclusion:</b> There is an epidemiological shift in the age of occurrence of measles in the region among students coming from various regions of the country staying predominantly in hostels. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=LC20-LC23&id=10488 https://doi.org/10.7860/JCDR/2017/28619.10488 Amelioration of Pain on Injection of Propofol: A Comparison of Pretreatment with Granisetron Vs Lignocaine Parvin Banu, Arunava Biswas, Syed Mohammed Naser,Sujata Ghosh, Kakoli Ghosh, Sangita Mandal <b>Introduction:</b> Pain during propofol injection is a very commonly and frequently encountered event during induction of anaesthesia. A 5HT3 antagonists like granisetron are commonly used just prior to intravenous propofol as pre anaesthetic medication to prevent emesis in patients. <b>Aim:</b> Comparison of pre treatment with granisetron versus lignocaine with respect to amelioration of pain induced by injection of propofol,in patient admitted for elective surgery with general anaesthesia. <b>Materials and Methods:</b> A randomized double blinded controlled study was conducted with patients divided into three groups with (n=30) in each group. Group I (the placebo group) received 2 ml of 0.9% normal saline, Group II received 2 ml of 1% lignocaine and Group III received 2 ml of granisetron (1 mg/ml) as pre treatment medication respectively. The patient’s complain regarding pain on intravenous propofol administration was recorded using the Verbal Rating Score. Pulse, BP, SpO2 were noted meticulously on three occasions–immediately after pre-treatment, injecting full dose of propofol (not for pain assessment) and after 10 minutes. The results were analysed using the null hypothesis and two sample t-tests. <b>Results:</b> It was observed and obvious that the relief of pain was significant (p<0.05) when granisetron or lignocaine was compared with the placebo group. But there was insignificant difference (p>0.05) when granisetron was compared with lignocaine in terms of relieve of pain induced by propofol. <b>Conclusion:</b> It was concluded that parenteral administration of granisetron can be considered to be superior to lignocaine as pre treatment medication for pain relief after propofol injection along with the advantage of its anti-emetic effect https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=UC09-UC12&id=10489 https://doi.org/10.7860/JCDR/2017/29503.10489 The Effects of Imaging Enhancement Tools in the Detection of Horizontal Root Fractures Mohammed Barayan, Ibrahim Nasseh, Hassem Geha, Marcel Noujeim <b> Introduction:</b> Detection of root fracture is challenging both clinically and radiographically. Root fractures occur in different planes with unpredictable presentations. <b> Aim:</b> The aim of the study was to evaluate the diagnostic accuracy of selected digital image enhancement tools in the detection of horizontal Root Fracture (RF). <b> Materials and Methods:</b> Fifty three roots, of single and multi-rooted teeth, in eight dentate human cadaver mandibles were selected for this study. Following minimally traumatic extraction of the teeth, horizontal fractures were induced in 23 roots and remounted in the empty sockets of their respective human dry mandibles. The remaining teeth with no fractures were used as the control group. Twenty two periapical radiographs were obtained by using the paralleling technique and using Complementary Metal Oxide Semiconductor (CMOS). Image J software was used to enhance the original images with the Inversion (IN), Histogram-Equalization (EQ), and Polynomial (Poly) tools. A total of 88 periapical images (original and three enhanced images) were reviewed independently by three Oral and Maxillofacial Radiologists and two Endodontists. Receiver Operating Characteristic (ROC) curve analysis was used to evaluate the accuracy of fracture detection and the kappa statistic was used to assess agreement among reviewers. <b> Results:</b> The diagnostic accuracy for one of the observers was significantly different in detection of RF with only EQ enhancement tool. Sensitivity and specificity were not significantly different. Interobserver agreement showed no significant difference between imaging methods. Intra-observer agreement was high to moderate. <b> Conclusion:</b> There was no significant difference between the different imaging modalities. No statistical difference for the agreement was found among or between the endodontists and radiologists in this study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC98-ZC101&id=10490 https://doi.org/10.7860/JCDR/2017/26775.10490 In Vitro Evaluation of Enamel Microhardness after Application of Two Types of Fluoride Varnish Fatemeh Molaasadolah, Solmaz Eskandarion, Atieh Ehsani, Meysam Sanginan <b>Introduction:</b> Use of fluoride compounds is one of the most effective ways of preventing decay and among these varnishes have high acceptance among different fluoride products. <b>Aim:</b> Hence, the aim of this research was to evaluate the micro-hardness of tooth enamel after the usage of two different commercial products of fluoride varnish. <b>Materials and Methods:</b> This in vitro experimental study was performed on 51 extracted premolar teeth. The teeth were divided randomly into three 17-membered groups. The first group received Duraflor varnish, the second group received Ariadent Iranian varnish while the third group received no treatment. Micro hardness of tooth enamel was measured utilizing Vickers method before and after the use of fluoride varnish. ANOVA, Tukey, and Wilcoxon statistical tests were utilized for statistical analysis of data. <b>Results:</b> The comparison of mean change in micro hardness before and after the use of fluoride showed that increase in micro hardness in Duraflor varnish and Ariadent varnish group was significant when compared to control group (p<0.05) but no significant statistical difference was observed in terms of mean of micro hardness after intervention between two groups of Duraflor varnish and Ariadent varnish (p>0.05). <b>Conclusion:</b> According to the findings, the use of fluoride significantly increased the enamel micro hardness which did not show a significant difference between two groups of Duraflor varnish and Ariadent varnish. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC64-ZC66&id=10412 https://doi.org/10.7860/JCDR/2017/30121.10412 Screening Mammography: A Pilot Study on Its Pertinence in Indian Population by Means of a Camp Joish Upendra Kumar, Vivek Sreekanth, Harikiran R Reddy, Aishwarya B Sridhar, Niveditha Kodali,Anitha S Prabhu <b>Introduction:</b> Breast cancer incidence and related mortality is increasing in Indian women. Indian ladies hesitate to seek medical care for breast related issues. Screening mammography, proved to effectively reduce mortality, has been deemed not feasible in Indian context due to cost considerations. The suggested alternatives have not been proven to improve mortality rates. <b>Aim:</b> To find the relevance of screening mammography camp among Indian women. <b>Materials and Methods:</b> A week long screening mammography camp was organized in a tertiary care hospital. Clinical examination was done followed by bilateral mammography. Mammograms were reported as per American College of Radiology-Breast Imaging Reporting and Data Systems (ACR-BIRADS) 5th edition specifications. Lesions deemed BIRADS 4 and 5 were biopsied. BIRADS 3 category findings were suggested short interval follow up. <b>Results:</b> A total of 118 women, ranging from 35 to 64 years of age with mean age of 49.6 years underwent mammography. Thirty ladies with dense breast compositions further underwent sono-mammography. Six (5.1%) new cases of breast carcinomas were detected during this study and 28 (23.7%) cases with probably benign findings were advised short interval follow up. <b>Conclusion:</b> Mammography, being a proven screening modality effective in reducing mortality, needs incorporation into the nationwide program for breast cancer detection, inspite of financial considerations. Organizing mammography camps will help create awareness and encourage public to utilize services. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=TC29-TC32&id=10464 https://doi.org/10.7860/JCDR/2017/29117.10464 Influence of Post Angulation between Coronal and Radicular Segment on the Fracture Resistance of Endodontically Treated Teeth Satheesh B Haralur, Anas Abdullah Lahig, Yahya Ahmed Al Hudiry, Abdullah Hassan Al-Shehri, Ahmed Abdullah Al-Malwi <b> Introduction:</b> The objectives of coronal restoration in the Endodontically Treated Teeth (ETT) include rehabilitation of aesthetics, function and prevention of coronal leakage. The long axis of root and the coronal segment in the maxillary anterior teeth varies according to the occlusal scheme. The restorative dentist is required to fabricate the post angulation in compatibility to contour of the adjacent teeth. <b> Aim: </b> To evaluate the influence of the angle between the long axes of core facial surface and the radicular segment of the post on fracture resistance of ETT. <b> Material and Methods:</b> Total of 30 maxillary intact canines was root canal treated, sectioned 2 mm above the CEJ. The custom made nickel-chromium endodontic posts were fabricated using direct method. The samples were divided among three groups of 10 each. The angle between coronal segment and radicular segment of post in Group-I, Group-II, Group-III were 5°, 10°, and 15° respectively. The teeth samples were cemented with full veneer metal crown and tested under universal testing machine. The static load at the angle of 130° was applied until the fracture to record the fracture strength. The obtained data was statistically analysed with ANOVA and Tukey post-hoc test. <b> Results:</b> The Group-III showed the highest fracture strength with 666.15 N. The Group-II and Group-I recorded the mean fracture strength at 443.37 N, and 276.74 N respectively. <b> Conclusion:</b> The endodontic post with higher angle between the long axis of facial surface and radicular segment long axis had the positive correlation to the fracture strength in ETT. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC90-ZC93&id=10470 https://doi.org/10.7860/JCDR/2017/27965.10470 Storage Medium Affects the Surface Porosity of Dental Cements M. Ali Saghiri, Asal Shabani, Armen Asatourian, Nader Sheibani <b>Introduction:</b> Calcium silicate-based cements physical properties is influenced by environmental changes. <b>Aim:</b> Here, we intended to evaluate the effect of storage medium on surface porosity of root Mineral Trioxide Aggregate (MTA) and Biodentine cement. <b>Materials and Methods:</b> A total of 40 polyethylene tubes were selected and divided into two groups: Group A (MTA) and Group B (Biodentine). Each group was subdivided into two subgroups (n=10). In subgroups A1 and B1, tubes were transferred to Distilled Water (DW), while samples of subgroup A2 and B2 were transferred to Synthetic Tissue Fluid (STF) as storage medium and samples were stored for three days. All specimens were then placed in a desiccator for 24 hours and then subject to surface porosity evaluation by Scanning Electron Microscopy (SEM) at ×500, ×1000, ×2000 and ×5000 magnifications. The number and the surface porosities were determined by Image J analysis. Data were analyzed by ANOVA at level of significance of p<0.05. <b>Results:</b> The lowest surface porosity was observed in MTA samples stored in STF and the highest was in Biodentine samples stored in DW. Significant differences were noted between groups and subgroups of each group (p< 0.05). MTA samples stored in DW and STF showed significantly lower surface porosities compared to Biodentine samples (p < 0.05). <b>Conclusion: </b>Storage medium can drastically affect the surface porosity of tested calcium silicate-based cements. However, MTA showed lower surface porosity compared to Biodentine cement, which can result in lower microleakage in applied area. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC116-ZC119&id=10517 https://doi.org/10.7860/JCDR/2017/28657.10517 Laparoscopic versus Open Repair of Para-Umbilical Hernia- A Prospective Comparative Study of Short Term Outcomes Sreeharsha Korukonda, Anandhi Amaranathan, Vishnu Prasad Nelamangala Ramakrishnaiah <b>Introduction:</b> Para-Umbilical Hernia (PUH) is one of the most common surgical problems. Since the prosthetic repair has become the standard of practice for inguinal hernia management, the same has been adapted for para-umbilical hernia management with better outcome. There is still debate going on regarding the optimal surgical approach. There are very few prospective studies comparing the laparoscopic and open method of para-umbilical hernia mesh repair. This study compared the short term outcomes following laparoscopic versus open mesh repair of PUH. <b>Aim:</b> To compare the early complications of open repair with laparoscopic repair of PUH. To compare the post-operative hospital stay of open repair with laparoscopic repair of PUH. <b>Materials and Methods:</b>This was a prospective comparative clinical study done from August 2014 to August 2016. All the patients above the age of 13 who attended our surgical outpatient department with PUH were taken into our study. Exclusion criteria included 1) Patients with obstructed or strangulated PUH 2) Patients with abdominal malignancies 3) Patients with coagulopathy, severe cardiopulmonary disease, ascites and renal failure 4) Patients who had PUH repair in combination with another major surgical operation such as laparoscopic cholecystectomy and inguinal hernia repair 5) Patients with recurrent PUH. Institute Ethical Committee clearance was obtained for this study. <b>Results: </b>Out of 40 patients with PUH, 20 received open meshplasty and 20 patients received laparoscopic meshplasty. Postoperative pain and length of hospital stay is significantly less in laparoscopic PUH repair. Postoperative complications like wound infection, seroma, and haematoma are relatively less in laparoscopic group though statistically not significant. <b>Conclusion:</b> Laparoscopic PUH repair has significantly better outcome in terms of postoperative pain and postoperative hospital stay. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PC22-PC24&id=10512 https://doi.org/10.7860/JCDR/2017/28905.10512 Prevalence of Principles of Piaget’s Theory Among 4-7-year-old Children and their Correlation with IQ Sugandha Marwaha, Mousumi Goswami, Binny Vashist <b>Introduction:</b> Cognitive development is a major area of human development and was extensively studied by Jean Piaget. He proposed that the development of intellectual abilities occurs in a series of relatively distinct stages and that a child’s way of thinking and viewing the world is different at different stages. <b>Aim:</b> To assess Piaget’s principles of the intuitive stage of preoperational period among 4-7-year-old children relative to their Intelligence quotient (IQ). <b>Materials and Methods: </b>Various characteristics as described by Jean Piaget specific for the age group of 4-7 years along with those of the previous (preconceptual stage of preoperational period) and successive periods (concrete operations) were analysed using various experiments in 300 children. These characteristics included the concepts of perceptual and cognitive egocentrism, centration and reversibility. IQ of the children was measured using Seguin form board test. Inferential statistics were performed using Chi-square test and Kruskal Wallis test. The level of statistical significance was set at 0.05. <b>Results:</b> The prevalence of perceptual and cognitive egocentrism was 10.7% and 31.7% based on the experiments and 33% based on the interview question. Centration was present in 96.3% of the children. About 99% children lacked the concept of reversibility according to the clay experiment while 97.7% possessed this concept according to the interview question. The mean IQ score of children who possessed perceptual egocentrism, cognitive egocentrism and egocentrism in dental setting was significantly higher than those who lacked these characteristics. <b>Conclusion:</b> Perceptual egocentrism had almost disappeared and prevalence of cognitive egocentrism decreased with increase in age. Centration and lack of reversibility were appreciated in most of the children. There was a gradual reduction in the prevalence of these characters with increasing age. Mean IQ score of children who possessed perceptual egocentrism, cognitive egocentrism and egocentrism in dental setting was higher. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC111-ZC115&id=10513 https://doi.org/10.7860/JCDR/2017/28435.10513 Study of Red Cell Fragility in Different Stages of Chronic Kidney Disease in Relation to Parathyroid Hormone Suchismita Panda, Anuva Mishra, Manoranjan Jena, Sashi Bhusan Rout, Srikrushna Mohapatra <b>Introduction:</b> Anaemia is one of the common complications associated with Chronic Kidney Disease (CKD) responsible for the increase in the morbidity and mortality in such patients. Several factors have been attributed to cause renal anaemia, amongst which hyperparathyroidism is one of the less recognised reasons. Most studies have been conducted in this regard in CKD patients undergoing haemodialysis. The level of PTH in early stages of chronic kidney disease has not been much studied. The excess amount of Parathyroid Hormone (PTH) secondary to CKD has been suggested to be a causative factor for anaemia. <b>Aim: </b>To evaluate the serum PTH level in CKD patients before haemodialysis and to study the association of the haemoglobin status with the parathyroid hormone. <b>Materials and Methods:</b> Forty CKD patients above 18 years of age before haemodialysis and 25 age and sex matched healthy controls were included in the study. Routine biochemical and haematological parameters such as Routine Blood Sugar (RBS), urea, creatinine, Na+, K+, Ca2+, PTH and Hb% were perfomed. Red cell osmotic fragility was measured by serial dilutions of whole blood with varying concentrations of sodium chloride ranging from 0.1% to 0.9%. <b>Results:</b> The study revealed a significant fall in Hb%, along with a rise in Median Osmotic Fragility (MOF) and PTH in the CKD patients when compared to the control group. Linear regression of PTH with Hb% revealed significant negative association between both the parameters with a R2 value of 0.677. Multilinear regression analysis of MOF and other independent variables such as Hb%, Na+, K+, Ca2+, urea, PTH and creatinine highlighted the variance of MOF by 72%, maximal variance contributed by PTH. Receiver Operating Curve (ROC) analysis revealed an area under the curve of 0.980 with a sensitivity of 100% and specificity of 87% in detecting osmotic fragility at a cut off value of PTH =100 pg/ml. <b>Conclusion:</b> The underlying cause of anaemia should be identified early in the CKD patients before haemodialysis. Secondary hyperparathyroidism should be ruled out as a causative factor of anaemia to slow down the progression of the disease process. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=BC29-BC32&id=10514 https://doi.org/10.7860/JCDR/2017/27344.10514 Severity and Frequency of Menopausal Symptoms in Middle Aged Women, Rasht, Iran Marzieh Masjoudi, Marjan Akhavan Amjadi, Ehsan Kazem Nezhad Leyli <b>Introduction: </b>Menopause is a natural event in women’s life. Some studies have shown that, these symptoms can lead to low quality of life. <b>Aim: </b>To identify the severity and frequency of menopausal symptoms in different stages of menopause, in a group of middle aged women. <b>Materials and Methods:</b> This cross-sectional study was conducted on 646 women aged 45-60 years in Rasht, Iran, who were included in the study by convenience sampling method. Menopause Rating Scale (MRS) was used to measure the severity of menopausal symptoms. Descriptive and analytical statistics by SPSS software version 19.0 was used for analysis. <b>Results:</b> Mean age of women was 50.7± 4.65 years. About half of the participants (49.2%) were postmenopausal. The remaining 18.1% (n=117) and 32.7% (n=211) were perimenopausal and premenopausal, respectively. The score of physical domain for menopause symptoms was higher in postmenopausal women. Joint and muscle problems were the most frequent symptoms in post and perimenopausal women. Also, total score for menopausal symptoms was more in postmenopausal group than other groups (p<0.001). Severe symptoms were seen only in three post-menopausal women and 55.2% of them had mild to moderate symptoms. <b>Conclusion:</b> The menopause related symptoms differed based on the stage of menopause. Such studies are useful for creating awareness among women so that they can identify common menopausal symptoms and consequently may improve their quality of life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=QC17-QC21&id=10515 https://doi.org/10.7860/JCDR/2017/26994.10515 Traumatic Dental Injuries Prevalence and their Impact on Self-esteem among Adolescents in India: A Comparative Study Nikita Goyal, Simarpreet Singh, Anmol Mathur, Diljot Kaur Makkar, Vikram Pal Aggarwal, Anshika Sharma, Puneet Kaur <b>Introduction:</b> Adolescents are mostly injured during sport activities, traffic accidents and some forms of violence which may lead to traumatic injuries. Traumatic injuries not only pose a health risk worldwide but are also regarded among serious social problems. Poor oral health has been related to poor social relationships that affect the ability to learn and grow which may lead to reduced self-esteem. <b>Aim:</b> This study was conducted to compare self-esteem of adolescents with and without anterior Traumatic Dental Injury (TDI). <b>Materials and Methods:</b> A population based comparative study was conducted among 10 to 17 years old adolescents from November 2014 to January 2016. The study sample comprised of 424 controls and 212 cases with 2:1 control-to-case ratio that were selected by four examiners along with a gold standard examiner. TDI was recorded using Ellis classification and self-esteem was recorded using Rosenberg’s Self-Esteem Scale (RSES). For comparing self-esteem of cases and controls according to RSES questions, t-test is used. Odds ratio (OR) was utilized to assess and compare the self-esteem according to high and low esteem in cases and controls. <b>Results:</b> Ellis Class I, Ellis Class II and Ellis Class III fractures were observed in 53.3%, 33.49% and 13.20% of cases, respectively. The maxillary arch was the most affected (72.48%) and on the hierarchy of causes, this study found that on most occasions dental injuries were caused by sports (40.09%). The total mean score of RSES in cases (23.16) and in controls (24.43) was also statistically significant (p<0.001). <b>Conclusion:</b> Improving oral health in schools may contribute considerably to increase the self-esteem of adolescents in a positive direction and help them in becoming socially competent adults. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC106-ZC110&id=10510 https://doi.org/10.7860/JCDR/2017/27496.10510 A Comparative Analysis of Master Casts Obtained using Different Surface Treatments on Impression Copings for Single Tooth Implant Replacement -An In vitro Study Surbhi Abrol, Archana Nagpal, Rupandeep Kaur Samra, Ramit Verma, Vishal Katna, Parikshit Gupt <b>Introduction:</b> Minor rotation of impression coping secured in the impression is an avoidable error that needs to be minimized to ensure precise positioning of implant analog in master cast. <b>Aim:</b> The aim of the study was to compare the precision in obtaining master casts by improving the stability of impression copings in the impression with the use of tray adhesive along various surface treatments to increase surface area and by mechanical locking. <b>Materials and Methods:</b> A total of 60 samples were made (15 samples for each group). A total of 15 samples for Group I were prepared with untreated impression copings, 15 samples for Group II with impression copings treated and modified by application of tray adhesive only. Group III includes 15 samples which were fabricated with impression copings modified by making four vertical grooves on surface of impression coping and coated with adhesive. Group IV had 15 samples which were fabricated with impression copings sandblasted with 50 µm aluminum oxide powder and coated with adhesive. Profile projector was used to evaluate the rotational accuracy of the implant analogs by comparing Molar Implant Angle (MIA) and Premolar Implant Angle (PIA) of test samples with reference model. One-way ANOVA and Student t-test were used to analyze the data. <b>Results:</b> One-way ANOVA didn’t show any significant differences for both MIA and PIA between the Groups I, II, III and IV. Student’s unpaired t-test revealed no significant difference in the mean MIA and mean PIA. <b>Conclusion:</b> Though results were statistically non-significant, all types of surface treatments of the impression copings showed more accurate transfer than those with no treatment. Sandblasted and adhesive coated impression copings showed minimum amount of rotation followed by those with vertical slots and adhesive coated impression copings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC102-ZC105&id=10501 https://doi.org/10.7860/JCDR/2017/28372.10501 Extrication of DNA from Burnt Teeth Exposed to Environment Gantala Ramlal, Devarajn Vevaraju, Arjun Yadav Vemula, Tipirisety Swapna, P Hima Bindu <b>Introduction:</b> Teeth are good sources of DNA in mass disasters especially in fires and explosions because they are largely protected from environmental and physical conditions. It is possible to obtain mitochondrial DNA (mtDNA) even in cases of degraded human remains. <b>Aim:</b> To obtain DNA from burnt teeth exposed to environment for a period of six months and 12 months and to highlight the importance of DNA obtained from tooth in identifying a deceased in fire accidents after being subjected to environment. <b>Materials and Methods:</b> Randomly 20 extracted teeth samples were collected. The teeth were divided into two groups (Group 1 and 2) and were subjected to 700°C using a Delta burnout furnace. Burnt teeth were exposed to environment for a period of six months and 12 months respectively. Data was analysed by Statistical Package for Social Sciences (SPSS) version 16.0. Data was summarized by percentages for count data. The comparison within group was done by single proportion test and the comparison between two groups was done by two proportion test. All p-value less than 0.05 were considered as statistically significant. <b>Results:</b> The present study revealed that mtDNA was obtained from eight extracted teeth samples among Group 1 and six extracted teeth samples among Group 2. <b>Conclusion:</b> Teeth are good source of DNA, even in cases where the bodies are burnt and exposed to environment.b# https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC120-ZC122&id=10525 https://doi.org/10.7860/JCDR/2017/26911.10525 Comparative Evaluation of Efficacy of Iontophoresis with 0.33% Sodium Fluoride Gel and Diode Laser Alone on Occlusion of Dentinal Tubules Anup Raghunath Patil, Siddhartha Varma, Girish Suragimath, Keshava Abbayya, Sameer Anil Zope, Vishwajeet Kale <b>Introduction: </b>Dentinal Hypersensitivity (DH) is one of the most commonly encountered clinical problems. Literature reveals no specific therapy to satisfactorily eliminate dentinal hypersensitivity. <b>Aim:</b> The aim of this study was to assess and compare the efficacy of iontophoresis with 0.33% Sodium Fluoride (NaF) gel and diode laser alone in dentinal tubule occlusion. <b>Materials and Methods: </b>This in vitro study included 20 teeth with intact root surfaces unaltered by extraction procedure for specimen preparation. Each tooth was cleaned, air dried and cut into three sections. Total 60 sections were prepared (30 longitudinal and 30 transverse sections), which were acid etched. In control group, no treatment was carried. In iontophoresis treatment group, samples were inserted into a foam tray containing 0.33 % NaF Gel and subjected to 1.5 mA output current for three minutes. In laser treatment group, specimens were lased with 980 nm diode laser at 0.5 W/PW (62.2J /cm2) in a noncontact mode for 30 seconds. Specimens were evaluated under Scanning Electron Microscope (SEM) at 10KV to 20KV under x 2000, x5000 magnification for surface characteristics and patency of dentinal tubules. Total number of tubules visible, open, completely and partially occluded were recorded in each microphotograph and compared. <b>Results:</b> On comparison, laser group showed the least number of open tubules i.e., 130 (31.1%) followed by iontophoresis group, 155 (51.32%) and control group 417 (100%). <b>Conclusion: </b>Diode laser application provided better results as compared to iontophoresis on occlusion of dentinal tubules. Hence, it can be used to treat the patients with DH. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZC123-ZC126&id=10526 https://doi.org/10.7860/JCDR/2017/29428.10526 Improving the Diagnosis of Scrub Typhus by Combining groEL Based Polymerase Chain Reaction and IgM ELISA Karthikeyan Anitha Patricia, Sugeerappa Laxmanappa Hoti, Reba Kanungo,Purushothaman Jambulingam, Nair Shashikala, Ashok C Naik <b>Introduction:</b> Scrub typhus, an acute febrile illness, caused by Orientia tsutsugamushi, is an important cause of pyrexia of unknown origin in regions of endemicity. This disease is mostly underdiagnosed or misdiagnosed, the reasons for this being a combination of factors which include clinical manifestations that can mimic other infections, lack of easy and reliable diagnostic methods and variation among strains in endemic areas. Hence, easy and reliable methods of diagnosis will contribute to rapid identification and treatment of the infection. <b>Aim:</b> The aim of the study was to compare four different methods of detection of scrub typhus and to identify one single test or a combination of tests detecting maximum number of cases. <b>Materials and Methods:</b> One hundred and forty-five suspected scrub typhus cases were included in this study. Duration of fever and presence of eschar in each patient was noted down. Enzyme-Linked Immunosorbent Assay (ELISA) to detect Immunoglobulin M (IgM) antibodies and Polymerase Chain Reaction (PCR) to detect three genes of Orientia, namely, 56 kDa, 16S rRNA, and groEL were done on these samples. The results of each test were analyzed to identify the test picking up maximum number of positive samples. Statistical analysis was performed using Chi-square test. The level of significance was set at p<0.05. <b>Results:</b> These tests showed that IgM ELISA (93%) and PCR (68%) picked up maximum number of positives. Statistical analysis performed using Chi-square test between the diagnostic assays showed that the p – value <0.001 was significant for IgM ELISA. Among the molecular markers, p-value was significant (<0.001) for groEL PCR. Further analysis of eschar positivity and duration of fever also showed that groEL PCR could detect DNA of the bacterium even in cases with 10 days of fever and this PCR was the best among the molecular markers used to detect the infection. <b>Conclusion:</b> This study suggests that IgM detection by ELISA and conventional groEL PCR, either in combination or alone, depending on the duration of fever, would enhance the diagnosis of scrub typhus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DC27-DC31&id=10519 https://doi.org/10.7860/JCDR/2017/26523.10519 Surfactant Therapy for Early Onset Pneumonia in Late Preterm and Term Neonates Needing Mechanical Ventilation Sujata Deshpande, Pradeep Suryawanshi, Kunal Ahya, Rajesh Maheshwari, Samir Gupta <b> Introduction:</b> Pathophysiology of pneumonia involves leakage of plasma proteins into the airways and accumulation of cytokines within the lung. Several in vitro and in vivo studies have demonstrated that this proteinaceous material and lung inflammation inhibit surfactant function. <b> Aim:</b> To evaluate whether exogenous surfactant therapy improves oxygenation and gas exchange in late preterm and term neonates with early onset pneumonia and respiratory failure. <b> Materials and Methods:</b> This prospective interventional cohort study was conducted at a tertiary care neonatal unit. Twenty four late preterm and term neonates with early onset pneumonia requiring mechanical ventilation for respiratory failure were included and received surfactant therapy. Oxygenation index, arterial/alveolar PO2 (a/A ratio), mean airway pressure and fraction of inspired oxygen were calculated from arterial blood gases obtained before and after surfactant therapy. Wilcoxon signed rank sum test was used for assessment of change in oxygenation variables 12 hours after surfactant therapy. Data regarding clinical outcomes and complications were collected and analysed. <b> Results: </b> Just over half (54.2%) of the study neonates were of term gestation. After surfactant therapy, the median Oxygenation Index (OI) decreased from 11.15 to 3.7 at one hour and the change was sustained and significant at 12 hours (p<0.05). The median a/A PO2 ratio improved from 0.09 to 0.3 within one hour of surfactant replacement and the improvement was significant at 12 hours (p<0.01). Twenty two neonates (92%) survived to discharge. Median duration of hospital stay was 15 days. <b> Conclusion: </b> Significant and rapid improvement in oxygenation in late preterm and term neonates with early onset pneumonia was seen after surfactant therapy, which is sustained for a longer period. There could be a substantial role for the use of surfactant in early onset pneumonia, although larger controlled trials are needed before definite recommendations can be made. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=SC09-SC12&id=10520 https://doi.org/10.7860/JCDR/2017/28523.10520 Role of Neck Dissection in Clinical T3N0M0 Lesion of Oral Cavity: Changing Trend Arjun Dass , Surinder K Singhal, RPS Punia, Nitin Gupta, Hitesh Verma, Shilpi Budhiraja, Minakshi Salaria <b>Introduction: </b>Neck dissection is an important part in the management of head and neck malignancies especially in terms of control of nodal metastasis. The study is focused on evaluating the profile of lymph nodes in T3N0M0 lesion of different subsides of oral cavity. <b>Aim:</b> To evaluate the utility of neck dissection in T3N0M0 stage of carcinomas of the different region of oral cavity. Materials and Methods: Ninety patients aged 20 to 70 years underwent treatment for carcinoma of the oral cavity at our center between 2005 and 2013. Of these, 39 patients were stage T3N0M0 and underwent excision of the primary lesion with neck dissection. The data were collected retrospectively from hospital record library. These patients were evaluated clinically, radiologically and compared with intra operative finding. Addition of radiotherapy was decided on final histopathology. <b>Results:</b> Out of 39 patients, the site of primary tumour in 21 patients was tongue, in 13 patients was Buccal Mucosa (BM), in 2 patients was lip and in 3 patients was Floor of Mouth (FOM) with tongue. In patients with clinically negative neck nodes, ultrasonography and intra-operative examination revealed the presence of suspicious nodes in 35.9% and 30.7% cases respectively. Occult metastasis in the nodes was identified on histopathological examination in 15 patients (38.5%). A total of 14 patients of carcinoma of tongue and one patient of BM showed positive nodes on histopathology. These patients with positive neck nodes on histopathology, were sent for postoperative radiotherapy. At follow up examination, four patients showed local and distal recurrence and they were managed accordingly. Out of 39 patients, 11 patients of BM, 2 patients of lip, 1 patient of FOM and 6 patients of tongue were disease free in last follow up. <b>Conclusion:</b> Selective neck dissection is an effective therapeutic intervention in patients without clinically involved neck nodes. It can upstage the tumour and additional treatment may be advised. In patients with carcinoma of buccal mucosa and lip, the patients can be kept under regular follow up when biopsy report showed excision with adequate margin and no nodal metastasis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=XC12-XC14&id=10521 https://doi.org/10.7860/JCDR/2017/28192.10521 All about Dowels - A Review Part I. Considerations before Cementation Zishan Dangra, Mahesh Gandhewar The optimal way of restoring a non vital tooth with dowel-core technique has long been a controversial matter. The purpose of this review was to assess the factors that may influence the successful restoration of root filled teeth with root canal dowels. The first part of the review discusses indications and physical parameters of dowel. Searches were performed in PubMed/Medline database using single or combined key words to obtain the most relevant list of references. Articles selected in the search process were obtained from the journals and reviewed with every aspect of dowel system for reconstruction of endodontically treated teeth. Medline search showed 228 articles for dowels but after applying exclusion criteria, only 51 articles remained to be included in Part I of this review. Out of which, 49 were in vitro studies and two were clinical studies. Reviewing the literature revealed that clinical data is still missing. Literature emphasizes that dowels should only be used for the retention of core material and not in view of reinforcing the remaining tooth structure. The dowel length is limited by the apical seal of four mm to six mm. Dowel width should be as small as possible. Canal configuration determines the selection between prefabricated and custom cast dowel. Fiber based dowel may be clinically appropriate for restoration of endodontically treated anterior tooth, although clinical studies are lacking. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZG06-ZG11&id=10518 https://doi.org/10.7860/JCDR/2017/26472.10518 MTA versus Biodentine: Review of Literature with a Comparative Analysis Mandeep Kaur, Harpreet Singh, Jaidev Singh Dhillon, Munish Batra, Meenu Saini An ideal dental repair material should possess certain exclusive properties such as adequate adhesive ability, insolubility, dimensional stability, biocompatibility, bioactivity etc. New materials claiming better performance are continuously being introduced in the market to optimize the care of dental patients. Biodentine has been recently introduced as the “the first all-in-one, bioactive and biocompatible material for damaged dentin replacement”. Manufacturers claim that Biodentine has noticeably shorter setting time in contrast to other silicate cements such as Mineral Trioxide Aggregate (MTA) and also has better mechanical and handling properties. This article is aimed to compare the properties of MTA and Biodentine analyzing the research work done in this field so far by various researchers all across the globe. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZG01-ZG05&id=10374 https://doi.org/10.7860/JCDR/2017/25840.10374 Coronary Endarterectomy: Recent Trends Ravi Ghatanatti, Anita Teli Coronary Endarterectomy (CE) assures complete revascularization of the myocardium in case of diffusely diseased vessels and prevents residual ischemia. Recently cardiac surgeons are performing increasing number of coronary endarterectomy and it has evolved as an important adjuvant procedure in Coronary Artery Bypass Grafting (CABG). There are controversies regarding the efficiency of CE. CE is criticised for its higher rates of morbidity and mortality. At present the available evidence supports CE in Off Pump Coronary Artery Bypass surgery (OPCAB) and along with valvular procedures. Graft patency is better with open technique. Postoperative anticoagulation regimen though not uniform, the overall outcome remains the same. Therefore, it is important to focus on the current results to accept CE as a routine procedure like CABG. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=PE01-PE04&id=10339 https://doi.org/10.7860/JCDR/2017/27036.10339 Food eponyms in Pathology Mourouguessine Vimal, Anandabaskar Nishanthi Pathology is an interesting and often challenging field. In many instances, Pathologists often hunt for clues to arrive at the diagnosis, in dark with a single beam of light. To make this tedious task more acceptable and more convenient, pathological findings are usually compared with food entities commonly used in our day to day life. Here, we have compiled pathological findings compared with certain food entities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=EE01-EE06&id=10360 https://doi.org/10.7860/JCDR/2017/28375.10360 Natural Killer Cells - Their Role in Tumour Immunosurveillance Preeti Sharma, Pradeep Kumar, Rachna Sharma An important component of the innate immune system, the natural killer cells that originate from the lymphoid cell lineage, hold tremendous potential as an effective therapeutic tool to combat a variety of cancers. Their vast capability to kill altered cells such as opsonized cells (antibody coated), tumour cells, genotoxically changed cells without affecting the healthy cells of the body, make them an effective therapeutic agent for various types of cancers. Besides, through interplay and molecular crosstalk via several cytokines, they also augment the adaptive immune response by, promoting the differentiation, activation and recruitment of component cells of the system. With the current advance knowledge of Natural Killer (NK) cells, their receptor-ligand interactions involved in functional regulation, various mechanistic approaches involving the role of cytokines led to desired modulation of NK cell activity in a tailor-made manner, for triggering clinically relevant responces. Several strategies have been adopted by researchers, to augment the efficacy of NK cells. Still many challenges exist for increasing the therapeutic relevance of these cells. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=BE01-BE05&id=10469 https://doi.org/10.7860/JCDR/2017/26748.10469 International Depository Authority and its Role in Microorganism’s Deposition Abhishek Parashar After the World Trade Organization’s agreement on Trade Related Aspect of Intellectual Property Right, patents have come into major play. Patenting of work related to live organisms that have medical, agricultural and other uses is always a tedious, complicated and controversial job. In view of this an agreement called as Budapest Treaty was passed in 1977 for deposition of microorganisms in culture collection centers for patent purpose. To make a culture collection center an IDA the culture center has to follow rules and regulations made in Budapest Treaty. Today several culture collection centers are working as International Depository Authority (IDA) in India and abroad that are storing microorganisms for patent purpose. India has two IDA units; one is Microbial Culture Collection in National Centre for Cell Science Pune, India, and second one is Microbial Type Culture Collection and Gene Bank at Institute of Microbial Technology Chandigarh, India. IDA unites are important for valuable sample depositions, supply of cultures, characterization of samples and conservation of biological materials. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=DE01-DE06&id=10408 https://doi.org/10.7860/JCDR/2017/29077.10408 Substitutes of Prescription Medicines - A Review of Concerns Relevant to Doctors and Patients Jayant Kumar Kairi, Ashok Kumar Sharma A very large part of India’s population fulfils its healthcare needs from government run healthcare delivery system which is free, contributory or highly subsidised. Use of medicines forms a large part of healthcare facility. As the number of medicines and brands are ever increasing in today’s market, it is usual for pharmacy to substitute a generic instead of the prescribed brand or a different brand if the prescribed brand is not available. Depending on the type of substitute, it could fall under ‘generic’ or ‘therapeutic’ substitution. For any condition, there may be numerous medicines existing, some of which probably got introduced more recently, may be more expensive and erroneously perceived to act better than the earlier known medications for the same ailment. Also, due to very high number of medicines that are approved and available for use in the market, it is impossible to stock all the medicines in any pharmacy. Generic and therapeutic substitutions should be formalised and implemented by institutions, with the consent and cooperation of all the stake holders as guided by World Health Organisation. The advantages and limitations of medicine substitutes are discussed in the review.. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=FE01-FE05&id=10439 https://doi.org/10.7860/JCDR/2017/28552.10439 A Humorously Serious Take on Plight of Postgraduate Medical Entrance Examinees in India Kaushal Deep Singh Following is a satire on the plight of postgraduate medical entrance examinees in India. It highlights the questions they have to face during their entrance examination preparations and the annoying explanations they have to read in the entrance preparation books. Though the system of examination is improving in India, few loopholes do exist and need to be rectified. This article, thus, attracts the attention of readers towards one such backdrop regarding controversial/wrong/misprinted questions which has come a long way but still has scope of improvement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=JI01-JI02&id=10447 https://doi.org/10.7860/JCDR/2017/28771.10447 Granular Cell Tumour of the Chest Wall: FNA Diagnosis with a Review of Literature and Elaboration of Cytological Mimickers Zeba Choudhary, prajwala gupta, purnima malhotra, minakshi bhardwaj, prafull kumar sharma Granular Cell Tumours (GCTs) are uncommon tumours which can be confused with other benign soft tissue tumours on clinical examination. Fine Needle Aspiration Cytology (FNAC) plays a significant role in their diagnosis. There are certain cytological mimickers of GCTs so a cytopathologist must be aware of its characteristic cytomorphology. These tumours can be present anywhere on the body; however, chest wall is one of the uncommon sites. We present a case of GCT present on the chest wall in an elderly male as a subcutaneous nodule. We have discussed the common cytological differential of GCTs, features of malignant GCTs along with cytomorphological and immunohistochemical features. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ED01-ED03&id=10337 https://doi.org/10.7860/JCDR/2017/29123.10337 Point of Care- A Novel Approach to Periodontal Diagnosis-A Review Nancy Srivastava, Prathibha Anand Nayak, Shivendra Rana Periodontal disease, one of the prevalent oral diseases, is characterized by gingival inflammation and periodontal tissue destruction. Diagnosing this disease is challenging to the clinicians as the disease process is discontinuous and shows periods of exacerbation and remission. Traditional diagnostic methods basically tells about the past tissue destruction so new diagnostic methods are required which is able to detect the active state of the disease, determine the future progression and also estimates the response to the therapy, thereby helping in the better clinical management of the patient. Both saliva and Gingival crevicular fluid (GCF) are believed to be reliable medium to detect the biomarkers which plays a pivotal role in measuring the disease activity. Keeping these observations in mind rapid chairside tests are developed to diagnose periodontal disease called as Point of Care (POC) diagnostics which simplifies diagnosis and helps in improving the prognosis. This review article highlights about the biomarkers used in the diagnosis and throws light on the various available point of care diagnostic devices. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZE01-ZE06&id=10411 https://doi.org/10.7860/JCDR/2017/26626.10411 Correction: 2017 May:11(5): LC01-LC06 <b>Nezal Azh, Fatemeh Nahidi, Giti Ozgoli, Gelayol Ardalan</b>, Adolescents Confusion in Receiving Health Services: A Qualitative Study. (Published in Journal of Cilinical and Diagnostic Research. 2017 May : 11(5)): LC01-LC06. In this article correction has been done in authors affiliation. "Shahid Beheshti University" replaced with "Shahid Beheshti University of Medical Science". https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZZ02-&id=10446 https://doi.org/10.7860/JCDR/2017/.10446 Correction: 2014 Aug:8(2): 12-14 <b>Joyashree Banerjee, Anindya Roy, Anilbaran Singhamahapatra, Pranab Kumar Dey, Achyut Ghosal, Anubrata Das</b>, Association of Body Mass Index (BMI) with Lung Function Parameters in Non-asthmatics Identified by Spirometric Protocols. (Published in Journal of Cilinical and Diagnostic Research. 2014 Aug : 8(2)): 12-14. A complaint was received with regard to plagiarism in the article entitled- “Association of body mass index with lung function parameters in non-asthmatics in Journal of clinical and Diagnostic Research 2014; 8 (2): 12-14, from another published source - West A, Burton D, Bell A. The Association of Body Mass Index with Airway Obstruction: Implications for the Inaccurate Differential Diagnosis of Asthma in Obesity. Canadian Journal of Respiratory Therapy, 47(2):11-22. Following the COPE guidelines, the degree of text duplication was checked and, as a result, was marked as “clear plagiarism”, for which the corresponding author(s) were contacted. They were asked for the raw data and an explanation for the same. Corresponding Author (a junior researcher) provided the raw data and accepted their error and promised not to repeat the same. Based on this, the decision has been taken by the Editor to publish a correction. The Editorial team regrets the misinformation and inconvenience caused to the original authors and the readers." https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZZ01-&id=10463 https://doi.org/10.7860/JCDR/2017/.10463 Correction: 2017 June:11(6): JC04-JC08 <b>Farajolah Maleki, Mehri Hosein Talaei, Seyed Rahmatollah Mousavi Moghadam, Shahryar Shadigo, Hamid Taghinejad, Alireza Mirzaei</b>, Investigating the Influence of Teachers' Characteristics on the Teacher-Student Relations from Students' Perspective at Ilam University of Medical Sciences. (Published in Journal of Cilinical and Diagnostic Research. 2017 June: 11(6)): JC04-JC08. In this article correction has been done in First author's affiliation. "Lecturer, Clinical Microbiology of Research Center, Ilam, Iran." replaced with "Lecturer, Clinical Microbiology of Research Center, Ilam University of Medical Science, Ilam, Iran." https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=August&volume=11&issue=8&page=ZZ03-&id=10574 https://doi.org/10.7860/JCDR/2017/.10574