Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Small Intestinal Lymphangioma Presenting as an Acute Abdomen with Relevant Review of Literature Basant Kumar, Ankur Bhatnagar, Vijai Datta Upadhyaya, Ajay Narayan Gangopadhyay Cystic lymphangioma of small bowel mesentery is rare with clinical features ranging from an asymptomatic abdominal lump to acute intestinal obstruction. We discuss two cases of lymphangioma of small bowel mesentery who presented to us as acute intestinal obstruction. In the first case exploratory laparotomy revealed a large multicystic lesion arising from small bowel mesentery just distal to the duodenojejunal junction having multiple small cysts filled with milky white fluid. The involved region of the bowel was excised. The second case had a large multicystic lesion involving the mesentery of proximal jejunum, dudenojejunal junction, encasing the entire superior mesenteric vessels. For this patient, debulking was done. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PD01-PD02&id=9962 https://doi.org/10.7860/JCDR/2017/22703.9962 Atypical Imaging Features of a Simple Intramuscular Lipoma Umamageswari Amirthalingam Lipoma is a benign tumour of mesenchymal tissue which closely resembles normal fat even histologically but for its biochemical and ultrastructural differences. Simple lipoma presents as a mass which resembles fat on all the imaging modalities. Atypical lipoma, lipoma variants and liposarcoma show specific imaging features. We report this case due to the varied imaging appearance of a simple lipoma. A 52-year-old lady presented with history of swelling along the anterior aspect of thigh. Sonography, CT and MRI had done which revealed an atypical lipoma; however excision biopsy proved to be a simple lipoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=TD01-TD02&id=9978 https://doi.org/10.7860/JCDR/2017/24408.9978 Paroxysmal Atrial Fibrillation due to Venomous Snake Bite Samarth Virmani, Rama Bhat, Raghavendra Rao, Raahat Kapur, Savio Dsouza Snake bites are common all around the world with a great prevalence in South Asia and the Indian subcontinent. Although they are associated with common complications such as local swelling, bleeding at site of bite, coagulopathy, etc., few rare cardiac complications such as myocardial infarctions and arrhythmias have also been described in literature. The following is a case report of a patient who had a snake bite with a Russell’s viper which resulted in atrial fibrillation, which resolved on treatment with anti snake venom. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OD01-OD02&id=9971 https://doi.org/10.7860/JCDR/2017/27553.9971 Surgical Management of a Separated Endodontic Instrument using Second Generation Platelet Concentrate and Hydroxyapatite Sl Satheesh, Shefali Jain, Atul Chandra Bhuyan, Lekshmy S Devi Fractured endodontic instrument is an unfortunate endodontic mishap which may obstruct thorough cleaning and shaping of the root canals with potential impact on the endodontic prognosis and treatment outcome. When the fractured segment lies apical to canal curvature, overzealous removal of tooth structure is required to gain access to the separated segment which in turn increases the likelihood of root fracture. In infected cases, the stage at which instrument separation occurs is crucial as root canal disinfection is jeopardized. This case report describes the surgical retrieval of a fractured endodontic file from the mesiobuccal canal of mandibular first molar by limited resection of mesial root. Second generation platelet concentrate called Platelet Rich Fibrin (PRF) and nanocrystalline hydroxyapatite and ß- tricalcium phosphate bone graft was placed to fill the surgical defect as the combination enhances the regenerative effect of PRF by exerting an osteoconductive effect in the bony defect area. The clinical and radiographic examination after eighteen months revealed complete periapical healing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZD01-ZD03&id=9991 https://doi.org/10.7860/JCDR/2017/25761.9991 Large Solitary Neurofibroma of Face in a Paediatric Patient Kumar Nilesh, Ramchandra G Naniwadekar, Aaditee V Vande Neurofibroma is a rare, benign, neurogenic tumour which may present as multiple lesions as a part of neurofibromatosis syndrome or as a solitary mass. This paper reports a case of large solitary neurofibroma of face in a young female patient. Clinical presentation, imaging characteristics and management of the pathology has been described in detail. The paper also reviews English literature for similar cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZD04-ZD06&id=9996 https://doi.org/10.7860/JCDR/2017/25991.9996 Infiltrating Ductal Carcinoma Co-Existing with Intraductal Papillary Carcinoma of Male Breast: A Rare Case Report Mayank Kumar, Bhaswanth Pottipati, Surekha U. Arakeri, Anita P. Javalgi Male breast carcinomas are rare tumours, accounting for less than 1% of all malignancies in men. Intracystic Papillary Carcinoma (IPC) in males is a very rare entity, representing 5-7.5% of all male breast carcinomas. It lacks the classical clinical, radiological and cytological features of malignancy and usually presents as a benign-appearing lump. We report a case of Infiltrating Ductal Carcinoma (IDC) co-existing with intracystic papillary carcinoma in a 53-year-old male who presented with lump in the right breast. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED04-ED05&id=10002 https://doi.org/10.7860/JCDR/2017/26818.10002 A Wide Spread Red Lesion on the Surface of the Tongue-A Case Report and Review of Differential Diagnosis Yenduluri Durga Bai, Sathasivasubramanian Sankarapandian, R Aditi The tongue is considered to be the strongest muscular organ in the body and a very important structure in the oral cavity. It is involved in various critical functions such as taste, speech, chewing and deglutition. It has been known to be a harbinger of systemic health and disease. Lesions occurring on the tongue vary widely in colour and consistency. Widespread red lesions on the tongue need to be differentiated carefully from each other for a proper diagnosis and treatment and must be followed up for recurrence. The present case report demonstrates a widespread longstanding recurrent red lesion occurring on the surface of the tongue, its diagnosis and management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZD07-ZD09&id=10005 https://doi.org/10.7860/JCDR/2017/27813.10005 An Unusual Cause of Organizing Pneumonia: Hydrocarbon Pneumonitis Kuruswamy Thurai Prasad, Sahajal Dhooria, Amanjit Bal3, Ritesh Agarwal, Inderpaul Singh Sehgal Hydrocarbon pneumonitis is a type of acute exogenous lipoid pneumonia due to the aspiration of petroleum products. The clinical and radiological features of this condition are non-specific and the diagnosis is usually missed if a careful history is not taken. Herein, we describe a 24-year-old male who was referred to us with a diagnosis of Interstitial Lung Disease (ILD) and was later found to have hydrocarbon pneumonitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OD03-OD04&id=10008 https://doi.org/10.7860/JCDR/2017/24194.10008 Radix Distolingualis: A Case Report, Review and Endodontic Treatment Guidelines Arunajatesan Subbiya, Suresh Mitthra, Sherin Banu, Dhakshinamoorthy Malarvizhi Variation in the root and canal morphology of maxillary second molars is quite common. The most common configuration is three roots and three or four canals. But the presence of an additional palatal root is rather uncommon and has been reported to have an incidence of 1.4%. The extra root is located mesiolingual or distolingual to the primary palatal root. This is a unique case report that describes the successful endodontic management of a maxillary second molar with Radix Distolingualis (RDL). Identification of this variation was done through clinical examination, multi-angled radiographs, surgical operating microscope and an accurate assessment of this morphology was made with the help of Cone Beam Computed Tomography (CBCT) imaging. In addition, this article also discusses the literature review, guidelines for diagnosis and treatment of RDL. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZD10-ZD13&id=10012 https://doi.org/10.7860/JCDR/2017/27480.10012 Cisplatin Induced Acute Myocardial Infarction and Dyslipidemia Lalith Prabhakar Hanchate, Shimpa Rakesh Sharma, Sadhana Madyalkar Myocardial infarction commonly occurs due to rupture of atherosclerotic plaque in the coronary arteries and is manifested on coronary angiography. Myocardial infarction with angiographically normal coronary arteries can occur due to hypercoagulable state, coronary spasm, embolism, arteritis, congenital condition and drugs. Illicit drugs such as cocaine, amphetamines and marijuana are known to cause myocardial infarction. Of the many medications that are associated with cardiovascular toxicity, chemotherapeutic agents form a large group with both acute and delayed cardiotoxicity. We present a case of acute myocardial infarction in a patient with no organic coronary artery disease on the Bleomycin, Etoposide and Cisplatin (BEP) regimen for treatment of testicular seminoma. Patient developed symptoms of Acute Coronary Syndrome (ACS) after his third cycle of the regimen. This case highlights the need for prior careful cardiovascular evaluation, close monitoring and use of strategies to prevent cardiovascular morbidity in patients on cisplatin therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OD05-OD07&id=10025 https://doi.org/10.7860/JCDR/2017/25546.10025 Providencia Rettgeri: An Emerging Nosocomial Uropathogen in an Indwelling Urinary Catheterised Patient Siddharth Sagar, Nagalakshmi Narasimhaswamy, Jessica D’Souza Providencia rettgeri (P. rettgeri) is an ubiquitous organism but is seldom associated with human disease. We report the isolation of P. rettgeri from the urine sample of a 39-year-old male patient on prolonged Foley’s catheterisation following a severe head injury. Identification of this organism was done by Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF) based systems. P. rettgeri is an emerging pathogen among long term catheterised patients. It reflects its ability to form biofilm on the surface of the indwelling catheter as well as the inherent urease producing property of the pathogen in question as a possible mechanism of pathogenesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DD01-DD02&id=10026 https://doi.org/10.7860/JCDR/2017/25740.10026 Necrotizing Fasciitis: A Rare Complication of Acute Necrotizing Pancreatitis Sumesh Kaistha, Ameet Kumar, TS Ramakrishnan Necrotizing pancreatitis occurs in 10 to 25% of patients requiring hospital admission for acute pancreatitis and carries a high mortality rate. Necrotizing pancreatitis can cause a spectrum of complications. However, we report an extremely rare complication of necrotizing pancreatitis: necrotizing fasciitis of the abdominal wall. A 56-year-old male patient presented to our center with discoloration of skin over left flank of 15 days duration and pus discharge from it since three days. Two months back he was managed at a private hospital as a case of acute necrotizing pancreatitis and was discharged after one week of inpatient treatment. After discharge patient continued to have malaise and weakness but was able to do his routine day to day activity. On presentation at our hospital, patient was in septic shock and was taken emergently to operating theatre for debridement. However, later, the patient succumbed to his illness. Necrotizing fasciitis is an extremely uncommon complication of necrotizing pancreatitis and has a fulminant course. Timely detection and debridement can avert a potential mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PD05-PD06&id=10032 https://doi.org/10.7860/JCDR/2017/27032.10032 A Rare Case of Intestinal Malrotation and Volvulus of Jejunum with Coexisting Carcinoid Tumour of Appendix Priyanka Tiwari, Darshan Patel, Vimal Dhaduk, Prasanna Kumar Reddy, Jainudeen Khalander Abdul Jameel Malrotation of the midgut is generally regarded as a paediatric pathology. It is rare in adults. Patients may present with symptoms of acute bowel obstruction or chronic abdominal pain. Barium study, Contrast Enhanced Computed Tomography (CECT), Magnetic Resonance Imaging (MRI), diagnostic laparoscopy and sometimes explorative laparotomy are used for diagnosis. Ladd’s procedure through the open approach has been the treatment of choice for complete malrotation of midgut, however there are reports on successful outcome for both complete and incomplete malrotation after laparoscopic approach as well. We report a case of a 25-year-old female who presented with a history of severe pain in abdomen for one week. CECT abdomen showed incomplete malrotation and volvulus in midgut. Laparoscopic detorsion of bowel loops, adhesiolysis, caecopexy and appendectomy was done. Patient’s symptoms subsided immediately after surgery. Histological analysis of the appendix specimen showed small appendiceal carcinoid, which was purely incidental. At three months follow up, patient was symptom free. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PD07-PD08&id=10040 https://doi.org/10.7860/JCDR/2017/25575.10040 Taeniasis: An Unusual Presentation Shobha Prasada, Sevitha Bhat, K Vidyalakshmi We report a case of 45-year-old male presenting with the history of nasal expulsion of segments of Taenia saginata. This route of expulsion is a rare occurrence. The report stresses this unusual presentation of taeniasis in endemic region. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DD03-DD04&id=10041 https://doi.org/10.7860/JCDR/2017/25763.10041 Native Valve Endocarditis Caused by Escherichia Coli Thangam Menon, Nandhakumar Balakrishnan, Shanmugasundaram Somasundaram, Prabu Dhandapani Escherichia coli is a rare cause of infective endocarditis. This report describes a case of native valve endocarditis caused by Escherichia coli in a 58-year-old male renal transplant patient who had a concurrent urinary tract infection caused by the same organism. The patient was successfully treated with antibiotics and recovered without surgical intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DD05-DD06&id=10046 https://doi.org/10.7860/JCDR/2017/27201.10046 Chryseobacterium Indologenes Pneumonitis in an Infant: A Case Report Parijat Das, Santosh Karade, Kanwaljit Kaur, Ravi Ramamurthy, Praveer Ranjan Chryseobacterium indologenes, a non-fermentative Gram-negative bacilli distributed widely in nature, is an emerging nosocomial pathogen, inherently resistant to a wide range of antibiotics. There is limited number of C. indologenes infections reported from India. We report a case of C. indologenes associated pneumonia in a three-month-old infant with congenital heart disease. This case highlights the importance of prompt diagnostic workup and targeted antibiotic therapy for its effective management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DD07-DD08&id=10047 https://doi.org/10.7860/JCDR/2017/27237.10047 Portal Venous Thrombosis- Disseminated Tuberculosis in Rheumatoid Arthritis Vasanthi Natarajan, Kevin John, David Jose, Pradeep Kalaiselvan, Ashok Kumar Das Vascular thrombosis is one of the complications of tuberculosis. Deep vein thrombosis and pulmonary thrombosis have been reported with pulmonary and extrapulmonary tuberculosis. Splenic involvement in abdominal tuberculosis is among the rarest manifestations. Disseminated tuberculosis is predominantly reported in rheumatoid arthritis following ingestion of biological agents. Here, we report a case of disseminated tuberculosis in a rheumatoid arthritis patient who was on steroids and methotrexate for a long period, presenting with multiple splenic lesion and portal vein thrombosis, which was not reported earlier. She was treated with antitubercular drugs, anticoagulants and showed improvement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OD08-OD10&id=10048 https://doi.org/10.7860/JCDR/2017/27640.10048 Enhanced Expression of FRA16B using AT-Rich DNA Binding Chemicals in a Woman with Secondary Amenorrhoea Gunasekaran Bhavani, S Sivaprakash, Chandra R Samuel, Sathiyavedu Thyagarajan Santhiya Fragile sites represent regions of chromatin that fail to compact during mitosis. Based on the prevalence and pattern of inheritance they are classified as rare fragile sites or common fragile sites. Rare fragile sites either occur spontaneously or can be induced by certain AT-specific binding chemicals namely distamycin, Hoechst 33258, Berenil and others. The most common of all rare autosomal fragile sites is fra(16)(q22) with a heterozygote frequency of ~5%. FRA16B results from an expansion of a 33 bp AT-rich Minisatellite repeat. These rare forms are usually heritable and segregate in a Mendelian fashion. The proband who was referred for secondary amenorrhoea, revealed 46,XX,fra(16)(q22.1) pat karyotype. Her father and younger sibling were also found to be carriers. This study aimed to delineate the genotypic and phenotypic features exhibited by these carriers and to evaluate FRA16B expression using AT-specific binding chemicals. The additives employed were Berenil, BrdU and Hoechst 33258. Berenil at a concentration of 150 µg/ml showed the highest expression of FRA16B. Although the recent breakthrough in molecular characterization of fragile sites plays a critical role in comprehending their association with various diseases, the physiological link between them and amenorrhoea is not clearly understood. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=QD01-QD03&id=10043 https://doi.org/10.7860/JCDR/2017/26545.10043 A Rare Case of Topiramate Induced Secondary Acute Angle Closure Glaucoma Ajit Kamalakar Joshi, Amit Hemant Pathak, Saurabh Dilip Patwardhan, Anil Narayan Kulkarni Secondary Acute Angle Closure Glaucoma (AACG) is a known side effect of Topiramate (TPM). Here, we present a case report of a 47-year-old male who was started on TPM 25 mg/day for migraine. He presented to the ophthalmology department of our hospital with sudden blurring of vision and colored halos after one day of starting TPM. A high index of suspicion, followed by appropriate investigations and prompt management that helped to manage TPM induced bilateral AACG with quick and complete visual recovery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ND01-ND03&id=10052 https://doi.org/10.7860/JCDR/2017/28093.10052 Variant Anatomy of the Hepatic Vasculature: Importance in Hepatobiliary Resections Sarika Rachel Tigga, Sandeep Saluja, Virendra Budhiraja, Rakhi Rastogi A variant anatomy of the hepatic vasculature has a clinically significant role in hepatobiliary transplantation, resection, tumour embolisation as well as in extrahepatic abdominal surgeries involving the stomach, pancreas or gall bladder. During routine cadaveric dissection, we observed a case of unusually small calibre hepatic artery proper. An accessory hepatic artery was seen emerging from the superior mesenteric artery to the right hepatic lobe along with an accessory hepatic vein from the right hepatic lobe that drained directly into the inferior vena cava. Such accessory hepatic vessels complicate and necessitate an alteration of surgical methodology during resection of hepatic lobes. Preoperative knowledge of variant hepatic vasculature is crucial for minimising the iatrogenic injury and facilitating successful abdominal surgeries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=AD01-AD03&id=10061 https://doi.org/10.7860/JCDR/2017/27193.10061 Bilateral Staghorn Calculus with Forgotten Double J Stent in Ileal Conduit Patient – A Rare Urological Challenge Rupesh Gupta, Ranjan Kumar Dey, Rakesh Sharma, Sweta Gupta Forgotten DJ stent associated stone formation is not an uncommon entity. Here we are reporting the uncommon case of bilateral staghorn calculus due to forgotten DJ stent who had undergone radical cystectomy with ileal conduit diversion six years back. Management of these cases is a challenging urological situation due to inaccessible ureteric orifices. Patient was successfully treated with minimally invasive therapy in the form of combined bilateral PCNL (Percutaneous Nephrolithotomy) and ESWL (Extracorporeal Shock Wave Lithotripsy) therapy. The purpose of reporting this case is to highlight the grave consequences of a forgotten DJ stent and to discuss the difficulties encountered during the surgical steps of stone removal. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PD09-PD10&id=10074 https://doi.org/10.7860/JCDR/2017/24704.10074 Aneurysmal Variant of Fibrous Histiocytoma- A Rare Entity Known for Recurrence Aniya Antony, Chokka Mahesh Kiran, Manjiri Phansa lkar, Chidambara Jothi, Jacob Jayakar Aneurysmal Fibrous Histiocytoma (AFH) is a distinct and a rare clinicopathological variant of Cutaneous Fibrous Histiocytoma (CFH). It differs from the usual benign fibrous histiocytoma clinically and morphologically with high rate of recurrence. Here, we report a case of AFH with history of recurrence which presented as a polypoid swelling and showed vascular spaces with no endothelial lining which was proved negative by CD34 immunostaining. The spaces were bordered by tumour cells. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED08-ED09&id=10080 https://doi.org/10.7860/JCDR/2017/26524.10080 Idiopathic Brachial Neuritis in a Patient with Multiple Myeloma Lale Cerrahoglu, Ozlem Erol, Tuba Cerrahoglu Sirin Idiopathic Brachial Neuritis (IBN), is a rare brachial plexopathy with an unknown aetiology. Multiple myeloma is a neoplastic plasma cell disease characterised by bone lesions. In this article, we present the case of a 59-year-old male patient with IBN associated with multiple myeloma, who was admitted to our clinic with right shoulder pain and right arm weakness. He experienced muscle weakness and atrophy in his right arm after a sudden onset of pain attack in the shoulder. Plexus and cervical vertebral MRI showed no pathology. Electrodiagnostic studies showed upper and middle trunk plexopathies. Laboratory analysis revealed anaemia, hypercalcaemia, renal dysfunction and monoclonal gammopathy in immunoglobulin electrophoresis. A bone marrow biopsy established the diagnosis of IgG kappa multiple myeloma. This is the first case report that presents the association of multiple myeloma and IBN. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OD11-OD12&id=10082 https://doi.org/10.7860/JCDR/2017/22426.10082 Ocular Dirofilariasis: A Rare case from Mumbai, India Sachee Agrawal, Rahul Agrawal, Jayanthi Shastri Dirofilariasis is a worldwide zoonotic filariasis. Human dirofilariasis is a zoonotic infection most commonly caused by Dirofilaria repens. Dirofilariasis, caused by Dirofilaria repens, has been reported to occur widely throughout Asia, Europe, and Africa. It has not been widely recognized in India; however, several cases have been reported in the last few years. Ease and frequency of international travel has probably contributed to the increase in the number of cases. There is probably a focus of human infection with D. repens in Kerala, India. We report a case of ocular dirofilariasis, from the Western part of India. Among the Indian case reports of human dirofilariasis caused by D. repens, majority had ocular infections and few had subcutaneous involvement of the face. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DD09-DD10&id=10085 https://doi.org/10.7860/JCDR/2017/26058.10085 A Report of Two Cases of “Giant Bartholin Gland Cysts” Successfully Treated by Excision with Review of Literature Anji Reddy Kallam, Vandana Kanumury, Nav Naveena Bhimavaraavaraavarapu, Bhavavika Soorada Bartholin’s gland cysts are one of the common vulval masses that may start as asymptomatic cysts but if left untreated, may become large and infected requiring medical attention. We are presenting two interesting and rare cases of giant Bartholin cyst and their treatment in this case report. Two female patients of perimenopausal age presented with giant vulval cysts to the outpatient department of Obstetrics and Gynaecology. They reached a size of 10 cm and 20 cm diameter respectively, presenting with some diagnostic and later reconstruction of the labia majus. MRI pelvis provided good information regarding the size, shape and extent of the cyst, which was very useful during surgery. Both these cases were successfully treated by excision of the cyst and histopathological examination after complete excision. One of the cases presented as dumb-bell shaped swelling with large cyst superiorly and smaller cyst extending into the buttock connected by narrow neck and showed cross fluctuation. This type of dumb-bell shaped presentation of Bartholin’s cyst is rather unusual and has not been reported in the available literature https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PD11-PD13&id=10088 https://doi.org/10.7860/JCDR/2017/26802.10088 Idiopathic Granulomatous Mastitis: A Clinical Puzzle in Breast Lump Cases Vivek G Nath, Rakesh Sahoo, Avinash Sahoo, Jithendra Kumar Barad, K A Arun Idiopathic granulomatous mastitis (IGM) is a rare benign disease, characterized by chronic inflammation and granulomatous disease process. A middle aged lady with breast lump for six months with equivocal mammographic and ultrasound results underwent lumpectomy and biopsy. Ruling out all other possible granulomatous diseases and malignancy, a diagnosis of IGM was made. IGM becomes clinically significant as it closely mimics carcinoma breast and some inflammatory and infectious pathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PD14-PD15&id=10089 https://doi.org/10.7860/JCDR/2017/27016.10089 Pulmonary Actinomycosis in a Patient with AIDS/HCV Payam Tabarsi, Sootiya Yousefi, Sayena Jabbehdari, Majid Marjani, Parvaneh Baghaei Pulmonary actinomycosis is a rare bacterial lung infection which is caused mainly by Actinomyces israelii. This non contagious infection can destroy parts of the lungs. There are variable presentations of pulmonary actinomycosis with similarity in manifestations to other infectious diseases of the lungs. Pulmonary actinomycosis is diagnosed by fine needle aspiration, bronchoscopy and finding of typical sulfur granules. We present a case of pulmonary actinomycosis in a middle aged (AIDS/HCV) man with massive hemoptysis and progressive dyspnoea. The bronchoscopy findings showed endobronchial mass with luminal occlusion in right upper lobe. Because of massive hemoptysis and poor response to conservative treatment and penicillin therapy, right upper lobectomy was needed to stop the bleeding. Histopathologic examination revealed the aggregations of filamentous Gram-positive organisms with characteristic pattern “sulfur granules”, indicating actinomycosis. The patient was followed by six months of oral amoxicillin and has no recurrent hemoptysis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OD15-OD17&id=10092 https://doi.org/10.7860/JCDR/2017/27593.10092 Large Isolated Major Aortopulmonary Collateral Artery Causing Severe Pulmonary Hypertension in an Infant: A Rare and Challenging Diagnosis Brajesh Kumar Kunwar, Snigdha Paddalwar, Mahesh Ghogare Major Aortopulmonary Collateral Artery (MAPCA) as an isolated congenital anomaly, without evidence of any structural heart disease, is a very rare observation. Previously published reports indicate that symptomatic infants with large isolated MAPCA usually present with congestive heart failure or recurrent respiratory tract infections. To the best of our knowledge, the present case of an infant with large isolated MAPCA is a unique case with a diagnostic dilemma due to presentation with severe pulmonary hypertension as a predominant sign. The infant was managed successfully by percutaneous obliteration with amplatzer vascular plugs, along with perioperative and postoperative sildenafil. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OD18-OD20&id=10094 https://doi.org/10.7860/JCDR/2017/27645.10094 Atraumatic Acute Compartment Syndrome of Forearm Following Artificial Mehndi (Henna) Dermatitis – A Rare Case Report Abhinav Sinha, Lakshay Goel, Rahul Ranjan, Sahil Gaba, Arvind Kumar Atraumatic compartment syndrome of the forearm is a rare entity. There are several papers available in the literature on the adverse effects of mehndi application; however Acute Compartment Syndrome (ACS) following mehndi application has never been reported. We present the case of a 25-year-old female, who presented with sudden onset swelling and pain in the left forearm. The patient had applied mehndi all over her left palm and forearm just two days prior to presentation. The patient had stretch pain and other clinical features suggestive of compartment syndrome of forearm and was hence taken up for an emergency fasciotomy. The fasciotomy wound healed without skin grafting and the patient achieved near normal range of movement of the affected elbow,wrist and fingers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=RD01-RD03&id=10096 https://doi.org/10.7860/JCDR/2017/27708.10096 High Grade Serous Cystadenocarcinoma of Testis- Case Report of a Rare Ovarian Epithelial Type Tumour Sithara Aravind, Sangeetha K Nayanar, R Varadharajaperumal, Tv Satheeshbabu, Satheesan Balasubramanian Ovarian epithelial type tumour of testis are extremely rare tumours that resemble ovarian surface epithelial tumours. They usually present as testicular or paratesticular tumours and can be serous, mucinous, endometrioid or Brenner tumour. Serous and mucinous types account for the majority of tumours. The tumours are benign, borderline or malignant, commonly borderline. Here, we report a case of high grade serous cyst adenocarcinoma of testis which manifested as extensive metastasis in supraclavicular, mediastinal and abdominopelvic groups of lymph nodes, lung and adrenal gland without clinical evidence of an overt primary tumour. We report this case so as to make clinicians and pathologists aware of this rare entity and to stress on the fact that this rare entity should be kept in mind when evaluating cases of metastatic adenocarcinoma in male patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED13-ED15&id=10097 https://doi.org/10.7860/JCDR/2017/27743.10097 Invasive Cystic Hypersecretory Carcinoma of Breast: A Rare and Under Diagnosed Variant of Ductal Carcinoma Nibedita Sahoo, Pritinanda Mishra, Susama Patra, Prakash Kumar Sasmal Handful cases of invasive Cystic Hypersecretory Ductal Carcinoma (CHC) have been reported so far in literature. Cystic hypersecretory lesions of breast have a spectrum of morphological features ranging from Cystic Hypersecretory Hyperplasia (CHH), CHH with atypia, in situ to invasive CHC. We are reporting a case of a 32-year-old female who had nipple discharge and lump in her right breast for one month. A modified radical mastectomy was done and morphological diagnosis of invasive CHC with axillary node metastasis was made. The postoperative events were uneventful. Invasive CHC being a rare entity, our understanding of its biological behavior, prognostic factors and genetic basis is limited. The authors are aware of only 15 similar cases being reported in the English literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED16-ED17&id=10098 https://doi.org/10.7860/JCDR/2017/27937.10098 Pigmented Villonodular Synovitis of Thumb-A Cytological Diagnosis Kaneeka Bhatnagar, Akshdeep Singh Bawa, Vikram Narang, Pavneet Kaur Pigmented Villonodular Synovitis (PVNS) is a unique benign proliferative process of unknown aetiology involving the synovial lined joints diffusely or focally. The entity remains a diagnostic challenge. This condition is attributed to an increased synovial proliferation causing villous or nodular changes of synovial lined joints leading to PVNS, Pigmented Villonodular Bursitis (PVNB) when arising from bursae or Pigmented Villonodular Tenosynovitis (PVNTS) originating from the tendon sheath. We present a case of a young female with nodular masses on right thumb with cytomorphological features on FNAC suggestive of PVNS which was finally confirmed by histopathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED18-ED20&id=10099 https://doi.org/10.7860/JCDR/2017/28184.10099 Congenital Ectropion Uveae with Glaucoma: A Case Report Rashmi Kumari, Bhawesh Chandra Saha, Bibhuti Prasanna Sinha Congenital Ectropion Uveae (CEU) is a rare anomaly characterised by ectropion uveae, iris hypoplasia, iridotrabecular dysgenesis and glaucoma. Hyperplasia of the iris pigment epithelium and its apparent spread over the anterior surface of the iris is supposed to cause the classic ectropion uveae in CEU. Almost all patients develop open angle glaucoma due to angle dysgenesis, so they should be carefully examined periodically for its early detection. We hereby report a case of isolated unilateral CEU without any systemic association which is quite uncommon. Loss of vision went unnoticed while the facial asymmetry secondary to progressive enlargement of one eye became the presenting complain due to this rare unilateral affliction. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ND04-ND05&id=10104 https://doi.org/10.7860/JCDR/2017/26198.10104 Semilobarholoprosencephaly – A Dreading Congenital Anomaly Bhushita B Lakhkar, Bhushan N Lakhkar, Bhavana B Lakhkar Holoprosencephaly (HPE) is a group of structural abnormalities of brain that is an important cause of childhood mortality and morbidity. They usually occur due to impaired midline cleavage of embryonic forebrain i.e., failure of differentiation of the prosencephalon into the telecephalon and diencephalon. De Myer classified this anomaly ranging from alobar to semilobar and lobar type. It can be associated with microcephaly and midline facial anomalies. We present a case of semilobar holoprosencephaly with corpus callosal agenesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=TD03-TD04&id=10105 https://doi.org/10.7860/JCDR/2017/26530.10105 Infantile Alexander Disease: Case Report and Review of Literature Soumyabrata Sarkar, Rupam Sinha, Amitabha Chakraborty, Tanya Khaitan, Biyas Bhowmik Alexander Disease (AD) is an autosomal dominant leukodystrophy and occurs predominantly in infants and children. It usually results in death within ten years after onset. Among the four subtypes, infantile form comprises the most of affected individuals. It presents in the first two years of life, typically with progressive psychomotor deficiency, loss of developmental milestones, seizures, and pyramidal signs. Clinical and magnetic resonance image findings usually establish diagnosis of AD. Here, we present a case of Infantile AD with characteristic clinical and radiological features. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZD14-ZD15&id=10106 https://doi.org/10.7860/JCDR/2017/26875.10106 Acquired Inhibitor of Factor VIII Presenting as Delayed Wound Healing Sushma Nayar, Kishore Babu Esakkimuthu Parvathi, Mayilananthi Kaliannan, Premlatha Sivasailam Acquired coagulation factor VIII inhibitor leads to a rare disease i.e., acquired haemophilia which is idiopathic in majority of cases and is seen with autoimmune diseases, haematologic and solid tumours, infections, in the post-partum period and also with certain long-term use of drugs like penicillin and its derivatives, phenytoin, sulfa antibiotics, chloramphenicol, methyldopa, chlorpromazine, levodopa, interferon-a, fludarabine, clopidogrel. We report a case here, with acquired Factor VIII (FVIII) inhibitor acquisition which presented with delayed wound healing as a result of protracted bleeding into the wound. The inhibitor was acquired due to prolonged chlorpromazine use. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED21-ED23&id=10109 https://doi.org/10.7860/JCDR/2017/21598.10109 MRI findings of Persistent Mullerian Duct Syndrome: A Rare Case Report Rambir Singh, Sunil D Kumar, Nidhi Aggarwal Embryologically mullerian duct derivatives lead to formation of female genitalia and wolffian duct derivatives to male genitalia. Presence of mullerian duct derivatives in a chromosomally normal male (XY) leads to male pseudohermaphroditism and is referred to as Persistent Mullerian Duct Syndrome (PMDS). A young male patient with bilateral cryptorchidism presented to our hospital who was subsequently imaged. There are many case reports of persistent mullerian duct syndrome but they focus mainly on surgical aspects. In this article, MRI features of persistent müllerian duct syndrome are presented. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=TD05-TD06&id=10113 https://doi.org/10.7860/JCDR/2017/27467.10113 Co-Inheritance of Haemoglobin D-Punjab and Beta Thalassemia - A Rare Variant Kalyan Mansukhbhai Shekhda, Alpa C Leuva, Jyoti G Mannari, Aashka Vikas Ponda, Amee Amin Haemoglobinopathies are a frequent cause of anaemia in Northwestern India due to traditional practices of consanguineous marriages. Haemoglobin D-Punjab is one of the most common subvariants (55%) of haemoglobin D, which can be inherited as a homozygous or a heterozygous trait with other haemoglobinopathies. Though, haemoglobin D-Punjab is commonly seen, a heterozygous trait with beta thalassemia is a very rare presentation. Here, we present a rare case of co-inheritance of haemoglobin D-Punjab and beta thalassemia in a 19-year-old male of Indian origin. He came with gradually progressive generalised weakness with easy fatigability for the past two months. No history of similar complaints in the past. On examination, he was pale and icteric with splenomegaly and Grade I hemorrhoids on systemic examination. On investigation, there was severe anaemia, pancytopenia (mixed picture on smear), vitamin B12 deficiency and raised Lactate Dehydrogenase (LDH). Haemoglobin electrophoresis showed co-inheritance of haemoglobin D-Punjab and beta thalassemia. After Pack Cell Volume (PCV) and B12 supplements, haemoglobin improved. He was counseled about his disease and advised regular follow-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OD21-OD22&id=10114 https://doi.org/10.7860/JCDR/2017/27816.10114 Multifocal Tubercular Dactylitis: A Rare Presentation of Skeletal Tuberculosis in an Adult Pravat Thatoi, Manoj Parida, Rakesh Barik, Bidyut Das Tubercular dactylitis is an uncommon form of osteo-articular tuberculosis seen in children. Multifocal involvement, simultaneously involving hands and feet is extremely uncommon. Here we report an adult patient with tubercular dactylitis involving multiple digits of both hands and second digit of right foot in absence of any risk factors like immunodeficiency or any debilitating condition. The patient was successfully treated with anti-tubercular drugs for six months. Mycobacterium tuberculosis infection of bones and joints can present in an unusual way but early diagnosis and treatment caries a good prognosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OD23-OD24&id=10115 https://doi.org/10.7860/JCDR/2017/27879.10115 Ichthyosis Uteri Associated with Endometrial Adenocarcinoma: A Case Report Nishu Bhardwaj, Preeti Diwaker, Priyanka Gogoi, Neelam Wadhwa, Kiran Mishra The replacement of the entire or extensive parts of endometrial lining by stratified squamous epithelium is a rare entity known as ichthyosis uteri. It is considered to be a benign condition but may be associated with dysplastic changes and primary squamous cell carcinoma of the endometrium. Its association with endometrial adenocarcinoma is very rare. The aetiology of this condition is not clearly understood till date. We report a case of ichthyosis uteri associated with endometrial adenocarcinoma in a 70-year-old female who presented with complaint of per-vaginal bleeding for six months and underwent hysterectomy after being diagnosed with endometrial carcinoma. Microscopic examination of sections revealed endometrioid adenocarcinoma International Federation of Gynaecology and Obstetrics (FIGO) Grade 3 along with extensive replacement of the endometrial lining by stratified squamous epithelium, consistent with ichthyosis uteri. Although ichthyosis uteri is considered benign and its malignant potential is yet to be established, its association with endometrial malignancies, both squamous and adenocarcinoma, necessitates extensive sampling of the uterus if any focus of squamous metaplasia is identified in a hysterectomy specimen, to rule out a co-existing carcinoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED24-ED25&id=10116 https://doi.org/10.7860/JCDR/2017/27951.10116 Apple-Peel Intestinal Atresia Along with Isolated Jejunal Duplication Cyst in a Newborn – An Extremely Rare Case Report and Brief Review Prasanta Kumar Tripathy, Kaumudee Pattnaik, Pradip Kumar Jena, Hiranya Kishor Mohanty Apple-peel type of intestinal atresia and non-communicating jejunal duplication cyst are rare congenital malformations. The coexistence is not reported in English literature. A five-day-old female neonate having intestinal obstruction and was found to have both the anomalies during laparotomy and was successfully managed. Being an extremely uncommon association between two congenital anomalies of gastrointestinal tract and surgical emergencies, it is reported with review of relevant literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=SD01-SD02&id=10123 https://doi.org/10.7860/JCDR/2017/26900.10123 Wunderlich Syndrome due to Ruptured Pseudoaneurysm of Angiomyolipoma in First Trimester: A Rare Case Report Sunil Raghunath Patil, Prakash Wamanrao Pawar, Ajit Somaji Sawant, Abhishek Jaysukhbhai Savalia, Ashwin Sunil Tamhankar Angiomyolipoma (AML) is a rare benign tumour of kidney which demonstrates rapid growth during pregnancy due to hormonal stimulation, leading to rupture. Majority of reported ruptured AMLs are in third trimester. We report a case of ruptured angiomyolipoma at 10th week of gestation, the earliest rupture known in singleton pregnancy. The AML had pseudo-aneurysm formation with extra-tumoural rupture during pregnancy, a finding never reported in literature yet. The patient had active bleeding with expanding peri-nephric haematoma during initial two days of conservative management. Hence, after counselling and taking prior informed written consent for Medical Termination of Pregnancy (MTP), computed tomography scan of abdomen with angiography followed by emergency coil embolization of the bleeding right upper polar segmental artery was done. After stabilization, MTP was done at 12th week of gestation. Counselling and consent for continuing or aborting the pregnancy is of utmost importance for best possible outcome for patient and foetus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PD16-PD18&id=10141 https://doi.org/10.7860/JCDR/2017/25399.10141 Kikuchi-Fujimoto Disease Masquerading as Acute Appendicitis Vinita Pandey, Yasmeen Khatib, Rahul Pandey, Archana Khade, Manisha Khare Kikuchi-Fujimoto Disease (KFD) is a self-limiting necrotizing lymphadenitis that usually presents with fever and cervical lymphadenopathy. Recognition of this condition is crucial, because it can be mistaken for tuberculosis, lymphoma and connective tissue disorders. When present at an unusual location the diagnosis can be challenging. We present an unusual case of Kikuchi-Fujimoto disease involving mesenteric lymph node masquerading as acute appendicitis along with its differential diagnosis. A 30-year-old female presented with complaints of acute abdominal pain, vomiting and fever. Physical examination revealed rebound tenderness in the right iliac fossa. The abdominal sonography was suspicious of acute appendicitis. The patient underwent appendectomy with excision of an enlarged mesenteric lymph node. On histopathology mesenteric node showed features of KFD which was confirmed on immunohistochemistry. Appendix was unremarkable. Although rare KFD should be added to the differential diagnosis of acute appendicitis in patients with enlarged mesenteric lymph nodes, Awareness of this disorder helps to prevent misdiagnosis and inappropriate treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED26-ED28&id=10142 https://doi.org/10.7860/JCDR/2017/27733.10142 Plasma Cell Disorders in HIV Infected Patients: A Case Series S Anuradha, Prayas Sethi People Living with HIV (PLHIV) are at an increased risk of developing malignancies. Plasma cell disorders are also reported with increased incidence in PLHIV compared to the general population. Here, we describe three different plasma cell disorders among PLHIV and highlight their atypical presentations and outcomes in these subjects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OR03-OR05&id=10103 https://doi.org/10.7860/JCDR/2017/25978.10103 Local Injection of Triamcinolone Acetonide: A Forgotten Aetiology of Cushing’s Syndrome Weera Sukhumthammarat, Prapaipan Putthapiban, Chutintorn Sriphrapradang Many different non systemic corticosteroid administrations can cause iatrogenic Cushing ’s Syndrome (CS). We herein report a case series of iatrogenic CS from keloid scars treatment and aesthetic regimen called mesotherapy. Our first patient developed CS after having exceeded recommended dose of intralesional injection of Triamcinolone Acetonide (TAC). Second case presented with CS followed by unidentified mesotherapy treatment for local fat reduction. Subcutaneous injections of dexamethasone were found to be the part of mesotherapy regimen in one case. Physicians should be insightful in prescribing TAC especially in those patients who have high predisposing factors for developing CS. In the same way, off-label mesotherapy combine with corticosteroid can lead to iatrogenic CS and Hypothalamic-Pituitary-Adrenal (HPA) axis suppression. Currently, there are no standard guidelines for mesotherapy treatment. Therefore, further clinical trials on dosage, duration and effective combination of mesotherapy regimens are needed to increase safety uses. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OR01-OR02&id=10091 https://doi.org/10.7860/JCDR/2017/27238.10091 Cytology of Collagenous Spherulosis: A Case Series Devi Subbarayan, Vijayashree Raghavan Collagenous Spherulosis (CS) is an uncommon benign entity characterized by the presence of pink hyaline globules composed of basement membrane like material. Although they are known to occur independently, they are more often found as incidental findings in association with benign proiferative breast lesions. As morphologically similar hyaline globules also occur in certain malignant lesions such as Adenoid Cystic Carcinoma (ACC) and adenomyoepithelial carcinoma, their presence may pose diagnostic problems. The present series is a retrospective analysis of six cases of CS reported cytologically over a period of three years from 2013 to 2016 at Chettinad Hospital and Research, Tamil Nadu, India. The cytopathologist should be aware of this benign entity to distinguish it from similar looking malignant lesions to avoid inappropriate management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ER01-ER03&id=10044 https://doi.org/10.7860/JCDR/2017/26967.10044 Rickettsial Fever Presenting with Gangrene: A Case Series Arun Prasannan, Premalatha Ramaswamy, Vinitha K. Anirudhan Rickettsial diseases comprise a wide spectrum of diseases which are reported from different parts of India quiet long ago. Many cases of rickettsial diseases go undiagnos due to lack of diagnostic techniques and the reported incidence and prevalence may be an underestimation of the actual burden of the disease. A higher index of suspicion, clinical awareness and proper use of available diagnostic tools would increase the frequency of diagnosis. Gangrene is an uncommon complication in cases of rickettsial fever. Extensive gangrene of the digits or whole limb, even requiring amputation has been more commonly reported with Rocky Mountain spotted fever. These cases are being reported to highlight the occurrence of gangrene in rickettsial fever and the importance of appropriate management at the earliest. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PR01-PR03&id=10024 https://doi.org/10.7860/JCDR/2017/25371.10024 The Need and Importance of Incorporating Academic Research Results in to the Curricula of Ayurveda in India. Janmejaya Samal, Ranjit Kumar Dehury Every year a noticeable number of MD and PhD students pass out from various Ayurveda colleges across the country. Each of these Post Graduate (PG) and doctoral students do submit a research thesis as a part of fulfillment of their respective degrees. As on 01/04/2015 there were 98 PG Ayurveda colleges in India with an admission capacity of 2441 seats each year. Moreover many of the post graduate institutes provide doctoral level (PhD) education which is primarily involved with research thesis. Such meticulous research carried out under the supervision of an academic expert should not go in vein and hence the research findings need to be slotted in to the respective areas and disciplines of Ayurveda syllabus. This will help in bringing in the latest scientific trends of Ayurveda to graduate students. Distressingly such practices are not in vogue in Ayurveda education system and most of the colleges follow the same stereotypic pedagogy using the classical texts of Ayurveda or their respective commentaries written decades back. Use of classical treatises and their respective commentaries offers very limited access to the recent scientific developments of Ayurveda as these commentaries are mostly one time efforts and do not undergo repeated revisions thus limiting the inclusion of present day innovations. In this commentary an effort has been made to understand the source, output, need and importance of such academic research finding with reference to their incorporation in to curricula of Ayurveda. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=KA01-KA03&id=10112 https://doi.org/10.7860/JCDR/2017/26742.10112 Effect of Ethyl Acetate Extract of Melothria Perpusilla on Oral Glucose Tolerance Test in Albino Rats Shailendra Vikram Jitendra Singh, Usham Dharmaraja Meetei, Subhalakshmi Devi Akham, Rita Devi Sanjenbam <b>Introduction: </b>Diabetes mellitus is a group of common metabolic disorders sharing the phenotype of hyperglycaemia. Certain disadvantages like side effects or less efficacy limit the optimal use of antidiabetic drugs. <b>Aim: </b>To evaluate the effect of Ethyl Acetate Extract of Melothria Perpusilla (EAEMP) on oral glucose tolerance test in albino rats. <b>Materials and Methods:</b> Six healthy albino rats weighing between 100-150 g were selected. The same set of six animals were used for the experiment throughout and successive tests were conducted after a drug wash out period of 10 days. Fasting blood glucose samples were measured using glucometer. A 2% gum acacia suspension {10 ml/kg per oral (p.o.)} was given in all six albino rats followed by the oral glucose load of 3g/kg. Glucose concentrations were estimated at one hour and two hour after the glucose load. Using the same set of animals, similar tests were repeated with the test dose of 250 mg/kg and 500 mg/kg of EAEMP and glibenclamide (0.5 mg/kg p.o.). In this experiment, glucose was given immediately at the dose of 3 g/kg p.o. after the treatments. Drug wash out period of 10 days was maintained in between the successive tests to avoid the interference of action of the drug with the other. The non parametric data were analysed by Kruskal Wallis test. <b>Results: </b> EAEMP produced a significant increase in the oral glucose tolerance test when compared with control and standard. <b>Conclusion:</b> Treatment with Melothria perpusilla lowers the blood glucose level due to higher oral glucose tolerance possibly due to release of insulin from the pancreas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=FF04-FF06&id=10001 https://doi.org/10.7860/JCDR/2017/26638.10001 Evaluation of Antiulcer Activity of Peltophorum Pterocarpum Bhupalam Pradeepkumar, CP Bhavyamadhuri, Y Padmanabhareddy, KV Veerabhadrappa, Gorantla Narayana, C Haranath, K Somasekharreddy, Akkiraju Sudheer <b>Introduction:</b> Peltophorum pterocarpum is a rich source for phenols and the wood, leaves, and flowers of the plant are used as medicinal agents in traditional medicine. Peptic ulcer is a major disease of gastrointestinal tract, affecting nearly 40 lac people each year worldwide and affects 10% of world population with different aetiologies. Peltophorum pterocarpum consists of phenols and flavonoids, tannins which have potential antioxidant and cytoprotective activity. <b>Aim:</b> To evaluate the antiulcer activity of methanolic extract of the leaves of Peltophorum pterocarpum (MEPP) on albino rats. <b>Materials and Methods:</b> The rats were divided into four groups as control, standard, test 1 (extract: 100 mg/kg) and test 2 (extract: 200 mg/kg) with six rats in each group. Gastric lesions were induced by oral administration of indomethacin (20 mg/kg) followed by pylorus ligation. Standard group of animals were treated with misoprostol and test group of animals were treated with MEPP at doses of 100 and 200 mg/kg. To determine the antiulcer activity of extract, mean ulcer index, free acidity and total acidity were evaluated. <b>Results:</b> Ulcer index was significantly decreased at p<0.01 in MEPP treated groups as compared to control group. Total and free acidity was significantly decreased at p<0.01 in MEPP treated groups as compared to control group. Histological analysis also supported the gastro protective effect of MEPP treated groups when compared with control groups. <b>Conclusion:</b> The study revealed that MEPP exhibited potential antiulcer activity and showed dose dependent antiulcer effect. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=FF01-FF03&id=9998 https://doi.org/10.7860/JCDR/2017/26171.9998 Bile Duct Adenocarcinoma with Acute on Chronic Pancreatitis: A Rare Complication of Long Standing Choledochal Cyst Ashish Gupta, Lileswar Kaman https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PJ01-PJ02&id=10004 https://doi.org/10.7860/JCDR/2017/27049.10004 Granular Cell Tumour of the Tongue: Report of a Case Swati Goel, Manish Goel https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZJ01-ZJ02&id=10006 https://doi.org/10.7860/JCDR/2017/28946.10006 Microtia in All the Siblings of a Family: A Rare Case Somashekar Gejje, Brijesh Mishra, Amrita Anandkumar Hongal https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PJ03-PJ04&id=10035 https://doi.org/10.7860/JCDR/2017/24346.10035 Intraosseous Epidermal Inclusion Cyst of the Great Toe: Masquerading as Bone Tumour Uma Kumar, Sangeeta Lamba https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=EJ01-EJ02&id=10100 https://doi.org/10.7860/JCDR/2017/29249.10100 Pneumatosis Cystoides Intestinalis Vamsidhar Rachapalli, Sreedhara B Chaluvashetty https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=TJ01-TJ02&id=10087 https://doi.org/10.7860/JCDR/2017/26197.10087 An Experience: An Oropharyngeal Airway with an Unique Feature Hojjat Pourfathi, Haleh Farzin https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=UL01-&id=10102 https://doi.org/10.7860/JCDR/2017/25476.10102 Survey of Diagnostic Criteria for Fetal Distress in Latin American and African Countries: Over Diagnosis or Under Diagnosis? Maria Paula Cateriano-Alberdi, Cecilia D Palacios-Revilla, Eddy R Segura https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=SL01-SL02&id=10034 https://doi.org/10.7860/JCDR/2017/27374.10034 Comment on “Serological Evidence of Scrub Typhus among Cases of PUO in the Kashmir Valley– A Hospital Based Study” Bhuvanesh Sukhlal Kalal, Siddharudha Shivalli https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DL01-DL02&id=10038 https://doi.org/10.7860/JCDR/2017/25345.10038 Can Unilateral Pityriasis Rosea be Considered a Form of Superimposed Lateralized Exanthem? Francesco Drago, Giulia Ciccarese, Aurora Parodi https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=WL01-&id=10050 https://doi.org/10.7860/JCDR/2017/27855.10050 Correspondence: Comparative Efficacy of Oil Pulling and Chlorhexidine on Oral Malodor: A Randomized Controlled Trial Ryan Armstrong https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=LL01-LL02&id=10065 https://doi.org/10.7860/JCDR/2017/29167.10065 Novel Technique for Precise Juxta-Crestal Periimplant Placement and Retention of Platelet Rich Fibrin (PRF) Membrane Manu Rathee, Mohaneesh Bhoria https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZL01-ZL02&id=10007 https://doi.org/10.7860/JCDR/2017/14454.10007 Visceral Leishmaniasis in an Immunocompromised Patient: Diagnostic Bone Marrow Cytomorphology Manjari Kishore, Garima Baweja Madaan https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=EL01-EL02&id=10013 https://doi.org/10.7860/JCDR/2017/28061.10013 An Unusual Presentation of Conjunctival Infection Shobha Pai, Madhurima Nayak, Gloria George https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=NL01-NL02&id=10122 https://doi.org/10.7860/JCDR/2017/26591.10122 Feasibility and Complications of Spinal Anaesthesia in Percutaneous Nephrolithotomy: Our Experience Manoj Kamal, Pradeep Sharma, Geeta Singariya, Rajesh Jain <b>Introduction: </b>Percutaneous Nephrolithotomy (PCNL) is the treatment modality used for the extraction of large renal stones, or multiple calculi or stones resistant to shock wave lithotripsy. The General Anaesthesia (GA) is the standard modality for PCNL. However, few studies conclude that Spinal Anaesthesia (SA) can be an alternative method of anaesthesia with similar incidence of complications. <b>Aim:</b> In our study we evaluated the feasibility of spinal anaesthesia in terms of intraoperative and postoperative results in patients undergoing PCNL. <b>Materials and Methods:</b> The total 1298 PCNL operations were done for kidney stone from January 2013 to December 2016, out of which 1160 patients underwent PCNL under SA while remaining 138 operations were carried out under GA in the prone position. We retrospectively collected data from the patient’s documents. The intraoperative haemodynamic stability was primary objective, and average fall of haemoglobin, postoperative anaesthetic outcome like total tramadol used in first 24 hours, surgical outcome like total clearance of stone burden, patient satisfaction, surgeon satisfaction, need of blood transfusion, conversion to general anaesthesia and pleural puncture were the secondary objectives. <b>Results:</b> The mean age of the patients was 38.0±17.1 years, and the mean operative time was 80.0±25.9 minutes. The mean calculus size was 30.2±11.8 mm. Return of sensory and motor activity took 150.0±29.2 minutes and 111.0±18.8 minutes, respectively. In first 10 minutes of anaesthesia, 148 (12.75%) patients developed hypotension, which was managed by ephedrine 6 mg intravenously (IV). Total seventy two patients (6.2%) needed blood transfusion and 32 (2.75%) complained of headache, dizziness and low back pain for two to four days after the operation, which improved with analgesics and bed rest. Ninety percent of the patients had complete clearance of calculus or there were no significant residual calculi larger than 5 mm on follow up ultrasonography. <b>Conclusion: </b>It can be concluded from our study that spinal anaesthesia is the safe and effective method of anaesthesia for PCNL in adult patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=UC08-UC11&id=10111 https://doi.org/10.7860/JCDR/2017/26425.10111 Effect of Agonist and Antagonist on the In Vitro Contractility of Inflamed Vermiform Appendix Phani Bhushan Singh, Pushpakant Tiwary, Sanjeev K Singh, Ratna Pandey, Atanu Roy, Amrita Ghosh Kar, Somprakas Basu, Anil Kumar Tiwarwari <b>Introduction:</b> Appendicitis poses a great health problem worldwide. Previous studies demonstrated structural damage to neuronal network and interstitial cell of Cajal in appendicitis. Above observations suggest for the alterations in appendicular motility/contractility in appendicitis. But the mechanisms involved in mediating the contractility in inflamed vermiform appendix is not known till date. <b>Aim:</b> The present in vitro study was performed to find out the mechanisms responsible for contractility in the inflamed human vermiform appendix. <b>Materials and Methods:</b> Contractions of the longitudinal muscle strips of inflamed appendix were recorded in vitro at 37±0.5°C. Control contractions were recorded for 30 min after an initial tension of 0.5 gram. Initially dose-response experiments of agonists (acetylcholine, serotonin and histamine) were performed separately and the dose that produced maximum contraction was determined with each agonist. This maximal dose of agonist was used to elicit contractions in next series of experiments before and after pre-treatment with appropriate antagonists like atropine, ondansetron (5-HT3 antagonist) and chlorpheniramine maleate respectively. <b>Results:</b> Acetylcholine (ACh) and serotonin (5-HT) elicited maximum amplitude of contraction at 10 µM and 1 µM concentration respectively. These contractions were significantly blocked by prior exposure of muscle strips with atropine (100 µM) and ondansetron (10 µM). Histamine produced very low amplitude of contractions in comparison to ACh or 5-HT and did not exhibit dose-response relations. The histamine induced contractions were blocked by H1 antagonist chlorpheniramine maleate (100 µM). <b>Conclusion:</b> The observations suggested that the contractility of longitudinal muscle strips of inflamed vermiform appendix in human beings was predominantly mediated by muscarinic and serotonergic (5-HT3) mechanisms, whereas, histaminergic mechanisms played a minor role in mediating the contractility. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=CC25-CC30&id=10124 https://doi.org/10.7860/JCDR/2017/28804.10124 Content Validation of Total Knee Replacement Rehabilitation Protocol in Indian Population P Antony Leo Aseer, G Arun Maiya, M Mohan Kumar, P V Vijayaraghavan <b>Introduction:</b> Total knee replacement (TKR) surgery has become the most successful surgery for patients with severe debilitating arthritis.The guidelines for rehabilitation progression should be tailored respecting the tissue healing parameters. Hence, the current literature states a need for protocol to mitigate these impairments and ultimately result in improved functional outcomes. <b>Objective:</b> The present study aimed to validate the content of TKR rehabilitation protocol in Indian population. <b>Materials and Methods:</b> The process of content validation involves development stage and expert judgment stage. The protocol was designed into three stages with extensive review of literature. After designing the protocol, nine experts in field of musculoskeletal Physiotherapy performed the judgemental process. The process of validation includes rating of experts in a 5 point likert grading on two parameters namely relevance and ease of performance. Based on expert’s inputs on TKR protocol, the level of agreement, content validation index and kappa value was calculated. <b>Results:</b> The three staged TKR protocol almost exhibited an excellent agreement on all stages. However, muscle activation exercises (except Vastus medialis obliques activation), stretching, strengthening program and functional training showed 100% agreement than other stages. <b>Conclusion:</b> The structured TKR protocol exhibited excellent content validity to its use in Indian population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=YC05-YC09&id=10137 https://doi.org/10.7860/JCDR/2017/27528.10137 Role of Provisional Fixation of Fracture Fragments By Steinmann-Pin and Technical Tips in Proximal Femoral Nailing for Intertrochanteric Fracture Mohit J Jain, Kinjal J Mavani, Dhaval Patel <b>Introduction:</b> Proximal Femoral Nailing (PFN) in Intertrochanteric Fractures (IF) is becoming the choice of implant due to better biomechanics and prevention of varus collapse associated with Dynamic Hip Screw (DHS). Technical difficulties and implant related complications are yet to be addressed. <b>Aim:</b> To understand the technical difficulties involved in PFN and role of provisional fixation of fracture by Steinmann-pin. <b>Materials and Methods:</b> In this study, 55 patients presented to a tertiary trauma center in India with trochanteric fractures from April 2010 to March 2012 were included and treated with PFN. All patients were followed-up for two years and final outcome assessment included shortening, neck shaft angle and Harris Hip Score was done. <b>Results:</b> In all except one, neck shaft angle greater than 130° was achieved and also maintained in the final follow up (Mean 131.1°). All fractures were united with mean shortening of 3.6 mm and average Harris Hip Score of 91 after two years. There were five complications which included one shortening, two varus collapses, one backed out screws and one reverse Z effect. <b>Conclusion:</b> Though PFN is technically challenging, with proper technique, gives excellent results with negligible varus collapse even in unstable fractures. Three most important technical aspects are achieving good non-varus reduction, inserting nail correctly and accurate placement of lag screws. The technique of provisional fixation of fracture fragments by Steinmann-pin significantly helps in achieving these and reduces the risk of implant failure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=RC01-RC05&id=10117 https://doi.org/10.7860/JCDR/2017/25755.10117 Assessing the Viability of Hadad Flap by Postoperative Contrast-Enhanced Magnetic Resonance Imaging Jyotirmay S Hegde, Sunil Kumar Saxena, AS Ramesh, K Nagarajan, Shreshta Bhat <b>Introduction:</b> The Expanded Endonasal Approaches (EEAs) have been widely used for various skull base lesions. The reconstruction of the skull base defects is of vital importance to prevent postoperative complications. The vascular pediclednasoseptal flap (Hadad-Bassagasteguy flap) is used as a workhorse in reconstruction of majority of the defects. <b>Aim:</b> The purpose of this study was: (a) To assess the postoperative MRI appearance of vascularised pedicled nasoseptal flap for its viability; (b) To determine the variations in MRI that may suggest potential flap failure. <b>Materials and Methods:</b> A prospective study of 13 patients was done, who underwent endoscopic skull base surgery with reconstruction using the Hadad-Bassagasteguy flap. Preoperative MRI was done to assess the size, extent and location of the lesion and a postoperative MRI was done to evaluate flap configuration, enhancement patterns, location, flap thickness and signal intensity characteristics. <b>Results:</b> The postoperative MRI of all patients showed a detectable flap covering over the skull base defects forming an “open cup” appearance. They were uniformly isointense on T1-weighted/ fat suppressed images to the adjacent nasal mucosa and hyperintense on T2-weighted images. On the MRI scans done after four weeks, all 13 of our patients had enhancing flaps. One flap migrated slightly to the left side; however, there was no Cerebrospinal Fluid (CSF) leak. <b>Conclusion:</b> Vascular pedicle nasoseptal (Hadad) flaps are being widely used. MRI is a very useful tool in assessing the viability of the flap postoperatively and to evaluate for variations that may suggest potential flap failure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=MC01-MC03&id=10118 https://doi.org/10.7860/JCDR/2017/26737.10118 Comparison of Polymerase Chain Reaction and Immunohistochemistry Assays for Analysing Human Papillomavirus Infection in Oral Squamous Cell Carcinoma Muhammad Sohail Awan, Babar Irfan, Ibrahim Zahid, Yumna Mirza, Syed Adnan Ali <b>Introduction:</b> Polymerase Chain Reaction (PCR) and Immunohistochemistry (IHC) are two well-known techniques used for the diagnoses of genetic diseases, tumours and different pathogens. PCR basically amplify regions of DNA within a single molecule which may have etiologic significance, it is a method for in vitro amplification of specific DNA or RNA sequences, whereas IHC is used to verify tissue constituents (the antigens) with the utilization of specific antibodies that can be visualized through staining. <b>Aim: </b>To compare and analyse PCR and IHC for their sensitivity to detect Human Papillomavirus (HPV) in Oral Squamous Cell Carcinoma (OSCC). <b>Materials and Methods:</b> This study was based on samples retrospectively collected from 47 patients with primary OSCC who were diagnosed and treated at The Aga Khan University Hospital, Karachi, Pakistan, during the period of January 2010 to December 2013. Inclusion criteria were complete clinicopathologic data, adequate clinical follow up and availability of sufficient paraffin- embedded tumour material. HPV general and type specific 16 and 18 were investigated by means of PCR. HPV immunoreactivity was further investigated by means of IHC. <b>Results:</b> Among the 47 evaluated patients, 32 (68.1%) were male and 15 (31.9%) were female, PCR detected the presence of HPV in 32 (68.1%) patients while IHC showed no positive test results. p53 was positive in 32 (68.1%) patients and negative in 15 (31.9%). HPV type 16 being most prevalent showing positivity in 27 (57.4%) patients whereas, type 18 was positive in only 1 (2.1%) patient. <b>Conclusion:</b> We concluded that PCR is more sensitive and reliable when diagnosing and detecting HPV for OSCC rather than IHC as results from IHC were all negative and insignificant, hence PCR should be the first initial diagnostic test for detecting HPV due to its better sensitivity and successful detection of HPV. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=XC10-XC13&id=10119 https://doi.org/10.7860/JCDR/2017/24742.10119 Perception and Attitude of Medical Students towards Communication Skills Lab and Teaching Module Rahul Tanwani, Rita Chandki, Ajay Joshi, Vinod Kumar Arora, Prem Nyati, Seema Sutay <b>Introduction:</b> The knowledge of proper communication skills with the patients plays a pivotal role in success of medical professionals. A practical approach would be to initiate its training at an early stage of education period of undergraduate medical students. <b>Aim:</b> To assess perception and attitude of medical students towards Communication Skills Lab (CSL) and teaching module in Central India. <b>Materials and Methods:</b> This cross-sectional study was conducted in Department of General Surgery at Index Medical College, Indore, India. Undergraduate medical students were trained as per a systematic teaching module in a well equipped ‘CSL’. Feedback was obtained via Likert scale and analysed after completion of the training course of eight days. <b>Results:</b> A majority of the students (96.43%) opined that the training had improved their communication with the patients. They also felt that such training should be integrated in regular teaching curriculum of our country. <b>Conclusion:</b> The training of basic communication skills can be introduced at an early stage of undergraduate medical curriculum in form of an effective, interesting and acceptable teaching module. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=JC12-JC14&id=10120 https://doi.org/10.7860/JCDR/2017/24858.10120 Pulpal Response to Ferric Sulfate and Diode Laser When Used as Pulpotomy Agent: An In vivo Study Sonia Sivadas, Arathi Rao, Srikant Natarajan, Ramya Shenoy, Suprabha Baranya Srikrishna <b>Introduction:</b> Ferric sulfate and Laser has been used for conventional pulpotomy therapy. Clinical and radiographic evaluation of pulpotomies using these have been done in numerous studies but there exists few studies analysing the histologic response of pulp to laser and ferric sulfate. <b>Aim:</b> The aim of the study was to evaluate and compare histological changes seen in the pulp following ferric sulfate and laser pulpotomy and compare these effects. <b>Materials and Methods:</b> This was a single blind in vivo study, consisting of 24 primary teeth. The teeth were randomly divided into two groups based on the material to be used and subgrouped based on the time period (30 and 45 days) of evaluation. The teeth were extracted after the study period and tissue processing done and subjected to Haematoxylin and Eosin staining procedure. The tissues were evaluated for dentin bridge formation, quality of dentin formation in the bridges, location of dentin bridges, tissue reaction to the material, inflammatory cell response and necrosis. The statistical analysis was done using SPSS 20.0 software. Intragroup comparisons of the observed values were analysed using Chi-square test. <b>Results:</b> Statistical analysis revealed non-significant difference between the two materials to produce reparative dentin and also the quality of dentin bridges formed in both the groups during both the observational periods. Majority of the samples in both ferric sulfate and laser group exhibited dentin bridge at the interface of the exposed pulp, bridging or attempting to bridge the site exposed to the pulpotomy material. The ability of the materials to evoke a foreign body and inflammatory cell responses in the pulpal tissue was not significant. All the samples of both the groups showed signs of necrosis with two samples of laser group showing severe necrosis in 45 days period. The difference between the groups in 30 days group was statistically significant. <b>Conclusion:</b> Laser and ferric sulfate are found to be able to initiate dentin bridge at the interface between the pulp and the material but the quality of bridge formed was better in laser group. Laser group showed more macrophage infiltration, inflammatory cell infiltration and areas of necrosis compared to ferric sulfate group though not statistically significant https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC87-ZC91&id=10121 https://doi.org/10.7860/JCDR/2017/25180.10121 Effect of Crown Angulation of Maxillary Incisor on Effective Arch Perimeter Megha Jain, Matrishva Vyas, Johar Rajvinder Singh <b>Introduction:</b> It has been postulated that crown angulation and inclination has potential space implication within the arch. With the insight of space implication of the axial relations of teeth, cases of genuine tooth size discrepancies can be dealt with improved stability. <b>Aim:</b> This in vitro study was designed to investigate and quantify the influence of angulation and inclination of maxillary incisors on the effective arch perimeter. <b>Materials and Methods:</b> Acrylic teeth were arranged over typhodont frame with spaced maxillary anterior segment. Known value of tip and torque in increments were incorporated to maxillary incisors through bracket positioning and corresponding consumption of the interdental spaces were measured using coordinate measuring machine. <b>Results:</b> Study revealed that increase in maxillary incisor crown angulation by 1o results in consumption of approximately 0.012 mm of arch perimeter. Similarly, there is a consumption of 0.021 mm of arch perimeter with each degree increase in labial crown inclination. <b>Conclusion:</b> The knowledge of the space implication can be included in the space analysis during the orthodontic treatment planning. Depending upon the amount of space discrepancy, an accurate degree of required alteration in the axial relation of one or more teeth can be planned. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC92-ZC96&id=10139 https://doi.org/10.7860/JCDR/2017/24222.10139 Revisiting Nitrofurantoin for Vancomycin Resistant Enterococci Suneeta Meena, Sarita Mohapatra, Seema Sood, Benu Dhawan, Bimal Ku Das, Arti Kapil <b>Introduction:</b> Enterococcal infection has emerged as a major therapeutic challenge. Emergence of High Level Aminoglycoside Resistance (HLAR) and Vancomycin-Resistant Enterococcus (VRE) has further limited the drug therapy in enterococcal infections. However, nitrofuratoin being an old drug reported to have less resistance in comparison to the other classes of antimicrobial agents. <b>Aim:</b> To detect susceptibility of nitrofurantoin against VRE isolates from Urinary Tract Infection (UTI) of outdoor and indoor patient departments. <b>Materials and Methods:</b> An observational study was carried out at a tertiary care hospital in New Delhi over a period of six months (from November 2015 to April 2016). A total of 14,714 urine samples were collected and processed from the patients symptomatic for UTI. The enterococcal isolates were identified and confirmed by standard phenotypic tests. The antimicrobial susceptibility tests of isolated organisms were performed by Kirby-Bauer Disc Diffusion Method as per Clinical and Laboratory Standards Institute (CLSI) 2015 guidelines. The Wilcoxon rank-sum (Mann-Whitney) test was used to compare continuous variables. Chi-square or Fisher’s exact tests were used to compare categorical variables. p<0.05 was considered as significant <b>Results:</b> A total of 70 enterococci species {Enterococcus faecalis (n=9), Enterococcus faecium, (n=61)} were isolated. Twenty six out of 70 isolates were observed resistant to vancomycin. Among 26 VRE, 21(80.76%) were susceptible to nitrofurantoin. Both the species {E. faecalis (80.32%) and E. faecium (88.8%)} were uniformly susceptible to nitrofurantoin. <b>Conclusion:</b> Nitrofurantoin has retained antimicrobial efficacy against emerging VRE in vitro and can be used for treatment of enterococcal urinary tract infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DC19-DC22&id=10140 https://doi.org/10.7860/JCDR/2017/25140.10140 Prevalence and Patterns of Multimorbidity among Human Immunodeficiency Virus Positive People in Odisha, India: An Exploratory Study Sanghamitra Pati, Shreeporna Bhattacharya, Subhashisa Swain <b>Introduction:</b> Improved and efficient Anti-Retroviral Therapy (ART) has turned HIV positive into a chronic disorder. The increase in life expectancy and quality of life comes with an increased risk of multimorbidity from the traditional risk factors. <b>Aim:</b> To explore the prevalence of multimorbidity among People Living with HIV (PLHIV). <b>Materials and Methods:</b> An exploratory cross-sectional study was carried out in an ART center of Odisha, India, from November 2013 to December 2013. A systematic random sampling was done to include 197 adult HIV positive patients receiving ART at least for one year or more. A structured questionnaire was used to collect data on socio-demographic profile, ART status, multimorbidity and opportunistic infections. <b>Results:</b> The prevalence of multimorbidity was 47.7% (95% CI 41% to 55%). Among them, the most common chronic conditions were pulmonary tuberculosis (28.4%), gastro-intestinal conditions (7.1%), neural disorders (5.1%) and hypertension (2.5%). In total, 48.7% had opportunistic infections; with 36% bacterial, 25% fungal and 21% viral infections. <b>Conclusion:</b> The prevalence of multimorbidity was high among HIV positive patients. Further research should explore the epidemiology of multimorbidity among HIV positive patients to formulate proper clinical practice guidelines to enhance long-term outcomes of PLHIV in the current treatment era. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=LC10-LC13&id=10014 https://doi.org/10.7860/JCDR/2017/22766.10014 Comparison of Neurological Soft Signs between Psychotic and Non Psychotic Patients Abdollah Farhadi Nasab, Bahare Sabbagh Abrishami, Behnaz Ghavami, Seyed Mostafa Hosseini-Zijoud <b>Introduction: </b>Neurological Soft Signs (NSS) are a group of non-specific signs manifested in some psychiatric patients. Till date, most studies have focused on NSS in schizophrenic patients. <b>Aim:</b> In the current study, the mean NSS score was compared between psychotic and non psychotic patients. <b>Materials and Methods:</b> This descriptive analytical study was conducted on 96 hospitalized patients having psychotic disorders. The patients were first examined by a psychiatrist and their axis I diagnoses (according to DSM-IV-TR) were made. Accordingly, the patients were divided into three groups of psychotic (schizophrenic and schizoaffective) and bipolar disorder patients with and without psychotic symptoms. Using a 28-item questionnaire, the patients were neurologically examined and their NNS scores were calculated. The mean scores were compared among the groups. <b>Results:</b> Based on the results, the mean NSS score in psychotic patients (schizophrenic and schizoaffective) was higher as compared to that in non-psychotic patients (bipolar disorder patients without psychotic symptoms) and this difference was statistically significant (p<0.0001). <b>Conclusion:</b> It seems that calculation of NSS score in psychotic patients can help predict the response to pharmaceutical treatment, risk of drug reactions/side effects and prognosis of disease. Drawing a definite conclusion in this regard requires further investigations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=VC09-VC11&id=10015 https://doi.org/10.7860/JCDR/2017/24728.10015 Lead Level in Umbilical Cord Blood and its Effects on Newborns Anthropometry Akbari-Nassaji Neda, Sabeti Fahimeh, Ziaei Kajbaf Tahereh, Fakharzadeh Leila, Nazari Zahra, Cheraghian Bahman, Cham Kouri Narges <b>Introduction:</b> High concentration of blood lead is accompanied by adverse health effects on growth of foetus and the newborn. <b>Aim:</b> The aim of this study was to determine umbilical cord blood lead level and its relationship with birth weight, length and head circumference of the newborns in Abadan, Iran. <b>Materials and Methods: </b>In this cross-sectional study, 3 ml blood was collected from the umbilical cord vein in 147 newborns, immediately after the birth. Blood lead was measured using atomic absorption spectrophotometry. Data collection instruments included demographic questionnaire (age of mother, gestational age, newborn gender, job and education of mother) and also data registration form (umbilical cord blood lead concentration, weight, length, and head circumference of newborn). Data was analyzed with SPSS software version 16.0. <b>Results: </b>The mean of umbilical cord blood lead was determined 0.65±0.32 µg/dl (0.3-1.35 µg/dl). The decrease of birth weight with increased blood lead level was small and was not statistically significant. There was reverse significant correlation between umbilical cord blood lead level and birth length and head circumference. There was no significant correlation between blood lead and other variables such as age, weight, education and job of mother and gestational age. <b>Conclusion:</b> Umbilical blood lead level was determined <5 µg/dl. Excess of umbilical cord blood lead caused decreasing birth weight, length and head circumference of the newborns. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=SC01-SC04&id=10016 https://doi.org/10.7860/JCDR/2017/24865.10016 Comparison between Two Endotracheal Tube Cuff Inflation Methods; Just-Seal Vs. Stethoscope-Guided Rishiraj Borhazowal, Minal Harde, Rakesh Bhadade, Sona Dave, Swapnil Ganeshrao Aswar <b>Introduction:</b>The Endotracheal Tube (ETT) cuff performs a critical function of sealing the airway during positive pressure ventilation. There is a narrow range of cuff pressure required to maintain a functionally safe seal without exceeding capillary blood pressure. <b>Aim:</b> We aimed to compare Just-Seal (JS) and Stethoscope-Guided (SG) method of ETT cuff inflation with respect to the volume of air required to inflate the cuff, the manometric cuff pressure achieved and also to assess for the occurrence of postoperative sore throat after extubation in both the groups. <b>Materials and Methods:</b> It was a prospective observational study done in a Tertiary Teaching Public Hospital over a period of 1½ years on 100 patients with 50 each in two groups; JS or SG method of cuff inflation. SPSS Version 17 was used for data analysis. <b>Results:</b> Statistically significant difference (p-value of less than 0.05) was noted between the two methods based on the volume of air injected into the cuff {the mean volume injected in JS was 6.79 ml and in the SG was 4.95 ml with p=5.71E-16 (< 0.05)} and cuff pressure achieved {mean cuff pressure achieved was 38.80 cm H2O in the JS and 29.64 cm H2O in SG with p=2.29E-14 (< 0.05)}. The incidence of post extubation sore throat was 54% (27 in 50) in the JS group and only 12% (6 in 50) in the SG; p= 0.00000797. <b>Conclusion:</b> ETT cuff inflation guided by a stethoscope is an effective technique for ensuring appropriate cuff pressures thus accomplishing the objective of providing safe and superior quality care of the patient both during and after anaesthesia and reducing the likelihood of even minimal risk complications that may still have legal implications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=UC01-UC03&id=10017 https://doi.org/10.7860/JCDR/2017/26301.10017 Investigating the Influence of Teachers' Characteristics on the Teacher-Student Relations from Students' Perspective at Ilam University of Medical Sciences Farajolah Maleki, Mehri Hosein Talaei, Seyed Rahmatollah Mousavi Moghadam, Shahryar Shadigo, Hamid Taghinejad, Alireza Mirzaei <b>Introduction:</b> Establishing an effective teacher-student relationship may affect the quality of learning. Such a complex human relationship may be influenced by various factors in addition to teacher and student. <b>Aim:</b> The present study aimed at investigating the influence of teacher characteristics on the Teacher-student relationship from students’ perspective. <b>Materials and Methods:</b> In this descriptive-survey research, statistical population included 1500 students at Ilam University of Medical Sciences Ilam, Iran. Out of which 281 students were selected by simple random sampling, they received and completed series of questionnaires. Data was collected using a researcher-made questionnaire containing 37 Likert type items from which 5 items measured demographic profile of participants and 32 items measured impact of teacher’s characteristics upon the teacher-student relationship. Data was analysed by SPSS software version 16 using descriptive statistics, t-test and One way ANOVA. <b>Results:</b> The current study included 281 students (117 (41.6%) male, 164 (58.4%) female) studying at Ilam University of Medical Sciences. The effect of teachers' characteristics on the teacher-student relationship from the students’ perspective in three areas (personal, professional and scientific) scored 4.37±0.54, 4.05±0.27, and 3.91±0.44, respectively. The highest score was related to “respect for students” (Mean=4.74, SD=0.55) and the lowest score was dedicated to ‘gender’ (Mean=2.40, SD= 0.64). Effect of other studied parameters was also higher than the average level. <b>Conclusion:</b> The findings indicated that teacher-student relationship and consequently the quality of education was overshadowed by the overall characteristics of teacher (namely- personal, professional and scientific). Notably, coupled with the professional and scientific properties of the teacher, his/her communication skills may also help to provide a favourable learning condition for the students. Therefore, attention to the education of scientific as well as professional skills of the teachers in interaction with students through appropriate workshops and training courses is a matter of great necessity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=JC04-JC08&id=10018 https://doi.org/10.7860/JCDR/2017/20109.10018 Evaluation of Competencies Related to Personal Attributes of Resident Doctors by 360 Degree Harsha Jani, Wasea Narmawala, Jaishree Ganjiwale <b>Introduction:</b> Postgraduate teaching involves training the residents in all spheres including professionalism, communication and interpersonal skills in addition to the basic clinical skills. Therefore, 360 degree evaluation has gained focus due to increased standards of medical care as shown in this study. <b>Aim:</b> To evaluate interpersonal and communication skills and professionalism in residents doctors using 360 degree evaluation method. <b>Materials and Methods:</b> The present study was a descriptive study conducted at a tertiary care hospital affiliated with a medical college. Taking up as a pilot project, 26 residents from four departments were recruited in this study. A five point likert scale (1 to 5,1 meaning poor, 5 meaning excellent) was used for scoring them on for their interpersonal and communication skills and professionalism by the persons working around their sphere like teachers, peers, nursing staff ,undergraduate students and patients/or relatives (360 degree). <b>Results:</b> Though the ratings by the peers and consultants were found to be slightly lower compared with nursing staff, undergraduate students and patients, there was good agreement between all of them. The mean score of all traits showed an increasing trend over the years of residency. <b>Conclusion:</b> Regular orientation programs for professionalism with 360 degree evaluation and subsequent feedback to the resident doctor about their strength and weaknesses can definitely bring out behavioural change in the resident doctor in practice. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=JC09-JC11&id=10027 https://doi.org/10.7860/JCDR/2017/25907.10027 Knowledge and Perception about Pharmacovigilance among Pharmacy Students of Universities in Sana’a Yemen Gamil Qasem Othman, Mohamed Izham Mohamed Ibrahim, Mohammed Alshakka, Mukhtar Ansari, Farouk Al-Qadasi, Abdulsalam M. Halboup <b>Introduction:</b> Pharmacists in community or hospital setting play a key role in reporting Adverse Drug Reaction (ADRs) during practice. Under reporting is considered as a profession malpractice worldwide. <b>Aim:</b> To determine the level of knowledge and perception about phramacovigilance and ADRs reporting among final year pharmacy students of Universities in Sana’a Yemen. <b>Materials and Methods:</b> A cross-sectional study design was conducted among 385 final year pharmacy students. One public and four private universities were selected randomly using a validated self-administered questionnaire. The questionnaire contained data about student demographic data, knowledge and perception about the ADRs. The data was analysed by SPSS program and Chi-square tests were used to assess the significance of association. <b>Results:</b> The male students were more knowledgeable than female (p=0.035), as well as private university students had better ideas on how to report ADRs than public university students (p=0.009). Private university students reported that pharmacovigilance topic is well covered in their curriculum compared to public university students (p=0.001). A significant difference was seen amongst the students of public and private universities when asked about reporting ADRs in future, former found more confident (p=0.001). Furthermore, the private university students also had more command on the concept of post-marketing surveillance than public university students (p=0.001). The private university students in Yemen were more known to causality assessment of ADRs as compared to the students of public universities (p=0.001). The results of perception revealed regarding perception toward ADRs and pharmacovigilance. Female students (p=0.018) and private universities students (p=0.001) had positive perception than male and public university students respectively. <b>Conclusion:</b> The findings showed poor knowledge among students in Sana’a Universities and positive perception towards pharmacovigilance and ADRs reporting. A poor knowledge among the future pharmacists suggests need for educational interventions and improvement of strategies to ease the reporting mechanisms. Steps can be taken to improve pharmacovigilance tools and methods in Yemen as well as incorporating subjects of pharmacovigilance in the health faculty’s curriculum in Yemen. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=FC09-FC13&id=10028 https://doi.org/10.7860/JCDR/2017/24228.10028 Seroepidemiology of Spotted Fever Rickettsiosis in Uttar Pradesh: A Prospective Study Chandra Dev Pati Tripathi, Mastan Singh, Jyotsna Agarwal, Chandra Kanta, Virendra Atam <b>Introduction:</b> Spotted Fever Rickettsiosis (SFR), an acute febrile illness caused by Rickettsia rickettsii, R. conorii and R. akari which is associated with considerable morbidity and mortality. SFR is one of the most covert emerging infections of the present time which is prevalent in various parts of India as shown by the increase in the number of clinically diagnosed patients in various states except Uttar Pradesh. <b>Aim:</b> To diagnose SFR in clinically suspected patients using serological tests and recognition of common epidemiologic situations and clinical manifestations of SFR in the state of Uttar Pradesh. <b>Materials and Methods: </b>Patients of all age groups presented with a diagnosis of Pyrexia of Unknown Origin (PUO) from May 2013 to February 2015 were evaluated. Testing was done using a nonspecific Weil felix test followed by more specific Enzyme Linked Immunosorbent Assay (ELISA) and a gold standard Immunofluorescence Assay (IFA) test for specific IgM antibodies against Rickettsia conorii. The data was statistically analysed on Graph Pad Prism (5.0) software by using Chi-square test. <b>Results:</b> Of the 432 patient samples tested by non specific Weil felix test, 200 (46.29 %) samples showed titre 1:80 or more and were taken as positive. Similarly out of the 432 blood samples tested by both ELISA and IFA based test against Rickettsia conorii IgM antibody, only 115 (26.62%) samples were found to be positive and these samples were also positive by Weil felix. The common symptoms noted were fever, hepatomegaly, thrombocytopenia, lymphadenopathy and rashes, nausea followed by icterus, cyanosis, headache, oedema and abdominal pain. Eschar was found in only four (3.4%) patients. We also found that 31 patients with SFR also had associated co-infections like typhoid, malaria, dengue and hepatitis. <b>Conclusion:</b> Our findings demonstrated that Weil Felix test can fill in as an underlying yet not sole strategy to perceive and analyse rickettsial ailments, as it needs specificity. So, it may be used to assess the burden in the area and later on other tests like ELISA or IFA can be added, as these are more specific diagnostic tests. Further, our results also showed that if a patient tests positive for the more common endemic infections, we must test for rickettsiosis so that appropriate treatment could be administered. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DC04-DC09&id=10029 https://doi.org/10.7860/JCDR/2017/25926.10029 Relationship between Automated Coronary Calcium Volumes and a Set of Manual Coronary Lumen Volume, Vessel Volume and Atheroma Volume in Japanese Diabetic Cohort Sumit K. Banchhor, Narendra D. Londhe, Luca Saba, Petia Radeva, John R. Laird, Jasjit S. Suri <b>Introduction:</b> A high degree of correlation exists between Coronary Artery Diseases (CAD) and calcification of the vessel wall. For Percutaneous Coronary Interventional (PCI) planning, it is essential to have an exact understanding of the extent to which calcium volume is correlated to the lumen, vessel, and atheroma volume regions in the coronary artery, which is unclear in recent studies. <b>Aim:</b> Four automated Coronary Calcium Volume (aCCV) measurement methods {threshold, Fuzzy c-Means (FCM), K-means, and Hidden Markov Random Field (HMRF)} and its correlation with three manual (experts) coronary parameters namely: Coronary Vessel Volume (mCVV), Coronary Lumen Volume (mCLV), and Coronary Atheroma Volume (mCAV), was determined in a Japanese diabetic cohort. <b>Materials and Methods:</b> Intravascular Ultrasound (IVUS) image dataset from 19 patients (around 40,090 frames) was collected using 40 MHz IVUS catheter (Atlantis® SR Pro, Boston Scientific®, pullback speed of 0.5 mm/sec). The methodology consisted of automatically computing the calcium volume in the entire IVUS coronary videos using FCM, K-means, and HMRF based pixel classification and comparing it against the previously published threshold-based method. The Coefficient of Correlation (CC) was then established between the four aCCV and three manually (experts) coronary parameters: mCVV, mCLV, and mCAV computed using iMAP software Boston Scientific®. Statistical tests (Two-tailed paired Student t-test, Wilcoxon signed rank test, Mann-Whitney test, Chi-square test, and Kolmogorov-Smirnov KS-test) were performed to demonstrate consistency, reliability, and accuracy of the proposed work. <b>Results:</b> Correlation coefficient of: (a) automated threshold-based volume; (b) automated FCM based volume; (c) automated K-means based volume; and (d) automated HMRF based volume and corresponding three manually (expert’s) coronary parameters (mCLV, mCVV, mCAV) were: (0.51, 0.40, 0.48), (0.52, 0.38, 0.49), (0.56, 0.45, 0.52), and (0.57, 0.42, 0.56), respectively.The CC between age and haemoglobin was 0.50. <b>Conclusion:</b> Automated coronary volume measurement using HMRF method is more accurate compared to threshold, FCM, and K-means-based method, since it is more strongly correlated with three expert’s readings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=TC09-TC14&id=10030 https://doi.org/10.7860/JCDR/2017/26336.10030 To Evaluate the Change in Brain Natriuretic Peptide Levels in Outpatients with Ischemic Cardiomyopathy and Its Association with Functional Capacity: A Pilot Study Amarapalli Jayachandra, Vivek Aggarwal <b>Introduction:</b> Literature is sparse on the clinical correlation of six minute walk test (6MWT) and Brain Natriuretic Peptide (BNP) levels in ischemic Cardiomyopathy (Ischemic CMP) patients. New York Heart Association (NYHA) classification is most commonly used for functional assessment of Heart Failure (HF), which is very subjective. This limitation is overcome by 6MWT which has prognostic significance in addition to assessment of level of functional impairment. Serum BNP correlate with clinical severity of HF as assessed by NYHA class. <b>Aim:</b> To evaluate the change in BNP levels in outpatients with ischemic CMP and its association with functional capacity. <b>Material and Methods:</b> Sixty seven patients of established ischemic CMP by coronary angiography With Left Ventricular Ejection Fraction (LVEF) <40%, were recruited on an Outpatients Department (OPD) basis and assessed for baseline BNP levels and functional capacity (NYHA class and 6MWT). These patients were managed on OPD basis and the treatment was optimised and all the aggravating factors like uncontrolled diabetes, hypertension and anaemia were corrected. Patients were also advised life style modifications and cessation of smoking and alcohol consumption. All these patients were followed up for six months with optimum medical treatment and repeat 6MWT and BNP levels. Primary end point was change in the functional class and the BNP levels at six months. Statistical analysis was done with paired t-test and Pearson correlation for BNP levels and 6MWT/NYHA class. <b>Results: </b>A total of 67 patients were enrolled, out of which 48 patients had six months follow up. Thirty two patients were in NYHA Class II and remaining was in NYHA Class III at the time of enrollment. At six months, 37 were in NYHA Class II and 11 in Class III. At enrollment, 37 cases were able to walk >300 m in six minutes and 11 cases walked < 300 m where as at six months 43 walked >300 m and five walked <300 m. As compared to baseline the mean distance covered in 6MWT showed significant improvement and with reduction in BNP levels at six months (p<0.001). Mean BNP levels correlated better with 6MWT (p <0.001) than NYHA class (p<0.67). <b>Conclusion:</b> In patients with established ischemic CMP with LVEF <40%, there is a significant reduction in BNP levels and improvement in 6MWT at six months with optimum medical therapy. A 6MWT correlated better with BNP levels than with NYHA class with a significant p-value. However, larger such studies and a longer duration of follow up is desirable to prove this association. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OC26-OC28&id=10031 https://doi.org/10.7860/JCDR/2017/26546.10031 Morphological Study of Human Liver and Its Surgical Importance Heena J Chaudhari, Minal K. Ravat2, Vasant H. Vaniya, Amul N. Bhedi <b>Introduction:</b> Liver is the largest abdominal organ located in right hypochondrium, epigastrium and left hypochondrium in upper abdominal cavity. Although the segmental anatomy of the liver has been extensively researched, very few studies have dealt with surface variations of the liver. The major fissures are important landmarks for interpreting the lobar anatomy and locating the liver lesions. <b>Aim:</b> To determine gross anatomical variations of liver and their clinical and surgical implications. <b>Materials and Methods: </b>Present morphological study was conducted on 80 formalin-fixed livers which were observed for the study in the Department of Anatomy, Baroda Medical College, Vadodara, Gujarat, India. Different variations in lobes, fissures and accessory lobes, decrease in size of lobes, lobar atrophy and any other variations on the surface of the livers were observed. The liver specimens were also classified according to netter’s six types of liver variations. <b>Results:</b> Total 80 cadaveric livers were studied. Out of which 14(17.5%) livers were normal and 66(82.5%) were abnormal. Out of 66, abnormal fissures were in 28(35%), abnormal lobes were in 29(36.25%), large papillary process in 1(1.25%), Pons hepatis joining the left lobe with quadrate lobe in 1(1.25%) liver, deep renal impression and corset constriction observed in 1(1.25%) and deep diaphragmatic groove were observed in 6(7.5%). <b>Conclusion:</b> The findings of our study may be helpful for surgeons and radiologists to avoid possible errors in interpretations and subsequent misdiagnosis, and to assist in planning appropriate surgical approaches. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=AC09-AC12&id=10020 https://doi.org/10.7860/JCDR/2017/24467.10020 Study of Association of Substance Use Disorders with Family Members’ Psychological Disorders Kamal Solati, Ali Hasanpour-Dehkordi <b>Introduction:</b> Substance Use Disorders (SUDs) represents a serious problem in Iranian community that may lead to psychological disorders in families. <b>Aim: </b>This study was conducted to investigate the association of SUDs with family members' psychological disorders. <b>Materials and Methods:</b> The sample size of the study consisted of 724 people referred to a counseling and psychology clinic in Shahrekord, southwest Iran. For data gathering, random method was adopted. After the relationship was established with the patients during the counseling and their confidence was gained, development of SUDs and related effect on the referred patient’s family members were investigated by a pre-developed checklist. The statistical tests used to analyse the data were chi-square, Fisher's-exact test, and odds ratio. <b>Results:</b> The most frequent disorder noted was depression (40.5%) followed by generalized anxiety disorder (21%), minor interpersonal and children's behavioural problems (15%), and hysteria (8%). Depression, hysteria, and minor interpersonal and children's behavioural problems in the women and men were reported 48% vs. 20%, 9% vs. 5%, and 10% vs. 27%, respectively. A significant association was seen between SUDs in the patients' spouses and children as well as in their families, and gender, marital status, and occupation, but not place of residence and education. <b>Conclusion:</b> An association was seen between the psychiatric disorders in the people referring the studied center and SUDs in their families. Addiction in family plays an important role in developing or recurring psychiatric disorders in other family members https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=VC12-VC15&id=10021 https://doi.org/10.7860/JCDR/2017/24547.10021 Evaluation of Hypoxia Inducible Factor-1a and Glucose Transporter-1 Expression in Non Melanoma Skin Cancer: An Immunohistochemical Study Iman Seleit, Ola Ahmed Bakry, Dalia Rifaat Al-Sharaky, Rania Abdel Aziz Ragab, Shimaa Ahmed Al-Shiemy <b>Introduction:</b> Hypoxia Inducible Factor-1 (HIF-1) is a mediator enabling cell adaptation to hypoxia. It plays its role mainly through transcription of many target genes including Glucose Transporter-1 (GLUT-1) gene. <b>Aim:</b> The present work aimed at evaluating the pattern and distribution of HIF-1a and GLUT-1 in each case and control. <b>Materials and Methods:</b> A case-control and retrospective study was conducted on archival blocks diagnosed from pathology department as, Basal Cell Carcinoma (BCC, 20 cases), cutaneous Squamous Cell Carcinoma (SCC, 20 cases) and 20 normal site-matched skin biopsies from age and gender-matched healthy subjects as a control. Evaluation of both HIF-1a and GLUT1 expression using standard immunohistochemical techniques was performed on cut sections from selected paraffin embedded blocks. <b>Results: </b>HIF-1a was expressed in 90%, 35% and 100% of normal skin, BCC and SCC tumour islands respectively. It was up regulated in both BCC and SCC compared with normal skin (p= 0.001, p<0.001 respectively). GLUT-1 was expressed in 100%, 70% and 100% of normal skin, BCC and SCC tumour islands respectively. It was down regulated in Non Melanoma Skin Cancer (NMSC) cases compared with normal skin (p=0.004). HIF-1a and GLUT-1 localization in tumour nests was central, peripheral or central and peripheral. Both HIF-1a and GLUT-1 showed variable expression in stroma, adnexa and inflammatory cells. No significant correlation was found between Histo (H) score or expression percentage values of HIF-1a and those of GLUT-1 in tumour islands or in overlying epidermis either in BCC or SCC. <b>Conclusion: </b>HIF-1a may have a role in NMSC pathogenesis through adaptation to hypoxia which results from excessive proliferation. GLUT-1 down regulation in NMSC may be explained by its consumption by proliferating tumour cells. The expression of HIF-1a and GLUT-1 in normal epidermis, stromal and adnexal structures needs further research. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=EC09-EC16&id=10022 https://doi.org/10.7860/JCDR/2017/25077.10022 Clinico-Haematological Profile of Hereditary Haemolytic Anaemias in a Tertiary Health Care Hospital in South India Chaitra Venkataswamy, AM Shanthala Devi <b>Introduction:</b> Hereditary haemolytic anaemia is a common inherited disorder causing varying degree of morbidity and mortality. This includes disorders due to haemoglobin defect, membrane defect, and enzyme defect. Among them haemoglobinopathies, a single gene disorder, constitutes the major part of the disorder and is distributed worldwide with an incidence of 5%. These inherited disorders pose a major public health problem and increase the burden both on the patient and the society. Presently, these disorders are not curable but can only be prevented. Improved awareness about these diseases among medical fraternity leading to diagnosis of carrier state, genetic counselling, and antenatal diagnosis may help in decreasing the prevalence of the disease. <b>Aim:</b> To determine the prevalence of hereditary haemolytic anaemia and to correlate clinical and haematological features. <b>Materials and Methods:</b> The study was carried for duration five and half years (four years of retrospective and one and a half years prospective). All the patients diagnosed as hereditary haemolytic anaemia based on peripheral smear and special haematological investigation were included in the study. The clinical parameters and haematological parameters of all these patients were studied. <b>Results:</b> A total of 322 cases of hereditary haemolytic anaemia were diagnosed over a period of five and a half years. Of them thalassaemia syndrome constituted 165 cases (51.24%), sickle cell disorders 78 cases (24%), hereditary spherocytosis 43 cases (13.3%), G6PD deficiency 20 cases (6.29%) and HbE disorder 12 cases (3.7%). One case of hereditary elliptocytosis and one case of HbD Punjab was detected. Among thalassaemia syndromes beta thalassaemia was commonest clinically presenting disorder with a high morbidity. Sickle cell anaemia showed a higher level of HbF and a relatively milder clinical course. Hereditary spherocytosis had varied age at presentation. In G6PD deficiency drug induced haemolysis was the commonest clinical presentation. HbE disorders were from the north eastern states. <b>Conclusion: </b> Haemoglobinopathies constitute the major group of hereditary haemolytic anaemia (74%). Genetic counselling is an important step in reducing the incidence of thalassaemia major. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=EC17-EC21&id=10023 https://doi.org/10.7860/JCDR/2017/25366.10023 Teneligliptin in Early Diabetic Kidney Disease: An Observation in Asian Indian Patients with Type 2 Diabetes Mellitus in Real-Life Scenario Kiran Shah <b>Introduction:</b> Teneligliptin is a recently developed Dipeptidyl Peptidase 4 (DPP4) inhibitor. Teneligliptin is suitable for glycaemic control in Type 2 Diabetes Mellitus (T2DM) patients with renal impairment including end stage renal disease. <b>Aim:</b> To assess the efficacy and safety of teneligliptin in Asian Indian T2DM patients with early Diabetic Kidney Disease (DKD). <b>Materials and Methods:</b> This was a single centre, retrospective analysis of patients with early DKD, who received teneligliptin 20 mg once daily for 24 weeks. Data related to glycaemic parameters, kidney function, lipid levels, retinopathy, neuropathy and safety variables available at 12 and 24 weeks were analysed. Descriptive statistical analysis was carried out. Statistical significance was assessed at a 5% level. <b>Results:</b> Total 37 patients (21 males; 16 females) were analysed. Compared to baseline, significant reduction in Fasting Plasma Glucose (FPG) (mg/dl) (143.89±28.26 vs 125.78±20.52, p=0.001); Postprandial Glucose (PPG) (mg/dl) (200.62±41.88 vs 165.76±26.02, p=0.001); Glycated Haemoglobin (HbA1c) (%) (8.65±0.58 vs 8.17±0.54, p=0.001) was noted at 12 weeks. This trend was further continued for 24 weeks with significant reduction in mean FPG, PPG and HbA1c to 113.73±16.82 mg/dl (p=0.008); 142.95±20.76 mg/dl (p=0.001); and 7.65±0.45% (p=0.001) respectively. Significant improvement in serum creatinine (mg/dl) (2.45±0.27 vs. 2.26±0.23, p=0.001) and eGFR (CKD-EPI), (ml/min/1.73 m2) (53.35±4.24 vs. 55.08±4.19, p=0.001) was noted at 12 weeks and continued for 24 weeks with reduction in serum creatinine of 0.37±0.18 mg/dl (p=0.001) and increase of eGFR of 4.60±1.59 ml/min/1.73 m2 (p=0.001). At baseline, proteinuria was noted in all patients while at 24 weeks, 40.5% (p=0.001) patients did not report proteinuria. Significant improvements in lipid parameters with no deterioration in retinopathy and subjective improvement in peripheral neuropathy was also noted. No adverse events were noted. <b>Conclusion:</b> Teneligliptin reported significant and sustained improvement in glycaemic control in Asian Indian Patients of T2DM with early DKD and was well tolerated. Additionally, Teneligliptin reported significant improvement in renal function. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OC22-OC25&id=10003 https://doi.org/10.7860/JCDR/2017/27013.10003 Atlantooccipital Fusion: Prevalence and its Developmental and Clinical Correlation D. K. Sharma, Deepak Sharma, Vandana Sharma <b>Introduction:</b> Atlantooccipital fusion or occipitalization of atlas or assimilation of atlas is a rare or uncommon abnormality recorded in anatomical, morphological and radiological studies. It is usually associated with reduction in dimensions of foramen magnum leading to acute or chronic neurovascular compression and clinical manifestations of varying severity. Though, atlantooccipital fusion is rare but it is important and significant for the physicians and surgeons for their diagnostic and therapeutic approach. <b>Aim:</b> To know the prevalence of atlantooccipital fusion in South Asian population predominantly in Central India and its embryological and clinical correlation by reviewing literature and earlier studies. <b>Materials and Methods: </b> This study included careful examination for the atlantooccipital fusion on total 192 human skulls of both genders, available in the Department of Anatomy AIIMS Raipur, Chhattisgarh, India, Department of Anatomy and Forensic Medicine of Gandhi Medical Colledge, Bhopal, Madhya Pradesh, India and Pt. Jawahar Lal Nehru Memorial Medical College, Raipur. Morphometric measurements of the abnormal skulls were done, analysed and recorded. Observations and findings of this study were correlated embryologically and clinically with the results and claims of previous studies and literature, and accordingly the conclusions were drawn. <b>Results:</b> We found only two skulls with atlantooccipital fusion, in overall study of 192 skulls. The first skull showed incomplete atlantooccipital fusion on the left side with little right lateral inclination and missing posterior tubercle/spinous process and adjoining part of posterior arch of atlas, whereas the second skull showed complete atlantooccipital fusion. <b>Conclusion:</b> We conclude that the prevalence of atlantooccipital fusion including complete and incomplete fusion was 1.04%, which is higher than the proclaimed prevalence rate of 0.12% to 0.72%, by the previous studies. In accordance with the fact that the atlantooccipital fusion represents a synostosis between the atlas and the occipital bone due to developmental abnormal segmentation of cranial part of paraxial mesoderm and abnormal fusion between segments of caudal occipital and cranial cervical sclerotomes, we would like to thereby assert that the fusion associated with the reduction in dimensions of foramen magnum (reduction also seen in our study) is definitely significant for diagnostic and therapeutic purposes to clinicians. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=AC01-AC03&id=9999 https://doi.org/10.7860/JCDR/2017/26183.9999 Buccal Mucosa Carcinoma: A Comparative Relative Risk Analysis between Tobacco and Non Tobacco Users Ramasamy Padma, Amitkumar Kalaivani, Sathish Paulraj, Sivapatham Sundaresan <b>Introduction:</b> In South India, buccal mucosa carcinoma is common cancer due to widespread use of tobacco in different form. Recently, areca nut (non tobacco) chewing habits have increased among young adults resulting in high morbidity and mortality. Thus, there is need to understand role of aetiology and risk of disease. <b>Aim:</b> To analyse relative risk of tobacco users and non tobacco users in buccal mucosa carcinoma. <b>Materials and Methods:</b> This prospective comparative study was conducted in Regional Cancer Centre, Kanchipuram, between 2013 and 2016. The subjects were divided as tobacco users and non tobacco users in order to evaluate the Relative Risk (RR) in these groups based on demographic and clinical characteristics by Chi-square analysis and Kaplan-Meier (log-rank test) applied for survival difference. All statistics considered at 95 % CI, p<0.05. <b>Results:</b> A total of 117 subjects were included in the study which constituted 87 (74.3%) tobacco users and 30 (25.7%) non tobacco users. In the study, demographic characteristics of gender [RR=0.365 (0.150-0.886), p=0.023] and age groups {RR=2.026 (0.905-4.996), p=0.04} showed significant difference in both study groups. Similarly, clinical characteristics of TNM (tumour node and metastasis) stage {RR=1.57 (0.338-3.31), p=0.024}, nodal status {RR=2.014 (0.412-4.454), p=0.017}, Grade of tumour {RR=1.293 (0.581-2.878), p=0.015}, perineural invasion {RR=2.601 (0.806-5.32), p=0.012} and extracapsular invasion {RR=1.627 (0.533-2.824), p=0.045} showed significant association. The estimated overall survival was 50%; tobacco users (44%) showed lower survival than non tobacco users (57%) with significant difference (p=0.042, p<0.05). <b>Conclusion:</b> The study revealed adverse affect of aetiology on survival and showed lower survival of tobacco users than non tobacco users. Hence, the study concluded that the tobacco consumption in different form is more aggressive than non tobacco consumption. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=LC06-LC09&id=9997 https://doi.org/10.7860/JCDR/2017/26108.9997 Sepsis Mortality in Critical Care and Prior Statin Therapy: A Retrospective Cohort Study in Central Argentina Liberth Incahuanaco Paricahua, Alexis Fabian Oleynick Goncalves, Sandaly Oliveira da Silva Pacheco, Fabio Juliano Pacheco <b>Introduction: </b>Sepsis is a major public health problem, frequent, costly, and often fatal. Despite of improvements in supportive treatments the incidence of sepsis and the number of deaths related to sepsis is increasing. Statins have been recently proposed as adjuvants in the treatment of sepsis, but its effects on mortality show conflicting results worldwide. <b>Aim: </b>The purpose of this study was to describe the clinical outcome of patients diagnosed with sepsis in a university-affiliated hospital in central Argentina and to evaluate it in relation to a group of septic patients with previous use of statins before the onset of sepsis. <b>Materials and Methods:</b> The present study was conducted as an observational retrospective research from April 2010 to December 2014 with patients over 18 years of age which were assigned to statins or control groups. Out of 2906 patients, 231 matched study and diagnostic criteria for sepsis and among them 33 (14.3%) belonged to the group of statins. The mean age was 64.2 ± 14.3 years. <b>Results:</b> The severity of sepsis on admission was as follows: Sepsis, n=147 (63.6%), Severe sepsis, n=26 (11.3%) and Septic shock, n=58 (25.1%). The mean length of stay in Intensive Care Unit (ICU) was10.8 ± 9.6 days and 21.2 ± 17 days in general hospital ward settings, without differences between groups of statin users and controls, p=0.873 and p=0.766, respectively. The in-hospital mortality rate was 31.2% (n=72). Previous statin use did not affect in-hospital or 30-day mortality (OR 0.978; 95% CI 0.339 to 2.274; p=0.789). Creatinine levels on days 3 and 14 were substantially higher in statins group (1.80 ±1.39 vs. 1.45 ± 1.47 mg/dl) (p=0.010) and (1.42 ± 1.14 vs. 1.09 ± 1.05 mg/dl) (p=0.009), respectively. <b>Conclusion:</b> Prior use of statins did not reduce in-hospital or 30-day mortality in septic patients and it may be associated with impaired renal function in this group of Argentinian participants. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OC17-OC21&id=9992 https://doi.org/10.7860/JCDR/2017/25810.9992 A Comparative Evaluation of the Influence of Command Set Methods on Microleakage of Glass Ionomer Cement: An In Vitro Study Sairaj Punnathara, Ramalingam Krishnakumar, Mohan Govindarajan, Momeka Kanaran, Sunil Thomas Philip, Aswin Saseendran Nair, Joby Peter <b>Introduction:</b> A major challenge when using glass ionomer cement in clinical situation particularly in paediatric dentistry is to overcome the problem of microleakage. Fast or command setting of Type IX glass ionomer cement using external energy source enhances the setting reaction and results in improved initial physical and mechanical properties. <b>Aim:</b> To compare and evaluate the influence of ultrasonic activation, halogen light irradiation and combined effect of both on microleakage of enamel adjacent to Type IX glass ionomer restorations. <b>Materials and Methods:</b> For forty premolar teeth, standard Class V cavities prepared were restored with GC Gold Label Type IX glass ionomer cement in vitro. The specimens were randomly divided into four groups: 1) Control group; 2) halogen group; 3) ultrasonic group; 4) ultrasonic with halogen group. The teeth were kept in distilled water for 24 hours. Teeth were exposed to 1500 thermocycles at temperature of 12°C ±2 and 60°C ±2 with alternate immersion in hot and cold water for one minute. First teeth were immersed in dye solution for four hours and then in developing solution for four hours. The samples were sectioned buccolingually through centre of the restorations and degree of dye penetration was assessed under stereomicroscope and scored. One-Way ANOVA model was constructed followed by post-hoc Tukey’s test for multiple pair wise comparison of mean values. <b>Results:</b> Statistically significant differences were found in microleakage among the four groups (p<0.001) with respect to dye penetration. Halogen group showed least microleakage followed by control but differences between them were statistically not significant (p>0.05). Similarly the differences between Ultrasonic plus halogen group and ultrasonic group were not significant (p>0.05). The differences between ultrasonic and halogen group were statistically significant (p<0.05). <b>Conclusion:</b> Halogen light decreases the microleakage of enamel adjacent to GC Type IX glass ionomer restorations, when used to accelerate the setting reaction of glass ionomers and can be used as command set method in paediatric dentistry. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC12-ZC15&id=9993 https://doi.org/10.7860/JCDR/2017/25830.9993 Improved Serodiagnostic Sensitivity of Strip Test for Latent Tuberculosis Songsri Kasempimolporn, Wichit Thaveekarn, Kanyanat Promrungreang, Orawan Khow, Supatsorn Boonchang, Visith Sitprija <b>Introduction:</b> Diagnosis of Latent Tuberculosis Infection (LTBI) is difficult due to no clinical manifestations. Cases of LTBI are mostly sputum negative. The World Health Organization recommends the Tuberculin Skin Test (TST) as the current diagnostic standard for LTBI. Our previously developed serologic strip test for LTBI detection had suboptimal sensitivity. Additional Mycobacterium tuberculosis (MTB) latency-associated antigens may improve the detection rate of LTBI. <b>Aim:</b> The present study aimed to optimize sensitivity of existing strip test. <b>Materials and Methods:</b> A combination of recombinant latency proteins Rv2029c, Rv2031c, Rv2032, Rv2627c, Rv3133c, and Rv3716c was used to prepare the strips and evaluate the performance with the sera of patients in four well-classified categories: LTBI, active pulmonary TB, healthy TB contacts and other non-TB diseases. <b>Results:</b> A total of 91 serum samples from various clinical categories were screened with the strips. Among clinically diagnosed LTBI patients, strip test yielded a sensitivity of 75.0%. Among clinically diagnosed non-LTBI subjects, strip test yielded 88.1% specificity. The diagnostic positive and negative predictive values for strip test in reference to various clinical contexts were 77.4% and 86.7%, respectively. <b>Conclusion:</b> Addition of the six potential latency proteins could improve the diagnostic performance of existing strip test for LTBI. The use of suitable immunodominant antigens could maximize sensitivity in the diagnosis and differentiate MTB infection status. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DC01-DC03&id=9994 https://doi.org/10.7860/JCDR/2017/25860.9994 Applicability of Tanaka Jhonston Method and Prediction of Mesiodistal Width of Canines and Premolars in Children Umapathy Thimmegowda, Divyashree, Kumar B Niwlikar, Vaibhav Khare, Ashwini Chikkanayakanahalli Prabhakar <b>Introduction:</b> Essential part of diagnostic procedures in mixed dentition analysis is to determine adequate space available for the erupting permanent teeth. Various methods of analysis for mixed dentition are available; among them Tanaka Johnston method of space analysis for children was developed for North American children and is widely used. Its reliability among different racial and ethnic groups is yet to be determined. <b>Aim:</b> To check the applicability of Tanaka Jhonston method and to derive the mesiodistal width of unerupted canines and premolars and also derive new regression equations for Bangalore population. <b>Materials and Methods:</b> Considering the selection criteria, 400 subjects of Bangalore aged 13-16 years were randomly selected and study models were prepared. Mesiodistal widths of permanent lower incisors, canines and premolars were measured. Estimated width of upper, lower canines and premolars were also derived using Tanaka Jhonston method. Data was utilized to predict mesiodistal widths of erupting permanent canines and premolars. Descriptive analysis, independent student t-test, correlation and regression analysis were carried out. <b>Results:</b> Measured and estimated widths of upper and lower canines and premolars were compared and the results showed that estimated widths of upper and lower canines and premolars over estimated as to the actual measurements. A new regression equation was developed by using the formula Y=a+b(X) where Y= predicted width of canine and premolars, “a” and “b” are the constants and X= lower incisal width. Regression equations for males and females were derived separately. <b>Conclusion:</b> The original Tanaka Jhonston method over estimated for local Bangalore population. New regression equations and prediction tables were derived for males and females separately, which should be more conveniently used chairside by the clinician. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC16-ZC19&id=9995 https://doi.org/10.7860/JCDR/2017/25962.9995 Effects of Counselling and Sole Reflexology on Fatigue in Pregnant Women: A Randomized Clinical Trial Fatemeh Shobeiri, Behnaz Manoucheri, Parisa Parsa, Ghodratolah Roshanaei <b>Introduction:</b> Increase of fatigue may lead to problems during pregnancy, delivery and post delivery. Sole reflexology is the application of pressure to areas on the feet. Reflexology is generally relaxing and may be an effective way to alleviate fatigue and stress. <b>Aim:</b> To investigate the effect of counselling and sole reflexology on fatigue in pregnant women, referred to the medical centers of Hamadan city, Iran. <b>Materials and Methods:</b> This study was a randomized clinical trial with three groups - Group A (counselling and reflexology), Group B (reflexology) and Group C (control) with pre and post intervention. A total of forty two pregnant women were selected for each group. Measurement tool was a 30 question standard checklist for fatigue assessment. For all three groups, an explanatory session was held to get their written consents and conduct a pretest. The intervention included five education sessions, twice a week about reflexology in the form of counselling and sole reflexology. The groups were assessed immediately after intervention. Data were analysed using IBM SPSS Statistics 20.0. To analyse the data, descriptive statistics, t test and ANOVA with repeated measures were used. <b>Results:</b> In group A and group B, the mean score of fatigue severity after the intervention demonstrated a significant decrease (p<0.05); furthermore, after intervention, a significant difference was observed between the control and experimental groups in terms of fatigue severity (p<0.01). <b>Conclusion:</b> Based on the results of this study, counselling and sole reflexology significantly decreased fatigue in pregnant women. It is hoped that the results of this study can be used by all treatment groups and midwives for controlling and providing midwifery cares for pregnant women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=QC01-QC04&id=9972 https://doi.org/10.7860/JCDR/2017/22681.9972 Evaluation of the Female Patients with Subclinical Hypothyroidism by Brainstem Auditory Evoked Potentials: Case-Control Study Sangeeta Gupta, Rajesh Kaiti, Gaurav Gupta <b>Introduction:</b> Hypothyroidism, a common endocrinological disorder is quite prevalent in its subclinical state in the adult population. Nervous system involvement is frequent in hypothyroidism with documentation of peripheral and central conduction delays as abnormal latency prolongations in Brainstem Auditory Evoked Potential (BAEP) records. Subclinical hypothyroidism however, has been less extensively studied for investigating the involvement of the auditory functions. <b>Aim:</b> To assess the auditory functions and Central Nervous System (CNS) involvement in the patients with subclinical hypothyroidism by recording BAEP. <b>Materials and Methods:</b> The study comprised of 50 females (25 females with subclinical hypothyroidism and 25 age-matched healthy females) in the age-group of 30-50 years. BAEP absolute and Interpeak Latencies (IPLs) (I, III and V, I-III, III-V and I-V) were compared between the two groups by unpaired t-test. The p<0.05 was considered as statistically significant. <b>Results:</b> Mean BAEP absolute latencies (III and V) increased in the subjects with subclinical hypothyroidism as compared to controls (p<0.001) (both the ears) and wave I absolute latency also increased with p<0.001 (both the ears) by unpaired t-test. Among IPLs (interpeak latencies), III-V and I-V IPLs exhibited increase (p<0.01), while I-III IPL did not vary with statistical significance (both the ears) in the two groups. <b>Conclusion:</b> Patients with subclinical hypothyroidism were found to demonstrate central as well as peripheral auditory pathway affections. BAEPs can prove valuable and sensitive tests to detect involvement of the CNS and auditory dysfunctions earlier in hypothyroidism. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=CC13-CC16&id=9989 https://doi.org/10.7860/JCDR/2017/25604.9989 Histopathological Analysis of Brain Tumours- A Seven Year Study from a Tertiary Care Centre in South India Renu Thambi, Subitha Kandamuthan, Sheeja Sainulabdeen, Letha Vilasiniamma, Tinu Ravi Abraham, Pk Balakrishnan <b>Introduction:</b> Tumours of central nervous system constitute 1%-2% of tumours in adults. The incidence of brain tumours has been reported to be around 3.9 and 3.0/one lac/year in males and females respectively. A few studies are available from India which show a lower incidence of brain tumours compared to the developed countries. Not much is known about the epidemiology of brain tumours in the population from South India. <b>Aim:</b> To identify the age groups, gender distribution, topography and different histological types of brain tumours. <b>Materials and Methods:</b> A total of 510 cases of brain tumours were identified over a period of seven years which were included in the present study. We retrieved the slides of these cases and reviewed them. Immunohistochemistry in required cases were done. Age and gender distribution, clinical presentation, site of tumour and histopathologic patterns with grade were noted and the data was analysed with SPSS software version 17.0. <b>Results:</b> Our analysis showed that most of the brain tumours occur between 40-60 years of age, with a male to female ratio of 0.9:1. Majority of cases involved dura and cerebral lobes except for the occipital lobe, and meningioma and glial tumours were the most common broad histological types. WHO grade IV tumours and metastasis were common in males compared to females. <b>Conclusion:</b> This study revealed the distribution of brain tumours in patients attending our institution. The results obtained were comparable with available worldwide data. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=EC05-EC08&id=9990 https://doi.org/10.7860/JCDR/2017/25623.9990 Association Between Left Ventricle Diastolic Dysfunction and Unfavorable Prognostic Markers in Patients with Aortic Insufficiency Meliza Goi Roscani, Juliana da Cunha Duarte, Gustavo Nicolodi Augusto, Thaysa Rodrigues de Moraes Salgueiro, Mariana N Meireles, Juliana I.F. Gobbi, Katashi Okoshi, João Carlos Hueb <b>Introduction:</b> The presence of symptoms, systolic dysfunction and Left Ventricle (LV) dilation are considered unfavourable prognostic markers in Aortic Valve Insufficiency (AVI). The role of diastolic dysfunction, which is considered unfavourable outcome marker in cardiac pathologies, is not well established in AVI. <b>Aim:</b> To evaluate if the presence of diastolic dysfunction may be associated with unfavourable prognostic markers in AVI patients. <b>Materials and Methods:</b> A cross-sectional prospective study was performed on 22 patients with moderate or severe AVI. They underwent clinical evaluation and transthoracic echocardiography. Associations between clinical, epidemiological and echocardiographic were evaluated by Student t-test for normally distributed variables or Mann-Whitney test for non-normal distribution. Comparison between proportions was performed by Chi-square test. <b>Results:</b> There was an association between increased LV filling pressure, assessed by E’ and E/E’ of Mitral Tissue Doppler, and impaired LV systolic function, respectively: R = 0.563, R2 = 0.281; p = 0.008 and R = 0.639, R2 = 0.378; p = 0.002. The LV indexed mass also was inversely associated with the LV ejection fraction (R = 0.62, R2 = 0.35 and p = 0.003). <b>Conclusion:</b> There was an association of LV diastolic dysfunction and ventricular hypertrophy with impaired left ventricle systolic function. Increased LV filling pressure and LV indexed mass should be considered in the management of AVI patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OC09-OC11&id=9974 https://doi.org/10.7860/JCDR/2017/23463.9974 Role of Anaemia and Magnesium Levels at the Initiation of Tuberculosis Therapy with Sputum Conversion among Pulmonary Tuberculosis Patients Yuthika Agrawal, Vipin Goyal, Abhishek Singh, Sandhya Lal <b>Introduction:</b> Both pulmonary Tuberculosis (TB) and anaemia are prevalent in India. Magnesium levels also influence TB. There is limited and inconsistent literature on the association among anaemia, serum magnesium levels and sputum conversion during tuberculosis treatment. <b>Aim:</b> To study the effect of anaemia and serum magnesium levels on sputum conversion in pulmonary TB patients. <b>Materials and Methods:</b> One hundred each of newly diagnosed sputum smear positive Pulmonary Tuberculosis (PTB), sputum smear negative PTB patients initiated on Directly Observed Treatment Short Course chemotherapy (DOTS) and healthy age and sex matched controls were recruited in the study. Patients were followed up prospectively until completion of first two months of intensive phase. Patients were evaluated before initiation of TB treatment by performing the complete blood counts with peripheral blood smear, serum biochemistry, serum iron, serum magnesium, serum ferritin and microscopic examination of sputum. After giving two months of Antitubercular Therapy (ATT), sputum smears were re-examined for presence of acid fast bacilli. Haemoglobin values less than 13 g/dl in males or 12 g/dl in females was defined as anaemia. Mean and Standard deviations were calculated. Independent t-test was used to compare between the groups. <b>Results:</b> Serum iron and serum ferritin was significantly lower in sputum positive PTB as compared to sputum negative PTB and controls. Anaemia was present in 162 (81%) patients of the study PTB cases. About 60% of anaemia in sputum positive cases was iron deficiency anaemia. Serum magnesium level was significantly lower in sputum positive PTB as compared to sputum negative PTB and controls though not in hypomagnesemic range. Delayed sputum smear conversion occurred in 12 (12%) sputum positive PTB patients. Of these, eight had severe iron deficiency anaemia, four with moderate anaemia. All 12 delayed sputum smear conversion had serum magnesium levels < 1.7 mg/dl (below normal reference range) (mean 1.42 +0.22 mg/dl). <b>Conclusion:</b> Sputum was found to be positive even after two months of ATT course because of baseline anaemia and lower levels of serum magnesium. Further multicentric studies are warranted to study mechanisms for TB associated anaemia and possible role of intervention for anaemia in TB patients. One needs to find out the mechanisms behind the role of anaemia and lower magnesium levels in delaying the sputum smear conversion in order to lay the foundation of effective interventions. Randomized controlled trials are warranted to generate higher levels of evidences to support our findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=BC01-BC04&id=9975 https://doi.org/10.7860/JCDR/2017/23734.9975 Study of Vitamin D Receptor Gene Polymorphism (FokI, TaqI and ApaI) Among Prostate Cancer Patients in North India Pankaj Ramrao Kambale, Deepa Haldar, B C Kabi, Kalpana Pankaj Kambale <b>Introduction:</b> Incidence of prostate cancer is rising worldwide. Multiple factors have been suggested for the aetiology of prostate cancer including ethnic, genetic and diet. Vitamin D (calcitriol) has been shown to have role in cell growth and differentiation and its deficiency is implicated as one of the aetiological factors in prostate cancer. Prostatic epithelial cells express Vitamin D Receptor (VDR) as well as 1a- hydroxylase enzyme that are required for the synthesis of calcitriol and its action. Polymorphism in VDR gene has been associated with prostate cancer in some epidemiological studies; but, there is paucity of information in the Indian context. <b>Aim:</b> The present study was aimed to explore the association of VDR gene polymorphism with the development of prostate cancer. <b>Materials and Methods:</b> Three Single Nucleotide Polymorphisms (SNP) sites viz., FokI, TaqI and ApaI were analysed in 120 cases of prostate cancer which were compared with their 120 healthy first degree relatives and 120 non-related controls in the Department of Biochemistry in collaboration with the Department of Urology. <b>Results:</b> Analysis showed significantly decreased incidence of Tt and Aa genotype in prostate cancer patients as compared to healthy non-relative controls (p=0.016 and 0.043 respectively). As compared to first degree relatives, incidence of Tt genotype is significantly lower in cases (p=0.005). No significant association was found with FokI polymorphism. <b>Conclusion:</b> This study suggests the protective role of heterozygous genotypes of TaqI and ApaI polymorphism against the development of prostate cancer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=BC05-BC08&id=9976 https://doi.org/10.7860/JCDR/2017/24290.9976 Need for Changes in the Practical Physiology Curriculum of Medical Undergraduates Rajni Goyal, Rajveer Garg, Puneet Raj Goyal <b>Introduction:</b> Physiology is one of the foundation sciences for the medical curriculum. It forms the basis of all life sciences. Physiology practical classes in India are divided into three sections: exercises in haematology, exercises on humans and experiments on amphibians. Faculty and students of medical schools in India are of the opinion that animal experiments should be discontinued, that the curriculum in experimental physiology and pharmacology needs to be updated, that the same understanding of topics could be obtained by using alternative methods and that there is an urgent need to introduce alternatives of animal experiments. <b>Aim: </b> To assess the need for changes in the practical physiology curriculum of medical undergraduates. <b>Materials and Methods:</b> The study was conducted among 300 MBBS, second and third professional students using a semi-structured questionnaire. The questionnaire consisted of two sections: the first section was based on the current experimental physiology curriculum regarding the relevance of topics taught in haematology, amphibian and human practical classes. In the second section, the opinion was also sought regarding introduction of new topics related to recent advances in clinical physiology and basic clinical skills. <b>Results:</b> More than 60% of the students marked most of the haematology experiments useful. All the amphibian practicals were considered irrelevant/not useful by more than 75% of the students. Regarding the human experiments, more than 70% of the students marked useful. More than 65% students were of the opinion that basic clinical skills should be introduced at undergraduate level. More than 50% students favoured introduction of topics from recent advances in physiology. <b>Conclusion: </b> The present study concludes that there is an imperative need to implement radical changes in the experimental physiology curriculum which should be in consonance with patient care for the doctors of tomorrow to render better health service. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=CC06-CC08&id=9977 https://doi.org/10.7860/JCDR/2017/24341.9977 Peripheral Smear Review and Bone Marrow Biopsy Correlation Adrian R. Bersabe, James K. Aden, Nathan M. Shumway, Michael B. Osswald <b>Introduction:</b> Peripheral Blood Smear (PBS) interpretation is a useful skill for Haematology/Oncology Clinicians (HOC). <b>Aim: </b> To explore practice patterns of PBS utilization for all benign haematology diagnosis in a non-simulated environment and to evaluate how it may guide the HOC in determining further work up and whether or not to perform a Bone Marrow Biopsy (BMB). <b>Materials and Methods:</b> A retrospective review was conducted on 451 outpatient referrals for benign haematology diagnosis. Patient demographics and diagnostic tests were recorded. We further analysed cases in which a blood smear was ordered or reviewed. In cases with PBS review, we recorded testing ordered by the HOC. <b>Results:</b> Records of 451 patients met inclusion criteria. The median age was 55 with males representing 51.9% of the cohort. Distribution of disorders were 50.6% (n = 228) erythrocyte (RBC), 25.5% (n = 114) leukocyte (WBC), 11.3% (n = 51) platelet (PLT), and 12.8% (n = 58) “other.” A CBC was ordered in 82.7% of cases (373/451). A PBS was ordered in 47.4% of CBCs obtained (177/373, p<0.001). Of these, documentation occurred in 49.2% (87/177) which led to further testing 41.4% of cases (36/87). A BMB was performed in 11.5% (10/87) of cases in which a PBS was reviewed compared to 4.3% (16/373) of cases where BMB was performed without PBS review (p=.019). Of the 36 cases in which PBS review led to testing, 10 BMBs (27.8%) were performed—all of which led to specific haematologic diagnosis. A specific diagnosis was found in 43.8% (7/16) BMBs performed without prior PBS review. <b>Conclusion:</b> PBS interpretation is an important skill for HOCs. Haematology/Oncology (H/O) training programs should continue to teach this skill to increase proficiency in order to help guide diagnostic evaluation of various haematologic disorders. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=JC01-JC03&id=9979 https://doi.org/10.7860/JCDR/2017/24506.9979 Performance of Disease-Specific Scoring Models in Intensive Care Patients with Severe Liver Diseases Maged T. EL-Ghannam, Moataz H. Hassanien, Mohamed D. EL-Talkawy, Abdel Aziz A. Saleem, Amal I. Sabry, Hoda M. Abu Taleb <b>Introduction:</b> Egypt has the highest prevalence of Hepatitis C Virus (HCV) in the world, estimated nationally at 14.7%. HCV treatment consumes 20% ($80 million) of Egypt’s annual health budget. Outcomes of cirrhotic patients admitted to the ICU may, in fact, largely depend on differences in the state of the disease, criteria and indications for admission, resource utilization, and intensity of treatment. <b>Aim:</b> The aim of the present study was to evaluate the efficacy of liver specific scoring models in predicting the outcome of critically ill cirrhotic patients in the ICU as it may help in prioritization of high risk patients and preservation of ICU resources. <b>Materials and Methods:</b> Over one year, a total of 777 patients with End Stage Liver Disease (ESLD) due to HCV infection were included in this retrospective non-randomized human study. All statistical analyses were performed by the statistical software SPSS version 22.0 (SPSS, Chicago, IL, USA). Child Turcotte Pugh (CTP) score, MELD score, MELD-Na, MESO, iMELD, Refit MELD and Refit MELD-Na were calculated on ICU admission. <b>Results:</b> ICU admission was mainly due to Gastrointestinal (GI) bleeding and Hepatic Encephalopathy (HE). Overall mortality was 27%. Age and sex showed no statistical difference between survivors and non survivors. Significantly higher mean values were observed for all models among individuals who died compared to survivors. MELD-Na was the most specific compared to the other scores. MELD-Na was highly predictive of mortality at an optimized cut-off value of 20.4 (AURC=0.789±0.03-CI 95%=0.711-0.865) while original MELD was highly predictive of mortality at an optimized cut-off value of 17.4 (AURC=0.678±0.01-CI 95%=0.613-0.682) denoting the importance of adding serum sodium to the original MELD. INR, serum creatinine, bilirubin, white blood cells count and hyponatremia were significantly higher in non survivors compared to survivors, while hypoalbuminemia showed no statistical difference. The advent of Hepatorenal Syndrome (HRS) and Spontaneous Bacterial Peritonitis (SBP) carried worse prognosis. Hyponatremia and number of transfused blood bags were additional independent predictors of mortality. <b>Conclusion:</b> In cirrhosis of liver, due to HCV infection, patients who died during their ICU stay displayed significantly higher values on all prognostic scores at admission. The addition of sodium to MELD score greatly improves the predictive accuracy of mortality. MELD-Na showed the highest predictive value of all scores. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OC12-OC16&id=9980 https://doi.org/10.7860/JCDR/2017/24543.9980 Modulation of Lung Function by Increased Nitric Oxide Production Md. Nazrul Islam, Ram Lochan Yadav, Prakash Kumar Yadav <b>Introduction:</b> Cigarette smoking reduces endogenous Nitric Oxide (NO) production by reducing Nitric Oxide Synthase (NOS) activity, which is one of the probable reason for increased rate of pulmonary diseases in smokers. Nitric oxide/oxygen blends are used in critical care to promote capillary and pulmonary dilation to treat several pulmonary vascular diseases. Among several supplements, the highest NOS activation has been proved for garlic with its unique mechanism of action. <b>Aim:</b> To investigate the effect of dietary supplementation of NO producing garlic on pulmonary function of smokers. <b>Materials and Methods:</b> The study was conducted on 40 healthy non-smoker (Group A) and 40 chronic smoker (Group B) males with matched age, height and weight. The pulmonary function tests- Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), FEV1/FVC ratio and Peak Expiratory Flow Rate (PEFR) were performed in non-smokers (Group A), smokers (Group B) and smokers after supplementation of approximately 4 gm of raw garlic (2 garlic cloves) per day for three months (Group C). Endogenous NO production was studied in smokers before and after garlic supplementation and in non-smokers without supplementation. The data obtained were compared between the groups using unpaired student’s t-test. The p-value considered significant at <0.05. <b>Results:</b> Our results showed that FVC, FEV1, FEV1/FVC ratio and PEFR were reduced significantly along with a significant decreased NOS activity among smokers (Group B) when compared with non-smokers (Group A). Garlic supplementation significantly improved the pulmonary function tests in Group C in comparison to Group B by increasing NOS activity. <b>Conclusion:</b> Dietary supplementation of garlic, which might be by increasing NOS activity, has significantly improved pulmonary functions in smokers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=CC09-CC12&id=9981 https://doi.org/10.7860/JCDR/2017/24650.9981 The Effect of Individual Factors, Socioeconomic and Social Participation on Individual Happiness: A Cross-Sectional Study Maryam Azizi, Fathola Mohamadian, Mozhgan Ghajarieah, Ashraf Direkvand-Moghadam <b>Introduction:</b> Happiness and exhilaration are the most essential demands of human innate psychological needs that affect both physical and mental health. <b>Aim:</b> The present study aimed to investigate the effect of individual factors, socioeconomic and social participation on individual happiness. <b>Materials and Methods:</b> In this study, we evaluated 15 to 54-year-old individuals to find the effects of individual factors, socioeconomic and social partnership (formal or informal) on human happiness. A random sampling method was used in the present study. The Oxford Happiness Questionnaire (OHQ) was used. Data analysis was performed using descriptive statistics including; frequency, percentage, Mean±SD. Correlation coefficient, one way ANOVA and logistic regression were also used as analytical statistics. <b>Results:</b> There was a significant relationship between gender (p=0.001, r=0.144), marital status (p=0.001, r=0.174), happy parents (p=0.001, r=0.194), educational grade (p=0.001, r=0.189), employment status (p=0.001, r=0.180), income (p=0.001, r=0.264), car ownership (p=0.001, r=0.173), informal social participation (p=0.001, r=0.3) and formal social participation (p=0.001, r=0.231) with happiness. However, the relationship between home ownership (p=0.346, r=-0.015), and happiness was not significant. <b>Conclusion:</b> It seems that good and cordial relations with others, including family, relatives and friends (informal social participation) are the main sources and the most important factors of life satisfaction and human happiness. Higher income can increase happiness by enhancing the possibility to access the needs, desires, problems solving, enhancing the social support and self esteem and opportunities to perform one’s favourite activities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=VC01-VC04&id=9982 https://doi.org/10.7860/JCDR/2017/24658.9982 Single Layered Versus Double Layered Intestinal Anastomosis: A Randomized Controlled Trial Sibabrata Kar, Vandana Mohapatra, Surendra Singh, Pratap Kumar Rath, Tapas Ranjan Behera <b>Introduction:</b> Gastrointestinal anastomosis is one of the most common procedures being performed in oesophagogastric, hepatobiliary, bariatric, small bowel and colorectal surgery; however, the safety and efficacy of single layer or double layer anastomotic technique is still unclear. <b>Aim: </b> To assess and compare the efficacy, safety and cost effectiveness of single layered versus double layered intestinal anastomosis. <b>Materials and Methods:</b> This prospective, double-blind, randomized controlled comparative study comprised of patients who underwent intestinal resection and anastomosis. They were randomly assigned to undergo either single layered extra-mucosal anastomosis (Group-A) or double layered intestinal anastomosis (Group-B). Primary outcome measures included average time taken for anastomosis, postoperative complications, mean duration of hospital stay and cost of suture material used; secondary outcome measures assessed the postoperative return of bowel function. Statistical analysis was done by Chi-square test and student t-test. <b>Results:</b> A total of 97 participants were randomized. Fifty patients were allocated to single layered extramucosal continuous anastomosis (Group-A) and 47 patients to double layered anastomosis (Group-B). The patients in each group were well matched for age, sex and diagnosis. The mean time taken for anastomosis (15.12±2.27 minutes in Group-A versus 24.38±2.26 minutes in Group-B) and the length of hospital stay (5.90±1.43 days in Group-A versus 7.29±1.89 days in Group-B) was significantly shorter in Group-A {p-value <0.001}. The postoperative return of bowel function was quicker in the single layer group (2.42±1.11 days) as compared to the double layer group (3.1±1.34 days). The cost of suture material used was relatively more in the single layered group (564 INR vs. 480 INR) which might be the only factor favoring a double layered anastomosis. However, there was no significant difference in the complication rates between the two groups. <b>Conclusion:</b> It can be concluded that single layered extramucosal continuous intestinal anastomosis is equally safe and perhaps more cost effective than the conventional double layered method and may represent the optimal choice for routine surgical practice. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PC01-PC04&id=9983 https://doi.org/10.7860/JCDR/2017/24817.9983 Role of Multivoxel Intermediate TE 2D CSI MR Spectroscopy and 2D Echoplanar Diffusion Imaging in Grading of Primary Glial Brain Tumours Abhishek Aggarwal, Pankaj Kumar Das, Arvind Shukla, Sagar Parashar, Mohini Choudhary, Arpit Kumar, Narendra Kumar, Shyamoli Dutta <b>Introduction:</b> Preoperative tumour grading is imperative owing to difference in invasive, aggressive tendencies of different grades of glial tumours implying varied prognosis, therapeutic options. Histopathological examination has inherent sampling errors. Magnetic Resonance Spectroscopy (MRS) and Diffusion Weighted Imaging (DWI) can provide non invasive information about internal mileu hence, aiding in tumour grading by adding to information provided by conventional MRI sequences. <b>Aim:</b> To evaluate the role of multivoxel intermediate TE 2D CSI MRS and 2D echoplanar diffusion imaging in grading of primary glial brain tumours. <b>Material and Methods:</b> A prospective study was conducted in Department of Radiology, Teerthanker Mahaveer Medical College and Research Centre, Uttar Pradesh, India, from April 2015 to August 2016 after obtaining necessary approvals from Institutional Ethical Committee and written informed consent from all participants on histopathological proven cases of glial brain tumours that underwent multivoxel MRS using intermediate TE 2D chemical shift imaging and DWI using 2D echoplanar imaging. Tumour grade calculated on MRI using MRS and DWI was compared with histopathological grading. Positive Predictive Value (PPV), Negative Predictive Value (NPV), Sensitivity, specificity and accuracy were calculated for each parameter and statistical significance was evaluated using two tailed Pearson test. <b>Results:</b> Choline: N Acetyl aspartate (Cho: NAA) and Choline: creatinine (Cho: Cr ) ratios from MRS as well as Apparent Diffusion Coffecient (ADC) values from DWI were significantly higher with increasing severity of tumour grade. Accuracy of 58.6% was obtained with DWI while it was 83% with MRS. MRS and DWI used together provided 88.4% accuracy. All parameters evaluated showed statistical significance. <b>Conclusion:</b> Both DWI as well as MRS were found to have statistically significant roles in grading of glial brain tumours. MRS was found to be more useful than DWI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=TC05-TC08&id=9984 https://doi.org/10.7860/JCDR/2017/24982.9984 Histomorphological Spectrum of Duodenal Pathology in Functional Dyspepsia Patients Anita Aujenath Chaudhari, Sharada Raju Rane, Meenal Vitthal Jadhav <b>Introduction:</b> Functional Dyspepsia (FD) is one of the most common causes of gastrointestinal symptoms aetiology of which is poorly understood. <b>Aim:</b> To study duodenal histomorphological features and their relationship with Helicobacter pylori (H Pylori) infection in patients of FD. <b>Materials and Methods:</b> This case control study included 50 cases of FD patients selected according to Rome III criteria and 30 age and sex matched controls. These were subjected to oesophago-gastro-duodenoscopy, rapid urease test for detection of H. pylori on gastric antral biopsy and duodenal biopsy from second part of duodenum for histopathological evaluation by light microscopy. Ten antral urease positive cases of FD with highest Intraepithelial Lymphocyte Count (IEL) were subjected to Immunohistochemistry (IHC). <b>Results:</b> Duodenal inflammation was an invariable feature noted in FD. Morphological spectrum consisted of increased IEL in 72%, increased duodenal eosinophils in 92%, presence of focal villous atrophy in 16%, lymphoid aggregates, colonic metaplasia, and duodenal H. pylori infection in 4% each. Gastric H. pylori positivity was noted in 48% cases of FD. Increased duodenal IEL count and duodenal eosinophilia was noted in 75%, 87.5% such cases. Same was noted respectively, with 61.5% and 95.15% cases with gastric H. pylori negativity. In cases of FD, duodenal IEL and eosinophil count in lamina propria showed statistically significant rise when compared with control and had positive correlation with gastric H pylori infection. On IHC, increased expression of CD 8 was noted in duodenal IEL and lymphocytes in lamina propria as compared to CD4. <b>Conclusion:</b> Our study provided some insight in pathogenesis of FD and role of H. pylori in its aetiology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=EC01-EC04&id=9985 https://doi.org/10.7860/JCDR/2017/25297.9985 Adequate Resources as Essential Component in the Nursing Practice Environment: A Qualitative Study Mozhgan Rivaz, Marzieh Momennasab, Shahrzad Yektatalab, Abbas Ebadi <b>Introduction:</b> Attracting and retaining well qualified nurses to develop healthcare systems and ensure patient safety is a global concern. In this regard, the quality of the practice environment plays a crucial role. <b>Aim:</b> To explore Iranian nurses perception on the key constituents of the nursing practice environment. <b>Materials and Methods:</b> This study was conducted using a qualitative approach. Twelve participants were purposively selected from five teaching hospitals in Shiraz, Iran. Data was collected through semi structured interviews, and analysed using qualitative content analysis. <b>Results:</b> Data analysis led to the extraction of two categories of ‘adequate staff’, with two subcategories of balanced workload and well qualified nurses, and ‘adequacy of physical resources’, with subcategories of equipment adequacy and appropriate physical structure as key elements of the nursing practice environment. <b>Conclusion:</b> Imbalanced workloads, inappropriate nurse-patient ratios, and inadequate physical resources negatively affected nurse’s perceptions of the quality of the nursing practice environment. The findings provide baseline data for health policymakers in different national and global areas to remodel the practice environment. The improvement of the practice environment, with adequate staffing levels and appropriate allocation of physical resources, is achievable to resolve this challenge and thus improve outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=IC01-IC04&id=9986 https://doi.org/10.7860/JCDR/2017/25349.9986 Evaluation of the Efficacy of Clinical Breast Examination Gloves in the Diagnosis of Breast Lumps Vanessa Monteiro Sanvido, Andrea Yumi Watanabe, Joaquim Teodoro de Araújo Neto, Simone Elias, Gil Facina, Afonso Celso Pinto Nazário <b>Introduction:</b> Recent studies have questioned the efficacy of mammography in reducing breast cancer-related mortality. Additionally, the efficacies of commercially available gloves marketed as aiding the detection of breast lumps have not been independently verified. <b>Aim:</b> To evaluate the efficacy of clinical breast examination gloves in the detection of breast lumps. <b>Materials and Methods:</b> During the period from October 2011 to June 2012, patients were submitted to clinical examination with and without gloves. This prospective study involved 202 patients who underwent conventional clinical breast examination (test 1) or clinical breast examination with Sensifemme® gloves (test 2). All patients underwent subsequent bilateral ultrasonography (test 3) to confirm the findings of the physical examinations. The Chi-square test was used to compare values, while the kappa concordance index was used to determine the concordance between the diagnostic tests. <b>Results:</b> The mean age of the patients was 43 years; 298 breast lumps were detected. In the clinical examination group (test 1), sensitivity was 54%, specificity was 78%, and accuracy was 57%. These rates for clinical breast examinations with gloves (test 2) were 68%, 58%, and 66%, respectively. The glove increased the diagnosis of breast nodules by 14%; the rate of false-positives was also higher (42% for test 2 compared to 22% for test 1). The accuracy of the glove was found to be superior to clinical examination after 100 patients had been examined. The kappa indices for test 1 vs. test 3 and for test 2 vs. test 3 were 0.15 and 0.16, respectively. <b>Conclusion:</b> Clinical examination using the glove was more effective than clinical examination with bare hands for the diagnosis of breast lumps, as it increased the sensitivity and accuracy of lump detection. However, this was at the expense of a higher false-positive rate, which can lead to further tests, unnecessary biopsies, and patient anxiety. The concordance of clinical examination results (whether performed with or without the glove) with those of ultrasonography is weak. Moreover, the glove has a steep learning curve that may discourage its use in certain circumstances. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=XC01-XC05&id=9987 https://doi.org/10.7860/JCDR/2017/25504.9987 Nature’s Benefaction as a Life Saver for an Avulsed Tooth: An In vitro Study Saumya Navit, Niharika Shahi, Suleman Abbas Khan, Anshul Sharma, Vartika Singh, Ratna Priya Mishra, Pragati Navit, Prerna Sharma <b>Introduction:</b> Dentoalveolar trauma is a very common and avulsion is the most frequent injury. Treatment of choice following avulsion is immediate reimplantation. However, in cases where this might not be possible the prognosis of reimplanted teeth can be improved by the selection of an appropriate storage media. Prevention of ankylosis and replacement resorption depends more on the potential of storage media to maintain cell viability rather than the extraalveolar time period. <b>Aim:</b> To compare and evaluate the efficacy of different storage media in maintaining the viability of Periodontal Ligament (PDL) cells in an avulsed tooth. <b>Materials and Methods:</b> A total of 58 freshly extracted human premolar teeth were divided into four experimental groups and two control groups. The positive and negative controls corresponded to 0 minute and an eight hours dry time, respectively. The experimental teeth were stored dry for 30 minutes and then immersed in one of the four media: Hank’s Balanced Salt Solution (HBSS), coconut water, aloe vera and saline for 45 minutes. The teeth were then treated with Collagenase Type II and Dispase for 30 minutes. The number of viable PDL cells were counted with a haemocytometer and analysed. The statistical analysis was done using SPSS version 15.0. The Analysis of Variance (ANOVA) and Post-hoc tests (Tukey-HSD) were performed to reveal the statistical significance. The values were represented in number (%) and mean±SD. <b>Results:</b> Statistical analysis demonstrated that among the experimental groups maximum percentage of viable cells were seen in HBSS (87.33%) followed by coconut water (79.87%), aloe vera (70.59%) and saline (50.56%). <b>Conclusion:</b> Within the parameters of this study, it can be concluded that the HBSS is the most effective storage media in maintaining the viability of PDL cells. However, in Indian scenario where availability of HBSS is questionable, coconut water can be considered as the best natural storage media for an avulsed tooth followed by aloe vera. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC01-ZC04&id=9954 https://doi.org/10.7860/JCDR/2017/26673.9954 Comparison of Efficacy and Safety of Cefpodoxime and Amoxicillin-Clavulanate Potassium in Paediatric Acute Otitis Media in Children below Two Years: A Prospective Longitudinal Study Arijit Ghosh, Sayan Chatterjee <b>Introduction:</b> Acute Otitis Media (AOM) is one of the frequently diagnosed diseases in children below two years. Amoxicillin-clavulanate potassium is the first line drug in treatment of Paediatric AOM (PAOM). Cefpodoxime has good antimicrobial activity against various types of microorganisms that include causative microorganisms of PAOM. <b>Aim:</b> To compare the efficacy and safety of cefpodoxime and amoxicillin-clavulanate potassium for the treatment of PAOM in children below two years. <b>Materials and Methods:</b> A prospective longitudinal study was conducted on children diagnosed with PAOM. Thirty-six children were included in the study: 17 in the Group A (amoxicillin-clavulanate potassium) and 19 in the Group B (cefpodoxime). Primary outcome of this study was clinical success rate at day 10 visit and secondary outcome was incidence of Adverse Events (AEs). <b>Results:</b> The clinical success rates were 93.8% in Group A and 88.2 % in Group B. These rates are comparable and no statistically significant difference was observed between the groups. Few mild and self-limiting AEs were observed and both the drugs were well tolerated. <b>Conclusion:</b> The results of this prospective study showed that a 10-day course of cefpodoxime is therapeutically comparable to amoxicillin-clavulanate potassium in terms of both efficacy and safety for the treatment of PAOM in children below two years. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=FC01-FC04&id=9955 https://doi.org/10.7860/JCDR/2017/25252.9955 Study of Retinal Nerve Fibre Layer Thickness and Visual Contrast Sensitivity in HIV Positive Individuals Rudrajit Paul, Asim K Ghosh, Adwaita Nag, Shyamapada Biswas, Britisundar Naiya, Jayati Mondal <b>Introduction:</b> Measurement of Retinal Nerve Fibre Layer Thickness (RNFLT) by Optical Coherence Tomography (OCT) is a sensitive, non invasive and cheap method of detecting early retinal changes in a variety of diseases. In HIV infection, RNFLT is altered and this may have effect on other visual functions like Contrast Sensitivity (CS) and visual acuity. Such ocular pathology can affect the daily life and profession (especially driving) of HIV infected individuals. However, studies on this topic in HIV infected population are rare from India. <b>Aim:</b> To study RNFLT, CS and their correlation in a sample of HIV positive Indian population. <b>Materials and Methods:</b> The present cross-sectional study was done in a tertiary care medical college hospital of Eastern India between May 2016 and September 2016. We did this study on HIV positive subjects with no clinically apparent ocular infection or other pathology. In this study, we have measured the RNFLT using the HRA-OCT Spectralis machine. The CS was tested using a smartphone version of the Pellie-Robson chart. CD4 count, visual acuity and colour vision were also tested. The data was analysed using SPSS version 20.0 for any correlation between these parameters. Pearson coefficient was used for continuous data and Spearman rank correlation was used for categorical data. A p-value <0.05 was considered significant. <b>Results:</b> We had 17 patients, that is 34 eyes. RNFLT loss was found in 21% of the eyes and borderline thinning was found in a further 26%. Predominantly, the temporal quadrant was involved. The mean of log CS was 1.33±0.38. Taking 1.5 as the cut-off value for normalcy, 47% of the eyes tested showed decreased CS. Log CS showed significant correlation with RNFLT of the temporal quadrant only (r=0.37; 95% C.I. 0.041 to 0.631; p=0.02). Temporal RNFLT also showed statistical correlation with the CD4 count. The low CS was also significantly correlated with low visual acuity (r=0.5). <b>Conclusion:</b> In HIV infected persons, subtle ocular changes may occur and this may affect visual functions quite early. Hence, a comprehensive eye check-up should include parameters like CS and OCT. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OC01-OC04&id=9956 https://doi.org/10.7860/JCDR/2017/24751.9956 Fabrication and Appraisal of Poly (Lactic-Co-Glycolic Acid) – Moxifloxacin Nanoparticles using Vitamin E–TPGS: A Potential Intracanal Drug Delivery Agent Hardik Makkar, Gaurav Patri <b>Introduction:</b> Nanotechnology is gaining momentum in the search for ideal biomaterials by dental researchers. The expansible nature of Endodontology deems exploration, learning and scrutinizing newer avenues which have the potential to be applied and investigated. The popularity of polymers as drug delivery vehicles has opened avenues for their application in the root canal system. This study utilized application of biodegradable polymers as potential drug delivery vehicles against Enterococcus faecalis, one of the main reasons for post treatment disease. <b>Aim:</b> This study aimed at fabricating Poly (Lactic-co-Glycolic Acid) (PLGA)-moxifloxacin nanoparticles and assessing its sustained antimicrobial efficacy with calcium hydroxide and chitosan-moxifloxacin hydrogel against Enterococcus faecalis. <b>Materials and Methods:</b> PLGA (50:50) in a quantity of 100 mg was dissolved in 1 ml ethyl acetate and 45 ml of 0.3% w/v Vitamin-E Polyethylene Glycol 1000 Succinate (vitamin E-TPGS) was kept for magnetic stirring in separate beaker. Moxifloxacin (50 µl) was added to polymer PLGA following which vitamin E-TPGS was added to the polymer. Nanoparticles were fabricated using ultrasonication and collected by centrifugation. Surface characterization was assessed using scanning electron microscope. Results were obtained in the form of zone of inhibition by the nanoparticles against Enterococcus faecalis and comparisons were made with chitosan-moxifloxacin hydrogel and calcium hydroxide using Analysis of Variance (ANOVA) followed by Student t-test. <b>Results:</b> Upon statistical analysis, the zone of inhibition against E. faecalis remained constant with PLGA-moxifloxacin nanoparticles for 14 days while it decreased with chitosan-moxifloxacin hydrogel and remained nil for calcium hydroxide (p<0.01). <b>Conclusion:</b> The study posits that PLGA encapsulated moxifloxacin nanoparticles showcased sustained antibacterial effect in low doses against the test pathogen. Its sustained and programmed release makes them unique contenders for further evaluation in Endodontics as potential intracanal medicaments. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC05-ZC08&id=9957 https://doi.org/10.7860/JCDR/2017/27633.9957 Comparison of Plasma Levels of Renin, Vasopressin and Atrial Natriuretic Peptide in Hypertensive Amlodipine Induced Pedal Oedema, Non-Oedema and Cilnidipine Treated Patients Kiran Shetty, Ranjan Shetty, Pragna Rao, Mamatha Ballal, Amruth Kiran, Sravan Reddy, Umesh Pai, Jyothi Samanth <b>Introduction:</b> Amlodipine is a third generation dihydropyridine group of calcium channel blocker and having an excellent antihypertensive profile. Pedal Oedema (PE) is the major drawback of amlodipine therapy and the incidence of Amlodipine Induced Pedal Oedema (AIPE) has been found significantly high. Several neurohumoral factors influence the incidence of oedema. <b>Aim:</b> We aimed to compare the plasma levels of renin, vasopressin and atrial natriuretic peptide in hypertensive AIPE, non-oedema and cilnidipine treated patients. <b>Materials and Methods: </b>The present prospective, interventional study was conducted on 104 mild to moderate hypertensive patients (52 patients in each group), after due consideration of eligibility criteria. Plasma Renin (PR), Vasopressin (VAS), and the Atrial Natriuretic Peptide (ANP) was estimated by ELISA test and compared between the AIPE, Amlodipine Treated Non-Oedema (ATNE) in Phase I, and AIPE and Cilnidipine Treated (CT) Groups in Phase II. <b>Results:</b> The clinical and demographic parameters were matched. PR was significantly high in AIPE group than the ATNE, and it was significantly reduced after one month follow up with the substitution of cilnidipine. The median (IQR) value of PR was 4.87 (3.58, 6.63), 3.50 (1.44, 5.47) and 2.66 (1.02, 5.66) ng/ml in AIPE, ATNE, CT group respectively. VAS was significantly high in AIPE group than ATNE, and it significantly reduced after one month follow up with CT group. The median (IQR) value of vasopressin was 6.78 (2.55, 9.16), 2.58 (1.61, 5.73) and 2.50 (1.23, 5.00) ng/ml in AIPE, ATNE and CT groups respectively. There was no significant difference seen in plasma ANP levels between the groups. The p-value was <0.05 which is statistically significant. <b>Conclusion:</b> The AIPE may not be volume overload or fluid retention; it may be due to persistent raise in adrenergic activity followed chronic amlodipine therapy. Cilnidipine relatively suppresses the sympathetic activity, and completely resolves the AIPE by significantly reducing PR and VAS levels. ANP did not show a difference between groups. Cilnidipine is the suitable alternative antihypertensive drug for AIPE patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=FC05-FC08&id=9958 https://doi.org/10.7860/JCDR/2017/25097.9958 Efficacy of Bromelain along with Trypsin, Rutoside Trihydrate enzymes and Diclofenac Sodium Combination Therapy for the treatment of TMJ Osteoarthritis - A Randomised Clinical Trial S Jayachandran, Priyanka Khobre <b>Introduction:</b> Osteoarthritis (OA) is a degenerative disorder characterized by chronic inflammatory response of cartilage and articular surface involving Temporomandibular Joint (TMJ). Pain as one of the major symptom of osteoarthritis affects the quality of life and is usually managed by Non Steroidal Anti Inflammatory Drugs (NSAIDs) such as diclofenac sodium. Bromelain, trypsin and rutoside trihydrate formulation can be used to treat this disease because of anti-inflammatory and anti-oxidant effects. <b>Aim:</b> To assess the effectiveness of oral bromelain, trypsin, rutoside trihydrate enzymes and diclofenac sodium combination therapy over diclofenac sodium for the treatment of TMJ osteoarthritis. <b>Materials and Methods:</b> Thirty Patients with symptomatic TMJ osteoarthritis were randomly divided into three groups. 10 patients were treated with diclofenac sodium (Group 1), 10 were given oral enzymes (bromelain, trypsin, rutoside trihydrate) and diclofenac sodium combination (Group 2), and 10 were treated with oral enzyme preparation (bromelain, trypsin, rutoside trihydrate) (Group 3). Patients were evaluated on day 1, day 4, day 7 and day 10. Comparison of pain rating within three groups was assessed using numeric rating scale. The efficacy criteria were analysed applying ANOVA followed by post-hoc test. <b>Results:</b> Inter group comparison of the effectiveness of management of pain, resulted in a value p < 0.05 between Group 2 and other two groups, which indicated that Group 2 patients responded better than Group 1 and Group 3, while p > 0.05 between Group 1 and Group 3 showed both groups responded equally to the treatment. <b>Conclusion:</b> The trial showed significant improvement in reducing pain in patients treated with oral enzymes and diclofenac sodium combination therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC09-ZC11&id=9964 https://doi.org/10.7860/JCDR/2017/25771.9964 Anthropometric Correlates for the Physiological Demand of Strength and Flexibility: A Study in Young Indian Field Hockey Players Hanjabam Barun Sharma, Jyotsna Kailashiya <b>Introduction:</b> Optimal strength and flexibility are essential for performance enhancement and injury prevention in hockey, and anthropometry is known to influence these parameters. <b>Aim:</b> To find anthropometric correlates for strength and flexibility score in young Indian field hockey players. <b>Materials and Methods:</b> Thirteen female and 19 male subjects volunteered for the study. Selected anthropometric variables: lengths, breadths, girths and body composition; strength and sit and reach score were measured for each subject. <b>Results:</b> Males were taller, leaner and stronger with longer upper limbs and broader chests. With few exceptions, taller, heavier and leaner players with longer trunks and limbs, broader chest and hip, and bulkier arms and lower limbs had stronger grip, back, upper and lower limbs. Heavier and taller players with longer trunk and more percentage of body fat were more flexible. Also, the stronger players had more percentage body fat and body mass index, which might be due to the strong positive correlation of percentage body fat and body mass index with fat free mass. <b>Conclusion:</b> Anthropometric variables, especially heights, breadths and body composition, show significant correlation with strength and flexibility, and hence may serve as monitoring tool and for talent identification. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=CC01-CC05&id=9965 https://doi.org/10.7860/JCDR/2017/26358.9965 Significance of Foetal Transcerebellar Diameter in Foetal Biometry: A Pilot Study Ramireddy Harikiran Reddy, Kumar Prashanth, Mahale Ajit <b>Introduction:</b> The most important parameter needed for appropriate management of pregnant women is accurate Gestational Age (GA). Routine sonographic estimation of GA by using Biparietal Diameter (BPD), Femur Length (FL), Abdominal Circumference (AC) and Head Circumference (HC) assumed important role in management of pregnancy. However, these parameters have limitations. BPD and HC are not reliable in case of moulding of foetal head in third trimester. Similarly, femur length is shortened in cases of achondroplasia. Transcerebellar Diameter (TCD) was developed as an alternative parameter of foetal brain growth and for estimation of GA. <b>Aim:</b> To evaluate accuracy of predicting GA using Foetal Transcerebellar Diameter (TCD) and to compare between TCD and other existing parameters in evaluating GA in 15 to 40 weeks of gestation. <b>Materials and Methods:</b> A prospective study was carried out in 100 pregnant women between 15 to 40 weeks of gestation, who came for routine antenatal sonography. Transcerebellar diameter was measured along with routine parameters. Subjects were divided into two groups based on GA (15-28 and 29-40 weeks). Gestational age using TCD and other parameters was calculated and compared with gestational age based on Last Menstrual Period (LMP). Correlation between the GA by LMP with GA by other ultrasound parameters was done by using Karl Pearson’s Correlation(r). <b>Results:</b> In 15-28 weeks, all parameters had nearly equal r-values. Among all parameters, TCD revealed highest correlation with value of 0.997. In 29-40 weeks, there was considerable difference in r-values. An r-value of 0.982 was noted, when the GA by TCD and LMP was compared, r-value of which is more than the other parameters. The least correlation was seen with BPD, r=0.951. The second most accurate correlation was seen with the FL with r-value of 0.981. <b>Conclusion:</b> TCD is an accurate parameter in estimation of gestational age in second and third trimesters as its values are in close relation with that of GA by LMP. It is also better predictor of the gestational age when compared to other parameters especially in third trimester. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=TC01-TC04&id=9968 https://doi.org/10.7860/JCDR/2017/23583.9968 Comparative Evaluation of Accuracy of Pulse Oximeters and Factors Affecting Their Performance in a Tertiary Intensive Care Unit Anupam Kumar Singh, Malvinder Singh Sahi, Bablesh Mahawar, Sajjan Rajpurohit <b>Introduction:</b> Pulse oximetry is a widely used tool, unfortunately there is a paucity of data investigating its accuracy in Intensive Care Units (ICU) and if they are able to meet mandated FDA criteria as claimed by them in critically ill patients. <b>Aim:</b> To assess bias, precision and accuracy of pulse oximeters used in ICU and factors affecting them. <b>Materials and Methods:</b> A prospective cohort study, including 129 patients admitted to the ICU of a tertiary referral centre. Pulse oximetry and blood gas were done simultaneously. Pulse oximetry was done using two pulse oximetres: Nonin and Philips. All physiological variables like haemoglobin, lactate, use of vasopressors and blood pressure were recorded. Bland Altman curves were constructed to determine bias and limits of agreement. Effect of physiological variables on bias and difference between performance characteristics of bias was determined using SPSS. <b>Results:</b> Pulse oximetry overestimated arterial oxygen saturation (SaO2) by 1.44%. There was negative correlation between bias and SaO2 (r=-0.32) and positive correlation with lactate (r=0.16). The Philips pulse oximeter had significant higher bias and variability than Nonin pulse oximeter. (2.49±2.99 versus 0.46±1.68, mean difference = 1.98, 95% C.I. = 1.53 – 2.43, p-value <0.001). <b>Conclusion:</b> Pulse oximetry overestimates SaO2. Bias tends to increase with rising lactate and hypoxia. There is heterogeneity in performance of various pulse oximetry devices in ICU. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OC05-OC08&id=9961 https://doi.org/10.7860/JCDR/2017/24640.9961 Use of Healthcare Services by Patients with Non-Communicable Diseases in Nepal: A Qualitative Study with Healthcare Providers Saval Khanal, Lennert Veerman, Lisa Nissen, Samantha Hollingworth <b>Introduction:</b> The healthcare systems in many Low-and Middle-Income Countries (LMICs) like Nepal have long focused on preventing and treating infectious diseases. Little is known about their preparedness to address the increasing prevalence of Non-Communicable Diseases (NCDs). <b>Aim:</b> This study aimed to investigate the use of healthcare services by patients with NCDs in Nepal. <b>Materials and Methods:</b> Nine healthcare providers (including health assistants, pharmacy assistants, nurse, specialised nurse, practicing pharmacists, chief hospital pharmacist, doctors and specialised doctor) from Pokhara, Nepal, were recruited using purposive sampling. In depth interviews about the magnitude of NCDs, first point of care, screening and diagnosis, prevention and management, follow-up, and healthcare system responses to NCD burden were conducted. Data were thematically analysed with a deductive approach. <b>Results:</b> Although the healthcare system in Nepal is still primarily focused on communicable infectious diseases, healthcare providers are aware of the increasing burden of NCDs and NCD risk factors. The first points of care for patients with NCDs are government primary healthcare facilities and private pharmacies. NCDs are often diagnosed late and opportunistically. NCD prevention and treatment is unaffordable for many people. There are no government sponsored NCD screening programs. <b>Conclusion:</b> There are problems associated with screening, diagnosis, treatment and follow-up of patients with NCDs in Nepal. Healthcare providers believe that the current healthcare system in Nepal is inadequate to address the growing problem of NCDs. The health system of Nepal will face challenges to incorporate programs to prevent and treat NCDs in addition to the pre-existing communicable diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=LC01-LC05&id=9970 https://doi.org/10.7860/JCDR/2017/25021.9970 Antimicrobial Effect of Leaves of Phyllanthus niruri and Solanum nigrum on Caries Causing Bacteria: An In vitro Study J sunitha, Swathy krishna, R Ananthalakshmi,J Sathiya Jeeva, AS Smiline Girija, Nadeem Jeddy <b>Introduction:</b> Solanum nigrum and Phyllanthus niruri are common herbs which are indigeneous to India. Solanum nigrum commonly called "manathakkali Keerai" in Tamil, forms an indispensable part of South Indian diet. Phyllanthus niruri (keezhanelli in Tamil) is a widely used medicinal plant, the leaves of which have been used extensively in Ayurveda and native medicine to cure various liver ailments. The herbs Solanum nigrum and Phyllanthus niruri have been found to be effective against numerous enteropathogens in various in vitro studies. <b>Aim:</b> To assess and compare the antibacterial efficacy of the crude alcoholic extract of the leaves of Solanum nigrum and Phyllanthus niruri against five cariogenic organisms. <b>Materials and Methods: </b> Standard strains of the micro-organisms were obtained from ATCC (American Type Culture Collection) and MTCC (Microbial Type Culture Collection) which comprised of Streptococcus mutans MTCC no. 890, Streptococcus oralis MTCC no 2696, Lactobacillus acidophillus MTCC no. 10307, Streptococcus sanguis ATCC no. 10556 and Streptococcus salivarius ATCC no. 13419. The organisms obtained were revived and lawn cultured on Trypticase Soy Agar-Blood Agar (TSA-BA) and de Man, Rogosa and Sharpe (MRS) agar media. The antibacterial effect of the dried and powdered leaves of Solanum nigrum and Phyllanthus niruri was tested using agar well diffusion method. The zones of inhibition obtained after incubation were measured and tabulated. The antibacterial activity for the two herbs was compared using the Mann-Whitney test. <b>Results:</b> The antibacterial zones of inhibition obtained for the herb Solanum nigrum was in the range of 12.3-14.6 mm and ranged from 9.7-11.6 mm for the herb Phyllanthus niruri. When the zones of inhibition were compared for the herbs, Solanum nigrum showed significantly greater zones of inhibition compared to Phyllanthus niruri for the organisms Streptococcus sanguis, Streptococcus salivarius, Streptococcus oralis and Streptococcus mutans (p-value<0.05). <b>Conclusion:</b> The alcoholic extract of leaves of Solanum nigrum and Phyllanthus niruri showed significant antibacterial activity against cariogenic organisms, with Solanum nigrum being more anti-cariogenic than Phyllanthus niruri. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=KC01-KC04&id=10066 https://doi.org/10.7860/JCDR/2017/23602.10066 The Serological Evidence of Cytomegalovirus Infection as a Potent Aetiological Factor for Cleft Lip/Palate, Mental Retardation and Deafness D.V. Divya, Madu Ghana Shyam Prasad, Ambati Naga Radhakrishna, S Pavani Reddy, K Pratyusha, K.V.K Santosh Kumar, R.V. Sandeep <b>Introduction:</b> Congenital Cytomegalovirus (CCMV) infection is estimated to occur in 0.5% to 2% of all deliveries across the world. According to the available literature about Human Cytomegalovirus (HCMV) infected children, 0.5% to 1% acquire Cytomegalovirus (CMV) in utero, 40% acquire the infection within the first decade of life, between 15% to 70% acquire CMV infection in group day care settings and continue to shed the virus for 6 to 48 months after primary infection. Although, 90% of the infected infants are clinically asymptomatic at birth, shreds of evidence show that these infants are at risk for audiological, neurological, and developmental sequelae. Despite this, HCMV still remains undetected due to silent or asymptomatic nature of the virus. <b>Aim: </b>The present study was aimed to test the hypothesis that HCMV can be a potential aetiologic factor in the development of cleft lip/palate, mental retardation and deafness. <b>Materials and Methods:</b> The study was carried out in a controlled setting under strict aseptic conditions. Blood samples were collected from 80 children, who were selected strictly adhering to the inclusion criteria and were divided into four groups containing 20 children each. Group 1: 20 children with cleft lip/palate, Group 2: 20 mentally retarded children, Group 3: 20 completely deaf children and Group 4: 20 normal Children (control). The samples were tested for HCMV-specific Immunoglobulin G (IgG) and Immunoglobulin M (IgM) antibodies by using solid phase enzyme-linked immunosorbent assay and the obtained data were analysed statistically using ANOVA and Post-Hoc Tukey’s tests. <b>Results:</b> In the study group (Group1, 2 and 3) children, the overall positivity for HCMV- specific IgG was 100% and 5% borderline to IgM antibodies whereas in the control group (Group 4) it was 80% negative to HCMV- specific IgG and 100% negative to IgM antibodies. <b>Conclusion:</b> From the observations noted in the present study, HCMV could be suggested as the potent aetiologic factor in the development of cleft lip/palate, mental retardation and deafness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC51-ZC54&id=10067 https://doi.org/10.7860/JCDR/2017/25118.10067 Otomycosis in a Rural Community Attending a Tertiary Care Hospital: Assessment of Risk Factors and Identification of Fungal and Bacterial Agents Priti Agarwal, Leimapokpampam Sumitra Devi <b>Introduction:</b> Otomycosis is one of the frequently encountered fungal infections of external auditory canal, commonly seen in tropical and subtropical regions of the world. Various host (local, systemic) and environmental factors can predispose a person to otomycosis. Although clinical presentations along with otoscopic findings of the patients are well suggestive of fungal infection, proper identification of causative agents is mandatory in order to prevent recurrences and complications. <b>Aim:</b> To define the aetiology of clinically diagnosed otomycosis in rural population, to derive association of risk factors with otomycosis, to isolate and identify fungal and bacterial agents and to analyze the association between them. <b>Materials and Methods:</b> A prospective study was conducted in the Department of Microbiology and Department of Ear, Nose and Throat (ENT), SGT hospital over eight months period. A total of 350 consecutive patients of more than five years of age with clinical diagnosis of otomycosis were included in the study. Demographic profile, predisposing factors, presenting complaints and clinical findings of clinically diagnosed patients were evaluated and analyzed. Samples were collected, transported and evaluated by both direct examination and culture method for bacteriological and mycological examination. <b>Results:</b> Male to female ratio in study participants was 1.3:1. Mycological examination yielded 346 fungal isolates in 310 samples from a total of 350 clinically diagnosed cases of otomycosis. Self cleaning, instillation of mustard oil and use of ear drops appeared to be common predisposing factors in otomycosis. Significant association was observed between these practices and otomycosis. Aspergillus species was the predominant fungi followed by Candida spp., Penicillium, Mucor and Trichophyton mentagrophyte. 11% of the cases were found to have mixed fungal and bacterial infections. <b>Conclusion:</b> The present study highlights the highest isolation of Aspergillus complex in cases of clinically diagnosed otomycosis in a rural community with higher practice of self cleaning and using home remedies and eardrops to get relief from sensation of blocked ear and itching. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DC14-DC18&id=10068 https://doi.org/10.7860/JCDR/2017/25865.10068 Evaluation of Myocardial Injury using Standard Diagnostic Tools and Tissue Doppler Imaging in Blunt Trauma Chest Parshotam Lal Gautam, Neeru Luthra, Manpreet Kaur, Jaspal Singh, Gurpreet Singh Wander, Rohit Tandon, Namrata, Nikhil Gautam <b>Introduction:</b> Myocardial contusion is an entity in chest trauma which is difficult to diagnose. Current practice relies more on cardiac-specific biochemical markers and standard echocardiography, but no gold standard test exists. The application of Tissue Doppler imaging is yet unexplored. <b>Aim: </b>The present study was designed to evaluate cardiac injury in patients with blunt trauma chest using conventional trans- thoracic echocardiography parameters and Tissue Doppler imaging. <b>Materials and Methods:</b> After ethical approval was taken from the Hospital and University and a written informed consent from all patients/attendants, this prospective study was conducted on a total of 30 patients in range of 15-60 years of age with blunt trauma chest. Patients with positive Trop-T and raised CPK (> 308 IU/L), raised CK-MB (> 24 IU/L) levels were suspected to have myocardial injury and were enrolled in the study. All patients fulfilling the inclusion criteria then underwent 2D-Echo and Tissue Doppler Imaging. Results of the observations were analysed using chi-square test. <b>Results:</b> Out of the total of 30 patients, 63.3% showed ECG changes suggestive of cardiac injury. A 76.7% patients suffered systolic dysfunction and 36.6% patients suffered diastolic dysfunction irrespective of ECG changes. On comparison of early filling velocity wave i.e., E wave (measured by transthoracic echocardiography) and tricuspid annular velocity Em wave (measured by tissue Doppler echocardiography) at tricuspid valve, we found statistically significant difference among two techniques. (p = 0.04) <b>Conclusion:</b> Echocardiography is very sensitive parameter for evaluation of myocardial contusion. Tissue Doppler imaging provides additional and reliable information. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OC33-OC36&id=10069 https://doi.org/10.7860/JCDR/2017/22746.10069 Correlation of Adiposity Indices with Electrocardiographic Ventricular Variables and Vascular Stiffness in Young Adults Varrshine Ravikumar, Hemamalini Ramasamy Vajravelu, Saravanan Ayyavoo, Balaji Ramraj <b>Introduction:</b>Excess adiposity constitute an important public health problem because of the associated increased risk of hypertension, coronary heart disease, type 2 diabetes and other disorders. Not only the contribution of general measures of adiposity but also central measures of adiposity have been observed. <b>Aim:</b> To compare and correlate the central and general adiposity indices with ventricular electrocardiographic variables and vascular stiffness indices in normal, overweight and obese young adults. <b>Materials and Methods:</b> This was a cross-sectional study. Nearly ninety subjects were enrolled and were divided into 30 normal weight, 30 overweight and 30 obese group based on the BMI classification of WHO for Asian population with their age ranging from 18-25 years. Waist and hip circumferences were measured using stretchable tape. Two novel indices-conicity index and abdominal volume index were calculated using standard formula. ECG and pulse wave were recorded using the Physiopac – Medicaid systems. Statistical analysis was done using SPSS version 19.0 software. ANOVA test was done to compare the variables among three groups. Pearson’s correlation coefficients were applied to establish the correlations between variables. <b>Results:</b> In our study Body Mass Index (BMI) and Conicity Index (CI) was significantly and strongly correlated with the ventricular electrocardiographic variables especially with QRS duration, QTc interval and with vascular stiffness indices. These indices can be used to assess the electrocardiographic abnormalities and vascular stiffness status. <b>Conclusion:</b> Excess adipose tissue in young adults was closely linked to ventricular depolarization and repolarization abnormalities and also to increased vascular stiffness. Adiposity indices in particular (BMI, CI) provide a simple and non invasive approach to assess these abnormalities at the earliest in order to prevent future complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=CC21-CC24&id=10062 https://doi.org/10.7860/JCDR/2017/27641.10062 Evaluation of Donor Site Morbidity Associated with Iliac Crest Bone Harvest in Oral and Maxillofacial, Reconstructive Surgery K.N.V Sudhakar, Rajat Mohanty, Vaibhav Singh <b>Introduction:</b> Iliac crest is the most common donor site for autogenous bone grafting as cortical bone, cancellous bone or combination of both can be harvested in abundance depending upon the need. Ilium provides highest concentration of osteo-component cells and greater quality of bone with less morbidity. <b>Aim:</b> The study was conducted to evaluate the donor site morbidity associated with autogenous iliac crest bone grafting for reconstruction in maxillofacial surgery. <b>Materials and Methods:</b> Around 12 patients, who had undergone iliac crest bone harvesting for various maxillofacial and reconstructive surgical procedures like cleft alveolus repair, malar augmentation, mandibular reconstruction following tumour resection and cyst enucleation and other surgical procedures performed in the Department of Oral and Maxillofacial Surgery, over a span of two years. The donor site was evaluated for the following factors: pain, neuropraxia, abnormal gait and scar evaluation. <b>Results:</b> None of the 12 patients had intraoperative complications like haemorrhage, damage to the muscles/ligaments, fracture of the ilium and damage to the acetabular fossa/femur head. Any major postoperative complications were also not recorded. Minor postoperative complications like pain, contour defect, walking difficulty were present, which gradually got resolved by the time of discharge. <b>Conclusion:</b> Anterior iliac crest provides an adequate harvest of cancellous, corticocancellous or bicortical grafts for reconstruction of various osseous defects in the maxillofacial region with least morbidity and should be considered as a major reservoir of bone for bony reconstructive procedures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC28-ZC33&id=10053 https://doi.org/10.7860/JCDR/2017/28688.10053 Sex Determination by Biometry of Anterior Features of Human Hip Bones in South Indian Population SSSN Rajasekhar, TK Vasudha, K. Aravindhan <b>Introduction:</b> Sex determination is the first step in establishing the identity of skeletal remains. Many studies included biometry of posterior features of hip bone. Very few studies are reported involving the biometry of anterior features of the hip bone. Anterior features of hip bone are important especially, if there is damage to the posterior features of hip bone in cases involving deliberate disfigurement of the body to resist identification of the crime in medicolegal cases. <b>Aim:</b> The present study was done to evaluate the effectiveness of anterior border parameters of the hip bone for prediction of sex using discriminant function analysis in South Indian population. <b>Materials and Methods:</b> A total of 206 dry bones were used (121 male and 85 female) and parameters like the distance between pubic tubercle and anterior rim of acetabulum, vertical acetabular diameter, transverse acetabular diameter, and the distance between pubic tubercle to highest point on the iliopubic eminence were measured using Vernier calipers. Normally distributed variables were compared using Students t-test to analyse the significance. <b>Results:</b> There was significant difference between the male and female hip bones of the observed variables with p-value less than 0.05. In parameters like the distance between pubic tubercle to anterior rim of acetabulum and distance between the highest points on iliopubic eminence to pubic tubercle the values were more in female when compared to males. In parameters like vertical and transverse acetabular diameters the values in males were more when compared to females. <b>Conclusion:</b> These parameters of hip bone can be utilised for sex determination in South Indian population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=AC13-AC16&id=10051 https://doi.org/10.7860/JCDR/2017/27927.10051 Maximal Aortic Valve Cusp Separation and Severity of Aortic Stenosis K Jayaprakash, VP Dilu, Raju George <b>Introduction:</b> An integrated approach that incorporates two dimensional, M mode and Doppler echocardiographic evaluation has become the standard means for accurate quantification of severity of valvular aortic stenosis. Maximal separation of the aortic valve cusps during systole has been shown to correlate well with the severity of aortic stenosis measured by other echocardiographic parameters. <b>Aim:</b> To study the correlation between Maximal Aortic valve Cusp Separation (MACS) and severity of aortic valve stenosis and to find cut-off values of MACS for detecting severe and mild aortic stenosis. <b>Materials and Methods:</b> In the present prospective observational study, we have compared the accuracy of MACS distance and the aortic valve area calculated by continuity equation in 59 patients with varying degrees of aortic valve stenosis. Aortic leaflet separation in M mode was identified as the distance between the inner edges of the tips of these structures at mid systole in the parasternal long axis view. Cuspal separation was also measured in 2D echocardiography from the parasternal long axis view and the average of the two values was taken as the MACS. Patients were grouped into mild, moderate and severe aortic stenosis based on the aortic valve area calculated by continuity equation. The resultant data regarding maximal leaflet separation on cross-sectional echocardiogram was then subjected to linear regression analysis in regard to correlation with the peak transvalvular aortic gradient as well as the calculated aortic valve area. A cut-off value for each group was derived using ROC curve. <b>Results:</b> There was a strong correlation between MACS and aortic valve area measured by continuity equation and the peak and mean transvalvular aortic gradients. Mean MACS was 6.89 mm in severe aortic stenosis, 9.97 mm in moderate aortic stenosis and 12.36 mm in mild aortic stenosis. MACS below 8.25 mm reliably predicted severe aortic stenosis, with high sensitivity, specificity and positive predictive value. MACS above 11.25 mm practically ruled out significant aortic stenosis. <b>Conclusion:</b> Measurement of MACS is a simple echocardiographic method to assess the severity of valvular aortic stenosis, with high sensitivity and specificity. MACS can be extremely useful in two clinical situations as a simple screening tool for assessment of stenosis severity and also helps in decision making non invasively when there is discordance between the other echocardiographic parameters of severity of aortic stenosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OC29-OC32&id=10045 https://doi.org/10.7860/JCDR/2017/27147.10045 Salivary Anti-50 kDa Antibodies as a Useful Biomarker for Diagnosis of Typhoid Fever Nur Eliyana Mohd Redhuan, Kai Ling Chin, Azreen Syazril Adnan, Asma Ismail, Prabha Balaram, Kia Kien Phua <b>Introduction:</b> Typhoid fever remains a scourge of humanity, especially in developing and under-developed countries due to poor sanitation and food hygiene. Diagnostic methods available for detection of this disease are not satisfactory due to a lack of sensitive, specific, rapid and convenient diagnostic test kits available in the market. <b>Aim:</b> To evaluate the feasibility of a Dot-EIA method for Ig-class specific salivary antibody detection for diagnosis of typhoid fever. <b>Materials and Methods:</b> Paired saliva and serum samples were collected in the year 2010 from patients and normal volunteers in Hospital Universiti Sains Malaysia, Kelantan, Malaysia, which is endemic for typhoid fever. A total of 11 culture-confirmed typhoid fever patients, 43 non-typhoid fever patients and 53 normal human control subjects were evaluated for antibodies against a 50 kDa antigen specific for Salmonella Typhi using Dot-EIA. <b>Results:</b> Ig class-specific screening of the test samples showed a higher sensitivity for IgA (90.9%) compared to either IgG (72.7%) or IgM (72.7%) antibodies in saliva, but for serum, IgG (90.9%) had a higher degree of sensitivity compared to IgA (36.4%) and IgM (63.6%). Combining all isotypes (IgA, IgG or IgM), serum showed a higher sensitivity (100.0%) compared to saliva (90.9%). Also, the specificity for serum (100.0%) was much higher than saliva (85.4%). <b>Conclusion:</b> Salivary IgA anti-50kDa antibody was found to be more suitable biomarker for routine screening, whereas serum IgG was more suitable for confirmatory test as it has higher specificity. Nevertheless, salivary IgA Dot-EIA is a convenient method for rapid testing, such as for Point-of-Care Diagnostics (POCD) and field epidemiological studies, due to its non-invasive nature and ease of use. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DC10-DC11&id=10055 https://doi.org/10.7860/JCDR/2017/21928.10055 Comparison of the Effect of PRP, PRF and Induced Bleeding in the Revascularization of Teeth with Necrotic Pulp and Open Apex: A Triple Blind Randomized Clinical Trial Vasundara Yayathi Shivashankar, Dexton Antony Johns, Ramesh Kumar Maroli, Mahalaxmi Sekar, Rathinavel Chandrasekaran, Shanmugavel Karthikeyan, Senthil Kumar Renganathan <b>Introduction:</b> Treatment of a tooth with necrotic pulp and open apex is a special challenge to the clinicians. Apexification with calcium hydroxide and MTA barrier technique fails to induce continued root maturation which makes the tooth susceptible to root fracture. Hence, an ideal outcome for such a tooth should be regeneration of pulp like tissue into the root canal capable of continuing normal root maturation. <b>Aim:</b> This study aims to compare the effect of Platelet Rich Fibrin (PRF), induced bleeding technique and Platelet Rich Plasma (PRP) in the revascularization of tooth with necrotic pulp and open apex. The main objectives of the study were to: (a) Radiographically evaluate the continuation of root development, increase in the dentin wall thickness and narrowing of canal space, apical closure and resolution of the periapical lesion; and to (b) To clinically evaluate the response to pulp sensibility testing and response to percussion and palpation tests. <b>Materials and Methods:</b> Sixty patients (6 to 28 years) with necrotic immature permanent tooth were randomly categorised into three groups after the root canal disinfection procedure. PRF as scaffolding material (Group A: n=20), revascularization with conventional induced bleeding technique (Group B: n=20), and PRP as the biomaterial (Group C: n=20). The primary outcome variable was measured using Periapical Index (PAI) (for periapical healing), Chen and Chen index (for apical responses), Schei’s ruler (for root lengthening and root thickening) and other clinical parameters. The Chi-square test was used to interpret the data among the three groups at the end of 12 months for the variables root lengthening and lateral wall thickness. ANOVA test was performed to compare the mean of the PAI scores of the three groups at preoperative stage and 12 months. If statistically significant, Bonferroni test was done to compare the outcome among the three groups. The significant level was set at p<0.05. Kappa agreement was used to see whether the clinical criteria of success (asymptomatic) were in agreement with radiographic criteria. <b>Results:</b> At the end of 12 months, patients presented with no pain and no signs of reinfection or no radiographic enlargement of the pre-existing apical pathosis in all the three groups. PRP was better than PRF and induced bleeding technique with respect to periapical wound healing when used in the regenerative endodontic procedures. The groups were comparable on grounds of root lengthening and lateral wall thickening. Type 3 apical response was the most common apical response in all the three groups. <b>Conclusion:</b> On analysing the pros and cons of the techniques performed, it is wise to establish induced bleeding technique as the standard endodontic procedure for revascularization of a non vital immature permanent tooth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC34-ZC39&id=10056 https://doi.org/10.7860/JCDR/2017/22352.10056 Wheatgrass: Green Blood can Help to Fight Cancer Rucha Diwakar Gore, Sangeeta Jayant Palaskar, Anirudha Ratnadeep Bartake <b>Introduction:</b> Oral squamous cell carcinoma is the sixth most common cancer worldwide and is one of the leading causes of death especially in developing countries like India. It is usually managed with the help of chemotherapeutic agents that are toxic not only to the tumor cells but also to normal cells in many ways. Whereas the traditional herbal medicines which are used from ancient days in India are generally known to be free of toxic effects and are effective. Wheatgrass is the young grass of the wheat plant ‘Tritcumaestivum Linn’, family Poaceae (Gramineae). It contains a number of vitamins, mineral, amino acids and vital enzymes, these play an important role in the anticancer approach of this herbal product. It is also called as ‘green blood’ because of its high content of chlorophyll, which bears a structural similarity to haemoglobin and this result in high oxygen supply to all the body tissues. <b>Aim:</b> To analyse the effect of the aqueous wheat grass extract on Oral Squamous Cell Carcinoma (OSCC) cell line by MTT assay. <b>Materials and Methods:</b> ‘KB cell line’ (Mouth Epidermal Carcinoma Cells) was used for the present study. Aqueous extract of wheat grass was prepared in the institution. The aim of the study was to assess the effect of the aqueous wheat grass extract on KB cell line(OSCC) by MTT assay. <b>Results:</b> A 41.4% of OSCC cell inhibition was observed at 1000 µg/ml dilution of aqueous wheatgrass extract in 24 hours. <b>Conclusion:</b> The aqueous extract of wheatgrass has an inhibitory effect on the oral cancer cell line proliferation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC40-ZC42&id=10057 https://doi.org/10.7860/JCDR/2017/26316.10057 Impact of Alcohol Dependency on Oral Health – A Cross-sectional Comparative Study Kakarla Priyanka, Kudlur Maheswarappa Sudhir, V. Chandra Sekhara Reddy, RVS. Krishna Kumar, G. Srinivasulu <b>Introduction:</b> Alcoholism is a chronic and progressive psychiatric illness characterised by a loss of control over alcohol consumption. Consumption of alcohol inevitably affects the oral cavity, oral mucosa and teeth. Literature indicates that alcohol dependents may have increased risk of dental caries, probing pocket depth and mucosal lesions. <b>Aim: </b>To assess the impact of alcohol dependency on oral health status among alcoholics in comparison with non alcoholics. <b>Materials and Methods:</b> A total 76 alcoholic patients visiting Psychiatric Department were compared with matched non alcoholics. Subjects were categorised as alcohol dependents based on American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria. Non alcoholic subjects were selected by controlling for potentially confounding variables such as for cigarette, smoking and age. Data was collected by interview and clinical examination. Oral health status of subjects was assessed using a modified WHO proforma and salivary pH and plaque pH were assessed. Chi-square test was used for assessing socio demographic details and Mann-whitney U test was used for prevalence of dental caries and periodontal diseases, Unpaired t-test was used for plaque and salivary pH. <b>Results: </b>There was no statistically significant difference noted among alcoholic and nonalcoholic control group with respect to socio demographic details. Prevalence of dental caries was higher in alcohol dependent subjects with a mean DMFT of 5.92 compared to nonalcoholic subjects (4.51). Prevalence of periodontitis was higher (89.61%) in alcohol dependent subjects compared to controls (78.67%). Prevalence of mucosal lesions among alcohol dependent subjects was 31.5% which was higher than the controls (25%). Subjects who were categorised as alcoholics showed a lower plaque and salivary pH compared to non alcoholics. <b>Conclusion:</b> Subjects categorised as alcohol dependent subjects had slightly lower mean plaque and salivary pH and a higher prevalence of dental caries, periodontitis and mucosal lesions compared with non alcoholic subjects https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC43-ZC46&id=10058 https://doi.org/10.7860/JCDR/2017/26380.10058 Prevalence of Flexible Flat Foot in Adults: A Cross-sectional Study Ashok Aenumulapalli, Manoj Mohan Kulkarni, Achleshwar Ramnarain Gandotra <b>Introduction:</b> Flat foot (pes planus) is a commonly observed disorder in clinical practice. The height of Medial Longitudinal Arch (MLA) determines the degree of pes planus. Majority of the previous studies on prevalence of flexible flat foot were done among children. <b>Aim:</b>The present study was undertaken to determine the prevalence of flexible flat foot among 18-21-year-old Indian adults using Navicular Drop Test (NDT) which is regarded as reliable and valid method to characterise MLA. <b>Materials and Methods:</b> The present study was a cross- sectional study in which Brody’s Navicular Drop Test was performed in five hundred healthy subjects (250 males and 250 females) aged 18-21-year-old. Navicular Drop (ND) of = 10 mm was regarded as flexible flat foot. Statistical analysis was done using SPSS version 23.0. <b>Results:</b> The prevalence of flexible flat foot was 13.6% (for males-12.8%; for females-14.4%). The median with Inter Quartile Range (IQR) for ND among males was 6 mm (4-8) and 6 mm (4-9) for right and left foot respectively. The median with IQR for ND among females was 6mm (4-10) and 7mm (3-8) for right & left respectively. The correlation of Right Side Navicular Drop (RND) with height and weight was significant, but insignificant correlation was found between RND and BMI. The correlation of Left Side Navicular Drop (LND) with height, weight and BMI of individuals was statistically not significant.The difference between the ND of males and female group was statistically not significant. <b>Conclusion:</b> The present study quantified the prevalence of flexible flat foot and gender wise normative values of ND among 18-21-year-old Indian adults. The information obtained by this study will be useful in field of orthopaedics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=AC17-AC20&id=10059 https://doi.org/10.7860/JCDR/2017/26566.10059 A Randomized Comparison between Video Demonstration and Verbal Instruction in Improving Rota Haler Technique in Children with Persistent Asthma: A Pilot Study Archana Arumugom, Venkatesh Chandrasekaran <b>Introduction:</b> Inhalation therapy is the cornerstone in management of asthma. Failure to use the device properly is one of the factors incriminated in poor control of asthma. <b>Aim:</b> To compare the technique of rota haler use in children with persistent asthma immediately after receiving either verbal instruction or a video based demonstration and again at one month following intervention. <b>Materials and Methods:</b> A total of 28 children, older than six years attending the childhood asthma clinic of our hospital, who were prescribed rota halers for the first time and who were technique naïve were enrolled into the study, after obtaining informed consent from the parents after meeting inclusion and exclusion criteria. They were then randomly assigned to either verbal instructions (group of 14) or video demonstration group (group of 14), for teaching them the rota haler technique. Their technique was then assessed using a modified version of the inhaler device assessment tool immediately after education and one month after the intervention. The proportions of children with good technique in both groups at both time points were compared. <b>Results:</b> There was no significant difference in the baseline variables like age, gender, location, socio-economic status and disease duration between both groups. The proportion of children achieving good technique was significantly more in the video group than the oral instruction group at immediate assessment and also at one month post intervention with an odds of 8 and 23.40 respectively (p=0.0262 and 0.0075 respectively). <b>Conclusion:</b> Video demonstration is effective in improving the technique of rota haler use at immediate assessment and at one month post intervention. Further studies are needed to validate this study and to assess factors that predict successful device use. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=SC05-SC07&id=10060 https://doi.org/10.7860/JCDR/2017/26720.10060 Effect of BMI, Body Fat Percentage and Fat Free Mass on Maximal Oxygen Consumption in Healthy Young Adults Himel Mondal, Snigdha Prava Mishra <b>Introduction:</b> Maximal oxygen consumption (VO<sub>2max</sub>) is an important measure of cardiorespiratory capacity of an individual at a given degree of fitness and oxygen availability. Risk of cardiovascular diseases increases with increasing degree of obesity and a low level of VO<sub>2max</sub> has been established as an independent risk factor for cardiovascular mortality. <b>Aim:</b> To determine VO<sub>2max</sub> in young adults and to find its correlation with Body Mass Index (BMI), Body Fat% and Fat Free Mass (FFM). <b>Materials and Methods:</b> Fifty four (male=30, female=24) healthy young adults of age group18-25 years after screening by Physical Activity Readiness Questionnaire (PAR-Q) participated in the study. Height was measured by stadiometer. Weight was measured by digital weighing scale with 0.1 kg sensitivity. Body fat% was measured by Bioelectrical Impedance Analysis (BIA) method. FFM was calculated by subtracting fat mass from the body weight. VO<sub>2max</sub> (mL.kg<sup>-1</sup>.min<sup>-1</sup>) was obtained by Submaximal Exercise Test (SET) by first two stages of Bruce Protocol with the basis of linear relationship between Heart Rate (HR) and oxygen consumption (VO<sub>2max</sub>). Data were analysed statistically in GraphPad Prism software version 6.01 for windows. <b>Results: </b> VO<sub>2max</sub> (mL.kg<sup>-1</sup>.min<sup>-1</sup>) of male (43.25±7.25) was significantly (p<0.001) higher than female (31.65±2.10). BMI showed weak negative correlation (r= -0.3232, p=0.0171) with VO<sub>2max</sub> but Body Fat% showed strong negative correlation (r= -0.7505, p<0.001) with VO<sub>2max</sub>. FFM positively correlated (r=0.3727, p=0.0055) with VO<sub>2max</sub>. <b>Conclusion:</b> Increased body fat is associated with decreased level of VO<sub>2max</sub> in young adults. Obesity in terms of Fat% is a better parameter than BMI for prediction of low VO<sub>2max</sub>. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=CC17-CC20&id=10039 https://doi.org/10.7860/JCDR/2017/25465.10039 Clinical and Laboratory Predictors of Frequency of Painful Crises among Sickle Cell Anaemia Patients in Nigeria Angela Ogechukwu Ugwu, Obike Godswill Ibegbulam, Theresa Ukamaka Nwagha, Anazoeze Jude Madu, Sunday Ocheni, Iheanyi Okpapala <b>Introduction: </b>The severity of Sickle Cell Anaemia (SCA) in terms of frequency of painful Vaso-Occlusive Crises (VOC) may be affected by clinical and haematological parameters amongst others. Elucidation of these factors in a given disease prevalent environment is necessary for prompt and effective management of patients with frequent painful VOC. <b>Aim:</b> This study aimed at determining the clinical and laboratory predictors of frequency of painful VOC among SCA patients in Enugu, Southeastern Nigeria. <b>Materials and Methods:</b> It was a cross-sectional study of 100 consecutive SCA patients receiving care at the University of Nigeria Teaching Hospital, Enugu, Nigeria between May 2012 and February 2014. The eligible patients were categorized into two groups namely; Group A and Group B. Group A/study group (severe disease) comprised SCA patients who had experienced three or more painful crises (=3 crises) in the last one year preceding the study but, currently in steady state, while Group B/control group (mild–moderate disease), comprised SCA patients matched for age, sex, highest educational status, and occupation but who have had no painful crisis or had only one or two painful crises (0–2 crises) in the last one year preceding the study and currently in steady state. <b>Results:</b> The overall mean age of the patients was 18.4±12.2 (range=2-52) years. The mean values of the haematological parameters including haemoglobin concentration, white cell count, platelet count, and neutrophil count were significantly higher in those with severe crises than mild-moderate crises (p<0.05). Sickle cell related complications including Avascular Necrosis (AVN) and leg ulcers were significantly higher in the study group than the control group (p<0.05). <b>Conclusion:</b> There was significant association between the frequency of crises and haemogblobin level, platelet and neutrophil counts and some clinical parameters: AVN, nephropathy and stroke. Future preventive interventions for reduction in frequency of crisis amongst patients with SCA could be targeted at controlling the blood levels of the identified haematological parameters. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=EC22-EC25&id=10042 https://doi.org/10.7860/JCDR/2017/26446.10042 Evaluating the Marginal Integrity of Bulk Fill Fibre Reinforced Composites in Bio-mimetically Restored Tooth Arun Kumar Patnana, V Narsimha Rao Vanga, Srinivasvas Kumar Chandrabhatla <b>Introduction:</b> Over the past years, composites in aesthetic dentistry are showing a considerable progress, but mechanical strength and polymerization shrinkage are the two main drawbacks, which limit their use in high stress bearing areas. <b>Aim:</b> To evaluate the marginal integrity of short glass fibre reinforced composite restorations, fibre reinforced composites with composite superficial layer, and fibre reinforced composites with underlying flowable composite layer. <b>Materials and Methods:</b> This study was done on twenty eight sound premolar teeth with standardized class V cavities restored under four groups as Group I: Particulate filler composite (Filtek Z 250 XT, 3M ESPE); Group II: Short glass fibre reinforced composite (everX Posterior, GC); Group III: Short glass fibre reinforced composite with an overlying layer of particulate filler composite; Group IV: Short glass fibre reinforced composite with an underlying layer of flowable composite (Filtek Z 250 XT, 3M ESPE). Test samples were immersed in a 2% methylene blue dye for 24 hours at 37°C and each tooth was sectioned bucco-lingually. Staining along the tooth restoration interface was recorded and results were analysed statistically using Independent sample t-test and Tukey’s post-hoc one-way ANOVA. <b>Results:</b> The results showed significant difference in the dye penetration between the restorative materials in the occlusal and gingival margins (p=0.02). Short fibre reinforced composites showed a statistically significant difference in the microleakage scores when compared with the particulate filler composites (p=0.01). <b>Conclusion:</b> Short glass fibre reinforced composite restorations showed an improved marginal integrity when compared to the traditional particulate filler composite restorations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC24-ZC27&id=10049 https://doi.org/10.7860/JCDR/2017/27835.10049 Aloe vera for Dry Mouth Denture Patients – Palliative Therapy Abdul Habeeb Bin Mohsin, S Varalakshmi Reddy, M Praveen Kumar, Sarah Samee <b>Introduction:</b> Xerostomia (dry mouth) is dryness of the mouth which is due to reduced salivary flow. Lack of adequate saliva causes discomfort in denture wearing patients and decreases retention of dentures. The ability of saliva to wet the tissue surface is one of the most important properties for oral comfort and retention of complete denture in dry mouth patients. <b>Aim:</b> This study was conducted to evaluate and compare the wetting ability of therapeutic Aloe vera saliva substitute and commercially available Aqwet saliva substitute on heat-polymerized acrylic resin. Contact angle of liquid saliva substitute was considered as an indicator of wettability. <b>Materials and Methods:</b> Aloe vera liquid (Aloe vera – Group I) and Aqwet saliva substitute (Aqwet – Group II) were compared in terms of their wetting ability. Forty samples of heat-polymerized acrylic resin were fabricated and divided into two groups with 20 samples in each. Advancing, receding contact angles and angle of hysteresis were measured using contact angle goniometer and DSA4 software analysis. Mann-Whitney U test was applied for statistical analysis of the study. <b>Results: </b>The mean advancing angle and receding angle of Group I (Aloe vera) was smaller than Group II (Aqwet). Mean angle of hysteresis of Group I (Aloe vera) was higher than Group II (Aqwet). Mann-Whitney U test revealed that there is no significant difference in contact angles between the two groups. <b>Conclusion:</b> Wetting ability of Group I (Aloe vera) saliva substitute was found to be better compared to Group II (Aqwet) on heat-polymerized acrylic resin. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC20-ZC23&id=10036 https://doi.org/10.7860/JCDR/2017/25084.10036 Analysis of Clinical Indicators of Quality in Patients with Endotracheal intubation Sulochana Dash, Sreelatha Balasubramanian <b>Introduction:</b> Quality and safety in anaesthesia is usually monitored by analysis of perioperative mortality–morbidity and are influenced by anaesthetic and non-anaesthetic factors. <b>Aim:</b> This study was conducted to analyse the incidence of clinical indicators of quality in endotracheally intubated patients undergoing general abdominal surgeries and obstetric and gynaecological procedures under general anaesthesia and to determine contributing factors for the same. <b>Materials and Methods:</b> This retrospective study was conducted at our institute over a period of 12 months and 709 case records of patients were reviewed. Patients aged 14 years and more belonging to all ASA groups undergoing abdominal surgeries for general and obstetric and gynaecological causes under General Anaesthesia (GA) with endotracheal intubation posted for both elective and emergency surgeries were included in the study. Demographic details including name, age, sex, hospital number, height, weight, body mass index, type of surgery, nature of surgery, duration, American Society of Anaesthesiologists (ASA) physical status were recorded and presence or absence of clinical indicators of quality (presence of cannot intubate cannot ventilate scenario, occurrence of dental injury, episode of non cardiogenic pulmonary oedema, incidents of residual neuromuscular blockade, existence of aspiration pneumonia, unplanned ICU/HDU admissions, interventions for respiratory/cardiac arrest, occasions of respiratory distress in the recovery period, occurrence of respiratory arrest within 48 hours and re-intubation) were noted and analysed for all 709 patients. <b>Results:</b> Total 709 patients were analysed in our study. We found that incidence of ICU admission was 1.83% and that of respiratory distress which needed intervention were 0.56%. A total of 0.28% patients needed reintubation. Residual neuromuscular blockade was seen in 0.28% patients. We did not find any case of respiratory and cardiac arrest and also there was no Cannot Ventilate and Cannot Intubate (CVCI) situation encountered in our study. SPSS for windows (version 17.0) was used as statistical software. Chi-square test was the statistical test for significance. A p-value < 0.05 was considered significant. <b>Conclusion:</b> Proper optimization of patients prior to surgery and optimal perioperative care will result in better quality of care and safety in anaesthesia. Documentation of events and its management during perioperative period will help to know the fields of inappropriate management and thereby improve the quality of care and detect the incidence rates with accuracy and help to formulate protocol for institution. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=UC04-UC07&id=10037 https://doi.org/10.7860/JCDR/2017/25120.10037 Acute Pyelonephritis - Correlation of Clinical Parameter with Radiological Imaging Abnormalities Leelavathi Venkatesh, Ramalingiah Karadakere Hanumegowda <b>Introduction:</b> Pyelonephritis (PN) is a suppurative infection of the kidney, most commonly due to bacterial infection and may be either acute or chronic. Acute PN (APN) subdivided into uncomplicated and complicated. Severity of PN cannot be assessed by clinical or laboratorial parameters alone, radiological imaging such as Ultrasound (USG) abdomen, Computed Tomography (CT) is required to know the nature, extent and severity of disease and for planning interventions. <b>Aim: </b>The aim of this study was to compare clinical and biochemical parameters with radiological findings (USG/CT) among patients diagnosed to have PN. <b>Materials and Methods: </b>The medical records of all patients admitted with PN at the Institute of Nephrourology, Bangalore from January 2016 to December 2016 were reviewed.Their clinical and biochemical parameter were compared with radiological findings.Statistical analysis was performed with Statistical Package for the Social Sciences (SPSS) Version 15.0. <b>Results: </b>There were 100 patients diagnosed with PN in the study period. Mean age of patient was 48.7 years and PN was common among females (62%). Classical triad of PN was present in 87% of patients. Acute kidney injury was present in 47% of patients. Diabetes (69%) was the most common comorbid condition. Positive urine culture was found in 24% of patients. USG abdomen was performed in all patients and it was suggestive of APN in 66% cases. CT abdomen was available for 74% and it revealed PN in 70%, of patients. Among these Emphysematous PN (EPN) was found in 4% and renal abscess in 3% of patients.In this study, USG findings of PN were correlated with triad of PN symptoms and those who had PN for the first time. <b>Conclusion:</b> In this study, majority of the patients presented with clinical triad of PN-fever, flank pain and dysuria. Urine culture was positive only in few cases. USG was able to diagnose large number of PN cases except emphysematous change and renal abscess which was detected by CT. The detection of PN was better with CT when compared to USG. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=TC15-TC18&id=10033 https://doi.org/10.7860/JCDR/2017/27247.10033 Computed Tomographic Estimation of Relationship between Renal Volume and Body Weight of an Individual Shweta Sudhakar TaTalhar, Jwalant E Waghmare, Lipika Paul, Sushilkumar Kale, Moreshwar R Shende <b>Introduction:</b> Knowledge of normal range of size and volume of abdominal organs plays a vital role in clinical practices as various medical conditions affects the abdominal organs causing alteration in their dimensions. <b>Aim:</b> The present retrospective study was done to establish the normal range of renal volume in study population and to see the correlation between renal volume and body weight of an individual. <b>Materials and Methods:</b> Computed tomographic evaluations of kidneys were performed on 140 kidneys of 70 individuals who had undergone abdominal CT scan for indications other than renal disease. We also excluded the patients diagnosed to have renal cysts, hydronephrosis or other renal diseases on CT examination. Renal length, width and depth were measured. Renal volume of both the kidneys was calculated by formula Kidney Volume (KV) =?/6 x Renal length (L) x Renal width (W) x Renal depth (D). Various body parameters like age, weight, sex were also recorded in the data sheet. <b>Results:</b> Mean renal volume for the right kidney was 83.26±18.33 cm3 for females (33 females out of 70) and 103.92±23.27 cm3 for males (37 males out of 70). However, mean renal volume for the left kidney was 89.17±19.41 cm3 in females and 106±26.79 cm3 in males. Left renal volume was apparently more than right renal volume, though statistically insignificant. In males, mean kidney volume was found to be 104.96 cm3 whereas in females, it was found to be 86.21 cm3. Kidney volume was found to be significantly greater in males than females among study population (t=3.79, p=0.0001). Renal volume significantly correlated with age and body weight of an individual. <b>Conclusion: </b>This study is a sincere attempt to establish a normograms of renal volume in study population. For the clinical assessment of renal pathologies, knowledge of renal volume is a vital parameter. In study group, most significant parameter associated with renal volume is body weight which can be used as an adjunct while evaluating renal pathological conditions. Of all the radiological imaging techniques, abdominal coronal computed tomography scan provides most accurate renal measurements. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=AC04-AC08&id=10010 https://doi.org/10.7860/JCDR/2017/25275.10010 Prevalence of Metabolic Syndrome among Psychiatric Inpatients: A Hospital Based Study from Kashmir Tajamul Hussain, Mushtaq Ahmad Margoob, Sheikh Shoib, Mahak Shafat, Rajesh Kumar Chandel <b>Introduction:</b> Over the last fifty years there has been dramatic change in the human environment, behaviours and way-of-life. These changes have resulted in escalating rates of metabolic syndrome not only in general population but also among people with mental illness. Various factors, like the lack of exercise, use of psychotropic medications and inadequate medical care leads to the increased risk of metabolic changes among people with mental illness. Hence, there is a greater need to evaluate metabolic syndrome in this population. <b>Aim:</b> To find the prevalence of metabolic syndrome among psychiatric inpatients in Tertiary Care Hospital in Kashmir region of North India. <b>Materials and Methods:</b> It was a cross-sectional study conducted at the Institute of Mental Health and Neurosciences, Kashmir, India. A total of 213 in-patients with a primary psychiatric diagnosis as per The International Classification of Diseases, Tenth Revision (ICD 10) Classification of Mental and Behavioural Disorders criteria were evaluated for the presence of metabolic syndrome. A modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criterion for the diagnosis of metabolic syndrome was used. All the intergroup comparisons for parametric data were done by Student’s t-test, whereas non-parametric data were analysed by Chi-square tests. A p-value <0.05 was considered statistically significant. <b>Results:</b> The overall prevalence of metabolic syndrome was 34.74%.The prevalence was higher in females (43.3%) than males (28.5%) (p<0.05) and it increased with age, with the highest prevalence in the age group >50 years (p<0.05). Among the diagnostic subgroups, the prevalence was highest among patients with unipolar depression (45.0%), while it was lesser in patients with bipolar disorders (37.88%) and psychotic disorders (30.95%). Prevalence of metabolic syndrome was significantly higher (63.64%) among patients taking second generation antipsychotics (p<0.05). <b>Conclusion:</b> Our study shows that metabolic syndrome is highly prevalent among psychiatric inpatients and needs to be addressed to prevent the risk for cardiovascular diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=VC05-VC08&id=10011 https://doi.org/10.7860/JCDR/2017/25801.10011 Assessment of Dental Caries Spectrum among 11 to 14-Year-Old School Going Children in India Radhey Shyam, BC Manjunath, Adarsh Kumar, Ridhi Narang, Ankita Goyal, Ankita Piplani <b>Introduction:</b> The quantification of dental caries is usually done by DMFT index but efforts are being made to find an alternative. Caries Assessment Spectrum and Treatment (CAST) is a recent, innovative caries assessment tool which can be used in epidemiological surveys. <b>Aim:</b> To assess dental caries using CAST index among 11-14-year-old school children in Rohtak city, Haryana, India. <b>Materials and Methods: </b>A cross-sectional study was carried out among 11-14-year-old children in schools of Rohtak City using multi stage cluster sampling technique. Rohtak city was divided in to nine clusters. In the 2nd stage, one school was randomly selected from each cluster with lottery method. Finally from each selected school, every odd roll number child between age group 11-14 years, were enrolled to reach a sample of 586. Caries was recorded using the CAST index. Each child was clinically examined by a trained examiner using CAST index. Descriptive and inferential statistics were done and Chi-square test was used to find association between caries prevalence and gender. Mann-Whitney U test was used to find any difference of mean DMFT between different age groups. <b>Results:</b> A total of 586 children were examined. Prevalence of dental caries was 28.6%. Highest caries was observed in lower right first molar and lower left first molar (13.8% and 11.6%) respectively. Pulpal involvement in lower molars was found more than the upper molars. <b>Conclusion:</b> CAST index presents a simple hierarchical structure of caries spectrum and is a promising index for epidemiological studies with complex quantifiability. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC78-ZC81&id=10107 https://doi.org/10.7860/JCDR/2017/27254.10107 Effect of Pranayama on Ppar-γ, Nf-κB Expressions and Red Complex Microorganisms in Patients with Chronic Periodontitis – A Clinical Trial Jaideep Mahendra, Little Mahendra, R. Ananthalakshmi, Prathahini S Parthiban, Sandhya Cherukuri, Mohammed Junaid <b>Introduction: </b>Sudarshankriya pranayama is the control of breathing movements to regulate the energy flow throughout the body, which has shown to positively affect immune function, autonomic nervous system and psychologic-neuro pathways. The practice of pranayama has been proven to show several benefits such as reduction in stress levels, relieves anxiety and depression, increase in antioxidant levels, reduces insulin resistance and improves respiratory function. <b>Aim:</b> The objective of the study was to evaluate the levels of Peroxisome Proliferator-Activated Receptor Gamma (PPAR-&#978;), Nuclear Factor-Kappa B (NF-&#954;B) and the presence of Red Complex Microorganisms (RCM) such as Treponema denticola, Porphyromonas gingivalis and Tannerella forsythia in the subgingivalpl aque samples of chronic periodontitis subjects before and after intervention with pranayama as an adjunct to Scaling and Root Planing (SRP). <b>Materials and Methods: </b>A total of 30 subjects (control group) were treated with SRP and 30 subjects (pranayama group) underwent SRP and pranayama for three months. Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), Bleeding Index (BI) and Plaque Index (PI) were recorded and the presence of PPAR-&#947;, NF-&#954; B and RCM were assessed at baseline and after three months using polymerase chain reaction. ANCOVA test was done to compare the clinical parameters between the groups. Fishers Exact test was done to identify RCM and Mann-Whitney and Wilcoxon-signed test was used to identify the expression of NF-&#954;B and PPAR-&#947; in the plaque samples. <b>Results: </b>The change in the mean CAL from baseline to third month was significantly higher in pranayama group compared to control group (p=0.05). There was a statistically significant reduction in the expression of NF-&#954;B and increase in PPAR-&#947; expression levels in pranayama group on comparison with the control group (p<0.001). The reduction in number of positive samples with T.denticola, P.gingivalis and T.forsythia at third month post-intervention did not affect the change in the expression levels of NF-&#954;B and PPAR-&#947;. <b>Conclusion:</b> The CAL showed significant improvement with reduction in the RCM, NF-&#954;B and increase in PPAR-&#947; levels in subjects who underwent pranayama as an adjunct to SRP. In future, pranayama can be used as an additional treatment modality to provide a new dimension in treatment of periodontitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC82-ZC86&id=10108 https://doi.org/10.7860/JCDR/2017/27846.10108 Frequency of Polyneuropathy in Patients on Long Term Peritoneal Dialysis Treatment Taner Basturk, Yener Koc, Arzu Ozdemir Kayalar, Figen Yilmaz, Nuri Baris Hasbal, Tamer Sakaci, Elbis Ahbap, Abdulkadir Unsal <b>Introduction:</b> Uremic polyneuropathy is very common among patients with Chronic Kidney Disease (CKD). The patients have electrophysiologic signs of impaired nerve function, although a lower percentage of patients are symptomatic. Electrophysiological parameters are quantitative indices of Polyneuropathy (PNP) severity. <b>Aim: </b>To assess the frequency of PNP in patients on long term Peritoneal Dialysis (PD) treatment. <b>Materials and Methods:</b> Twenty three PD patients were analysed, who were receiving dialysis for at least five years and the study population divided into two groups according to duration of PD treatment. Group 1 consisted of the patients who were dialysed for at least 10 years and Group 2 consisted of patients who were dialysed for five to nine years. Patients who switched from Haemodialysis (HD) to PD and patients with coexisting diseases that could lead to disturbances in nerve conduction were excluded from the study. PNP was diagnosed when slowing of Nerve Conduction Velocity (NCV) and/or lengthening of distal latencies and/or decrease in amplitude of muscle action potential were present in two or more nerves and longer F wave response was present in one or two nerves. Carpal Tunnel Syndrome (CTS) was diagnosed if slowing of NCV and/or decrease in amplitude of muscle action potential and/or lengthening of distal latency of either sensory or motor median nerve present. <b>Results: </b>PNP was observed in 17 of the patients {73.9%; Group 1 (n=10) and Group 2 (n=7)}. Mixed type sensory motor neuropathy was diagnosed in nine patients from Group 1 and five patients from Group 2; one patient from Group 1 had demyelinating PNP affecting motor and sensory nerves; one patient from Group 2 had axonal PNP affecting motor and sensory nerves. From Group 1, two patients had CTS related to PNP and one patient had CTS without PNP. The results of motor conductivity testing showed lower conduction velocity for left popliteal nerve in Group 1 and Group 2 patients (13.85±2.17 ms, 4.80±1.11 ms, p=0.01). In both groups, mean motor and sensory latency, amplitude and velocity of other nerves were not found to be significantly different (p>0.05). <b>Conclusion:</b> PNP is a common complication in long term PD patients. Over five years of treatment, frequency of PNP and CTS do not increase with duration of dialysis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OC37-OC40&id=10101 https://doi.org/10.7860/JCDR/2017/24572.10101 An Indian Tertiary Care Hospital Scenario of Papillary Carcinoma of Thyroid Ponnuswamy Karkuzhali, Muthureddy Yogambal, Manoj Kumar <b>Introduction:</b> Thyroid carcinoma is the most common endocrine malignancy and its Papillary Histotype {Papillary Carcinoma of Thyroid (PTC)} is the most common type of Thyroid cancer. The clinicopathological features of PTC vary with geographical location. <b>Aim:</b> To describe the clinicopathological profile of PTC in a Tertiary Care Hospital located in Chennai, Tamil Nadu, India. <b>Materials and Methods: </b>Data on age, sex, centricity of the tumour, presence of calcifications, infiltration, metastasis, associated non malignant conditions and frequency of histological subtypes of all cases of PTC diagnosed in Department of Pathology, Madras Medical College Chennai, Tamil Nadu, India between January 2007 and December 2011 were obtained from clinicopathological documents and analysed statistically. <b>Results:</b> Statistically significant correlations were found between age and sex, age and metastasis, sex and centricity, sex and metastasis, size of lesion and sex, size of lesion and age, size and presence of calcifications and presence of calcifications and metastasis. <b>Conclusion:</b> Scenario of PTC in our tertiary care setup which warrants attention is male preponderance of multicentric lesions. Further, a high association with colloid nodular goitre, while low incidence of tall cell variant is notable clinico pathological scenarios in this study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=EC26-EC29&id=10095 https://doi.org/10.7860/JCDR/2017/27673.10095 To Evaluate the Effectiveness of TBTS – A Novel Device to do Self–Stretching of Gastro–Soleus Muscle in Patients with Equinus Deformity Tufail Muzaffar, Abdul Hamid Rather, Kaleem ul Haque, Sheikh Javeed Ahmad <b>Introduction:</b> Various methods have been used for management of equinus deformity. However, stretching gastroc-soleus muscle and achilles tendon is a difficult task. It is labour intensive, which makes the provision of treatment difficult for many patients. <b>Aim: </b>To study the effectiveness of Tension Bar Tendon Stretch (TBTS) compared to conventional stretching in patients with equinus deformity in terms of improvement in equinus angle and spasticity. <b>Materials and Methods:</b> A prospective randomised case control study was done on 16 patients of both the sexes in the age group four years to 56 years. Patients were stratified based on presence or absence of spasticity. Patients were further randomly allotted to the study or control group. Study group received stretching with TBTS in addition to the conventional rehabilitation programme. Patients were assessed in terms of improvement in equinus deformity and spasticity (modified Ashworth scale). These indices were measured at 0 month (pre-treatment), 1 month (post-treatment), and 6 months (follow up). <b>Results:</b> Equinus deformity in patients with spastic equinus changed from 22.4° to 12° in study group while in control group change was from 21° to 17°. The difference was statistically significant with p-value of 0.001. Non-spastic (post accidental) changed from 30° to 15° in study group while in control group change was from 31° to 23° with p-value of 0.001. Modified Ashworth Score (MAS) was assessed only in spastic equinus, while in study group MAS changed from 2.8 to 1.5 and MAS change was 2.6 to 2 in control group; this difference after six months of therapy was statistically significant with a p-value of 0.001. <b>Conclusion:</b> TBTS can be an effective tool in rehabilitation of patients having equinus deformity; it provides an effective and patient controlled stretching and no need for a physical therapist. TBTS is a novel but simple instrument that can be made locally by the patient or the family. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=YC01-YC04&id=10093 https://doi.org/10.7860/JCDR/2017/27626.10093 Focal Adhesion Kinase Expression in Ameloblastoma: A Preliminary Observational Study Snehal Patil, Gargi Sachin Sarode, Sachin C. Sarode, Rahul Anand, Shankargouda Patil <b>Introduction:</b> Focal Adhesion Kinase (FAK) is a membrane-associated molecule, which plays a major role in tumourigenesis by promoting cell survival, proliferation, migration, and invasion. Hence, FAK is a well known molecule that has been targeted therapeutically for the treatment of various malignancies. Ameloblastoma (AB) is a locally invasive, destructive and recurrent benign odontogenic lesion. Based on these properties, we have hypothesized that odontogenic epithelium of AB could show increased expression of FAK. <b>Aim:</b> To study the expression of FAK in odontogenic epithelium of AB using immunohistochemistry. <b>Materials and Methods:</b> Thirty four paraffin embedded AB and 17 Dental Follicle (DF) tissues were retrieved from archives. Immunohistochemical staining was performed using FAK antibody on 5 µm thick formalin fixed paraffin embedded sections. The expression of FAK was studied in ameloblast like cells and stellate reticulum-like cells and was graded as negative, weak and strong. The data was analysed using chi-square test and Fisher's-exact test. <b>Results:</b> In AB, both ameloblast like and stellate reticulum like cells showed positive expression of FAK in the cytoplasm in all the cases (34). The epithelial islands from all the DFs (17) were negative for FAK expression. The difference in the expression of FAK in ameloblast like and stellate reticulum like cells was statistically significant (p<0.0001). Statistically significant difference was observed in the expression of FAK in stellate reticulum like cells of AB and odontogenic epithelial islands of DF (p = 0.0017). All the AB cases showed strong expression of FAK in ameloblast like cells and negative expression was seen in all the cases of DF. <b>Conclusion:</b> FAK was strongly expressed in AB as compared to epithelial islands of DF. FAK could be responsible for the neoplastic nature of AB and possibly play a role in tumour invasiveness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC47-ZC50&id=10064 https://doi.org/10.7860/JCDR/2017/28895.10064 Comparative Assessment of Conventional Composites and Coloured Compomers in Permanent Molars of Children with Mixed Dentition: A Pilot Study Shivayogi M Hugar, Divyata Kohli, Chandrashekhar M Badakar, Supriya S Vyavahare, Parin P Shah, Niraj S Gokhale, Punit M Patel, Madhura V Mundada <b>Introduction:</b> Early treatment of carious lesions in children is important for the maintenance of oral health. Multicoloured restorations could be the impetus for an extremely nervous or defiant child to take dental treatment. <b>Aim:</b> The aim of this study was to assess and compare the clinical success of conventional composites and coloured compomer material in first permanent molars of children with mixed dentition. <b>Materials and Methods:</b> A total of sixty sites, divided into two groups, with thirty subjects in each group using split mouth design were chosen amongst patients reporting to Department of Pedodontics and Preventive Dentistry. In control group conventional composites were placed, similarly coloured compomers were placed in experimental group under standard operating protocol. Patients were recalled for assessment of clinical success amongst control as well as experimental group at regular intervals of one; three and six months follow up based on Modified Ryge’s Criteria. Statistical analysis was done using Chi-square test using SPSS version 20.0 (Chicago, USA). <b>Results:</b> Both conventional composites and coloured compomers had comparable retention rates in terms of anatomical form, marginal integrity, secondary caries and marginal discolouration. <b>Conclusion:</b> The coloured compomer material showed promising results in this six month follow up study in permanent molars and had properties comparable to that of conventional composites. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC69-ZC72&id=10083 https://doi.org/10.7860/JCDR/2017/25596.10083 Index/Ring Finger Ratio, Hand and Foot Index: Gender Estimation Tools Sonia Gupta, Vineeta Gupta, Nutan Tyagi, Ettishree, Sinthia Bhagat, Mohit Dadu, Nishita Anthwal, Tahira Ashraf <b>Introduction:</b> Gender estimation from dismembered human body parts and skeletal remains in cases of mass disasters, explosions, and assaults cases is an imperative element of any medico-legal investigations and has been a major challenge for forensic scientists. <b>Aim:</b> The aim of the present study was to estimate the gender by using index and ring finger length ratio, hand and foot index along with the correlation of both the hand and foot index to determine the vital role of all the indices in establishing gender identity. <b>Materials and Methods:</b> A descriptive cross-sectional study was done on 300 subjects (150 males and 150 females). Various anthropometric measurements like hand length, hand breadth and hand index, Index Finger Length (IFL), Ring Finger Length (RFL) and IFL/RFL ratio as well as foot length, foot breadth and foot index were estimated in millimeters (mm) with the help of a sliding-anthropometric caliper. The data was analysed using independent t-test and Pearson correlation coefficient test. A probability value (p) of < 0.05 was considered statistically significant. <b>Results:</b> The index and ring finger ratio was found to be higher in females as compared to males. The hand and foot index was more in males than in females. The index and ring finger length ratio, hand and foot index between males and females was found to be statistically significant for both hands and feet. A statistically significant correlation was determined between hand indexes versus foot index. <b>Conclusion:</b> This study can be useful to establish the gender of a dismembered hand or foot when subjected for medicolegal examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC73-ZC77&id=10084 https://doi.org/10.7860/JCDR/2017/25807.10084 Retrospective Study of Root Canal Configurations of Mandibular Third Molars Using CBCT- Part-II Pavithra Somasundaram, Manjusha Rawtiya, Shefali Wadhwani, Roshan Uthappa, Vinay Shivagange, Sheeba Khan <b>Introduction:</b> Abnormal root canal morphologies of third molars can be diagnostically and technically challenging during root canal treatment. <b>Aim:</b> The aim of this retrospective study was to investigate the root and canal morphology of mandibular third molars in Central India population by using Cone Beam Computed Tomography (CBCT) analysis. <b>Materials and Methods:</b> CBCT images of 171 mandibular third molars were observed and data regarding number of roots, number of canals, Vertucci’s classification in each root, prevalence of C shaped canal, gender and topographical relation of morphology in mandibular third molar was statistically evaluated. <b>Results:</b> Majority of mandibular third molars had two roots (84.2%) and three canals (64.3%). Most mesial root had Vertucci Type II (55.6%) and Vertucci Type IV (22.2%), distal root had Type I canals (87.5%). Over all prevalence of C shaped canals in mandibular third molars was 9.4%. <b>Conclusion:</b> There was a high prevalence of two rooted mandibular third molars with three canals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC55-ZC59&id=10072 https://doi.org/10.7860/JCDR/2017/20153.10072 Association between Single Nucleotide Polymorphisms of SMAD3 and BMP5 with the Risk of Knee Osteoarthritis Amar Chandra Sharma, Rajeshwar Nath Srivastava, Sudeepti Ratan Srivastava, Devendra Parmar, Ajai Singh, Saloni Raj <b>Introduction:</b> The role of genetic factors influencing osteoarthritis (OA) susceptibility is well documented and several candidate genes have been identified to be associated with it. Among these genes are Bone Morphogenetic Protein 5 (BMP5) and Smad family member 3 (SMAD3), all involved in Transforming Growth Factor (TGF) signaling pathway. The knee is the commonly affected joint, and knee OA has an especially high prevalence in Asian population. <b>Aim:</b> To investigate associations between Single Nucleotide Polymorphisms (SNPs) rs12901499 in SMAD3 and rs921126 in the BMP5 gene with knee OA susceptibility in and around Lucknow, Uttar Pradesh, India. <b>Materials and Methods:</b> SNPs rs12901499 in SMAD3 and rs921126 in BMP5 were genotyped in patients with knee OA and age- sex matched OA-free controls from our population. A total of 450 patients with knee OA and 458 controls were enrolled in the study. Venous blood samples were obtained from all cases as well as controls for PCR-RFLP (Polymerase Chain Reaction- Restriction Fragment Length Polymorphism). Data was collected and entered in excel sheets. Statistical analyses of the data were performed using statistical software package SPSS version 16.0. Chi-square, Student’s t-test and logistic regression tests were used to analyse the data. <b>Results:</b> GA and GG genotypes of both SNPs (rs12901499 and rs921126), and variant G, were associated with a significantly increased risk of knee OA. A significantly increased risk of knee OA was associated with the genotype GG and GA of rs12901499 (p < 0.03 and p <0.004 respectively) and rs921126 (p< 0.0001 and p<0.001 respectively) compared with the AA genotype. In addition, those bearing at least one G allele (GG + GA) had a significantly increased risk of knee OA compared with those without the G allele (AA) in rs921126 (p< 0.0001). However, in rs12901499, significant association with the risk of knee OA was not found (p<0.4). On age and gender based stratification, the association between the risk of OA and rs921126 GG mutant compared with AA homozygotes was strong in both gender (adjusted OR= 2.93 for male and 2.25 for female) and in those aged >55 years (adjusted OR= 3.4), similarly in rs12901499, GG mutant compared with AA homozygote was strong in female (adjusted OR= 1.5) and in those aged >55 years (adjusted OR= 1.5). <b>Conclusion:</b> The results showed that both in SMAD3 rs12901499 and BMP5 921126, G allele is significantly associated with knee OA. A to G change and variant G genotype may contribute to knee OA risk in our study population of Lucknow. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=GC01-GC04&id=10073 https://doi.org/10.7860/JCDR/2017/22371.10073 Photographic Assessment of Cephalometric Measurements in Skeletal Class II Cases: A Comparative Study Pooja Mehta, Roshan M Sagarkar, Silju Mathew <b>Introduction:</b> Cephalometry has many limitations of which radiation exposure is most important. Hence, there is a need to resort to other safer methods which could give equal if not better results. <b>Aim:</b> The purpose of this study was to compare and correlate the craniofacial measurements obtained from cephalometric radiographs and analogous measurements from standardized facial profile photographs in skeletal class II cases. <b>Materials and Methods:</b> A total of 30 lateral cephalograms and profile photographs of patients exhibiting skeletal class II malocclusion, in the age group of 19-25 years of age, were examined in this study using Dolphin software (version 11.8). A standardized protocol was followed for all the lateral cephalograms and photographs. A total of 15 parameters were studied in this study out of which seven were angular and eight were linear parameters. Angular parameters included Frankfort Mandibular Plane Angle (FMA), Mandibular Plane-Occlusal Plane (MP-OP) angle, Occlusal Plane (OP) angle, gonial angle, ANB angle, facial angle and convexity whereas linear parameters included Anterior Facial Height (AFH), Ramal height, Posterior Facial Height: Anterior Facial Height (PFH/AFH), convexity (in mm), Nasion perpendicular- Point A, Nasion perpendicular- Pogonion, Witts and Mandibular body length. All these parameters were digitised on both the cephalogram and photographs and were compared using one sample-2 tailed t-test, Pearson correlation coefficient. Bland-Altman Plot was considered to find comparison between the measurements from photographs and cephalograms in skeletal class II patients. <b>Results:</b> On comparing the angular cephalometric and photographic variables for the skeletal class II subjects we found the cephalometric parameters like FMA, MP-OP angle, OP, gonial angle, convexity (in degrees) to have an insignificant difference compared to the analogous photographic measurements. On comparing the linear cephalometric and photographic variables, it was found that all the cephalometric parameters like AFH, ramal height, PFH/AFH, N perp-Point A, N perp-Poghad a good relationship with the analogous photographic measurements. <b>Conclusion:</b> The photographic method can be considered as a repeatable and reproducible method if a homogeneous protocol is followed. Thus, photographic measurements may reflect to be a rational and practical diagnostic substitute to measurements obtained from cephalograms in Class II malocclusion subjects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC60-ZC64&id=10075 https://doi.org/10.7860/JCDR/2017/25042.10075 Factors Hindering Practice of Day Care Surgery in a Tertiary Care Centre in Southern India: A Patient's Perspective Chellappa Vijayakumar, Tp Elamurugan, Sundaramurthi Sudharsanan, Sadasivan Jagdish <b>Introduction:</b> Day care surgery offers cost containment, effective usage of hospital beds, reduced incidence of nosocomial infection and early recovery in home environment. In developing countries like India, there are various factors that influence the success of day care surgery. <b>Aim:</b> To assess the factors hindering the practice of day care surgery in a tertiary care centre in South India. <b>Materials and Methods:</b> This observational study was conducted in the Department of General Surgery, JIPMER, Puducherry, India, from January 2013 to March 2014. All male patients with uncomplicated inguinal hernia who were admitted for elective surgery under one particular surgery unit and who were found fit for discharge on Postoperative Day 1 (POD1) based on clinical fitness were included in the study. A questionnaire containing the patient’s acceptance decision, VAS (Visual Analogue Scale) pain score and the reason for non acceptance if any was used for assessment. <b>Results:</b> Among the 89 patients who were fit for discharge on POD1, the decision for discharge was accepted by 57 patients. 32 patients were not satisfied of the decision for discharge on POD1. The common reasons for dissatisfaction with the decision were persistent pain at operated site (13 patients with mean VAS score 8.3), non availability of health care resources in their locality (12 patients) and unwillingness to travel on POD1 (four patients). <b>Conclusion:</b> A comprehensive and well presented preoperative counselling along with an effective primary health service would help in promoting day care surgery in developing countries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PC05-PC07&id=10076 https://doi.org/10.7860/JCDR/2017/25445.10076 Stereomicroscopic Dye Leakage Measurement of Six Different Root Canal Sealers Srinidhi V. Ballullaya, Vusurumarthi Vinay, Jayaprakash Thumu, Srihari Devalla, Bollu Indira Priyadarshini, Sagarika Balla <b>Introduction:</b> Hermetic sealing of the root canal is the most desirable outcome of any root canal treatment, but almost always the filling of the root canal is defective, which is a multifactorial outcome. One such factor majorly influencing the obturation is the root canal sealer used. <b>Aim:</b> The present study was done for evaluating microleakage in different root canal sealers. <b>Materials and Methods:</b> Sixty extracted human single rooted teeeth were used in this in-vitro study. Sealers tested for microleakage in this study were zinc oxide eugenol based sealer, Sealapex, AH Plus, MTA Plus, EndoRez, Endosequence BC. All the specimens were examined under stereomicroscope for microleakage and the obtained data were statistically analysed using One-way ANOVA test and Tukey’s multiple comparision tests using the software GraphPad Prism 7.02. <b>Results:</b> The Endosequence BC group showed the least dye leakage and the highest leakage was seen in Zinc oxide Eugenol based sealer. <b>Conclusion:</b> Bio ceramic salers being hydrophilic show better sealing ability compared to resin based and eugenol based sealers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZC65-ZC68&id=10077 https://doi.org/10.7860/JCDR/2017/25780.10077 Altmetrics – A Collated Adjunct Beyond Citations for Scholarly Impact: A Systematic Review Basavaraj Patthi, Monika Prasad, Ritu Gupta, Ashish Singla, Jishnu Krishna Kumar, Kuldeep Dhama, Irfan Ali, Lav Kumar Niraj <b>Introduction:</b> In emerging figures, scholars are unifying social media tools like blogs, Twitter, and Mendeley into their professional communications. The online, open nature of these tools reveals the scholarly action to be clear and unambiguous. Metrics which is set on these activities could enlighten broader, faster measures of impact, supplementing traditional citation metrics. <b>Aim:</b> The present review aims to analyse the correlation of altmetrics with the traditional citations in medical research. <b>Materials and Methods:</b> The search strategy used a combination of controlled vocabulary and free text terms. The main database searched were PubMed, PubMed Central, Cochrane Review, Embase and Google Scholar from 2010 to 2016. Out of the total 78 titles appeared seven articles fulfilled the criteria and were selected for the review. <b>Results:</b> The positive correlation between altmetrics and traditional citations indicates that the two are not entirely different from each other and are familiar with each other. Altmetrics are usually accessible earlier and enable us to evaluate the social impact of scholarly research, almost at the actual time. <b>Conclusion:</b> Much work is needed to develop this research which will focus on the clarity of the impact signal. Thus newer dimensions, such as altmetrics and article-level metrics are an effort to explore the influence of research across the worldwide population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZE16-ZE20&id=10078 https://doi.org/10.7860/JCDR/2017/26153.10078 Immunodiagnosis of Human Fascioliasis: An Update of Concepts and Performances of the Serological Assays Bahador Sarkari, Samaneh Abdolahi Khabisi Human Fascioliasis (HF) is a foodborne neglected parasitic disease caused by Fasciola hepatica and Fasciola gigantica. New epidemiological data suggest that the endemic areas of the disease are expanding and HF is being reported from areas where it was previously not observed. Diagnosis of HF is challenging. Performances of parasitological approaches, based on the detection of parasite’s egg in the stool, are not satisfactory. Currently serological methods for the diagnosis of HF are mainly based on detection of anti-Fasciola antibodies in serum. Although, there have been some improvement in the development of immunological diagnostic tests for the diagnosis of HF, yet these tests suffer from insufficiency in sensitivity or/and specificity. Detection of antigens, rather than antibodies, seems to be a suitable approach in the diagnosis of HF. Antigen can be detected in sera or stool of the fascioliasis patients. Circulating antigen in serum disappears within a short time and most of the circulating antigens are in immune complex forms which are not freely available to be detected. Therefore, antigenemia might not be an appropriate method for the diagnosis of HF. Detection of antigen in stool (coproantigens) seems to be a suitable alternative method for the diagnosis of HF. Recent data provided convincing evidence that detection of coproantigen improved and simplified the diagnosis of HF. The present review highlights the new achievements in designing and improvement of diagnostic approaches for the immunodiagnosis of HF. Moreover, current status of the available immunodiagnostic techniques for the diagnosis of HF, their strengths and weaknesses has been discussed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OE05-OE10&id=10086 https://doi.org/10.7860/JCDR/2017/26066.10086 Oral Health and Quality of Life: Current Concepts RM Baiju, Elbe Peter, NO Varghese, Remadevi Sivaram The recognition of health related quality of life began ever since WHO expanded the definition of health in 1948. This has resulted in the paradigm shift of health and disease from a medical model to a biopsychosocial model. Oral health too denotes not merely the absence of disease but the general well being so that the person can perform functions like eating, talking and smiling and also can contribute creatively to the society. Health related quality of life is a trade-off between how long and how well people live. To explain the concept various theoretical models have been proposed, of which the conceptual model of Wilson and Cleary 1995 is a comprehensive one. Even after much research and thousands of publications the definition of oral health related quality of life is still vague. But the patient’s self perception about his oral health and related life quality are significant in clinical dental practice, dental education and research. It is widely shown that oral conditions can have varied impacts on daily living. To assess this, many measures or scales are available. They differ depending on the response format, number of items, context of use and the population in which it is applied. Patient reported outcome assessment is a less developed area in clinical dentistry and research and in future it has the potential to become the primary or secondary outcome measure in clinical interventional research. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZE21-ZE26&id=10110 https://doi.org/10.7860/JCDR/2017/25866.10110 Microleakage at the Different Implant Abutment Interface: A Systematic Review Sunil Kumar Mishra, Ramesh Chowdhary, Shail Kumari <b>Introduction:</b> Presence of gap at the implant-abutment interface, leads to microleakage and accumulation of bacteria which can affect the success of dental implants. <b>Aim:</b> To evaluate the sealing capability of different implant connections against microleakage. <b>Materials and Methods:</b> In January 2017 an electronic search of literature was performed, in Medline, EBSCO host and Pubmed data base. The search was focused on ability of different implant connections in preventing microleakage. The related titles and abstracts available in English were screened, and the articles that fulfilled the inclusion criteria were selected for full text reading. <b>Results:</b> In this systematic review, literature search initially resulted in 78 articles among which 30 articles only fulfilled the criteria for inclusion and were finally included in the review. Almost all the studies showed that there was some amount of microleakage at abutment implant interface. Microleakage was very less in Morse taper implants in comparison to other implant connections. Majority of studies showed less microleakage in static loading conditions and microleakage increases in dynamic loading conditions. <b>Conclusion:</b> External hexagon implants failed completely to prevent microleakage in both static and dynamic loading conditions of implants. Morse taper implants were very promising in case of static loading and also showed less microleakage in dynamic loading conditions. Torque recommended by manufacturer should be followed strictly and zirconia abutments were more prone to microleakage than titanium abutments and should be avoided. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZE10-ZE15&id=10054 https://doi.org/10.7860/JCDR/2017/28951.10054 Kimura’s Disease without Peripheral Eosinophilia: An Unusual and Challenging Case Simulating Venous Malformation on Imaging Studies-Case Report and Review of literature Vivek Dokania, Digvijay Patil, Ketan Agarwal, Prajakta Thakur, Piyush Prajapati Kimura’s Disease (KD) is a rare chronic inflammatory disorder presenting as multiple painless solitary subcutaneous nodules, predominantly in the head and neck region and frequently associated with regional lymphadenopathy and/or salivary gland involvement. Because of painless nature and indolent course, there is usually a delay in the patient’s presentation. KD may radiologically mimic other chronic inflammatory conditions like tuberculosis, vascular malformations and neoplasms. Clinical correlation and histological evaluation along with elevated peripheral eosinophil and serum IgE level are considered important for confirmatory diagnosis. We report a case of painless swelling over right submandibular region extending to the right superficial parotid. The haematological reports were within normal limits. Ultrasound (USG), Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiogram (MRA) favoured a diagnosis of venous malformation. However, histopathological examination of excised lesion confirmed a diagnosis of KD. This case proves the possibility of the KD even in the absence of peripheral eosinophilia and/or elevated serum IgE level, and may mimic venous malformation on imaging studies. Therefore, KD must find a place in the differentials of solitary painless neck swelling even in the absence of peripheral eosinophilia and/or elevated IgE level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ME01-ME04&id=10063 https://doi.org/10.7860/JCDR/2017/28603.10063 Role of Endocannabinoids on Neuroinflammation in Autism Spectrum Disorder Prevention Syed Shahid Habib, Khalid Al-Regaiey, Shahid Bashir, Muhammad Iqbal Autism Spectrum Disorder (ASD) disease has become a mounting socio-economical alarm around the world. Neuroinflammtion had been shown in postmortem brain specimens from ASD patients. The Endocannabinoids System (ES) consists of a family of locally produced, short-lived, endogenous, phospholipid-derived agonists (endocannabinoids) that control energy balance and body composition. The growing number of medical benefits of ES, such as their ability to regulate processes like neuroinflammation, neurogenesis and memory, raise the question of their potential role as a preventive treatment of ASD. To test this hypothesis, basic and clinical studies allow us a thorough investigation of the role of ES in the pathogenesis of ASD. This hypothesis will help to understand the mechanism of ES and its role in ASD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=CE01-CE03&id=9969 https://doi.org/10.7860/JCDR/2017/23862.9969 Phytotherapy in Streptococcus agalactiae: An Overview of the Medicinal Plants Effective against Streptococcus agalactiae Somayeh Delfani, Mahmoud Bahmani, Reza Mohammadrezaei-Khorramabadi, Mahmoud Rafieian-Kopaei Streptococcus agalactiae is a spherical and Gram-positive bacterium that causes postpartum sepsis, endometritis, chorioamnionitis and premature delivery in pregnant women. The use of herbs and natural ingredients for the treatment of various disorders has been common. The present review is a report on the medicinal plants with anti-Streptococcus agalactiae effects. In this review, the search was carried out in Web of Science, PubMed, Scopus, Google Scholar and Science direct by keywords such as bacteria, Streptococcus agalactiae and medicinal plants. According to the search results, 10 medicinal plants are used as anti-bacterial against Streptococcus agalactiae. Results of this study suggest that the active ingredients listed in this review paper used for pharmacological studies on Streptococcus agalactiae so it can produce effective natural antibiotic for the future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DE01-DE02&id=9988 https://doi.org/10.7860/JCDR/2017/25530.9988 Basic Concepts and Clinical Outcomes of Drug-eluting Balloons for Treatment of Coronary Artery Disease: An Overview Ramakrishna C. D., Bhargav A. Dave, Pankaj S. Kothavade, Kajal J. Joshi, Ashok S. Thakkar The technology of percutaneous coronary intervention for atherosclerotic coronary artery disease has evolved considerably since its inception. Though Drug-Eluting Stent (DES) reduces the rate of restenosis, long-term safety outcomes and persistent restenosis in complex lesion subset remain area of concern. Recently, Drug-Eluting Balloon (DEB) represents a novel treatment strategy for atherosclerotic coronary artery disease. DEB demonstrated its added value in preclinical studies. Inspired by these results, several clinical trials particularly in complex lesion subsets have been started to explore the value of this novel treatment strategy in a broader range of lesions. This review would summarise material compositions and different characteristics and clinical outcomes of currently available DEB. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OE01-OE04&id=10000 https://doi.org/10.7860/JCDR/2017/26321.10000 Death Rate of Dental Anaesthesia Hamed Mortazavi, Maryam Baharvand, Yaser Safi Death was the most important side effect of anaesthesia in dentistry. In this article we reviewed more than 20 studies with adequate data focusing on death associated with dental procedures since 1955 and found 218 deaths out of 71,435,282 patients (3 deaths per 1,000,000 persons) with the mortality rate of 1:327,684. In addition, mortality rate per million has dropped to half (6.2 per 1,000,000 vs. 3 per 1,000,000) since 1955 till the last report in 2012 without any sex predilection. In children, most cases died in the age of two to five years. Hypoxia was the most common cause of death, and cardiovascular, respiratory, and endocrine disorders, hepatic cirrhosis, septicaemia, and bacterial endocarditis were the most frequent underlying systemic disease in deceased patients. Although rare death following general anaesthesia in dentistry, is a critical side effect mostly seen in patients with compromised health condition. Therefore, appropriate case selection in regard with patients’ general health status as well as standard technical and equipment conditions are mandatory to diminish the risk of death during dental anaesthesia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZE07-ZE09&id=10009 https://doi.org/10.7860/JCDR/2017/24813.10009 Analysis of Survival Data: Challenges and Algorithm-Based Model Selection Kaushik Sarkar, Ranadip Chowdhury, Aparajita Dasgupta Survival data is a special form of time to event data that is often encountered while modelling risk. The classical Cox proportional hazard model, that is popularly used to analyse survival data, cannot be used for modelling risk when the proportional hazard assumption is violated or when there is recurrent time to event data. In this context we conducted this narrative review to develop an algorithm for selection of advanced methods of analysing survival data in the above-mentioned situations. Findings were synthesized from literature retrieved from searches of Pubmed, Embase, and Google Scholar. Existing literature suggest that for non-proportionality, especially due to categorical predictors stratified Cox model may be useful. An accelerated failure time model is applicable in case of different follow-up time among different experimental groups and the median time to event is the outcome of interest instead of hazard. Extended Cox models and marginal models are used in case of multivariate ordered failure events and the type of model depends upon the presence of clustering and nature of ordering. In the presence of heterogeneity, a shared frailty model is used that is analogous to mixed models. More advanced models, including competing risk and multistate models are required for modelling competing risk, multiple states and multiple transitions. Joint models are used for multiple time dependent outcomes with different attributes. We have developed an algorithm based on the review for appropriate model selection to curb the challenge of modeling survival data and the algorithm is expected to help the naïve researchers in analysing survival data. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=LC14-LC20&id=10019 https://doi.org/10.7860/JCDR/2017/21903.10019 Drug Resistance Pattern in the Recent Isolates of Salmonella Typhi with Special Reference to Cephalosporins and Azithromycin in the Gangetic Plain Shesh Raj Patel, Sujit Bharti, Chandra Bhan Pratap, Gopal Nath <b>Introduction:</b> Typhoid fever is an endemic disease in India against which many antibiotics are available. In the recent times, emerging resistance to traditional antibiotics, such as Ampicillin, Chloramphenicol and Trimethoprim/sulfamethoxazole, Azithro-mycin and third generation Cephalosporins are being reported and increasingly being used in the treatment of invasive Salmonella infections. However, the latter two drugs have been reported with occasional clinical failures. Currently, we do not have data regarding their drug resistance levels in the recent isolates of Salmonella enterica subspecies enterica serotype Typhi. <b>Aim:</b> To determine the current levels of drug resistance of the two drugs (i.e., cephalosporins and azithromycin) against S. Typhi isolates. <b>Materials and Methods:</b> It is a prospective case study. A total of 47 recent strains of S. Typhi were isolated from blood and stool specimens. These isolates were subjected to identification and confirmation by biochemical, serological tests followed by genotypic methods. The antimicrobial testing was done by disc diffusion and Minimum Inhibitory Concentration (MIC) methods for various in use antibiotics including ceftriaxone and azithromycin from February 2011 to March 2013 in the Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India. <b>Results:</b> It was intriguing to see the return of conventional drugs such as chloramphenicol, amoxicillin and co-trimoxazole. The drugs like quinolones, ceftriaxone and azithromycin were found to be ineffective against >20% of the isolates. However, nalidixic acid was found to have maximum resistance (36/47,76.6%) while highest sensitivity was observed for chloramphenicol (1/47,2.1%). Moreover, co-trimoxazole (9/47,19.1%) has displayed with significant come back. <b>Conclusion:</b> It could be concluded that combination of amoxicillin and co-trimoxazole would prove as good as azithromycin or ceftriaxone alone for empirical therapy of S. Typhi infection. However, detection of an isolate (1/47, 2.1%), sensitive only to chloramphenicol, a drug known for causing bone marrow suppression, is an alarming sign. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=DM01-DM03&id=9973 https://doi.org/10.7860/JCDR/2017/23330.9973 Immediate Effects of Paraspinal Dry Needling in Patients with Acute Facet Joint Lock Induced Wry Neck Sukumar Shanmugam, Lawrence Mathias <b>Introduction:</b> Acute facet joint lock induced wry neck (AFJL-WN) is common among adult population and it is primarily managed by medications and physiotherapy. However, the immediate recovery from pain and movements restriction caused by AFJL-WN is not documented in favour of existing interventions. <b>Aim:</b> To evaluate the immediate effects of paraspinal dry needling (PSDN) on acute neck pain and movement deficit in patients with AFJL-WN. <b>Materials and Methods: </b> A total of 21 patients with AFJL-WN were treated with single session of PSDN for 12-15 minutes. The Visual Analog Scale (0-100mm) and Hand Held Goniometer were used to assess the immediate, 24 hours and 1 week follow-up neck pain and cervical spine’s range of motion respectively. The mean and standard deviation was used to make inferences. <b>Results:</b> Immediately after PSDN the pain score was reduced and cervical spine range of motion have improved. The 24 hours and 1 week follow-up pain and range of motion scores have shown the sustained improvement without deteriorations. <b>Conclusion:</b> PSDN is effective method to achieve pain free neck movements in patients with AFJL-WN. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=YM01-YM03&id=10079 https://doi.org/10.7860/JCDR/2017/26407.10079 Clinical Significance of the Forsaken aVR in Evaluation of Tachyarrhythmias: A Reminder Dharmendra Jain, Pradeep Nigam, Manoj Indurkar, Riyas Chiramkara <b>Introduction:</b> Mechanism of a regular, monomorphic Wide QRS Complex Tachycardia (WCT) is an important diagnostic challenge in day to day practice for the clinicians and affects further management and prognosis. Many of the WCT and Narrow Complex Tachycardia (NCT) produce certain characteristic changes in lead aVR by which we can differentiate between them. <b>Aim:</b> The present study was aimed to evaluate tachyarrhythmias in relation to lead aVR and to highlight the clinical significance of lead aVR, “The Neglected Lead”. <b>Materials and Methods:</b> This is prospective study in which 55 consecutive cases of tachyarrhythmias excluding sinus tachycardia, atrial fibrillation and atrial flutter were taken for the study admitted in from ICCU of Department of Medicine at S.S. Medical College and S.G.M. Hospital Rewa (M.P.), India, during July 2014 to September 2015, fulfilling the required study protocol. The data was collected regarding detailed history, physical examination; necessary investigations (including ECG and echocardiography) were done. <b>Results:</b> Among 55 patients, 30 were of WCT and 25 were of NCT. The most common cause of WCT was Ventricular Tachycardia (VT) (83.3%) and rest were Supra Ventricular Tachycardia (SVT) with aberrancy (16.7%). The most common cause of NCT was Atrioventricular Nodal Tachycardia (AVNRT) (84%) followed by Atrioventricular Reciprocating Tachycardia (AVRT) (16%). The present study observed that 38.1% of the AVNRT cases and 50% of AVRT cases showed positive ‘p’ wave in lead aVR. The present study observed that 75% cases of AVRT showed ST segment elevation in lead aVR while only 33.3% cases of AVNRT showed ST elevation. In the present study 80% of the patients with WCT were diagnosed to have VT using Brugada algorithm while using Vereckei’s new aVR algorithm, 83.3% were diagnosed to have VT. <b>Conclusion:</b> Lead aVR, one of the most neglected leads on 12 lead ECG, is a very important diagnostic tool for identification and categorization of different type of tachyarrhythmias. The presence of ST elevation in lead aVR on ECG showing NCT is relatively sensitive for diagnosing AVRT. New aVR algorithm by Vereckei is more sensitive for differential diagnosis of WCT. One should pay careful attention to lead aVR which provides essential diagnostic information. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OM01-OM04&id=10138 https://doi.org/10.7860/JCDR/2017/29194.10138 Whole-Exomes Sequencing Delineates Gene Variants Profile in a Young Saudi Male with Familial Hypercholesterolemia: Case Report Edem Nuglozeh Familial hypercholesterolemia is an autosomal dominant genetic disease characterized by earlier elevated Low-Density Lipoprotein (LDL) cholesterol levels and increased risk for premature Myocardial Infarction (MI). Albeit the diagnosis of some medical Familial Hypercholesterolemia (FH) cases are due to mutations in PCSK9, APOB, or LDLR, detection of mutation rate and profiles relies heavily on different gene pools and ethnicity. We ran exome sequencing on blood genomic DNA (gDNA) from a 26-year-old Saudi patient on Ion Proton Platform (Ion Torrent, Guilford, Connecticut, USA) as part of a pilot study preluding the establishment of the Saudi Human Genome project. The sequencing results were analysed using Ion suit Bioinformatics system. The patient was matched with a lady of lean body mass and Welsh descent, who suffered from hypercholesterolemia. The first analysis of known FH genes identified five mutations in APOB, 25 mutations of known genes linked to FH, six mutations in LPR2, one mutation in LDLR, and three mutations in PCSK9. Finally, using disease filter algorithms, we filtered out more than 2000 intronic synonymous variants with likely no biological functions. No major new locus was found in FH. However, via variant reduction and TVC protocols we detected 15 new variants, among which 14 genes are linked to hypercholesterolemia, type-I, and type-II diabetes. We also detected three mutations in PCSK9 and confirmed one by Sanger. Taken together, this report suggests that the genetic determinant of FH in this Saudi patient is likely to be heterogeneous, complicating the diagnostic and novel gene discovery process. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=GD01-GD06&id=10143 https://doi.org/10.7860/JCDR/2017/28156.10143 Bilateral Giant Juvenile Fibroadenoma of Breast Nikhil Makkar, Sumitoj Singh, Surinder Paul, Mandeep Singh Sandhu, Ashok Kumar Fibroadenomas are benign lesions of breast commonly found in young age group. These focal tumours contain both mesenchymal and glandular tissue. Giant juvenile fibroma of breast is rare variant of fibroadenoma found usually in less than 20 years of age. They present with rapid enlargement of single or multiple, discrete, painless large nodule of breast. A 14-years-old premenarche girl presented with large bilateral breast lumps for two months. FNAC showed features of juvenile fibroadenoma. Breast conserving surgical excision of lumps was performed and histopathology confirmed the diagnosis of juvenile fibroadenoma. Giant juvenile fibroadenomas are characterised by rapid enlargement of encapsulated mass. The aetiology is unknown, although end-organ hypersensitivity to normal level of estrogen is postulated. We present a case of bilateral giant juvenile fibroadenoma for its rarity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED10-ED12&id=10081 https://doi.org/10.7860/JCDR/2017/21136.10081 Upper Gastrointestinal Bleed as a Manifestation of Poorly Differentiated Metastatic Squamous Cell Carcinoma of the Lung Richa Bhardwaj, Gaurav Bhardwaj, Arun Gautam, Raffi Karagozian Gastrointestinal (GI) metastasis from primary lung cancer is a rare clinical finding. Lung cancer most often metastasizes to the brain, bone, liver, and adrenal glands; with gastrointestinal involvement being very rare. We report a case of a 39-year-old female with a diagnosis of poorly differentiated Squamous Cell Carcinoma (SCC) of the lung presenting with dizziness and melena . Esophagogastroduodenoscopy (EGD) showed a bleeding mass in the stomach. Final biopsy report and Immunohistochemistry (IHC) of the specimen were consistent with SCC lung metastasis. While it is imperative to have a high clinical suspicion for GI metastasis in patients with primary lung cancer presenting with GI symptoms, it may be challenging to establish diagnosis. Endoscopy along with pathology and immunohistochemistry play a crucial role in differentiating primary GI malignancies from metastasis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=OD13-OD14&id=10090 https://doi.org/10.7860/JCDR/2017/27040.10090 Idiopathic Tumoral Calcinosis – Rare Clinico Pathological Entity: A Report of Two Cases Sreedevi Jakka, Radhika Narayan, Minakshi Mishra, Farah Rana, J.K.Laik Tumoral calcinosis is a rare disease reported mainly in blacks of tropical and subtropical African regions. It is characterized by tumour-like periarticular deposits of calcium that are found in the regions of the hip, shoulder, elbow and small joints of hands and feet. The involvement of this disease in a healthy patient is extremely rare in young and middle aged individuals. We are presenting two cases with large, painless periarticular swellings in subscapular joint and feet. First case presented with recurrent swelling in different anatomical locations at different time intervals involving the hip and followed by shoulder joint. Second case presented with swelling around the ankle joint. These two cases were diagnosed as Idiopathic tumoral calcinosis based on biochemical, radiological and histopathological findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED06-ED07&id=10070 https://doi.org/10.7860/JCDR/2017/26779.10070 Mastoid Osteoma of Temporal Bone – A Rare Case Report Rahul Kumar Singh, Amit Goyal, Amit Kumar, Gaurav Kataria, Amber Kesarwani Osteomas of the temporal bone are rare entity with incidence of 0.1% - 1% of all benign tumours of skull. They are slow growing benign lesion of temporal bone. We report a rare case of mastoid osteoma of size more than 5 cm. A 40-year-old female patient presented to us with left post auricular bony swelling of size greater than 5 cm. Diagnosis of mastoid osteoma was made after relevant investigations including High Resolution Computed Tomography (HRCT) temporal bone. Complete surgical excision was done with good cosmetic outcome without recurrence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=MD01-MD02&id=9966 https://doi.org/10.7860/JCDR/2017/24897.9966 Page Kidney in Wunderlich Syndrome Causing Acute Renal Failure and Urosepsis: Successful Timely Minimally Invasive Management of a Devastating Clinical Entity Sundaramoorthy VijayGanapathy, Vilvapathy Senguttuvan Karthikeyan, Ashwin Mallya, Jayaram Sreenivas Wunderlich Syndrome (WS) is an uncommon condition where acute onset of spontaneous bleeding occurs into the subcapsular and perirenal spaces. It can prove fatal if not recognized and treated aggressively at the appropriate time. A 32-year-old male diagnosed elsewhere as acute renal failure presented with tender left loin mass, fever and hypovolemic shock with serum creatinine 8.4 mg/dl. He was started on higher antibiotics and initiated on haemodialysis. Ultrasonogram (USG), Non-Contrast Computed Tomography (NCCT) and Magnetic Resonance Imaging (MRI) showed bilateral perirenal subcapsular haematomas – right 3.6 x 3.1 cm and left 10.3 x 10.3 cm compressing and displacing left kidney, fed by capsular branch of left renal artery on CT angiogram. Initial aspirate was bloody but he persisted to have febrile spikes, renal failure and urosepsis and he was managed conservatively. Repeat NCCT 10 days later revealed left perinephric abscess and Percutaneous Drainage (PCD) was done. Patient improved, serum creatinine stabilized at 2 mg/dl without haemodialysis and PCD was removed after two weeks. To conclude, bilateral idiopathic spontaneous retroperitoneal haemorrhage with renal failure is a rare presentation. This case highlights the need for high index of suspicion, the role of repeated imaging and successful minimally invasive management with timely PCD and supportive care. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=PD03-PD04&id=9963 https://doi.org/10.7860/JCDR/2017/24731.9963 Aggressive Angiomyxoma in Males Priyadarshini Dehuri, Debasis Gochhait, BH Srinivas, Sarath Chandra Sistla Paratesticular aggressive angiomyxoma is a very rare tumour in males. Most of documented cases of aggressive angiomyxomas have been seen in genital, perineal and pelvic regions in women of child bearing age. We report two cases of aggressive angiomyxomas in males who presented with inguinal swellings. A globular mass with greyish white, glistening cut surface was received after excision of the mass. Microscopic examination revealed a paucicellular tumour comprising of spindle shaped cells along with vessels of varying calibre. The accompanying stroma was myxocollagenous. In addition there was evidence of fat infiltration in one of the cases. Immunohistochemical staining showed CD34, desmin, vimetin positivity and negative staining for S100, actin, Estrogen Receptors (ER) and Progesterone Receptors (PR). The microscopic and immunohistochemical features favoured the diagnosis of aggressive angiomyxoma. This report of angiomyxoma in two cases of males assumes great significance in view of the extreme rarity of the tumour in males and its locally infiltrative nature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ED01-ED03&id=9960 https://doi.org/10.7860/JCDR/2017/26738.9960 Familial Cancers of Head and Neck Region Reshma Venugopal, Radhika Manoj Bavle, Paremala Konda, Sudhakara Muniswamappa, Soumya Makarla Cancers that occur in families more often than would be expected by chance are termed as familial cancers. They occur due to an inherited genetic mutation and account for 5%-10% of all cancers. This review article presents some of the common Familial Cancer Syndromes (FCS) such as MEN 2B, hyperparathyroidism-jaw tumour syndrome, familial oral squamous cell carcinoma, melanoma, nasopharyngeal carcinoma, paraganglioma, neurofibroma and other syndromes associated with head and neck region. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZE01-ZE06&id=9967 https://doi.org/10.7860/JCDR/2017/25920.9967 Effect of Fluoxetine on the Hippocampus of Wistar Albino Rats in Cold Restraint Stress Model Saikarthik Jayakumar, Gunapriya Raghunath, Saraswathi Ilango, J Vijayakumar4, R Vijayaraghavan <b>Introduction: </b>Stress has been known to be a potential modulator of learning and memory. Long term stress can lead to depression. Fluoxetine is a selective serotonin reuptake inhibitor group of drug used in the treatment of depression. <b>Aim: </b>The present study was conducted to evaluate the potential of Fluoxetine on cold restraint induced stress in the hippocampus of Wistar rats. <b>Materials and Methods: </b>A total of 18 male wistar albino rats were divided randomly into three groups (n=6). Group 1 was the control group which were kept in normal laboratory conditions. Group 2 was the negative control group which were given cold restraint stress for period of four weeks. Group 3 was the experimental group, where the animals were pretreated with fluoxetine 10 mg/kg for a period of one week followed by cold restraint stress for 30 minutes and cotreated with fluoxetine 10 mg/kg for a period of four weeks. The whole study was done for a period of five weeks followed by behavioural studies and subsequently sacrificed with removal of brain for various histological, Immunohistochemical (IHC), neurochemical and antioxidant analysis. The values were expressed as Mean±SEM. One-way analysis of variance followed by Tukey’s multiple comparisons test was used for the comparison of means. A probability of 0.05 and less was taken as statistically significant using Prism Graphpad software version 6.01. <b>Results:</b> The results show there was significant improvement in the Morris water maze test after treatment with fluoxetine in Group 2. Similar results were also noted in the levels of neurotransmitters and antioxidant levels in brain and also in the number of cells counted in IHC and histological studies by H&E when Group 3 was compared with Group 2. The treatment reversed the damage in Group 2 which was comparable with the control group. <b>Conclusion:</b> The results revealed that administration of fluoxetine 10 mg/kg given orally has a potential antistressor effect by improving the neurogenic and neuroprotective effect on the cold restraint stress induced hippocampal damage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=AF01-AF06&id=9953 https://doi.org/10.7860/JCDR/2017/26958.9953 Clinician Corner– A Simple and Efficient Modified Goshgarian Arch (“T” Arch) Appliance for Correcting Single Tooth Scissor Bite Vikram Rajendra Pagar Patatil, N G Toshniwal, Sayali Vikram Pagar Patatil, Pawankumar Dnyandeo Tekale, Harshal Ashok Patil Scissor bite is a rare form of malocclusion that is often accompanied by varying degrees of facial asymmetry. Correction and treatment of scissor bite in posterior teeth is a challenging job for an orthodontist. There are several treatment options for correction of scissor bite in posterior teeth but some have their own ill-effects on the dentition thus contributing further to the problem and some require patient compliance which compromises the outcome of the treatment. Therefore to overcome these drawbacks we have designed a new appliance to correct the molar scissor bite. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZH01-ZH02&id=9959 https://doi.org/10.7860/JCDR/2017/25938.9959 A Rare Case of Bi-rooted Deciduous Canine Shrestha Shukla, Aarti Garg, Ravinder Garoo https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZJ03-ZJ04&id=10144 https://doi.org/10.7860/JCDR/2017/24569.10144 Correction: 2016 Nov:10(11): CC09-CC13 <b>Hanjabam Barun Sharma, Jyotsna Kailashiya,</b> Gender Difference in Aerobic Capacity and the Contribution by Body Composition and Haemoglobin Concentration: A Study in Young Indian National Hockey Players. (Published in Journal of Cilinical and Diagnostic Research. 2016 Nov:10(11): CC09 - CC13. In this article, typographical error was present in table/figure 3 and Results last line of paragraph 3. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=11&issue=6&page=ZZ02-ZZ02&id=10202 https://doi.org/10.7860/JCDR/2017/.10202 Retracted: 2015 Jan:9(1): TC13-TC16 <b>Fahad Mohammed Ali AlShehri,</b> Comparative Study of Pineapple Juice as a Negative Oral Contrast Agent in Magnetic Resonance Cholangiopancreatography. (Published in Journal of Cilinical and Diagnostic Research. 2015 Jan: 9(1)): TC13-TC16. This article has been retracted by the editorial due to high plagiarism content(including 1 image) and failure of author to provide data to support the study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2017&month=June&volume=&issue=&page=ZZ01-ZZ01&id=10071 https://doi.org/10.7860/JCDR/2017/.10071