Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Primary Iliopsoas Abscess Caused by <i>Salmonella paratyphi</i> A-A Rare Case Aniruddha Bhosale, Sanjay Kolte Salmonella paratyphi A is a gram negative bacillus causing enteric fever. Although it can cause other systemic pathologies, localised infections in the form of abscess are rare. In literature hepatic, splenic, thyroid, renal, ovarian, psoas abscesses have been reported to be caused by Salmonella paratyphi. Iliopsoas abscesses mentioned in literature were associated with osteomyelitis, septic arthritis or other local pathologies. No case of Primary Iliopsoas Abscess (IPA) caused by Salmonella paratyphi A is mentioned in literature. We present a case of primary iliopsoas abscess, which was caused by Salmonella paratyphi A. Abscess was drained and antibiotics were started according to sensitivity report with complete recovery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=PD03-PD04&id=12083 https://doi.org/10.7860/JCDR/2018/37207.12083 Laparoscopic Simple Nephrectomy in a Severe Kyphoscoliotic Patient Sandeep Gupta, Alankar Jaiswal, Dilip Kumar Pal Laparoscopic surgery in patients with spinal deformity are always challenging to surgeons due to unpredictable position of viscera inside abdomen and lack of working space within the abdomen. We are reporting a case report of laparoscopic simple nephrectomy in a patient with severe kyphoscoliosis who presented with symptoms of flank pain and imaging showed non-functioning kidney. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=PD01-PD02&id=12080 https://doi.org/10.7860/JCDR/2018/37142.12080 A Rare Cause of Ophthalmia Neonatorum-<i>Achromobacter denitrificans</i> Viraraghavan Vadakkencherry Ramaswamy, Gajanan Venkat Rao, N Suryanarayana A 72-hour-old neonate presented with lethargy and eye discharge. Keratitis and corneal ulceration was present on the left side. Work up revealed early onset sepsis with meningitis and keratoconjunctivitis. A rare organism Achromobacter denitrificans was isolated from the blood and the eye discharge. This is the first case report of Achromobacter denitrificans causing early onset sepsis and keratoconjunctivitis in a neonate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=SD01-SD02&id=12112 https://doi.org/10.7860/JCDR/2018/37366.12112 Postpartum Page Kidney Secondary to HELLP Syndrome Sheshang Uday Kamath, Bhushan Patil, Sujata Kiran Patwardhan Page Kidney is a unique clinical entity causing hypertension secondary to external renal compression. We report the case of a female patient who was antenatally diagnosed to have HELLP syndrome and subsequently developed a spontaneous subcapsular haematoma causing Page kidney that was promptly diagnosed and managed in the postpartum period. A 30-year-old female patient presented to the emergency department with chief complains of pain in the right lumbar region and intermittent high grade fever since 10 days. Patient was 20 days post-partum and presented with hypertension. An ultrasound of the abdomen and CECT abdomen was done to evaluate the cause for tenderness and to our surprise there was a subcapsular haematoma measuring 8×5×3 cm compressing the right kidney. An open exploration for evacuation of haematoma was done. Acute kidney injury with HELLP syndrome is a known entity however; renal subcapsular haematoma secondary to low platelets is a rare finding. A high index of suspicion is essential to timely diagnose Page kidney. Page kidney as mentioned in previous literature and as observed in this case report is a reversible cause of hypertension and a low threshold for capsulotomy and drainage of the haematoma with optimal post-operative management of this condition would prevent long term sequela of hypertension among young patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=PD05-PD06&id=12113 https://doi.org/10.7860/JCDR/2018/37371.12113 “Mesiodentes-A Common Supernumerary in a Unique Appearance”: A Case Report and Literature Review Suma Sogi, Deepika Patidar, Dinesh Chand Patidar, Priyanka Prasad Mesiodens is the most common form of supernumerary teeth. When mesiodens erupt in multiples, either labial or palatal to permanent central incisor, it presents a rare condition “Mesiodentes”. This case report demonstrates the presence of erupted double mesiodens giving an unaesthetic appearance in a non-syndromic 10-year-old male patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZD01-ZD03&id=12115 https://doi.org/10.7860/JCDR/2018/37467.12115 A Rare Combination of Genitourinary Vascular Anomaly Rohini Arathala, Vishwajit Ravavindra Deshmukh, S Nagaraj, Hemanth Kommoru, K Ariyanachi Vascular anatomy of the genitourinary system is essential to understand the complications related to surgeries, as it may influence the blood flow to the kidney and to the gonads. In the present case report, arterial and venous variations were presented in the kidney. The inferior polar artery to the kidney was seen to arise from the aorta on the left side and the left testicular artery was one of the branches from the inferior polar artery. On the right side, duplication of renal veins was present and right gonadal vein was draining into the accessory renal vein, instead of inferior vena cava. Knowledge regarding such variations is of much use for the vascular surgeries in the retroperitoneal region and during the transplantation surgeries. Sometimes, these accessory arteries may compress renal pelvis, causing hydronephrosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=AD01-AD03&id=12133 https://doi.org/10.7860/JCDR/2018/36655.12133 Intraoperative Rupture of Hydatid Cyst Membrane: A Flexible Rhino-laryngoscope Innovation to the Rescue Nishant Sahay, Umesh Kumar Bhadani, Poonam Kumari The present case report describes a catastrophe avoided during operative removal of hydatid cyst located in the lower lobe of left lung. The intrabronchial hydatid cyst membranes ruptured intraoperatively and were aspirated in the bronchi. The aspiration caused collapse of left upper lobe of lung. In the absence of flexible fibre optic or rigid bronchoscope for airway management, this potentially dangerous condition was diagnosed and successfully managed innovatively using a rhino-laryngoscope. An improvised arrangement using a paediatric suction catheter with its distal end cut and secured by adhesive paper to a rhino-laryngo fibrescope was made. This arrangement of suction catheter attached to a rhino-pharyngo-laryngoscope was then used to remove more than four pieces of membranes of hydatid cyst under direct vision from the tracheobronchial tree preventing an airway catastrophe. The case report thus highlights importance of quick thinking and effective resource management even in resource limited settings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=UD01-UD02&id=12136 https://doi.org/10.7860/JCDR/2018/31450.12136 Septic Arthritis of Shoulder Joint an Unusual Complication of Acute Cholangitis Sudhir Maharshi, Shyam Sunder Sharma, Vaibhav Jain, Bharat Sapra Acute cholangitis manifest as jaundice, abdominal pain and fever. Patients of severe acute cholangitis may develop septic shock, altered sensorium and later may progress to multiorgan failure. Septic arthritis of shoulder joint usually develops due to septicaemia, direct inoculation or because of direct spread of infection from adjacent tissue. There is no reported case of septic arthritis of shoulder joint, secondary to acute cholangitis in literature. Herein, we are reporting a first of its kind case of septic arthritis of left shoulder joint secondary to complication of acute cholangitis, which was managed successfully with antibiotics and arthroscopic debridement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OD06-OD07&id=12141 https://doi.org/10.7860/JCDR/2018/37598.12141 First Successful Use of Low Dose Amoxicillin-Clavulanic Acid in Management of Drug Resistant Tuberculosis Gyanshankar Mishra, Jose A Caminero Resistance to anti-tuberculosis drugs is a formidable obstacle to effective tuberculosis (TB) care. A case of Pre-XDR (Pre-Extensive Drug Resistant) pulmonary TB was reported with limited therapeutic options, where low dose amoxicillin-clavulanic acid was used as an integral component of a successful regime for the first time in medical literature. World health organisation recommends giving amoxicillin-clavulanate along with meropenem as one of the therapeutic options in drug resistant tuberculosis, where clavulanate and not amoxicillin is being relied upon for anti TB activity. However, across the spectrum of dosage of amoxicillin-clavulanate combination, the dose of clavulanate is constant at 125 mg, whereas the dose of amoxicillin varies at 250 mg, 500 mg and 875 mg. This explains the rationale behind the use of low dose amoxicillin-clavulanate in combination with meropenem as a part of treatment regime for drug resistant TB. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OD08-OD10&id=12145 https://doi.org/10.7860/JCDR/2018/37279.12145 Extra G Positive Band on Long Arm of Chromosome 9 and Long Y-Chromosome in a Patient Presenting with Infertility: A Case Report Afreen Aftab, Kundavi Shankar, Bibhas Kar This is a case report of a male patient with rare 9qh+ variant containing extra G positive band along with an increase in heterochromatin in the long arm of Y-chromosome, presenting with primary infertility. There have been various reports on the involvement of 9h+ variation in infertility. In this case, the association maybe coincidental and not causal as the proband’s mother was also presented with similar 9qh+ variation and hence, is not infertile. Besides Yqh+ has been reported to be involved in male factor infertility or subfertility. There have been reports suggesting that epigenetic modifications accompanying cases of inherited heterochromatin polymorphisms may lead to phenotypic effects with clinical significance such as infertility that may not be seen in the parents. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=GD01-GD02&id=12159 https://doi.org/10.7860/JCDR/2018/37442.12159 Haemangioma of Cervix - A Case Report Manan B Shah, Kalyani Raju Haemangiomas are very common benign vascular lesions. However, haemangioma of cervix is very rare. They are more common in 2nd and 3rd decades of life. Most of them are asymptomatic and discovered incidentally. Surgical excision remains the treatment of choice in most of the cases and alternatively conservative treatment can also be considered which is helpful in preserving fertility in the young females. We present a case of cervical haemangioma in a 38-year-old female which was diagnosed incidentally. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ED04-ED05&id=12170 https://doi.org/10.7860/JCDR/2018/36854.12170 Sinus of Valsalva Aneurysm Dissecting into Interventricular Septum Compressing RVOT Nishu Raj, Pallavi Sinha, Neeraj Wadhwa, Sunil Kumar Puri Aneurysm of sinus of valsalva is a rare disorder. Rupture of sinus of valsalva into the right atria, right ventricle and the left ventricle is more commonly seen. Dissection of sinus of valsalve into the interventricular septum is rare, moreover right ventricular outflow tract obstruction due to it is still rarer. We present a case of ruptured sinus of valsalva aneurysm into the interventricular septum causing right ventricular outflow tract obstruction presenting with heart block. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=TD01-TD02&id=12171 https://doi.org/10.7860/JCDR/2018/37143.12171 Duplication of Superior Vena Cava with Atrial Termination of Right Hepatic Vein in Tetralogy of Fallot: A Rare Association ANSUL KUMAR1, AJIT PADHY2, VIJAY GUPTA3, ARPITA RAI4 Anomalous hepatic venous drainage into the right atrium in association with Tetralogy of Fallot (TOF) is a rare presentation. Here, authors present a very interesting case of anomalous hepatic venous drainage into the right atrium. A 23-year-old patient presented with vascular combination of duplication of Superior Vena Cava (SVC) with an atrial termination of Right Hepatic Vein (RHV) in TOF. Separate cannulation and looping were required to have a better venous drainage while performing the intracardiac procedures through right atrium on cardiopulmonary bypass. This was the first case of this kind reported in the literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=PD09-PD10&id=12195 https://doi.org/10.7860/JCDR/2018/24831.12195 Hepatic Hydrothorax without Apparent Ascites and Dyspnea - A Case Report Jing He, Rasha Haykal, Hongchuan Coville, Jaya Prakash Gadikota, Christopher Bray A 78-year-old female with a past medical history of alcoholic cirrhosis was hospitalised with recurrent lower gastrointestinal bleeding due to rectal ulcers. The ulcers were successfully treated with cautery and placement of clips. However, a recurrent large right-sided pleural effusion without apparent ascites and dyspnea were found incidentally during the hospitalisation. The initial fluid analysis was exudate based on Light’s criteria with high protein. The fluid analysis was repeated five days later, after rapid reaccumulation which revealed transudates. Other causes of pleural effusion like heart failure, renal failure or primary pulmonary diseases were excluded. Hepatic hydrothorax was considered and the patient was started with the treatment of Furosemide and Spironolactone. The atypical presentation of hepatic hydrothorax may disguise the diagnosis and delay the treatment. Therefore, for a patient with recurrent, unexplained unilateral pleural effusions, even with atypical fluid characterisation and in the absence of ascites, hepatic hydrothorax should still remain on the top differential with underlying cirrhosis to ensure optimal treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OD14-OD16&id=12181 https://doi.org/10.7860/JCDR/2018/37185.12181 A Cutaneous Ciliated Cyst Mimicking a Pilonidal Cyst Seda Gun, Duygu Kuru, Levent Yildiz Cutaneous Ciliated Cyst (CCC) is a benign tumor encountered especially in the upper extremities and the perineal area in young women after puberty. CCC is located in the subcutaneous tissue in deep dermis, and histologically, it is a single, unilocular or multilocular cyst with mullerian origin and is lined with an epithelium similar to that of fallopian tube. In this case report, the histopathological immunohistochemical findings and controversial pathogenesis of a rare CCC case is described. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ED06-ED08&id=12253 https://doi.org/10.7860/JCDR/2018/36504.12253 Type-I Fused Decidious Dentition in Mandibular Arch-Report of a Case and Clinical Considerations Hemant Sawhney, Anju Anu Jose Developmental anomalies of teeth are of clinical interest because of the problems associated with them. This report describes a unique case of unilateral fusion of primary mandibular lateral incisor and canine and discusses the possible future treatment options anticipated for management of fused deciduous teeth. Clinically, this case provides an insight into management options for fused deciduous teeth for general dental practitioners. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZH01-ZH03&id=12116 https://doi.org/10.7860/JCDR/2018/36812.12116 Biomechanical Study of Trapezoidal Plate, Delta Plate and Miniplate in Subcondylar Fracture Jyotish Saikia, Sanjeev Kumar, Harsh Jain, Amit Gupta <b>Introduction:</b> Condylar fracture accounts for 25-35% of all mandibular fracture. When it comes to open reduction and internal fixation, the design of the plate plays a crucial role to withstand the amount of masticatory force in the condylar region. <b>Aim:</b> To evaluate the biomechanical stability of osteosynthesis using the Trapezoidal plate, Delta plate and Miniplate in subcondylar fracture. <b>Materials and Methods:</b> The condyle of 36 porcine hemimandible was osteotomized at a defined location with the help of a jig. Three groups A, B, C were created and each group had 12 hemimandibles. Group A was fixed with trapezoidal plate, group B was fixed with delta plate and group C was fixed with 2 four-hole miniplates. Each group was subjected to a linear loading using a Universal Testing Machine (UTM) in four different directions. The direction of the force used was from lateral to medial, medial to lateral, anterior to posterior and posterior to anterior was indicated using (1,2,3,4) respectively. Yield load and yield displacement were measured for the trapezoidal plate, delta plate and miniplate. Means were derived and compared for statistical analysis using the Kruskal-Wallis test and Mann-whitney U test with a confidence level of 95%. <b>Results:</b> None of the plates fractured. Screw loosening was seen in one delta plate and in two miniplate. In posterior to anterior and from medial to lateral the trapezoidal plate tolerated the highest load. From anterior to posterior and lateral to medial the miniplate tolerated the maximum load. Statistically significant difference was seen for yield load and no difference was seen for yield displacement in three groups. <b>Conclusion:</b> This biomechanical study indicates that like miniplate, trapezoidal and delta plates exhibit stable osteosynthesis for subcondylar fractures. The trapezoidal and delta plate has the advantages of providing three dimensional stability using single plates. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZF01-ZF03&id=12134 https://doi.org/10.7860/JCDR/2018/36725.12134 A New Grading System for Macular Lesions of Paucibacillary Leprosy Mohan Zachariah Mani https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=WL01-WL02&id=12183 https://doi.org/10.7860/JCDR/2018/38008.12183 Bacteriological Profile of Wounds Due to Occupational Injuries among Fisherman Community of Puducherry, India Geethavani Babu, S Balamuruganvelu, Sreenivasalu V Reddy, R Srikumar, M Chandru, Bhargavi E shree, S Bamini <b>Introduction:</b> Fishermen are more prone to wound infections because of their working environment. Secondary bacterial infection due to poor sanitary conditions among such a community can result in further contamination of the wound, which leads to surgical removal of damaged tissue and amputation. <b>Aim: </b>To determine the bacterial profile and antimicrobial resistance pattern of wound due to occupational injuries in the fishermen community of Puducherry, India and to analyse their health-seeking behaviour. <b>Materials and Methods:</b> About 292 Pus/wound swab were collected from wound infections of fishermen who were actively involved in fishing and fishing-related activities in and around Puducherry, India. The wound swabs were inoculated on to Blood agar, Chocolate agar, MacConkey agar, Thioglycolate broth for phenotypic characterisation and antimicrobial sensitivity test of the isolated pathogen was performed. Additional information regarding socioeconomic status, details of injury, fishing methods employed and health-seeking attitude was collected and analysed. <b>Results:</b> In the present study 162 (55.5%) of the samples showed the single type of growth. Interestingly 47 (16.1%) showed polymicrobial growth. The most common pathogen isolated was Staphylococcus aureus 136(53.1%) followed by 34(13.3%) Coagulase-negative Staphylococcus spp. (CONS), 23 (9.0%) Pseudomonas spp., 22(8.6%) Streptococcus pyogens, 20(7.8%) E.coli and other pathogens isolated were Klebsiella pneumoniae 6 (2.3%), Proteus spp. 5(1.90%), Enterococcus spp. 3 (1.20%), Diphtheroids 3 (1.20%), Enterobacter spp. 2 (0.80%) and Streptococcus spp. 2 (0.80%). Antimicrobial Susceptibility Testing (AST) revealed 83 (61.0%) of Staphylococcus aureus and 11 (32.3%) CONS were methicillin resistant. 14 (60.9%) of Pseudomonas spp., 11 (55.0%) of E.coli and 2 (33.3%) of Klebsiella pneumoniae isolates were Extended Spectrum Beta Lactamase (ESBL). <b>Conclusion:</b> Present data suggest the majority of the isolates were organisms causing secondary bacterial infection mainly due to lack of first aid and poor access to tertiary care hospitals. The percentage of drug resistance was higher in this community which is of major concern. Most fishermen living in the coastal areas of Puducherry were of traditional type still following olden methods of fishing. Hence, steps must be taken to educate and provide basic aids for such socially marginalised population in order to prevent further complications and for the betterment of their lifestyle. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=DC11-DC15&id=12184 https://doi.org/10.7860/JCDR/2018/37409.12184 Comparative Evaluation of Procalcitonin and Interleukin-6 as Diagnostic and Prognostic Biomarkers for Sepsis Padmanaban Kandaswamy, Hemlata, Gyan Prakash Singh, Mohammad Kaleem Ahmad <b>Introduction:</b>Diagnosis of sepsis is based on host’s systemic inflammatory response to infection including life-threatening organ dysfunction. Various biomarkers are available for diagnosis and prognostication of patients with sepsis, Procalcitonin (PCT) and interleukin-6 (IL-6) being most reliable. <b>Aim:</b> To compare PCT and IL-6 as diagnostic and prognostic biomarkers of sepsis in patients admitted with Systemic Inflammatory Response Syndrome (SIRS). <b>Materials and Methods:</b> After taking Ethical Committee Approval, a total of 51 patients aged 15-65 years admitted in ICU with SIRS were identified. Patients with baseline Sequential Organ Failure Assessment (SOFA) score of 0 and 1 were categorised into non-infectious group and SOFA of greater than 2 into infectious group. Procalcitonin and IL-6 were measured on day 1 and 3 using enzyme-linked immunosorbent assay. Collected data were analysed using SPSS software version 22.0. Parametric data were compared using Student’s t-test. Other tests used were Mann-Whitney U test, Pearson’s chi-square test, Fisher’s-exact test, Friedman’s test, ANOVA. <b>Results:</b> PCT (day 1 and 3) was significantly higher in the infectious group than non-infectious group (p<0.001) and day 1 PCT was found to be better in diagnosing sepsis with Area Under the Curve (AUC) of 0.90 (95% CI, 0.789-1.000) (p=0.001). Unlike day 1 PCT, day 3 PCT was statistically significant in predicting mortality with AUC of 0.982 (95% CI, 0.956-1.000) (p<0.005). IL-6 was found to be better in predicting mortality with day 1 AUC of 0.987 (95% CI, 0.966-1.000) (p<0.005) and day 3 AUC of 0.981 (95%CI, 0.953-1.000) (p<0.005). Multivariate analysis of mortality prediction showed day 1 IL-6 to have a better mortality prediction value (p=0.047). <b>Conclusion:</b> PCT on day 1 was found to be better in identifying sepsis and day 1 IL-6 and day 3 PCT in predicting mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=UC17-UC21&id=12185 https://doi.org/10.7860/JCDR/2018/37394.12185 A 3D FEM Comparison of Labial and Lingual Orthodontics for Maxillary Midline Diastema Closure Shilpa Kumari, G Hanmanth Reddy, Johar Rajvinder Singh, Kumar Nilotpal, Swati Sharma, Jamoy James <b>Introduction:</b> Lingual orthodontics is gaining popularity day by day. However very few information is present in literature regarding physiologic reaction that occurs after force application, efficacy and rate of tooth movement in lingual orthodontics when compared with labial orthodontics. <b>Aim:</b> This study was designed for comparison of aforesaid parameters in midline diastema cases with both lingual as well as labial orthodontics. <b>Materials and Methods:</b> Cone-beam computed tomography scanning was used to create geometric models for maxillary central incisors. Two 3D finite element models of maxillary central incisors having diastema, bonded with 0.018” brackets, labially and lingually with 0.017”×0.025” SS arch wires placed was constructed. These models were then meshed and analysed with commercially available finite-element analysis software. Diastema closure was simulated by applying 50 gm of mesial force from maxillary right central incisor to maxillary left central incisor. Software was used to compare the stress in periodontium, efficacy and rate of the instantaneous displacement of tooth (maxillary right and left central incisor) under labial and lingual loading during the midline diastema closure retraction. <b>Results:</b> More stress and displacement of teeth for closing the gap can be observed for labial loading compared to the lingual loading. <b>Conclusion:</b> By applying equal force labially and lingually more bodily movement is seen in labial mechanics whereas lingual mechanics shows mesial crown tipping as well as bodily movement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZC32-ZC36&id=12186 https://doi.org/10.7860/JCDR/2018/35510.12186 Nurse Manager's Emotional Intelligence in Educational Hospitals: A Cross-sectional Study from the West of Iran Ali Bikmoradi, Fatemeh Abdi, Alireza Soltanian, Naser Farahman Dmoqadam, Yadollah Hamidi <b>Introduction:</b> Identifying and promoting nurse managers emotional intelligence is critical in order to promote the quality of health care and educational services. Effective managers deploy emotional intelligence for control and management of their own and employees’ feelings and emotions in order to achieve organisational goals. Personal characteristics of managers could also influence their management, leadership and quality of services at any organisation and personnels performance as well. <b>Aim: </b>This study aimed to investigate nurse managers emotional intelligence in educational hospitals of Hamadan University of Medical Sciences. <b>Materials and Methods: </b>A cross-sectional study was conducted with 370 nurse managers of five educational hospitals of Hamadan University of Medical Sciences, Iran in 2016. Data were collected using inspired Bradberrys Emotional Intelligence Questionnaire and were analysed by descriptive and inferential statistics using Pearson correlation coefficient test, t-test and Variance analysis. <b>Results:</b> Emotional intelligence of nurse managers was excellent with good ability level 216 (58.3%), moderate ability level 134 (36.2%) and low and very low ability level 20 (5.4%). The mean score of nurse managers emotional intelligence was 80.46±6.7 which interpreted good ability level. There was significant relation between mean score of nurse managers emotional intelligence and gender, age, marital status, number of children, educational level, work experience, managerial work experience, job and life satisfaction (p=0.04). <b>Conclusion: </b>The results indicate a significant and positive relationship between emotional intelligence and some demographic characteristics. Moreover, nursing management boards should work on all aspects of emotional management and consider demographic characteristics for selection of managers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=IC07-IC11&id=12187 https://doi.org/10.7860/JCDR/2018/36373.12187 Relationship between Glycaemic Parameters and Mean Platelet Volume among Pre-Diabetics and Non-Diabetics in a Predominantly Tribal Population Suchismita Panda, Manoj Kumar Dash <b>Introduction:</b> Pre-diabetics are considered an important risk set within the population who though ‘apparently normal’ are at the highest risk of progression to clinical diabetes. Interventions in this subset can reduce or delay the onset of many dreaded complications of hyperglycaemia, especially cardiovascular complications, which are one of the leading causes of morbidity and mortality. <b>Aim:</b> The study was designed and carried out to determine the relationship between Mean Platelet Volume (MPV) and glycaemic parameters in non-diabetics of predominantly tribal origin. <b>Materials and Methods:</b> The study subjects were selected on the principle of convenient and consecutive sampling. Adult patients self-reporting to the Central Laboratory of a medical college hospital located in a predominantly tribal district of Odisha. Blood samples were collected for routine haematological and biochemical parameters. Based on the fasting plasma glucose, the patients were divided into normoglycaemics and pre-diabetics. The linear relationship between the quantitative variables was evaluated by computing the Pearson’s correlation coefficients. The independent relationship between MPV and the other study variables was analysed by multiple linear regressions. <b>Results:</b> The study was conducted with a total of 109 individuals (62 males and 47 females). Glycaemic parameters were significantly different between pre-diabetics and normoglycaemics with higher level in the pre-diabetics compared to normoglycaemics. Fasting Plasma Glucose (FPG) and Post Prandial Plasma glucose (PPPG) showed modest (r<0.5) positive correlation with MPV with variable statistical significance, but blood insulin level showed strong (r>0.5) positive correlation that was robustly significant. MPV was regressed on FPG, PPPG, insulin, cholesterol and total platelet count. The R square of the model varied between 0.415 and 0.637 for all the datasets with the highest value (0.637) for the pre-diabetics group. The strongest and statistically significant independent correlation was seen between MPV and insulin in all the datasets, with highest values in the pre-diabetics group (standardised beta coefficient=0.680). <b>Conclusion:</b> The glycaemic parameters especially fasting blood glucose, PPPG, and insulin were found to be correlated with MPV in both normoglycaemics as well as pre-diabetics. The pre-diabetics showed higher levels than normoglycaemics. Thus, MPV may serve as an important marker in early detection of cardiovascular complications, in the non-diabetics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=BC18-BC22&id=12188 https://doi.org/10.7860/JCDR/2018/36564.12188 Correlation of HDL Associated Paraoxonase 1 with Oxidative Stress Markers in Hypertensive Dyslipidemic Patients Sudeep Kumar, Jyoti Batra, Manisha Arora <b>Introduction:</b> Paraoxonase 1 (PON 1) is an esterase, exclusively synthesised by the liver and a high density lipoprotein-associated antioxidant enzyme. <b>Aim:</b> To determine the PON 1 and oxidative stress markers and to find out the possible correlation between them in hypertensive dyslipidemic patients. <b>Materials and Methods:</b> This study included 500 patients, out of which 250 were diagnosed with hypertension and the remaining 250 acted as controls age and sex-matched individuals. PON 1 activity was measured manually by using spectrophotometer, Malondialdehyde (MDA) by TBA method, Superoxide Dismutase (SOD) by Marklund and Marklund, lipid profile was measured by biochemistry auto-analyser. The statistical differences between cases and controls were determined by independent student’s t-test. <b>Results:</b> There were significantly increased levels of PON 1, vitamin E and C and SOD in hypertensive subjects as compared to controls. With respect to lipid profile, significantly increased levels of total cholesterol, triglyceride, Low Density Lipoproteins (LDL-c), Very Low Density Lipoprotein (VLDL-c) and decreased level of High Density Lipoproteins (HDL-c) in cases as compared to controls were observed. Moreover, PON 1 statistically and positively correlated with HDL-c, SOD, vitamin E and C and it negatively correlated with MDA. <b>Conclusion:</b> It concludes that, in hypertension which is caused due to the interplay of several confounding factors such as oxidative stress, increased oxidised LDL lipoprotein and decrease in the level of antioxidants, the PON 1 activity is found to alter. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=BC23-BC26&id=12189 https://doi.org/10.7860/JCDR/2018/37108.12189 Mandibular Lingual Concavity: A Cross-sectional Analysis using Cone Beam Computed Tomography Fatemeh Salemi , Abbas Shokri , Maryam Foroozandeh , Manoochehr Karami , Zahra Khalili <b>Introduction:</b> Cross-sectional analysis using Cone Beam Computed Tomography (CBCT) is appropriate for assessment of lingual undercuts and prevention of lingual cortex perforation and subsequent complications. <b>Aim:</b>This study aimed to assess the mandibular lingual undercut in the first molar site on CBCT scans to prevent lingual cortex perforation during implant insertion. <b>Materials and Methods:</b> This cross-sectional study was conducted on 164 CBCT scans (77 males and 87 females with a mean age of 43.9±12.3 years). The following information was collected: Type of ridge morphology (U: lingual undercut, C: convex, P: parallel), ridge width, ridge height, the angle between the lingual surface and the line drawn above the canal, distance between the deepest point in the lingual surface and the line drawn perpendicular to the lingual surface, distance between the most prominent point of the lingual surface and the ridge crest and distance between the most prominent point in the lingual surface and the inferior border of the mandible. Analysis of variance and t-test were used to compare mean values of CBCT measurements between gender and age groups. <b>Results:</b> Type U (50%) was the most common type followed by type C (26.2%) and type P (23.8%). No significant correlation was noted between age and depth of lingual undercut or type of ridge morphology or between ridge morphology and gender (p>0.05). Ridge height (p=0.002) and distance between the most prominent point of the ridge and the ridge crest (p=0.021) were significantly greater in males than in females. <b>Conclusion:</b> Type U ridge morphology had the highest prevalence. Mandibular lingual concavity must be taken into account during implant placement to prevent accidental perforation of lingual plate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZC37-ZC41&id=12190 https://doi.org/10.7860/JCDR/2018/35850.12190 Assessment of Serum Retinol Binding Protein 4 in Patients with Hepatocellular Carcinoma Yehia Mohamed El Shazly, Mohamed Abd El Moghny, Reham Ezzat Al Swaff, Hany Ali Hussein, Hany Samir Rasmy, Moataz Aly Ahmad <b>Introduction:</b> Retinol Binding Protein 4 (RBP4) may be indirectly involved in the induction of carcinogenesis as it was identified as a key regulator of insulin resistance in obesity and diabetes. Data about serum level of RBP4 in patients with Hepatocellular Carcinoma (HCC) are rare. The role of RBP4 in liver cirrhosis has to be further investigated as it may act as a novel biomarker for screening of HCC. <b>Aim:</b> To determine the value of serum RBP4 in Egyptian patients with Hepatitis C Virus (HCV) (genotype 4) related liver cirrhosis and HCC. <b>Materials and Methods:</b> This study was a randomised, cross-sectional, comparative study designed to measure serum RBP4 level in patients with HCV-related cirrhosis. Ninety patients were randomly recruited between October 2016 and November 2017 from the Hepatology outpatients’ clinic of Ain Shams University Hospitals and were divided into two groups as follow: Group I: 60 patients with HCV related liver cirrhosis and HCC, Group II: 30 patients with HCV related liver cirrhosis. Data were analysed with the program Statistical Package for Social Science (SPSS) under windows version 11.0.1. The statistical analysis was calculated using Student’s t-test (t), Pearson Correlation coefficient (r) test, chi-square test (c2). <b>Results:</b> The study revealed that patients with HCC had higher levels of serum RBP4. However, neither the number of hepatic focal lesions nor the total tumour burden had any significant correlation with serum RBP4 (p-value: 0.440 and 0.193 respectively). Serum RBP4 had also insignificant correlations with Child-pugh score, Model for End Stage Liver Disease (MELD), score Homeostasis Model of Assessment-Insulin Resistance index (HOMA-IR) and Body Mass Index (BMI). Serum RBP4 at a cut-off value >12.5 mg/mL had 73.3% sensitivity and 53.3% specificity for detection of HCC (overall accuracy=67.6%). Notably, higher values of HOMA-IR index were found among patients with HCC (mean value 2.838±1.827; range 0.400-7.300). <b>Conclusion:</b> RBP4 was significantly re-upregulated in patients with HCC from its reduced levels in cirrhotic patients. RBP4 has the potential to be a biomarker for the screening of HCC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OC27-OC31&id=12172 https://doi.org/10.7860/JCDR/2018/36609.12172 Effect of Vitamin C Supplementation on Anthropometric Measurements, Lipid Profile and Atherogenic Indices in Obese and Non Obese Individuals Ganesh H Ghanwat, Ajit V Sontakke <b>Introduction:</b> The prevalence of obesity is increasing day by day in India. Since obesity is associated with occurrence of oxidative stress, antioxidants can be used to treat the obesity and overcome associated complications. <b>Aim:</b> The present study was aimed to analyse the effect of vitamin C intake on anthropometric measurements, lipid profile and atherogenic indices in obese and non obese individuals and to find out the correlation between study variables. <b>Materials and Methods:</b> Total 39 male individuals; 20 obese and 19 non obese were involved in this study and they received 1500 mg vitamin C daily for three months. After 12-14 hours of overnight fast, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Body Mass Index (BMI), Body Adiposity Index (BAI), Waist Circumference (WC), Hip Circumference (HC), Waist to Hip Ratio (WHR), Waist to Height Ratio (WHtR), serum lipid profile and atherogenic indices were measured, in obese and non obese individuals, at the initiation of the work and after consumption of vitamin C, by the end of three months. Total study subjects were divided into two groups for convenience and called on two consecutive days. Data were analysed by using two tailed Student’s t-test. <b>Results:</b> Present study reported significant decrease in SBP, BMI, BAI, WC, HC, WHR, WHtR, in both obese and non obese individuals and significant decrease in TC, TG, VLDL-C but no alteration in Low Density Lipoprotein-Cholesterol (LDL-C) and HDL-C in obese individuals. Similarly, no significant changes were observed in lipid profile of non obese and atherogenic indices of both obese and non obese subjects, after the consumption of vitamin C. <b>Conclusion:</b> Present study concludes that, daily intake of 1500 mg of vitamin C has positive lowering effect on anthropometric measurements and lipid profile however it is not significantly effective in lowering atherogenic indices in a short span of three months. Long term administration of vitamin C may be helpful for dieticians and clinicians in advising high intake of vitamin C through the diet like amla, guava, citrus fruits etc., in controlling obesity and related disorders. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=BC11-BC17&id=12173 https://doi.org/10.7860/JCDR/2018/36904.12173 Demographic, Clinical and Endoscopic Characteristics of Active and Antibiotic-resistant <i>H. pylori</i>-associated Gastritis in Egyptian Adults Fady Maher Wadea, AMR Talaat Elhawary <b>Introduction:</b> In Egypt the prevalence of H. pylori infection is high up to 90% in adults. Sequels of infection range from asymptomatic colonisation of the gastric mucosa to acute gastritis, chronic gastritis, atrophic gastritis, intestinal metaplasia, dysplasia and cancer. Antimicrobial resistance increases with time and decline in eradication rate reported globally. <b>Aim:</b> To determine demographic, clinical and endoscopic presentation of H. pylori infected Egyptian adults and characteristics of patients resistant to eradication therapy used in Egypt. <b>Materials and Methods:</b> This was a retrospective observational study which included 202 patients who had chronic active H. pylori gastritis and were referred to Internal Medicine Department Endoscopy Unit, Zagazig University Hospital; a tertiary referral centre from June to December 2017. Retrospective analysis of demographic features such as age and sex, clinical presentation, endoscopic features such as distribution of gastritis, nodularity, ulcers, erosions, polyps, Gastroesophageal Reflux Disease (GERD) and duodenitis as well as histological reports were used. Data were computerised and statistically analysed using SPSS program version 24.0. <b>Results:</b> Middle-aged females had more infection and referral for endoscopic evaluation. Persistent epigastric pain is the common presentation. Pan gastritis and diffuse erythematous mottling are the common endoscopic criteria while mucosal nodularity was present in 21.8% especially in females. Mild activity is the more pronounced histological finding. Associated features were the presence of apparent submucosal vasculature (39.6%), erosions (22.8%), ulcers (22.8%), hyperplastic polyps (5.9%), incompetent cardia (89.1%), GERD mainly of Type A (40.6%) and mild duodenitis (52.5%). Resistance to first line therapy was seen in 45.5% of patients. Epigastric pain, the presence of apparent submucosal vasculature and GERD were independently associated with resistant infection (p<0.001, 0.001, 0.001, respectively). False negative stool antigen was present in 22.8%. <b>Conclusion:</b> Females are more affected and presented with persistent epigastric pain and pangastritis type of mild activity. Availability of other antibiotics as the first line eradication therapy is needed. Patients with epigastric pain, apparent submucosal vasculature and GERD have resistant infection and other eradication regimens should be used however larger studies are needed to confirm the same. Improving diagnostic tests to avoid unnecessary endoscopic referral is needed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OC32-OC37&id=12174 https://doi.org/10.7860/JCDR/2018/37045.12174 Study on Hair Fall with Hair Related Problems among Males of Age 18-50 Years: Study on Chennai Based Population Priyadharshini Mahendra Varman, Christina Mary P Paul, Pradeep Rajan, R Preethi, Premkumar, R Priya, S Priyanka, Rajeshkumar <b>Introduction:</b> Male pattern hair loss is often regarded as a relatively minor medical condition; however, may result in anxiety and depression in some men as it impacts self-image. Hair loss is a common cosmetically and psychosocially distressing condition, however this condition attracted the least attention and there are limited studies on its prevalence and its grade in the Indian subcontinent. <b>Aim:</b> To determine the prevalence of hair fall and certain hair related problems among men of age 18-50 years and to identify the factors associated with them. <b>Materials and Methods:</b> The present study was a community based cross-sectional study done over a period of two months. The study was conducted in both rural and urban populations of Thiruvallur district, namely Nazarethpet and Adyalampet which are the field practice areas of ACS Medical College and Hospital, Chennai, Tamil Nadu, India. A total of 393 men selected by simple random sampling in the age group of 18-50 years, were included in the study after getting their informed consent. A customised interview schedule was used for data collection after it was pilot tested. The PHQ 9 questionnaire was applied to the participants following which the weight and height of the subjects were measured. The questions on the interview schedule were also verbally translated into the regional language of the study subjects which was Tamil. <b>Results:</b> Prevalence of hair fall was found to be 60.3%, prevalence of dandruff was found to be 17.1% and the prevalence of baldness was found to be 50.4%. Prevalence of greying among men aged 18-35 years was found to be 37.97%. Of the participants, 59% claimed awareness of creams and medications as a treatment option for hair related problems. Awareness of hair transplantation was present among 55.5% of the study subjects. <b>Conclusion:</b> The present study showed high prevalence rates of hair related problems and that the knowledge regarding treatment options for hair related problems is not adequate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=LC09-LC12&id=12175 https://doi.org/10.7860/JCDR/2018/36050.12175 Impulsivity in Suicide Attempters: A Cross-sectional Study from a Teaching Hospital in India Vishnu Gade, Lokesh Kumar Kalasapati, Ravali Reddy Kadari, Snigdha Kalidindi, Raghuram Macharapu, CM Pavan Kumar <b>Introduction:</b> Studies have consistently reported that a considerable proportion of suicide attempts are impulsive and unplanned. However, data on the characteristics of these impulsive attempters is still limited. The relationship between impulsive behaviour and suicide attempts can be thought of having two dimensions: a suicide attempt can be impulsive or not and the suicide attempter can have impulsive traits or not. The impulsiveness of many attempts and the fluctuating nature of suicidal thinking are of concern, as many prevention strategies rely on the early identification of either suicidal thoughts and/or plans. <b>Aim:</b> The present study was attempted to measure the intensity of the suicide attempt, and to assess the relationship of the suicide intent score with the three second order factors (Attention impulsiveness, motor impulsiveness, non planning impulsiveness) of impulsivity in Barratt Impulsiveness Scale to identify the pattern (if any) of suicidal intent before an impulsive attempt. <b>Materials and Methods:</b> This was a hospital based cross sectional study. Socio-demographic and clinical profile sheet which included different variables was completed on 72 attempters. Beck’s Suicide Intent Scale (SIS) was used to assess the severity of the intent in the patient and Barratt Impulsiveness Scale (BIS-11) was used to measure the personality construct of impulsiveness. Data entry and analysis was done using SPSS 20 statistical software and descriptive statistics, chi-square test, t-test were used to find significance across groups. Statistical significance was assumed at p<0.05. <b>Results:</b> Among the 72 attempters, 38 (52.8%) were male and 34 (47.2%) were females. Majority of the sample were illiterate 30 (42%), from a rural background 61 (84.7%), whose primary method of attempt was by ingestion of poison 51 (70.8%) due to family/inter personal problems 43 (59.7%). The sample was divided based on their scores of suicide intent scale and the three second order factor scores of BIS. High suicide intent score was present in majority of the patients 35 (48.6%), and 14 (19.5%) patients had low suicide intent score. The mean scores of impulsivity were highest among the low suicide intent group, and were gradually decreasing as the intent of the attempt was increasing (from low to high) in the sub scales of attention impulsiveness (15.6±1.94) and non-planning impulsiveness (31.5±2.65) which suggests that low intent attempts may be impulsive acts. When individual suicidal intent groups were compared, a significant difference found between motor impulsiveness and non-planning impulsiveness within medium intent (p=0.043) and between attention impulsiveness and non-planning impulsiveness within high intent (p=0.012). <b>Conclusion:</b> There is a significant association between impulsivity and intent, and it is an important factor of suicide behaviour in suicide attempters. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=VC15-VC20&id=12177 https://doi.org/10.7860/JCDR/2018/34699.12177 Students Perception on Clinical Application Based Biochemistry Practical Examination Vijetha Shenoy Belle, BS Varashree, Sravya Poduri, Krishnananda RV Prabhu <b>Introduction:</b> In the conventional method of practical examination candidate has to perform the given test/s directly without the need to know its clinical relevance. In this model of clinical application based biochemistry practical examination student has to solve the given case, decide which are the relevant test, perform a given test selected by examiner and then hat o interpret the result. So this method may help to foster clinical reasoning in a student in the current competency based education. <b>Aim:</b> To assess the perception of first-year MBBS undergraduate students on clinical application based biochemistry practical examination. <b>Materials and Methods:</b> Prior permission from the institutional Ethics Committee was obtained for the present prospective observational study. A total of 198 first year MBBS students appearing for 3rd sessional practical examination enrolled after obtaining the consent. A questionnaire which consisted of 10 questions were given to the student and asked to answer within 15 minutes. Based on the feedback, Cronbach’s alpha and frequency distribution were calculated using SPSS 15.0 version. <b>Results:</b> Students perception of the clinical application based biochemistry practical examination was much better compared to the conventional method. <b>Conclusion:</b> Clinical application based biochemistry practical examination should be included as an essential component of practical examination. This will facilitate clinical reasoning amongst students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=JC17-JC19&id=12178 https://doi.org/10.7860/JCDR/2018/36834.12178 Characterisation of Multidrug-resistant <i>Alcaligenes faecalis</i> Strain AF1 Isolated from Patient of RUTIs: A Study from Bangladesh Farhana Momtaz, Md Hazrat Ali, Md Nazmul Hossain, Md Javed Foysal, Mariya Kibtiya Sumiya, Kamrul Islam <b>Introduction:</b> Alcaligenes faecalis is a common environmental bacterium that often infects human as an opportunistic pathogen. It rarely causes Urinary Tract Infection (UTI) in human; however, infection brings severe outcomes. Also, the treatment of A. faecalis associated infections with common antibiotics can be difficult due to a high level of antibiotic resistance. <b>Aim:</b> Molecular characterisation of A. faecalis isolate from women suffering from Recurrent Urinary Tract Infections (RUTIs). <b>Materials and Methods:</b> The study was conducted in the USDA-laboratory of the Department of Genetic Engineering and Biotechnology, Shahjalal University of Science and Technology, Sylhet, Bangladesh. The present study conducted from July 2017 to December 2017, characterised an A. faecalis strain from the women suffering from RUTIs by applying 16s rRNA gene sequencing and phylogenetic analysis. Antibiogram profiling was done by means of disk diffusion assay. Analysis of in-silico SNP variants was done using Geneious software. <b>Results:</b> The isolates were resistant to seven out of ten commercial antibiotics used to treat UTI in Bangladesh. Phylogenetic and evolutionary distance data analysis revealed a close proximity of the study AF1 strain with other A. faecalis strains identified from the environment, especially from a previously characterised water sample. In-silico variants search found nine potentials of Single Nucleotide Polymorphism (SNPs) in the studied strain compared to other environmental A. faecalis bacteria characterised from India, South-Korea, Japan, Mexico and Brazil. <b>Conclusion:</b> The present study revealed the transmission of environmental opportunistic pathogens to human and cause chronic infections in Bangladesh. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=KC01-KC04&id=12179 https://doi.org/10.7860/JCDR/2018/37240.12179 Assessment of Mental Disability using Indian Disability Evaluation Assessment Scale in Obsessive Compulsive Disorder and Dysthymic Disorder Roopesh NV Gopal, Sathish SV Kumar <b>Introduction:</b> Obsessive Compulsive Disorder (OCD) is characterised by recurrent obsessions or compulsions that are severe enough to be time-consuming or cause marked distress or significant impairment and is given disability benefits as per the existing Indian disability act. Dysthymic Disorder (DD) is a chronically depressed mood that occurs for most of the day, more days than not for at least two years and may also lead to disability for which benefits are not given. In view of limited research and the paucity of data, the current study was conducted to address these lacunae. <b>Aim:</b> To assess mental disability in OCD and compare it with DD for benefits under the Indian disability Act. <b>Materials and Methods:</b> The present study was a cross-sectional hospital-based comparison study conducted in two group of 30 patients each diagnosed to have OCD and DD during October 2009 to September 2011 in a medical institution in Karnataka, India. Diagnostic and Statistical Manual of Mental disorders (DSM)-IV criteria were used for diagnosis of OCD and DD. Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HAM-D) and Indian Disability Evaluation and Assessment Scale (IDEAS) were used. Statistical Package for Social Sciences (SPSS) version-16.0 software was used for analysis. For continuous data, student’s t-test and for categorical data, ‘chi-square test’ was used respectively. <b>Results:</b> The mean disability score was 6.39 (SD=1.5) and 6.13 (SD=1.14) in OCD and DD respectively. Disability score was not found to be different within the various groups, of socio-demographic parameters like age, sex, occupation, residence education, socioeconomic status in OCD and DD conditions. The percentage of moderately disabled patients were more in the DD group (53.3%) than in the OCD group (36.7%). In the domain of self-care and duration of illness, there was a significant difference between the OCD and DD group (p<0.05). Mild (n=19) and moderate (n=11) disability in obsession and compulsion categories showed no statistical significance. <b>Conclusion:</b> Disability in DD was similar to that of OCD as total disability score had no significant difference between the two groups. However, further research is needed to assess the extent of disability in non-psychotic disorders for disability benefits. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=VC21-VC23&id=12180 https://doi.org/10.7860/JCDR/2018/37374.12180 A Comparative Study on the Efficacy of i.v. Cyclophosphamide Pulse Versus Oral Cyclophosphamide in Bullous Pemphigoid Rajkumar Kannan, Jayakalyani Vijayananth, Muthusubramanian Chandrasekar <b>Introduction:</b> Bullous pemphigoid is an acquired autoimmune blistering disorder characterised by subepidermal bullae and deposition of complements and antibodies along the basement membrane zone. It most commonly affects the elderly and hence is frequently associated with co-morbidities. Corticosteroids have been the mainstay of treatment. <b>Aim:</b> To compare the efficacy and safety of i.v. Cyclophosphamide pulse versus oral cyclophosphamide in patients of bullous pemphigoid. <b>Materials and Methods:</b> The study was conducted in the Department of Dermatology at a tertiary care centre from May 2017 to April 2018. A diagnosis of bullous pemphigoid was made based on the clinical and histopathological findings. A thorough history and detailed physical examination was done. Patient’s demographics, co-morbidities and treatment history were recorded. A total of 15 patients were chosen for the study. They were randomly divided into two groups. Both groups were started on tab. Prednisolone 1 mg/kg/day. In group A eight patients were started on i.v. Cyclophosphamide pulse 500 mg intravenous, at 28 days interval. In group B seven patients were started on tab. Cyclophosphamide 50 mg/day. Patients were followed with periodical complete haemogram, liver function tests and urine analysis monthly during treatment and for a period of 3 months after achieving remission. <b>Results:</b> I.v. Cyclophosphamide pulse was found to have shorter duration of treatment and lesser cumulative dose when compared to oral cyclophosphamide. <b>Conclusion:</b> I.v. Cyclophosphamide pulse proves to be an effective drug for bullous pemphigoid than daily oral cyclophosphamide, but warrants close monitoring. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=WC01-WC03&id=12270 https://doi.org/10.7860/JCDR/2018/37164.12270 Effect of Er: YAG Laser on Cavity Preparation and Surface Treatment in Terms of Microleakage Yeliz Guven, Oya Aktoren <b>Introduction:</b> Er:YAG laser is one of the most preferred laser types used in preparation of dental hard tissues. Since lased dentin surfaces have significantly different characteristics when compared to bur-prepared surfaces, adhesion performance of adhesive systems may differ, too. Microleakage is an important determinant in assessing the success of restorative materials and cavity preparation methods. <b>Aim:</b> The aim of this study was to assess the microleakage of three different adhesive systems in Er:YAG laser and bur prepared cavities. <b>Materials and Methods: </b>Cavities prepared either with Er:YAG laser or diamond bur were randomly assigned to eight groups (n=10): Group 1: Laser preparation+Clearfil Tri-S (C3S) Bond; Group 2: Laser preparation+Adper SE Plus (SE) Bond; Group 3: Laser preparation+ laser etching+ Adper Single Bond 2 (SB2); Group 4: Laser preparation+ acid etching+ SB2; Group 5: Laser preparation+SB2 (no etching); Group 6: Bur+acid etching+SB2; Group 7: Bur+C3S; Group 8: Bur+SE. The groups prepared conventionally (Groups 6-8) served as control groups. The teeth/restoration interfaces were assessed for dye penetration by a stereomicroscope and an image analysis program. The data was analysed by Kruskal Wallis and Mann-Whitney U tests. <b>Results:</b> The highest microleakage was observed in the gingival interface of Group 5 and the lowest microleakage was seen in the occlusal interface of Group 3 and Group 6. When the effects of laser and bur preparation methods on occlusal and gingival microleakage levels were compared, the statistically significant difference was found between the SE Bond-applied groups (Groups 2 and 8). SE Bond has demonstrated significantly less microleakage in Er:YAG laser prepared cavities than bur prepared cavities. <b>Conclusion:</b> Interaction pattern of the adhesive systems with the lased substrate can differ from those with the conventional ones and particular characteristics of the adhesive systems have a strong influence on the success of the resin–dentin bond. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZC42-ZC46&id=12281 https://doi.org/10.7860/JCDR/2018/36960.12281 Production of Monoclonal Antibody Anti-NS1 Induced by DENV3 Indonesian Clinical Isolate to Detect Native NS1 Antigen of all DENV Serotypes Tika Widayanti, Beti Ernawati Dewi, Sabar Pambudi <b>Introduction:</b> Dengue Virus (DENV) infection is a mosquito-borne disease, the most severe manifestation of the infection could lead to a lethal Dengue Haemorrhagic Fever (DHF) and/or Dengue Shock Syndrome (DSS). The currently licensed DENV vaccine has been launched in the market with some limitation applications in the field. Therefore, accurate diagnosis system is needed to identify effective treatment of DENV-infected patients and prevent the fatal outcomes caused by the severe complications. Non-Structural-1 (NS1) protein of DENV has been known as a biomarker for dengue diagnosis since the protein is abundantly circulating in the blood during the acute phase of the disease. <b>Aim:</b> To produce and characterise mouse monoclonal Antibodies (mAbs) anti-DENV NS1 antigen. <b>Materials and Methods:</b> This was an experimental study. Hybridoma mAb-producing cells were obtained by the fusion between PAI mouse myeloma cells and B cells from an immunized mice with lysed Chinese Hamster Ovary (CHO-K1) cells expressing NS1 protein. Monoclonal antibodies were tested against native NS1 antigen from DENV1, DENV2, DENV3, and DENV4 respectively, by ELISA, IFA and Western Blot analysis. <b>Results:</b> Hybridoma selection with indirect ELISA showed 16 clones that potentially produce anti-NS1 antibodies. Six out of 16 clones showed positive results by IFA analysis against NS1 transfected CHO-K1 cells. Three mAb clones 4-2D, 4-4F, and 2-7A were able to recognise the specific NS1 antigen for all DENV serotypes and did not react against other DENV proteins. Moreover, clone 4-4F showed dissociation constant (Kd) approximately 1.25+0.47 nM indicating the antibody has a strong binding affinity to NS1 antigen. <b>Conclusion:</b> The monoclonal antibodies anti-NS1 induced by DENV3 Indonesian clinical isolate are potentially used as the main reagent for development of the DENV NS1 diagnostic test. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=KC05-KC08&id=12182 https://doi.org/10.7860/JCDR/2018/37333.12182 Prevalence of Childhood Hypertension in South Asia: A Systematic Review and Meta-Analysis Baby S Nayak, Anjalin Dsouza, Sheela Shetty, N Ravishankar <b>Introduction:</b> Hypertension is an emerging problem among children and adolescents in both developing and developed countries. Early diagnosis of hypertension is important to reduce the morbidity associated with it. <b>Aim:</b> To estimate the prevalence of childhood hypertension in South Asian Region. <b>Materials and Methods:</b> A comprehensive systematic literature search was conducted. PubMed-Medline, CINAHL, IndMED, and J-Gate databases were searched for original research articles published between 1980 and 2015. Study samples included children less than 18 years of age. Prevalence rate as set by each study was considered as outcome measure. We considered the articles published only in English language. For each electronic data base, search strategy specific to that database was developed. Two reviewers independently scrutinised the studies and reviewed data in a pre-tested proforma. Random effect model was used for meta-analysis. <b>Results:</b> A total of 1322 titles were screened for eligibility of which 1234 titles were excluded as they were not relevant. Full text articles were obtained for 88 studies, of which 52 studies were found to have eligible data for the review and were included in the final synthesis. Analysis of the data from 1,65,791 samples showed the overall prevalence of childhood pre-hypertension as 14.62% with 95% Confident Interval, CI (10.63-18.6%) and childhood hypertension as 5.54% with 95% CI (4.62-6.46%) <b>Conclusion:</b> There is significant high prevalence of childhood hypertension, highlighting the need for public awareness interventions such as school health program, parents’ education, screening of school children and adolescents for hypertension. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=LC13-LC18&id=12200 https://doi.org/10.7860/JCDR/2018/36400.12200 Pulmonary Functions in Patients with Subclinical Hypothyroidism Suchet Trigotra, Nadeema Rafiq, Shikha Jaiswal, Swati Chouhan, Suvarna Prasad, Sunidhi Sharma <b>Introduction:</b> Hypothyroidism affects all organ systems of the human body including the respiratory system. Subclinical hypothyroidism is the earliest stage of hypothyroidism and has a high prevalence rate worldwide. <b>Aim:</b> To assess the pulmonary function tests in female patients of subclinical hypothyroidism to find out lung function impairment if any. <b>Materials and Methods:</b> The study comprised of 60 female participants (30 patients with subclinical hypothyroidism and 30 healthy controls) in the age-group of 20-40 years. Pulmonary function tests were performed by using computerised spirometer Helios 401 (RMS, Chandigarh). The parameters of the two groups were compared by student’s t-test and p<0.05 was considered statistically significant. <b>Results:</b> The patients of subclinical hypothyroidism showed a highly significant reduction in Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), Peak Expiratory Flow Rate (PEFR) values and their predicted percentages as compared to healthy controls (p<0.001), Forced Expiratory Flow 25%-75% (FEF25-75%) and its predicted value was also significantly lower in patients than in controls (p<0.05), but the difference in values of FEV1/FVC% between two groups was not statistically significant (p>0.05). <b>Conclusion:</b> Pulmonary functions are affected in the patients with subclinical hypothyroidism. Therefore, pulmonary functions should be evaluated in subclinical hypothyroid patients to detect early respiratory dysfunction. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=CC01-CC03&id=12205 https://doi.org/10.7860/JCDR/2018/37512.12205 Evaluating a Risk Score for Lower Extremity Amputation in Patients with Diabetic Foot Infections Akash Chetpet, Bharat Dikshit, Deepak Phalgune <b>Introduction:</b> Factors associated with Diabetes Mellitus (DM) patients developing a foot ulcer are well defined, but risk factors for amputation are less clear. There are substantial morbidity and mortality associated with Lower Extremity Amputation (LEA) in patients with DM. The ability to identify which patients hospitalised for diabetic foot are at highest risk of LEA, could help clinicians to direct patients for special preventive efforts. <b>Aim:</b> To develop a scoring system to predict the risk of LEA in patients with a diabetic foot ulcer. <b>Materials and Methods:</b> One hundred and fifty patients with infected diabetic foot ulcer were included for this prospective, observational study. Score was allotted to following variables: age, sensory neuropathy, motor neuropathy, deformity, Infectious Diseases Society of America (IDSA) infection grade, past H/O amputation, ulcer depth grade, duration of DM, HbA1c, Rutherford grading and ankle brachial index. Total score of each subject was calculated after adding scores of risk factors. Statistical significance of categorical variables was tested using chi-square test or Fisher’s-Exact test. Threshold cut-off of total risk score for predicting incidence of amputation was determined using Receiver Operating Characteristics (ROC) curve analysis. Measures of diagnostic efficacy indices such as sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. <b>Results:</b> Patients with score of >16.5 were at increased risk of LEA and risk of amputation increased as the score increased. Percentage of patients who required amputation was significantly high in >65 years of age, duration of DM >20 years, sensory neuropathy Grade 2, presence of motor neuropathy, presence of deformity, IDSA infection Grade IV, past H/O amputation, ulcer depth Grade IV, HbA1c =12.5% (113.5 mmol/mol), ankle brachial index =0.9 or =1.30, and Rutherford Grading IV. Multivariate analysis revealed that duration of DM, HbA1c, Rutherford grading and ankle brachial index were significantly associated with LEA. <b>Conclusion:</b> The score will help clinicians to identify patients at high risk of LEA on examination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=PC14-PC19&id=12214 https://doi.org/10.7860/JCDR/2018/36712.12214 Educational Intervention Based on Protection Motivation Theory to Improve Vitamin E and C Consumption among Iranian Factory Workers Sahar Mohammad Nabizadeh, Parvaneh Taymoori, Mohammad Saleh Hazhir, Mehra Shirazi, Daem Roshani <b>Introduction:</b> Various studies have suggested the protective role of antioxidant vitamins such as vitamin C and E against toxic injury and disease resulting from toxic metals. Thus, studying the antioxidant vitamins consumption behaviour, particularly in high-risk groups such as factory workers with high exposure to toxic metals is emphasised. <b>Aim:</b> This study examined the effects of educational interventions based on the Protection Motivation Theory (PMT) among cement factory workers after intervention and six months of follow-up. <b>Materials and Methods:</b> Cement factory workers were randomly assigned into three groups: indirect (n=70), face-to-face (n=70) and control (n=70). The content of face-to-face interventions included multimodal lectures with powerpoint presentations, discussion, questions and answers, individual counselling sessions, and educational pamphlets and booklets. The indirect group received recently designed educational content through pamphlets and booklets. Workers completed PMT questionnaire and Food Frequency Questionnaire (FFQ) at baseline, post-intervention, and at the six-month follow-up. <b>Results:</b> Results showed significant positive changes on all PMT constructs, knowledge, and vitamins E and C consumption in both intervention groups at immediate post-intervention and at six month follow-up. Knowledge and intention remained higher in face-to-face groups than in indirect group and higher maintenance was also observed in relation to vitamins and C consumption in the face-to-face group. <b>Conclusion:</b> Findings of this study indicated the PMT intervention, particularly face-to-face intervention, is sound and can be performed for other protective dietary behaviours, such as other antioxidants consumption. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=JC01-JC06&id=12079 https://doi.org/10.7860/JCDR/2018/37056.12079 Assessment of Renal Parameters in Patients on Proton Pump Inhibitors and Risk of Chronic Kidney Disease Shivaganesh Chellappa, Madhavi Eerike, Venu Gopala Rao Konda, Ruckmani Arunachalam, Durga Krishnan <b>Introduction:</b> Proton Pump Inhibitors (PPIs) are one of the commonly prescribed drugs for peptic ulcer. It has been reported that 25% to 70% of prescriptions do not have proper indication. Recently these drugs are linked with increased incidence of kidney disease. <b>Aim:</b> The present study was conducted to assess the renal parameters in patients on PPI and to correlate it with the duration of treatment and Chronic Kidney Disease (CKD). <b>Materials and Methods:</b> A prospective observational study was carried out among 30 control and 30 test participants. Subjects were enrolled according to inclusion and exclusion criteria. After getting written informed consent, demographic and medication details were recorded. Blood sample was collected for estimation of serum creatinine and Blood Urea Nitrogen (BUN). Estimated Glomerular Filtration Rate (eGFR) was calculated based on serum creatinine levels. Demographic data, medication details and eGFR were expressed as percentage and renal parameters analysed by ANOVA and unpaired t-test. A p<0.05 was considered significant. <b>Results:</b> About 66.67% in control group and 86.67% in test group were males. Only 60% of them were using pantoprazole regularly for peptic ulcer. There was a significant increase (p<0.05) in serum creatinine and not in BUN in test group when compared to control. About 13% of participants had serum creatinine above 1.3 mg/dL. About 40% of test group subjects eGFR was less than <90 mL/minute/1.73 m2. There was no correlation between renal parameters and type and regularity of use of PPI. <b>Conclusion:</b> The use of PPI whether regular or irregular, irrespective of the type was associated with significant increase in serum creatinine and caused decrease in kidney function status. Study with large sample size is required for giving definitive conclusion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=FC05-FC09&id=12122 https://doi.org/10.7860/JCDR/2018/36570.12122 Erythromycin Resistance Determinants in Clinical Gram Positive Cocci Isolated from Nigerian Patients David Olusoga Ogbolu, Oyebode Armstrong Terry Alli, Adeolu Sunday Oluremi, Christianah O Onifade <b>Introduction:</b> The emergence of erythromycin resistant Gram positive cocci in various parts of the world has become worrisome in clinical settings in recent times, however there is little or no information on the determinants of erythromycin resistance from Nigeria. <b>Aim:</b> This study investigated the determinants of erythromycin resistance in clinical Gram positive cocci bacteria isolated from Nigeria patients. <b>Materials and Methods:</b> Assembly of isolates of non-duplicate staphylococci from various clinical specimens from south western and northern hospitals of Nigeria were collected. While enterococci were obtained from our culture collection which were previously collected from healthy people from community. Characterisation of 25 staphylococci and enterococci each were done using standard microbiology procedures, susceptibility pattern to erythromycin and other panel of antimicrobial agents including Minimum Inhibitory Concentrations (MICs) to erythromycin was determined. Erythromycin resistance genes were amplified using Polymerase Chain Reaction (PCR). <b>Results:</b> None of the strains had ermA and mefA but the strains showed heterogeneous possession of ermB, ermC, msrA and msrB genes in no particular pattern including multiple genes acquisition. MIC50 and MIC90 of staphylococci strains to erythromycin were 2 µg/mL and >64 µg/mL, respectively; wherein 7 (28%) were sensitive to erythromycin, while 11 (44%) of enterococci were sensitive to erythromycin with MIC50 and MIC90 of 1 and >64 µg/mL, respectively. One of the staphylococci isolates had inducible clindamycin resistance. <b>Conclusion:</b> In conclusion, high level staphylococci and enterococci resistance was found to various antibiotics with limited therapeutic option. Ribosomal methylation and efflux are the main resistant determinants found in these isolates. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=DC05-DC10&id=12123 https://doi.org/10.7860/JCDR/2018/30684.12123 Prevalence of Sexually Transmitted Diseases Detected in Cervical Cytology Smears in Urban and Rural Population of Lucknow, Uttar Pradesh, India Jata Shankar Misra, Anand Narain Srivastava, Hem Prabha Gupta <b>Introduction:</b> Sexually Transmitted Diseases (STDs) are very common in the young sexually active Indian women particularly in rural areas because of poor genital hygiene. <b>Aim:</b> The present study was carried out to compare the prevalence of different STDs in the urban and rural population of Lucknow, Uttar Pradesh. <b>Materials and Methods:</b> The present prospective observational study was conducted in 2369 rural women attending camps in 126 villages of West Lucknow between May 2013 and March 2017 undergoing cervical cancer screening and in 38,478 urban women attending Gynaecology Outpatient Department (OPD) of KG Medical University, Lucknow, Uttar Pradesh, India, between April 1971 to November 2005 in which the data were collected retrospectively. Statistical analysis was performed with SPSS version 18.0 and the results were subjected to chi-square test. <b>Results:</b> The incidence of Candida albicans was higher in rural women (4.7%) as against 1.1% seen in urban cohorts. The trend was reverse with Trichomonas vaginalis, the incidence being high (2.9%) in the Urban women than 1.0% in the rural group. The viral STDs were rarely seen in both the groups ranging from 0.1% to 0.6%. Association of Squamous Intraepithelial Lesions (SILs) of the cervix with non-viral STDs was more pronounced in rural women than in their urban counterparts while this was very high with viral STDs in both the groups. All the STDs except HSV were commonly seen in younger sexually active women between 21-30 years. Leucorrhoea was commonly associated with all STDs in both groups but the incidence was almost double in rural women. <b>Conclusion:</b> All the STDs examined were commonly seen in younger women between 21-30 years mostly with symptoms of leucorrhoea. Hence, cytological screening is felt mandatory in such women to rule out any STD infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=QC07-QC11&id=12124 https://doi.org/10.7860/JCDR/2018/34245.12124 Burn Wound Healing Potential of Honey, Sandal Wood, Calendula and Cooling with Tap Water-A Comparative Study on Wistar Rats Jayshree Shriram Dawane, Anand Biradar, Ketan Vaidya, Ashutosh Sharma, Madhura Bhosale, Vijaya Anil Pandit <b>Introduction:</b> Burn injury is always associated with high morbidity and mortality depending on the percentage of burns. Slow wound healing, infection, pain, and hypertrophic scarring continue to remain a major challenge to the clinicians in the management of it. <b>Aim:</b> To study the burn wound healing potential of Honey, Sandal wood, Calendula and cooling with tap water on wistar rats. <b>Materials and Methods: </b>Fifty four rats of either sex weighing 180-200 gm were (n=6) divided into nine groups which were-Group 1: Control (Ointment base), Group 2: Honey, Group 3: Sandalwood paste, Group 4: Calendula ointment, Group 5: Honey and Sandalwood paste (H+S), Group 6: Honey and Calendula ointment (H+C), Group 7: Honey and sandalwood and Calendula (H+C+S), Group 8: cooling with tap water and Group 9: 1% Silver sulfadiazine. Rats were anaesthetised with thiopental sodium and placed in supine position touching shaved back to the bottom of tray containing hot water 90°C for 6 seconds. The animals were resuscitated with 5 mL of normal saline intra-peritoneally. Drug treatment was given according to groups topically for 25 days. Wound contraction was expressed as reduction in percentage of the original wound size. The parameters observed were epithelisation period and percentage of wound contraction. Statistical analysis was done with One-way ANOVA followed by Tukey’s test. <b>Results:</b> Significant improvement in wound contraction was seen in all the groups except in control and H+C+S group. Epithelisation started early in H+S combination group, significant (p<0.001) improvement with complete healing and hair growth was seen. Results of Calendula, Honey and Tap water groups were comparable with silver sulfadiazine. <b>Conclusion:</b> Honey, sandalwood, calendula and cooling with tap water was effective in reducing the initial damage. Honey and Sandalwood combination showed better effect with complete burn wound healing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=FC10-FC13&id=12125 https://doi.org/10.7860/JCDR/2018/36971.12125 Role of Hepcidin on Response of Erythropoietin Stimulating Agents in Anaemic Advanced Chronic Kidney Disease Patients Satyendra Kumar Sonkar, Anil Kumar, Neeraj Kumar Singh, Gyanendra Kumar Sonkar, Sant Pandey, Vivek Bhosale <b>Introduction:</b> Anaemia contributes significantly to the morbidity and mortality in Chronic Kidney Diseases (CKD). Erythropoietin Stimulating Agents (ESA) have revolutionised the management of the anaemia in CKD patients. However, over 50% of the patients do not reach the target haemoglobin level. Hepcidin which plays important role in iron metabolism and inflammation may be the cause of this hyporesponsiveness to ESA. <b>Aim: </b>The present study was aimed to assess possible relation between hepcidin and erythropoietin therapy with special attention to hyporesponsive anaemia in advanced kidney disease. <b>Materials and Methods: </b>In this cross sectional study, total of 81 clinically stable patients from Department of Medicine and Nephrology, King George’s Medical University, Lucknow of advanced CKD on ESA for past 12 weeks were enrolled. Patients whose haemoglobin rose more than 2 gm/dL or were above 10 gm/dL were classified as responders while below 10 gm/dL were classified as poor responders. <b>Results:</b> In present study, majority 54 patients (66.7%) were poor responders to ESA. We found significant higher level of hepcidin in poor responders (p=0.01) while no significant variation in serum iron, Transferrin Saturation (TSAT) and ferritin. High sensitivity C-Reactive Protein (hsCRP) was markedly elevated with median value 3.13 mg/L and Interquartile Range (IQR) (1.14-13.78) in all patients. <b>Conclusion:</b> Hepcidin may be one of the causes of hyporesponsiveness to ESA due to reticulo-endothelial blockade of iron. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OC14-OC16&id=12142 https://doi.org/10.7860/JCDR/2018/36051.12142 Comparative Evaluation of Porosities and Solubility for Different Non-Metallic Denture Base Material Mohammed Abdullah Quassem, Hamada Zaki Mahross <b>Introduction:</b> Surface Porosities and solubility are undesirable characteristics of PMMA that significantly weaken a denture base and promote staining, harboring of organisms such as Candida Albicans and bond failures between the artificial tooth and denture base resin. <b>Aim:</b> To evaluate and compare porosities and solubility between thermoplastic flexible and conventional heat cured acrylic resin denture base material. <b>Materials and Methods: </b>A total of 40 disc samples of thermoplastic and heat cured resin were prepared and divided into 2 groups: group I flexible polyamide resin and group II heat cured resin and then they were further distributed for solubility and porosity testing. Solubility was measured by registering the desorption of the samples that gained water after four weeks then weighed weekly till six weeks. The porosity was estimated quantitatively by total pore volume (W0). An electronic analytical balance was used to weight the samples. The data was collected and statistically analysed using ANOVA test. A paired sample t-test and independent t-test at the significance level of (a = 0.05) were used for comparison between two groups. <b>Results:</b> The change in solubility over time for flexible and conventional group was statistically non-significant. In comparison between flexible vs. conventional solubility; it was noted statistically non-significant at all storage time. The change in porosity with time for flexible and conventional group was statistically significant. <b>Conclusion:</b> More porosity of the flexible (thermoplastic polyamide nylon) resin would eventually promote hygiene maintenance. Flexible denture bases may be indicated in patient’s requiring replacement of teeth in aesthetic zone, severe soft and hard tissue undercuts, allergy to acrylic or metal. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZC18-ZC22&id=12132 https://doi.org/10.7860/JCDR/2018/36219.12132 Aspects of the Sinonasal Sarcoidosis Manifestations in Iran Ali Safavi Naeini, Arda Kiani, Shapoor Safari, Jahangir Ghorbani, Kimia Taghavi ,Mojganmotevally Bashi, Mehdi Kazempour-Dizaji, Atefeh Abedini <b>Introduction:</b> Sinonasal Sarcoidosis (SNS) is the most common involvement of upper respiratory tract sarcoidosis disease. Not much data is available on the detailed diagnostic aspects of Iranian sinonasal sarcoidosis patients. <b>Aim:</b> The current study is the first report from Iran that evaluates the prevalence and describes the clinical features of patients with sinonasal sarcoidosis in Iran. <b>Materials and Methods:</b> This cross-sectional descriptive study was performed on the eighty eight newly diagnosed and biopsy proven sarcoidosis patients who were suspected to have head and neck disorders. Sinonasal involvement of sarcoidosis was examined via Computed Tomography of Para-nasal Sinuses (CT PNS) imaging as well as rhinoscopy, and histopathologic examinations on the nasal or sinusitis mucosa biopsy sample. Data were analysed by Statistical Package for Social Sciences (SPSS) and differences between two groups were obtained using the ?2 test, the Mann-Whitney test and independent t-test with consideration of a statistically significant p-value of <0.05. <b>Results:</b> Sinonasal disorders were observed in 32 patients. Association of sinonasal and pulmonary sarcoidosis were confirmed in 18 of 32 SNS patients (56.25%). Rhinoscopy investigations demonstrated that the prevalent presenting signs were nasal crusting in 4 patients (14.3%), septal perforation in 3 patients (8.6%), mucosal hypertrophy in 9 patients (28.6%), synechia in 2 patients (5.7%), middle turbinate hypertrophy in 4 patients (11.4%) and submucosal nodule in 10 patients (31.4%). <b>Conclusion:</b> Endoscopic investigations indicated that the most frequent manifestation of SNS cases was inflammatory rhinosinusitis often with nodular lesions on the septum and turbinates. Further studies with bigger sample size are recommended in order to measure the sensitivity and specificity of nasal obstruction as a diagnostic parameter of sinonasal sarcoidosis patients of Iran. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OC17-OC21&id=12144 https://doi.org/10.7860/JCDR/2018/36637.12144 Comparative Analysis of Cranial Capacity with Body Mass Index and Academic Performance of First Year Medical Students Mariappan Senthiappan Arathi, Ganesan Durga Devi, Dorairaj Sreelekha,Rajasundaram Archana, Mariappan Senthiappan Anandi, Manickam Subramanian <b>Introduction: </b>The cranial capacity indirectly reflects the volume of the brain, hence may predict the mental ability of an individual. <b>Aim:</b> To estimate the cranial capacity and correlate it with Body Mass Index (BMI) and academic performance of first-year students of a Medical College in Chennai, Tamil Nadu, india. <b>Materials and Methods:</b> A total of hundred first year MBBS students aged between 17 and 19 years were selected for the present study from Sree Balaji Medical College and Hospital, Chrompet, Chennai, India. Cranial capacity and BMI were calculated by standard methods. The average academic performance during the year was obtained by calculating the average of the total marks secured in the academic year. All the above data were tabulated and analysed statistically by using Pearson’s correlation test and Paired Student t-test. <b>Results:</b> The cranial capacity had no significant correlation with the academic performance in the present study. However, the BMI had a significant correlation with cranial capacity; this may be because larger cranial capacity is required for controlling larger muscular body mass. <b>Conclusion:</b>The present study showed a larger cranial capacity was related with increased BMI and hence may be helpful in the medicolegal and anthropological examination to find the relations between cranial capacity and age, height, body weight and BMI. There was no significant correlation between academic abilities with cranial capacity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=AC01-AC04&id=12137 https://doi.org/10.7860/JCDR/2018/36370.12137 Serum Adiponectin Levels in Insulin Resistant Infertile Women Kadangudi Aravaanan Arul Senghor, shivasekar Meera, V M Vinodhini <b>Introduction:</b>Adiponectin, a beneficial adipocytokine plays a crucial role that regulates insulin sensitivity and also has a role in the ovulation process. Visceral adiposity adversely affects the reproductive hormone production and ovulation that impacts fertility in reproductive females. Adiponectin may be considered as the vital link between central obesity and insulin resistance that regulates ovulation to occur. <b>Aim:</b> To compare the levels of Adiponectin in insulin resistant and non-insulin resistant infertile women with ovulatory dysfunction and to correlate Adiponectin levels with hormones such as Luteinising Hormone (LH), Follicle-Stimulating Hormone (FSH), LH/FSH ratio, Thyroid Stimulating Hormone (TSH), insulin and variables like Waist Circumference (WC) and Waist-Hip Ratio (WHR). <b>Materials and Methods:</b> The present cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, SRM Medical College and Research centre, Tamil Nadu, India. The study included 88 married women of reproductive age group between 20 to 40 years attending the infertility clinic. All the participants had a complete physical examination with measurements of weight (Kg), height (m), WC (cm) and HC (cm) to calculate the BMI and WHR. After overnight fasting, blood samples were collected on second or third day of menstrual cycle for estimating LH, FSH, TSH, insulin and Adiponectin levels. Based on HOMA-IR calculation the individuals were categorised as Insulin resistant Group (A) n=48 with HOMA-IR =2 and non-Insulin resistant Group (B) n=40 with HOMA-IR <2. Serum Adiponectin levels were measured by Human Adiponectin ELISA kit (Biovendor). Statistical analysis was done with Student’s t-test and Pearson correlation analysis. <b>Results:</b> The Adiponectin levels in insulin-resistant women were significantly decreased (3.4±1.3) µg/mL compared to non-IR women (5.2±2.0) µg/mL, p <0.05. A significant negative correlation was observed between Adiponectin with WC, insulin levels and LH/FSH. <b>Conclusion:</b> The present study clearly highlighted the fact that infertile women with insulin resistance have decreased adiponectin levels that subsequently affects the ovulatory process. Adiponectin is one of the important factors that influence ovulation and implantation of fertilised ovum. Thus, improvement in insulin resistance increases the chance of ovulation in reproductive females. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=BC04-BC06&id=12138 https://doi.org/10.7860/JCDR/2018/36605.12138 Effect of Blood Storage on Biochemical Parameters Assessed at Periodic Intervals in CPDA1 Blood Bags Ujwal B Upadya, HS Seema, Kaviraj Motakapalli <b>Introduction:</b> Blood when stored at 4°C, effectuates alterations in biochemical and mechanical properties of red blood cells because of storage conditions, which are called as storage lesions. Red blood cells lose their viability over a period of time even after storing blood with Citrate Phosphate Dextrose Adenine (CPDA-1) anticoagulant. <b>Aim:</b> To observe the changes in biochemical parameters namely Glucose, Urea, Creatinine, Total protein, Aspartate Transaminase (AST), Albumin, Sodium, Potassium and Chloride in stored blood. <b>Materials and Methods:</b> The present study was a prospective study conducted on blood samples donated by 50 healthy voluntary donors. Biochemical parameters namely Glucose, Urea, Creatininie, Total protein, AST, Albumin, Sodium, Potassium and Chloride were estimated in stored blood collected in CPDA1 blood bags on 0,3,7,14 and 21st day. All the data were analysed using SPSS 22.0 software. Students t-test was used to find the effect of blood storage on its biochemical parameters. Correlation analysis was used to find the relationship between biochemical parameters and period of storage. <b>Results:</b> Significant changes were observed in serum AST, Total protein, Albumin, Urea, Chloride, and Potassium levels (p-value <0.05). Rest of the biochemical parameters did not show any significant change over the period of storage time. <b>Conclusion:</b> In the present study, authors observed that there were significant changes in some of the biochemical parameters namely serum AST, Total protein, Albumin, Urea, Chloride, and Potassium levels (p-value<0.05) assessed at periodic intervals. The changes might be due to spontaneous haemolysis or non viable red blood cells caused due to storage. Therefore, it is better to transfuse blood as early as possible in order to prevent a negative impact on the biochemical composition of red blood cells. Also, usage of CPDA2 or SAGM anticoagulant solutions may to some extent minimise this issue. The further contrivance of newer anticoagulant solution in blood bags can be focused upon to reduce the impact of storage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=EC05-EC07&id=12139 https://doi.org/10.7860/JCDR/2018/37223.12139 Prolidase Activity and Oxidative Stress in Patients with Glioma Akhilesh Kumar Verma, Kulwant Singh, Surendra Kumar Pandey, Ragini Srivastav <b>Introduction:</b> Glioma is a glial cell tumour. Altered inflammatory responses and oxidative stress can be associated with induction of angiogenesis and uncontrolled growth of cells. Prolidase is a metalloenzyme also associated with angiogenesis and cancer. However, studies on prolidase and oxidative stress in glioma patients are limited. <b>Aim:</b> To observe the prolidase activity and oxidative stress markers, such as Total Oxidant Status (TOS), Total Antioxidant Status (TAS) And Oxidative Stress Index (OSI), in patients with glioma. <b>Materials and Methods:</b> Total 46 patients with glioma, 20 cadaver and 46 healthy volunteers of age and gender matched were selected as Cases, Control-1 and Control-2, respectively. Blood and brain tissues of respective area of cases and Control-1 were collected, while only blood was collected from Control-2. After brain tissue homogenisation and sera separation, prolidase activity and oxidative stress parameters were assessed spectrophotometrically. <b>Results:</b> Prolidase activity and oxidative stress was found to be significantly elevated in the glioma tissues as well as sera of the patients with glioma as compared to healthy and cadaver controls (all p<0.01). Total oxidant status and oxidative stress index were also significantly elevated in glioma tissues and sera of patients with glioma, while total antioxidant status was significantly decreased (all p<0.01). <b>Conclusion:</b> The present study showed that prolidase activity and oxidative stress markers such as TOS and OSI were significantly elevated in the patients with glioma, while level of TAS was decreased. Thus, it seems that elevated prolidase activity and oxidative stress markers might be associated with the pathogenesis of glioma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=BC07-BC10&id=12140 https://doi.org/10.7860/JCDR/2018/37281.12140 Comparative Evaluation of Haemodynamic Response during Induction of General Anaesthesia and Incidence of Myoclonus with Etomidate and Propofol: A Randomised Controlled Trial Balwinder Kaur, Tejinderpal Kaur Grewal, Priyanka Gupta <b>Introduction:</b> An ideal induction agent for general anaesthesia should maintain haemodynamic stability, have minimal respiratory side effects, has rapid clearance and minimal drug interaction. Sudden hypotension has deleterious effects on maintaining circulation to vital organs. <b>Aim:</b> To compare the haemodynamic response during induction in general anaesthesia and to evaluate the incidence of myoclonus with etomidate and propofol in adult patients posted for elective surgery. <b>Materials and Methods:</b> A total of 100 adult patients of ASA Grade I and II between 18-60 years of age were randomised into two groups of 50 each receiving propofol {Group P 2 mg/kg Intravenous (i.v)} or etomidate (Group E 0.3 mg/kg i.v) as induction agent. The haemodynamic parameters including Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), SpO2 and EtCO2 were measured as baseline parameters before induction, immediately after induction, at intubation and then every 1 minute till 10 minutes and every 2 minutes till 20 minutes after intubation. Any myoclonus during induction was noted. Statistical analysis was done using EpiInfo software (7.1.0.6 version) and Microsoft Excel 2010. <b>Results:</b> The demographic variables were comparable in both the groups. Statistical evaluation showed that the decrease in SBP, DBP and MAP was statistically significant (p-value<0.05) in Group P. The incidence of myoclonus was significantly high with etomidate. There was no significant difference with regards to HR, SpO2 and EtCO2. <b>Conclusion:</b> Etomidate is a better agent for induction than propofol in view of haemodynamic stability but has high incidence of myoclonus. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=UC13-UC16&id=12160 https://doi.org/10.7860/JCDR/2018/30183.12160 Is Serum Lactic Acid a Reliable Indicator for Diagnosing Fat Embolism Syndrome? Chandra Sekhar Bhumireddy, Surendra Umesh Kamath, Sunil Lakshmipura Krishnamurthy <b>Introduction:</b> The incidence of Fat Embolism Syndrome (FES) has been reported to occur in 0.5 to 3% of patients with isolated long bone fracture. FES is most commonly associated with long bone fractures, if associated with polytrauma then the chance of manifestation increases by 11%. Fat embolism is a clinical entity diagnosed mainly by Gurd’s criteria which includes clinical signs and blood parameters. There is no single blood parameter to detect FES at earliest. A high lactate level is an early sign of tissue hypoxia. In patients with femur shaft fracture tissue hypoxia is the most important cause of increased lactate levels. Increased blood lactate level is related to increased mortality. <b>Aim:</b> To establish the relationship between serum lactic acid and fat embolism in patients with fracture shaft of the femur. <b>Materials and Methods:</b> The present was a prospective study done at Kasturba Medical College Hospitals, Mangalore, Karnataka, India, on 40 patients with femur shaft fracture. Statistical analysis was done using SPSS (version 17.0). <b>Results:</b> In the present study, four patients out of 40 had FES (Gurd’s criteria), whose serum lactic acid was high (>25) within 72 hours of injury. Fourteen patients had elevated lactic acid (>20) but did not develop FES. All patients with FES had elevated serum lactic acid which was statistically significant (p-value 0.003), yet serum lactic acid estimation was less sensitive 28.7%. <b>Conclusion:</b> In conclusion serum lactic acid is specific (100%) for fat embolism but not sensitive (28.7%). By using serum lactic acid level, development of fat embolism can’t be predicted however, elevated lactic acid level will help us in risk stratification. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=RC01-RC03&id=12161 https://doi.org/10.7860/JCDR/2018/35705.12161 Histogenesis of Thyroid Gland in Dead Human Foetuses of Different Gestational Age Anandi Neel Bande, Megha Arun Doshi, Ramesh Balkrishna Vaidya, Manisha Randhir Dhobale, Nitin Radhakishan Mudiraj <b>Introduction:</b> In human beings the thyroid gland is one of the largest differentiated endocrine gland. The function of thyroid gland is to promote growth and development of the brain during fetal life and for the first few years of post-natal life. <b>Aim:</b> To study the histological features of thyroid gland in human fetuses of different gestational age. <b>Materials and Methods:</b> Thyroid glands were dissected in 40 spontaneously aborted normal human fetuses fixed in 5% formalin with gestational age ranging from 11 weeks to 38 weeks. After tissue processing, paraffin blocks were prepared. All sections were stained with Haematoxylin-Eosin. The sections of first two groups of this study (upto 16 weeks) were also stained with PAS to confirm the colloid. <b>Results:</b> Process of arrangement of thyroid follicles begins from 13th week onwards with gradual increase in their number and size. First appearance of colloid in follicles (Thin rim) was observed at 14th week and was confirmed by PAS. Thickness of capsule and vascularity of the gland increased with advancement of gestational age. Parafollicular cells or C cells were found after 17th week of gestation. <b>Conclusion:</b> In the present study, pre-colloidal stage was seen before 13 weeks and linear but partially overlapping developmental stages like folliculogenesis, colloid formation and maturation of follicles were observed after 14th week of gestation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=AC05-AC08&id=12166 https://doi.org/10.7860/JCDR/2018/34519.12166 Intrapulpal Rise in Temperature Due to Various Curing Units- In Vitro Study Jasmeet Chandhok, Deepika Chandhok, Grishmi Niswade <b>Introduction: </b>Dental pulp is a highly vascularized tissue whose vitality is known to be impaired during tooth preparation and clinical restorative procedures but the rise in its temperature during the use of light curing units is often overlooked. The dental pulp is a low compliance system which does not respond well to increased temperature. <b>Aim:</b> The purpose of this study was to examine the temperature rise caused by different light curing units i.e., LED (Light Emitting Diode), QTH (Quartz Tungsten Halogen), PAC (Plasma Arc Curing) and to examine the influence of Remaining Dentin Thickness (RDT) i.e., 2mm, 1mm and 0.5 mm on the temperature increase in pulp. <b>Materials and Methods:</b> Dentin disks of different thicknesses i.e., 0.5mm, 1mm and 2mm were prepared. Composite resin was placed on the dentin disks which were cured using three different lights. The intrapulpal changes in temperature during the curing of the composite resin were determined with the help of a thermo couple. Ten readings were taken for each light curing unit at 2mm, 1mm and 0.5 mm RDT and the temperature rise in Degree Celsius was recorded. <b>Results:</b> The changes in the intrapulpal temperature due to LED, QTH and PAC with 0.5mm, 1mm and 2mm RDT dentin disks were determined as a difference between the initial and maximum temperature values. When the results were compared among PAC and LED, the intrapulpal rise in temperature was significantly higher with PAC. With respect to QTH and LED and QTH and PAC, QTH had highly significant values of temperature rise when compared to LED and PAC. <b>Conclusion:</b> It was observed from the study that remaining dentin thickness is inversely proportional to temperature rise. Also, the choice of curing unit is vital when polymerising light activated resin based restorations minimise any thermal damage to pulp. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZC23-ZC26&id=12146 https://doi.org/10.7860/JCDR/2018/37555.12146 Estimation of Antiphospholipid Antibodies, Anticardiolipin Antibodies, Beta-2 Glycoprotein 1 Antibodies in Recurrent Pregnancy Loss - A Case-control Study Nilam bhasker, Meenakshi Kar, Dharmendra kumar <b>Introduction:</b> Recurrent miscarriage is the occurrence of three or more consecutive pregnancy loss before 20 weeks of gestation. Antiphospholipid Antibodies (APAs) are one of the causes responsible for recurrent pregnancy loss. <b>Aim:</b> Estimation of APAs, Anticardiolipin Antibodies (ACAs) and Beta-2 Glycoprotein 1 Antibodies (b-2 GP1 Abs) in recurrent pregnancy loss and also to assess which antibody has strong correlation with habitual abortion patients. <b>Materials and Methods:</b> This was a case-control study that included the total number of 45 women of reproductive age group from Obstetrics and Gynaecology Department, KGMU, Lucknow, Uttar Pradesh, India, out of which 30 women had been taken as case and 15 as control. Dilute Russell Viper Venom Test (DRVVT) was applied for Lupus Anticoagulant (LA) and Enzyme Linked Immunosorbent Assay (ELISA) for ACA, APA and b-2 GP1 Ab. <b>Result:</b> Majority of cases showed higher positivity for b-2 GP1 Abs 11/30 (36.7%) with lesser positivity for ACA 4/30 (13.4%) and APAs 4/30 (13.4%). All the antibodies were absent in control group. Majority of cases showed positivity for b-2 GP1 Ab out of which two cases also showed positivity for ACA, APA and LA. <b>Conclusion: </b> b-2 GP1 Abs are useful and a significant marker in recurrent pregnancy loss in women as compared to ACA and APAs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=EC08-EC11&id=12147 https://doi.org/10.7860/JCDR/2018/35387.12147 Changing Trend of Clinical and Epidemiological Profile of Lung Cancer – Experience from a Tertiary Care Centre in Southern India Manoj Kumar Panigrahi, Vinod Kumar Saka, Venugopal Jaganathan, Mathanraj Sinnassamy, Narendra Kumar Narahari <b>Introduction:</b> There has been a renewed interest in lung cancer epidemiology owing to changing trend in histology with a relative increase in adenocarcinoma worldwide. However, such a trend was not observed across India over the last six decades. <b>Aim:</b> To assess the demographic profile, smoking status, histological types/patterns and stage of lung cancer among patients visiting a tertiary care centre/hospital in south India. <b>Materials and Methods:</b> Cross-sectional study was conducted over a period of two years including patients with cytohistological confirmation of lung cancer. Non-Small Cell Lung Cancer (NSCLC) was staged as per 7th edition of TNM classification and Small Cell Lung Cancer (SCLC) as either limited or extensive disease. <b>Results:</b> A total of 125 patients {115 (92%) NSCLC, 10 (8%) SCLC} were diagnosed with lung cancer. Mean age of presentation was 55±9.62. Seven (5.6%) patients were =40 years. Ninety-five (76%) were male. Overall 71 patients (57.72%) were smokers. Cough in 110 (88%), dyspnea in 92 (73.6%) and chest pain in 63 (50.4%) were the predominant symptoms among patients. Most common histological type was adenocarcinoma in 67 patients (53.6%) followed by squamous cell 39 patients (31.2%), small cell carcinoma 10 patients (8%), undifferentiated 7 patients (5.6%) and large cell carcinoma 2 patients (1.6 %). Majority of NSCLC patients 70 patients (61%) presented with stage IV disease followed by IIIB (17.4%), IIIA (12.2%), IIB (6%) and IIA (3.4%). Nine out of ten with SCLC had extensive disease. Most non-smokers (73%) had adenocarcinoma where as equal proportions (41%) of smokers had squamous cell and adenocarcinoma each. Adenocarcinoma was five times more common in females than males and squamous cell carcinoma was 3.8 times more common than adenocarcinoma in smokers. <b>Conclusion:</b> Adenocarcinoma was found as the commonest type of lung cancer in southern Indian population with a trend of diminishing male-female ratio. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=LC01-LC03&id=12148 https://doi.org/10.7860/JCDR/2018/36768.12148 Can Betatrophin Predict the Risk of Preeclampsia? Engin Ersin Simsek, Halim Omer Kasikci, Onder Sakin, Semih Korkut <b>Introduction:</b> Preeclampsia, a hypertensive disease of pregnancy, is globally one of the primary causes of maternal morbidity and mortality. Betatrophin is shown to be a novel adipokine in pathophysiology of metabolic disorders. It plays a role in glucose and lipid metabolism and is associated with diabetes mellitus, obesity and metabolic syndrome. <b>Aim:</b> To analyse the relationship between betatrophin levels and the occurrence/severity of preeclampsia. <b>Materials and Methods:</b> A prospective cross-sectional study was carried out for a sample of 73 women diagnosed with preeclampsia (severe and mild) and 76 healthy pregnant controls matched for betatrophin levels, age, Body Mass Index (BMI), and gestational age. All data were analysed using the Statistical Package for the Social Sciences (SPSS) version 17 program (SPSS Inc., Chicago, IL, USA). Distribution of data was evaluated with Kolmogorov–Smirnov test. Results were presented as medians (interquartile range) except for normal parameters that are presented as mean±SD. The data with normal distribution were analysed with one-way ANOVA test whereas data without normal distribution were evaluated with Kruskal-Wallis test. Correlations between betatrophin and biochemical markers were assessed using Spearman’s correlation test. Results were evaluated with 95% confidence intervals and the level of significance was indicated as p<0.05. <b>Results:</b> Betatrophin levels (in ng/mL) were 2.2±0.6 in severe preeclampsia group, 2.0±0.5 in mild preeclampsia group, and 1.3±0.6 in control group. There were significant differences between severe preeclampsia and control groups (p<0.001) and also between mild preeclampsia and control groups (p<0.001). On the other hand, no significant difference was found between severe and mild preeclampsia groups. Furthermore, betatrophin concentrations were found to be significantly positively correlated with both diastolic blood pressure and Homeostasis Model Assessment of Insulin Resistance Index (HOMA-IR) (p<0.001). This is also shown to be associated with the presence of preeclampsia. <b>Conclusion:</b> Betatrophin is believed to be an important predictive biomarker that can be studied for early diagnosis and management of preeclampsia in pregnancies with high risk. More specifically, studies that focus on the evolution of this relationship over the pregnancy weeks could help reduce the maternal and fetal death rates in developing countries. Further randomized trials are needed in order to determine the applicability of this approach in clinical practice. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=QC12-QC15&id=12149 https://doi.org/10.7860/JCDR/2018/36991.12149 Predictive Performance of Quick Sequential Organ Failure Assessment Scoring in an Argentinian Hospital Javier Osatnik, Bárbara Tort-Oribea, Juan Folco, Ariel Sosa, Dabiel Ivulich, María Mercedes Kleinert, Javier Eugenio Roberti <b>Introduction:</b> The early identification and treatment of sepsis in emergency setting could improve patients’ survival. The Quick-SOFA score is a simple tool that could contribute to this identification. <b>Aim:</b>To evaluate mortality rate in Emergency Department along with predicting sepsis by Quick-SOFA. <b>Materials and Methods:</b> This was an observational, prospective study performed in an emergency department of an Argentine Hospital. The studied patients were =18 years of age, with infection or suspicion of infection. For qSOFA, 1 point was assigned for each of following: respiratory rate >21 breaths/min, systolic arterial blood pressure =100 mm Hg, and altered mental status. A qSOFA score of =2 was considered positive. To assess the performances of the qSOFA and SIRS, sensitivity and specificity was calculated. <b>Results:</b> A total of 157 patients were included with mean age corresponding to 62.9±19.2 years out of which 76 (48.4%) patients were women. Upon admission, 58/157 (36.9%) patients showed a positive-qSOFA, and 120/157 (76.4%) patients were SIRS positive (=2 signs). 69/157 (46%) cases developed sepsis; 22/157(14%) patients died during their stay. The discrimination of sepsis using qSOFA was comparable with the SIRS criteria (p=0.399) and the discrimination of in-hospital mortality using qSOFA was better than SIRS criteria (p=0.0488). A qSOFA Area Under the Curve (AUC) for predicting sepsis was 0.765 (95% CI 0.69-0.84) while qSOFA AUC for predicting in-hospital mortality was 0.71, (95% CI 0.59-0.83). <b>Conclusion:</b> The newly introduced qSOFA provided better discrimination than SIRS for predicting in-hospital mortality whereas both scores showed comparable discrimination for predicting sepsis in Emergency Department. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OC22-OC26&id=12150 https://doi.org/10.7860/JCDR/2018/37018.12150 Variation in the Duration of Recumbency Post-spinal Anaesthesia in Relation to the Occurrence of Post-dural Puncture Headache Elkanah Ayodele Orimolade, Simeone Olugbade Olateju, Joseph Olorunsogo Mejabi, Adedapo Omowonuola Adetoye, Innocent Chinedu Ikem, Funbi Anthony Ayeni, Oluwadare Esan <b>Introduction:</b> Post-Dural Puncture Headache (PDPH) remains one of the most dreaded complications of spinal anaesthesia. Duration of recumbency has been considered as a factor in the occurrence of PDPH. <b>Aim:</b> This study aimed to look at the incidence of PDPH among two groups of patients that had six and twelve hours of recumbency post-spinal anaesthesia. <b>Materials and Methods:</b> Patients aged 15 years and above with lower limb pathologies that required surgery under spinal anaesthesia were prospectively recruited into two groups: group A patients had 6 hours of recumbency post spinal anaesthesia while group B had 12 hours. Data on the occurrence of PDPH among the two groups were collected. All patients had dural puncture with either 23G or 25G spinal needles. <b>Results:</b> One hundred and five patients, with mean age of 45.9 years were studied. The M:F was 1.8:1. Forty eight patients had 6 hours of recumbency while fifty seven patients had 12 hour recumbency. The incidence of PDPH in the patients studied was 9.5% with an average Pain Numerical rating score of 6. There was no significant difference in the incidence of PDPH following either 6 or 12 hours of recumbency (p-value <0.5). <b>Conclusion:</b> Six hours of recumbency from the time spinal anaesthesia was administered in the theatre is as safe as 12 hours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=UC09-UC12&id=12151 https://doi.org/10.7860/JCDR/2018/37183.12151 Correlation Between Sexual Satisfaction and Self-Esteem and Stress in Women of Reproductive Age Safieh Jamali, Neda Poornowrooz, Zahra Mosallanezhad, Mahshid Alborzi <b>Introduction:</b> Marital satisfaction is one of the factors affecting quality of life, quality of sexual relations, and interpersonal relationships. <b>Aim:</b> To determine the relationship between marital satisfactions, perceived stress, and self-esteem among reproductive age women in Jahrom City, Iran. <b>Materials and Methods:</b> This cross-sectional study was conducted on 300 women who attended Women’s Healthcare Clinic of Jahrom, Iran from June to December 2017. The tools used were Larsson sexual satisfaction questionnaire, Cohen’s perceived stress scale, and Rosenberg self-esteem questionnaire. Data were analysed using ANOVA, Pearson’s correlation coefficient, and Spearman test. <b>Results:</b> The mean age of women was 29.55±6.68 years. In addition, 3(1%), 27(9%), 138(46%) and 132(44%) of subjects showed zero, low, moderate, and high levels of sexual satisfaction. There was a significant correlation between sexual satisfaction with self-esteem (p<0.05) and stress (p<0.05). In addition, positive significant correlations were found between sexual satisfaction with the women’s education (p<0.05 r=0.22), spouses’ education (p=0.003 r=0.17), Husband Employment status (p=0.04 r=0.11), and family income levels (p=0.03 r=0.12). <b>Conclusion:</b> There were significant correlations between marital satisfaction, self-esteem and stress. Sexual satisfaction improved in individuals with high self-esteem whereas it decreased with increasing stress levels. Therefore, health planners should adopt strategies to increase self-esteem and reduce stress in reproductive age women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=QC16-QC19&id=12152 https://doi.org/10.7860/JCDR/2018/37423.12152 Major Hepatectomies: Outcome and Perspectives from Eastern Nepal Narendra Pandit, Laligen Awale, Shailesh Adhikary <b>Introduction:</b> Liver resection is a widely used surgical procedure for different benign and malignant pathology, which carries a significant morbidity and mortality (5-10%). Post-hepatectomy liver failure and bile leak are the major complications of major (>3 segments) hepatectomy, and is also the determinant factor for mortality. However, recently due to multimodality development like better surgeons experience, advanced imaging modality and better surgical planning, the outcome has significantly improved. Moreover, with relocation of experienced surgeons, selection of patients and sharing of operative techniques and perioperative care pathways had made possibility of performing major hepatectomy at even low volume academic centre, with almost comparable outcome to high volume centre. <b>Aim:</b> To study the outcome of major hepatectomy at an academic institute of Nepal, which has a specialised hepatopancreatobiliary unit with its trained surgeon from a high volume centre. <b>Materials and Methods:</b> Retrospective analysis of all patients undergoing major hepatectomy between December 2015 to July 2017 was done. Patient demographics, clinical characteristics, operative details, morbidity and mortality were recorded. <b>Results:</b> There were 6 (24%) major hepatectomy, out of 25 liver resection. Five (83.3%) were for malignant pathology: Right hepatectomy-1; Extended right hepatectomy-1; Central hepatectomy-1; Left hepatectomy-3. The mean age of the patient was 50.8 years, with M:F ratio of 1:2. Jaundice was seen in 50% of patients and none required preoperative biliary drainage or portal vein embolisation. The mean operating time, blood loss and transfusion requirement were 216 minutes, 408 mL and one pint respectively. Three (50%) patients developed major bile leak, which was managed conservatively. There was no postoperative, 30-day or 90-day mortality. <b>Conclusion:</b> Major hepatectomy is a safe and feasible option at our centre despite limited resources and low-volume set-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=PC10-PC13&id=12153 https://doi.org/10.7860/JCDR/2018/37712.12153 Insight into the Possible Association between Gene Polymorphism of IFN-? and IL-22 with Psoriasis in Punjab, India Arun Kumar Rawat, Aadil Wani, Tahseena Akhtar, Parneet Kaur, Tarun Narang, Dimple Chopra, Tej Bali Singh, Rajinder Kaur <b>Introduction:</b> IFN-? and IL-22 are Th1/Th17 cytokine which have been shown to play important role in the development of autoimmune disorder like psoriasis. <b>Aim:</b> To identify the possible association of IFN-? and IL-22 Single Nucleotide Polymorphisms (SNPs) with psoriasis as well as to find correlation between serum level of IL-22 and IFN-? with severity of psoriasis. <b>Materials and Methods:</b> A total of 168 psoriasis patients and 152 healthy controls were included in the study. A 3 ml of blood sample was collected from each psoriasis patients and healthy control for further analysis of SNP and serum level of cytokine. A part of blood sample was used for isolation of DNA for gene polymorphism study in psoriasis patients. Gene polymorphism of IL-22 (rs1179251 and rs2227513) and IFN-? (rs2430561, rs2069709) were studied by ARMS PCR method whereas serum level of IL-22 and IFN-? was analysed using commercially available ELISA kits. Odds Ratio (OR) with 95% Confidence Interval (95% CI) was calculated to assess the relative risk of psoriasis for various genetic variants. <b>Results:</b> Serum level of IL-22 and IFN-? was found to be (74.4±24.1 and 96.7±31.7 pg/ml respectively) significantly high (p<0.001), and associated with PASI score in psoriasis patients. In genotype analysis, a significant association was found between gene polymorphism of IFN-? (rs2430561 and rs2069709) and IL-22 (rs1179251 and rs2227513) with psoriasis. <b>Conclusion: </b>These results suggest that polymorphism of IFN-? and IL-22 genes can be responsible for elevated serum level of IFN-? and IL-22 cytokines. As these cytokines play key role in pathogenesis of psoriasis thus in conclusion gene polymorphism of IFN-? and IL-22 may be responsible factor for increased susceptibility to psoriasis in north Indian population, Punjab, India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=GC01-GC05&id=12154 https://doi.org/10.7860/JCDR/2018/36381.12154 Enterococcus faecalis an Emerging Microbial Menace in Dentistry-An Insight into the InSilico Detection of Drug Resistant Genes and Its Protein Diversity Vijayashree J Priyadharsini, AS Smilinegirija, A Paramasivam <b>Introduction:</b> Antimicrobial drug resistance is evolving as a serious threat to mankind due to indiscriminate use of antibiotics and lack of awareness about the mechanisms involved in drug resistance. Enterococcus faecalis, a common pathogen of the oral cavity has gained drug resistance over a period of years, making treatments refractory and ineffective. <b>Aim:</b> To detect the antimicrobial resistance encoding genes of Enterococcus faecalis employing computational tools. <b>Materials and Methods:</b>Antibiotic resistance genes were detected by retrieving sixteen genome sequences of Enterococcus faecalis from NCBI database which were further analysed using ResFinder. PlasmidFinder identified resistance encoding plasmids from recruited genomes under study. Protein sequences of most common phenotypes were subjected to protein BLAST and non-duplicate isolates showing 95-100% identity were selected for multiple sequence alignment using MEGA v7.0. Additionally, reconstruction of phylogenetic tree was performed to ascertain the diversity of these proteins among different genus and species. <b>Results:</b> In silico analysis of genomes revealed that almost all the probed isolates exhibited resistance towards glycopeptides and macrolides. The genes lsa(A) were found in 100% of the isolates, followed by tet (M) and erm (B) exhibiting a frequency of 37.5% and 25% respectively. Apart from major antibiotics, the isolates also demonstrated resistance towards aminoglycoside, phenicol, tetracycline and trimethoprim class of antimicrobials. <b>Conclusion:</b> The present investigation has emphasised the novelty in the application of in-silico tools in the understanding of the antibiotic resistance profile explored by the dreadful endodontic pathogen viz., E. faecalis. Further, this approach will aid in the implementation of improved treatment strategies and will facilitate to combat the dissemination of resistant gene cassettes to other oral pathogens or commensals residing in the vicinity https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=GC06-GC10&id=12155 https://doi.org/10.7860/JCDR/2018/36480.12155 Effect of Yoga and Physical Exercise on Motor Functions among Substance Abusers: A Randomised Comparative Study Ananda Gaihre, Sasidharan K Rajesh <b>Introduction:</b> Substance abuse disorder is characterised by severe motor function impairment. Rehabilitation programs should augment the motor function to reduce the risk of relapse. Yoga and exercise-based intervention are emerging as an add-on therapy for the management of addictive behaviours. <b>Aim: </b>To evaluate the influence of yoga-based program as an add-on in augmenting the motor function in comparison to physical exercise to afresh admitted substance abusers. <b>Materials and Methods: </b>The randomised, comparative study included sixty-six male participants from a residential rehabilitation unit. In addition to standard rehabilitation treatment, partakers in the yoga or physical exercise group underwent supervised daily training for 12 weeks. The study assessed the participants on Finger Tapping Task, O’Connor Tweezer Dexterity Test, and Automatic Mirror Tracer at the baseline and following 12 weeks of intervention. Group difference was calculated by chi-square test, the Mann-Whitney test or Student t-test. While, paired sample t-test was used to determine with-in group change. <b>Results:</b> A significant enhancement in tapping speeds was observed in both the yoga and the exercise group at 0-10 seconds (TSI) and 10-20 seconds (TS2), but not statistically significant at 20-30 seconds (TS3). The results from the tweezer dexterity were significantly better following yoga (p< 0.001, d = 0.99) and exercise (p< 0.001, d = 0.82). Furthermore, a significant reduction was seen in Mirror tracing time after yoga (p< 0.034, d = 0.39) and exercise (p< 0.006, d = 0.53), with differences high in the exercise group. Statistically significant median decrease in mirror error score observed in yoga, z = -1.991, p = .046, but not in physical exercise z = -1.590, p = .112. <b>Conclusion: </b>Current outcomes propose that the add-on yoga or physical exercise-based intervention demonstrated the enhancement of motor function. Based on authors review of literature, this is the first study that stated the potential benefit of yoga or physical exercise among substance abuse on motor function. Comprehensive trials are needed to understand the potential long-term effects on rehabilitation and relapse prevention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=VC10-VC14&id=12156 https://doi.org/10.7860/JCDR/2018/35341.12156 Predictors of Past Quit Attempts and Length of Abstinence Among Waterpipe Smokers in Lebanon Nelly Layoun, Souheil Hallit, Mirna Waked, Zeina Aoun Bacha, Alain Leveque, Michele Dramaix, Pascale Salameh <b>Introduction:</b> The popularity of waterpipe smoking is dramatically increasing in Lebanon, reaching 36.9%, the highest among countries in the region, with a false belief that waterpipe is less dangerous and toxic compared to cigarettes. <b>Aim: </b>To assess factors associated with the quit attempts and their past length of abstinence in a Lebanese sample of waterpipe smokers. <b>Materials and Methods:</b> A cross-sectional study was conducted between March 2014 and March 2015 involving 127 patients. A questionnaire was completed by each participant; Quit attempts, real quit attempt durations and the intention to seriously quit waterpipe smoking in 2 months were assessed. Two forward logistic regressions were performed, taking into account the variables in the bivariate analysis that showed a p-value <0.2. <b>Results:</b> Past attempt to quit waterpipe smoking was significantly higher among smokers who had cough and expectoration for more than 3 weeks (OR=8.2), at higher stages of readiness to quit (OR=2.78) and being highly motivated (OR=2.27). A longer duration of abstinence to smoke waterpipe was higher among waterpipe smokers less than 45 years (OR=6.85), who considered it very important to report health warning on tumbac packages (OR=3.09) and with a low waterpipe dependence (OR=2.13). <b>Conclusion:</b> Health care professionals should play an important role in explaining the side effects of waterpipe smoking in order to decrease dependence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=LC04-LC08&id=12157 https://doi.org/10.7860/JCDR/2018/34524.12157 Periodontal Conditions during Arthritis Therapy with TNF-α Blockers Rudolf Schiefelbein, Holger Friedrich Rudolf Jentsch <b>Introduction: </b>Chronic Periodontitis (CP) and Rheumatoid Arthritis (RA) are both inflammatory diseases, characterised by severe inflammation of the associated tissues. Patients with RA have been reported to have poorer periodontal conditions such as more gingival bleeding, higher probing depth (PD) and Clinical Attachment Level (CAL) or missing teeth. However TNF-a blockers used in the treatment of RA seemed to positively influence the immune response of the periodontium. <b>Aim:</b>The aim of the present study was to verify if RA-patients under continuous medication with TNF-a blockers had better or worse periodontal health than non-RA-patients with periodontitis. <b>Materials and Methods:</b> The present case-controlled study included 13 patients with RA and 13 age and sex-matched non-RA periodontitis patients. In the RA-patients, RA-medication and duration of use were registered. In all patients Gingival Bleeding (GBI), Plaque Control Record (PCR), Bleeding on Probing (BOP), Probing Depth (PD), Clinical Attachment Level (CAL) and the number of teeth were recorded. For all patients the severity and extent of periodontitis was recorded respecting the classification system for periodontal diseases as well as serum level of C-Reactive Protein (CRP). Wilcoxon and Chi-square tests were performed for statistical analysis. <b>Results:</b> RA-patients had significantly less BOP (15.38% vs. 27.23%, p=0.045). RA-patients had a tendency to lower PD-values (2.54 mm vs. 3.15 mm, p=0.068) and fewer sites with PD=5 mm (6.00 vs. 17.46, p=0.099). Comparing severity and extent of periodontitis RA-patients had significantly better periodontal conditions (p=0.033). No significant influence of the duration of RA-medication was found. <b>Conclusion:</b> RA-patients treated with TNF-a blockers for more than 12 months have better periodontal health than non-RA-patients with periodontitis. These findings can be explained through the benefits of the TNF-a medication for host immune modulation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZC27-ZC31&id=12158 https://doi.org/10.7860/JCDR/2018/36791.12158 Thoracic Paravertebral Block for Postoperative Pain Management in Patients Undergoing for Nephrectomy: A Randomised Clinical Trial Anupam Mishra, Reetu Verma, VK Bhatia, Girish Chandra, Rajni Gupta, Ajay Chaudhary <b>Introduction:</b> Pain is one of the most dreaded side effects of surgery for the patient during as well as after surgery. Effective postoperative pain control is an essential component of the care of the surgical patient. Inadequate pain control may result in increased morbidity or mortality. <b>Aim:</b> To compare Thoracic Para Vertebral Block (TPVB) and IV PCA (fentanyl) and with IV PCA alone, for postoperative analgesia and also to compare intraoperative and postoperative haemodynamic changes and side effects in patients undergoing open nephrectomy. <b>Materials and Methods:</b> Patients were randomised into two groups, 30 patients in each group. GROUP A: Received preoperative single thoracic paravertebral block (20 mL 0.25% bupivacaine) + General Anaesthesia + PCA with iv fentanyl (2 microgm/mL), Basal infusion-20 microgm/hour, Demand dose -12 microgm, Lockout interval- 20 minutes. GROUP B: Received General Anaesthesia + PCA with iv fentanyl (2 microgm/mL), Basal infusion-20 microgm/hour, Demand dose-12 microgm, Lockout interval-20 minutes. Postoperative pain score, amount of fentanyl consumption, Demand dose and haemodynamic stability was assessed. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical analysis software. The values were represented in Number (%) and Mean±SD. <b>Results:</b> Group A which received preoperative TPVB and IV PCA showed less analgesia, less fentanyl consumption, less demand dose and better haemodynamic stability in comparison to the Group B which received IV PCA alone (p<0.001). <b>Conclusion:</b> TPVB provide excellent and prolonged postoperative analgesia, significantly reduced consumption of rescue analgesia and less demand dose in the postoperative period in comparison to iv PCA alone, good opioid sparing and pre-emptive effect in patients undergoing nephrectomy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=UC05-UC08&id=12117 https://doi.org/10.7860/JCDR/2018/33936.12117 A Drug Utilisation Surveillance Study to Assess the Clinical Utility and Safety of Oral Natural Micronized Progesterone SR in High Risk Pregnancies: NAP-DELAY Study Piyush Prabhat, Krishnaprasad Korukonda <b>Introduction:</b> High risk pregnancy represents a clinical enigma with several management strategies suggested as prophylaxis or therapeutic approach. In most cases of women with Unexplained Bad Obstetric History (BOH) or Preterm Birth (PTB), luteal phase insufficiency has often been suggested as the underlying cause that may require long-term administration of progesterone. Natural progesterone offers complimentary anti-inflammatory, immunomodulatory and uterine quiescence actions that go a long way in continuing pregnancy till term while avoiding complications of preterm delivery or infant mortality. <b>Aim:</b> To understand the clinical efficacy and safety of Natural progesterone as primary or secondary prophylactic strategy for High risk women with risk factors for PTB or BOH. <b>Materials and Methods:</b> Retrospective, case cohort analyses of Natural progesterone prescriptions utilising the Drug utilisation surveillance sheet were carried out at 40 centres across India between July and October’16. Descriptive statistics was utilised to describe the numerical and categorical (nominal and continuous) data. <b>Results:</b> Consecutive prescription records of 185 patients with High risk pregnancy were available for analyses. Baseline demographics included mean age of 28.4 yrs, body weight 60.5 kg with mean abortion rate of 1.5 and 2 for BOH women with first or second trimester loss. Natural progesterone as OMP SR was supplemented for PTB prophylaxisin BOH cases with first or second trimester loss cases, Cervical factor, Still birth, Spotting and Placenta previa. The preferred dosage of OMP SR for women with Cervical factor, First or Second trimester loss was 300 mg for mean duration of 19, 16 and 21 weeks respectively. Similarly in the unexplained Recurrent Pregnancy Loss (RPL) cases, OMP SR was administered in mean dosage of 271mg for 18±5 weeks to prevent pregnancy loss. In all cases, pregnancy was continued till 34th week with no adverse health outcome. Common adverse events including gastritis (n=4, 2.2%), vomiting (n=4, 2.2%), drowsiness (n=8, 4.3%), dizziness (n=6, 3.2%), spotting (n=2, 1.1%), and treated symptomatically with none requiring further hospitalisation or referral. <b>Conclusion:</b> Clinical supplementation with oral NMP SR suggests therapeutic compliance and safety profile for long-term administration especially in High risk pregnancies involving unexplained BOH or PTB risk. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=QC04-QC06&id=12118 https://doi.org/10.7860/JCDR/2018/34886.12118 Evaluation of the Role of Dermatoglyphics, Oral Micronuclei and ABO Blood Grouping in Determining Type 2 Diabetes-A Multi-Parameter Approach Ratna Kumari VN Tarigoppula, Manasa Syamala, Ahmed Mujib Bangalore Raheem, Shruthi K Patil <b>Introduction: </b>Diabetes mellitus type-2 affecting around 12% of Indian population is a multifactorial metabolic disease with several complications warranting high concern for effective prevention and control measures. <b>Aim:</b> To evaluate the role of dermatoglyphics, oral micronuclei and ABO blood grouping in determining Type 2 diabetes. <b>Materials and Methods:</b> A total of 44 diabetic patient and 45 age and sex matched healthy controls were selected. Palmar prints, oral cytosmears and blood samples were collected from both groups. Fingerprints and ATD angle were assessed from the palmar prints. Oral smears obtained were stained using Papanicolaou stain and assessed for micronuclei frequency. About 1 mL of blood sample obtained by venepuncture method was subjected to ABO blood grouping. Dermatoglyphic findings were expressed as Mean±SD. Independent sample t-test was used for comparison of ATD angle and oral micronuclei frequency in both groups. Chi-square test was used for testing the association of blood grouping to diabetes mellitus. <b>Results:</b> On fingerprint analysis, ulnar loops were found to be more in diabetics with reduced number of whorls. There was slight increase in arches as well except in left hand of diabetic females. Statistically significant results were obtained with ATD angle and oral micronuclei with diabetics having higher values. There was no significant association found between diabetes and blood groups. <b>Conclusion:</b> A panel of biomarkers which are simple, economical and rapid improves the screening surveillance of diabetes and act as an additional diagnostic tool. Micronuclei and ATD angle in the present study exhibited significant results and might be possible components of the panel. Mass screening of high risk individuals at community level can be achieved using a kit with the biomarkers. To validate the relation of blood groups to diabetes further evaluation over larger population is needed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZC12-ZC17&id=12119 https://doi.org/10.7860/JCDR/2018/35920.12119 Utility of Ovarian Tumour Marker Cancer Antigen-125 and Endocrine Hormonal Status in Polycystic Ovary Syndrome Shahid Akbar Mujawar, Vilas Namdeorao Kurude, Harshada Ashok Gaikwad, Vinayak Wamanrao Patil <b>Introduction:</b> Polycystic Ovary Syndrome (PCOS) is the most common endocrinopathy in women of reproductive age. Women with PCOS are at increased risk of reproductive abnormalities with a prevalence of up to 10%. <b>Aim:</b> To assess the concentrations of ovarian tumour marker Cancer Antigen-125 (CA125), Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH) And Prolactin (PRL) among women with PCOS in order to get insight of how these biochemical parameters play a crucial role in the pathogenesis of PCOS and to evaluate their diagnostic utility. <b>Materials and Methods:</b> A total of 60 subjects were enrolled for the prospective comparative case-control study. Out of these 60 subjects, a healthy control group of 30 subjects with non-hirsute, non-obese women with regular menstrual cycles were included as control. PCOS group of 30 women were selected as a study group who were already diagnosed by clinician. Their height (meters) and weight (kg) were measured and recorded. This measurement was used for calculating Body Mass Index (BMI) in kg/m2. Serum CA-125, LH, FSH and PRL were estimated by the chemiluminescent method on Immulite 1000. Data were presented as number, percentage, mean and standard deviation. Statistical analysis was done by normal distribution z-test. <b>Results:</b> The statistical significant alterations were observed in the levels of CA125, LH and PRL between PCOS group and control group. FSH level was insignificantly different in PCOS as compared with that of controls. <b>Conclusion: </b>An ovarian tumour marker CA125 and endocrine hormones such as LH, FSH and PRL are of paramount importance for the correct diagnosis with degree of severity in patients with PCOS. The present study confirms the elevated levels of LH as a regular feature of PCOS. Also, the possible correlation of CA125 and PRL in women having PCOS suggests that the combination of the ovarian tumour marker and this hormonal status can be used in biochemical screening of ovarian cancer. However, further prospective and controlled studies are needed to investigate their utility in prediction of ovarian cancer in women having PCOS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=BC01-BC03&id=12120 https://doi.org/10.7860/JCDR/2018/36048.12120 Influence of Working Length on Post-operative Pain after Single or Two-visit Endodontic Treatment: A Randomised Clinical Trial Alessandra Manchini Cardoso Tarallo, Felipe de Souza Matos, Eduardo Bresciani,Luiz Renato Paranhos, Carlos Henrique Ribeiro Camargo <b>Introduction:</b> Microorganisms in the cemental canal can lead to the development of periapical lesions and its mechanical removal by means of overinstrumentation may be more favourable for the success of endodontic treatment. However, instrumentation of the apical foramen remains a controversial issue because it can be a traumatic procedure to the periapical tissues. <b>Aim:</b> Considering that post-operative pain is an essential feature of symptomatic periradicular inflammation, this clinical trial evaluated the influence of two different foraminal working lengths on post-operative pain and mechanical allodynia after endodontic treatment completed in single-visit or two-visit. <b>Materials and Methods:</b> Forty eight adult patients indicated for primary endodontic treatment of tooth with asymptomatic apical periodontitis were randomly assigned to 4 groups (n = 12): SV0 – single-visit and instrumentation up to the apical foramen; SV+1 – single-visit and instrumentation 1 mm beyond the apical foramen; TV0 – two-visit and instrumentation up to the apical foramen; TV+1 – two-visit and instrumentation 1 mm beyond the apical foramen. All participants received a visual analog scale to record their assessment of pain at 3 hours to 7 days and data were analysed statistically by Kruskal-Wallis test (a = 5%). For mechanical allodynia evaluation, bite force measurement was performed using a digital gnathodynamometer just before and 7 days after treatment and data were analysed statistically by ANOVA and Tukey’s test (a = 5%). <b>Results:</b> No statistically significant difference was found among the 4 groups in relation to post-operative pain at all time points assessed. Bite force values were significantly higher 7 days after endodontic treatment, indicating that there was a significant reduction of mechanical pain in all groups, with no significant difference among them. <b>Conclusion:</b> All groups exhibited the same rate of post-operative pain at the time points assessed and endodontic treatment effectively increased the mechanical pain thresholds. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZC06-ZC11&id=12114 https://doi.org/10.7860/JCDR/2018/35913.12114 Role of Ambulatory Blood Pressure Monitoring in Chronic Hypertensive Patients on Antihypertensive Therapy-A Cross-sectional Study J Sankar, NK Mahesh, Prafull Sharma, Lekshmi Sankar, Arjun Balasubramanian <b>Introduction:</b> Regular monitoring of blood pressure in chronic hypertensive patients on antihypertensive therapy is essential to assess cardiovascular events and to prevant target organ damage. <b>Aim:</b> The present study was undertaken as an attempt to correlate the relation between random blood pressure monitoring and 24 hour Ambulatory blood pressure monitoring in chronic hypertensive patients on therapy and to assess the efficacy of antihypertensive medication in chronic hypertensive patients. <b>Materials and Methods:</b> The study was undertaken as a prospective cross-sectional study among 100 patients during the period of June 2015 to June 2016 using convenient sampling technique. As per Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High blood Pressure (JNC 7) guidelines, cases of diagnosed hypertension on regular medication and on follow-up in the outpatient department of General Medicine in a tertiary care hospital were included in the study. Blood pressure was recorded using a mercury sphygmomanometer or aneroid or electronic device as per JNC guidelines. After that Ambulatory Blood Pressure Monitoring (ABPM) device was attached on a belt connected to a standard cuff in the upper arm which uses an oscillometry technique to detect systolic, diastolic and Mean Arterial Blood Pressure (MAP). Descriptive statistics was expressed by means and proportions. Paired t-test was used to find statistically significant difference in related sample observations. A p-value <0.05 was considered statistically significant. <b>Results:</b> Majority of the study participants were males and were in the age group of 31-40 years. There was a significant difference between random (clinic) blood pressure and ambulatory blood pressure recordings. It was observed that 36 patients (36%) were dippers, 54 patients (54%) were non-dippers, 10 patients (10%) were reverse dippers independent of clinical blood pressure readings. <b>Conclusion:</b> Ambulatory blood pressure monitoring gives a true estimate of 24 hour readings rather than a single clinic blood pressure which can be influenced by so many factors. It also gives an estimate of other variables like morning surge and nocturnal dip. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OC01-OC04&id=12081 https://doi.org/10.7860/JCDR/2018/37103.12081 Exploring Time Management Skills of First Year Undergraduate Medical and Allied Health Science Students Reem Rachel Abraham, Saleena Ummer Velladath, Zizy Ezreen Binti Ezie Elman, Lutdfi Bin Mohamad Sobri, Muhammad Danish Syahmi Bin Saha, Maryam Sofia Binti Ghazali, Adi Aslam Bin Abu Bakar, Asrar Mohammed Hussain <b>Introduction:</b> Time management skills are considered as very important for health science students as they are required to do multitasking, acquire not only discipline based knowledge and skills, but also engage in other academic activities and research as well. <b>Aim:</b> The present study explored and compared time management skills of first year undergraduate medical students and allied health science students. <b>Materials and Methods:</b>The present study was conducted on first year undergraduate medical student at Melaka Manipal Medical College (MMMC) and allied health science student at School Of Allied Health Science (SOAHS), MAHE, Manipal. Data was collected from the study sample (n=303) using a pre-developed questionnaire in which students indicated their responses on a 5-point Likert’s scale. The questionnaire had 27 items grouped into three domains: Time Planning (TP; 16 items), Time Attitude (TA; 7 items) and Time Wasters (TW; 4 items). The total mean scores of all items, as well as domains were compared between the students using independent sample t-test. <b>Results:</b> Analysis of the data revealed that there was no statistical difference between the total mean scores of both groups (MMMC: 3.2 (0.51); SOAHS: 3.2 (0.39), p-value >0.9). Comparison of mean score value of domains between the groups indicated similar and the statistically insignificant values for TP and TA domains for both groups whereas a high, however statistically insignificant mean score for TW, for SOAHS students compared to MMMC students. Ten and nine items had a mean score value below 3, for SOAHS and MMMC students respectively, out of which five items were common for both groups (TP3, TP4, TA2, TA6, TW4). <b>Conclusion:</b> The present study revealed that time management skills of both medical and allied health science students were moderate and almost similar. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=JC07-JC10&id=12082 https://doi.org/10.7860/JCDR/2018/37174.12082 Dosimetric Comparison between Two Different Intensity Modulated Radiation Therapy and 3D-Conformal Radiation Therapy Planning Techniques for Carcinoma of Breast Following Conservative Surgery Michelle D' Almeida, Jyothi Nagesh, Ramya Balasubramanian, Srinidhi Gururajarao Chandraguthi, Sarath S Nair, Shreekripa, Krishna Sharan <b>Introduction:</b> The anatomy of the chest wall is curved which makes it quite complicated to plan radiation therapy for breast cancer. There are different techniques for delivering external beam radiation therapy. Therefore, it is essential to know the technique by which we can render a better treatment. Aim: To compare and analyse three different planning techniques namely Three Dimensional Conformal Radiation Therapy (3DCRT), two field Intensity Modulated Radiation Therapy (IMRT) and multiple field IMRT using dosimetric parameters. <b>Materials and Methods:</b> In this retrospective dosimetric study, we evaluated 10 breast cancer patients. For each patient, three plans namely 3DCRT, two field IMRT and multiple field IMRT (7 beams) were generated on the computed tomographic images using Oncentra Treatment Planning system. A dose of 50Gy in 25 fractions was prescribed to the Planning Target Volume (PTV). The plans were compared with each other on volume coverage (conformity and homogeneity) and organ-at-risk sparing. Paired t-test was used for identifying statistical differences between the plans. A significance level, p=5% or 0.05 was chosen. <b>Results:</b> The dose conformity was best by multiple field IMRT (p=0.0001). Both two field IMRT and multiple field IMRT provided more homogenous dose distribution with homogeneity index of 1.09±0.01 and 1.08±0.01 respectively when compared to 1.11±0.01 by 3DCRT (p=0.001 and 0.0001, respectively). D2 (dose received by 2% of the tumour volume), a measure of maximum dose was greater in 3DCRT. While dose to the critical organs was considerably less in both two field IMRT and 3DCRT than in multiple field IMRT, two field IMRT achieved lowest doses. Moreover, there was a substantial increase in the Monitor Units (MUs) for multiple field IMRT when compared with the other two techniques. <b>Conclusion:</b> Two field IMRT have the features intermediate of 3DCRT and multiple field IMRT. The two field IMRT is on the beneficial side with homogenous dose distribution in the target and less dose to the critical organs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=XC01-XC04&id=12073 https://doi.org/10.7860/JCDR/2018/31495.12073 Supraclavicular Brachial Plexus Block: Comparision of Two Different Doses of Dexmedetomidine as an Adjunct to Bupivacaine: A Study Anil Radhakrishnan Pillai, Nagalakshmi Palanisamy, RV Ranjan , Sagiev Koshy George,TR Ramachandran, Titu George Oommen , Sujatha Chinthavalli, Sunil Kumar Valasareddy <b>Introduction:</b> Supraclavicular brachial plexus block is commonly performed for upper limb surgeries. A variety of adjuvants are added to the local anaesthetic to fasten the onset and prolong the duration of sensorimotor block. <b>Aim:</b> To assess the efficacy of two different doses of Dexmeditomidine as an adjuvant in supraclavicular brachial plexus block. <b>Materials and Methods:</b> This was a prospective randomised study conducted on 99 ASA I and II patients, aged 18-60 years, posted for upper limb surgeries. Patients were randomised into three groups. Group S received 25 mL of 0.5% bupivacaine and 2 mL of NS, Group D20 received 25 mL of 0.5% bupivacaine and 20 µg of Dexmeditomidine in 2 mL NS, Group D40 received 25 mL of 0.5% bupivacaine and 40 µg of Dexmeditomidine in 2 mL NS. Statistical analysis was performed using ANOVA test and Bonferoni’s correction for intergroup comparison. <b>Results:</b> The onset of sensory block was faster in D40 group (8.94±2.99 minutes) compared to D20 (14.55±2.89 minutes) and S group (21.36±4.3 minutes). The onset of motor blockade was 24.55±4.5 minutes in S group, 16.97±16.97 minutes in D20 group and 10.15±2.92 minutes in D40 group. Duration of sensory block was longer in D40 (14.47±0.975 hours) compared to D20 (12.52±1.307 hours) and S group (7.27±1.26 hours). The total mean duration of motor blockade was 6.242±1.22 hours in S group, 11.17±1.254 hours in D20 group and 13.09±1.18 hours in D40 group. The haemodynamic parameters were comparable in all the three groups. <b>Conclusion:</b> Faster onset, longer duration of sensorimotor blockade and prolonged postoperative analgesia proved Dexmeditomidine was effective when used with bupivacaine as an adjuvant in supraclavicular blocks and the effect is also dose dependent. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=UC01-UC04&id=12074 https://doi.org/10.7860/JCDR/2018/35177.12074 Role of Real Time PCR Quantization in Diagnosis and Prognosis of Leptospirosis and Analysis of the Association between Bacterial Load and Various Complications Linda Rose Jose, Neelambike M Sumana, K Anuradha, B Sumangala <b>Introduction:</b> Leptospirosis is considered as an underreported and underdiagnosed disease. There is paucity of data regarding the incidence of leptospirosis from Mysore, Karnataka. This study throws light into the incidence of leptospirosis and the recent developments in the diagnostic techniques used in the laboratory. <b>Aim:</b> This study aims to analyse the use of Real-Time PCR for diagnosis of leptospirosis and to compare the association of bacterial load with various complications. <b>Materials and Methods:</b> This study was carried out from April 2013 to April 2016 in a tertiary care center, Mysore, Karnataka, India. Hundred conventional PCR positive cases for leptospirosis were included in this study so as to determine the bacterial load. Ethical clearance was obtained from the institutional ethical committee. Details of patient including the sample number, patient name, age, sex, date of collection, address, duration of illness, and symptoms of the illness were also recorded. Human blood samples were collected for the study and Real Time PCR was used to determine the copy number present in each leptospirosis suspected sample. The correlation of bacterial load and various laboratory parameters was done using Spearman’s Rank correlation coefficient. <b>Results:</b>Out of the 100 in-house PCR positive cases, only 43 gave a positive result with Real-Time PCR. An increased bacterial load was seen associated with meningitis combined with thrombocytopenia and hepatomegaly. Patients with chronic kidney disease also showed high bacterial load. It was difficult to categorize complications based on the bacterial load as majority of the complications fell in the least and the highest bacterial load category. <b>Conclusion:</b> The Real-Time PCR did not prove to be successful in the early diagnosis of the disease during this study period which may be either due to prolonged storage of DNA or lack of precision of the kit. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=DC01-DC04&id=12075 https://doi.org/10.7860/JCDR/2018/36127.12075 Evaluation of Dental Non-Metric Traits in Ethnic Tamil Population: An Aid in Forensic Profiling Monika Srivastav, R Bharanidharan, R Ramya, Thayalan Dineshkumar, Arulmozhi Nanda Kumar, A Ramesh Kumar <b>Introduction:</b> Non-metric dental traits are features of dental morphology that show alteration in their appearance both within and between the populations. These traits seem to be controlled in part by genetics so these can be successfully used in the description of the ethnicity which can be helpful in identification of the person through the dental records. <b>Aim:</b> The analysis aimed at assessing the frequency of dental non-metric traits in the ethnic Tamil Population as some dental variants are constant within a given geographical area, which suggests that the frequency of the trait can be mapped within a population. <b>Materials and Methods:</b> An observational study was conducted in SRM dental college from July 2017 to December 2017 (over a period of five months). The study sample included 1000 participants, (500 males, 500 females). The non-metric dental traits which were assessed were cusp of carabelli, talon’s cusp, shovelled incisor, and peg shaped lateral incisor, protostylid, dryopithecus groove pattern, hypoconulid, parastyle, paracone, bushman canine, interruption grooves, tuberculum dentale. The participants were subjected to visual examination and photographic records. Descriptive analysis was done in this study. <b>Results:</b> Out of the 12 non-metric dental traits which were assessed in the present study, only 5 non-metric dental traits were found to be prevalent among this population. The frequencies were cusp of carabelli 230 out of 1000 (23%){male (90 out of 500) female (140 out of 500)}, shovelled incisor 80 out of 1000 (8%){male (50 out of 500) female (30 out of 500)}, peg lateral 50 out of 1000 (5%) {male (20 out of 500) female (30 out of 500)}, interruption groove 20 out of 1000 (2%) {male 20 out of 500)}, dryopethicus groove 20 out of 1000 (2%) {male (10 out of 500) female (10 out of 500)}among the ethnic Tamil population. <b>Conclusion:</b> The present study highlights the fact that two non-metric traits i.e., cusp of carabelli and shovelled incisor found to be more common in males and females of ethnic Tamil population. This fact represents that these traits are the most common in ethnic Tamil Population which could be used as one of the validation tools for Human identification. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=HC01-HC03&id=12076 https://doi.org/10.7860/JCDR/2018/36166.12076 Calculation of Glomerular Filtration Rate from Renal Volume in Kidney Donors using Hert's Formula Vimal Dixit, Omar Salim Akhtar <b>Introduction:</b> The incidence of Chronic Kidney Disease (CKD) is rising throughout the world, and with it, the need for kidney transplants. The 'Gold Standard' in measuring Glomerular Filtration Rate (GFR) in potential kidney donors remains a renogram. In many countries, access to this technology remains limited and expensive. We evaluated a Computed Tomography (CT)- based method of calculating the GFR using estimated renal volume, as first described by Herts' et al. <b>Aim:</b> To compare differential renal function as assessed by isotope renal scan using 99mTc Diethylene-Triamine-Penta-Acetic Acid (DTPA) with CT scan measured differential renal volume. Further, we aimed to compare and correlate the CT scan measured volume based GFR, with GFR estimated using Modification of Diet in Renal Diseases (MDRD) and Cockcroft-Gault (CG) methods. <b>Materials and Methods:</b>A total of 61 healthy donors (47 female, 14 male) were studied. Standard contrast CT scan was performed using non-ionic iodinated contrast. Special volumetric 3D analysis was used to calculate the volume. Herts formula was used to calculate the GFR. DTPA renogram was done on all patients with a Gamma Camera. The results were compared with MDRD and CG estimated GFR on all patients using Analysis of Variance (ANOVA) and Tukey Post-Hoc Test. <b>Results:</b>The Volume Calculated-GFR correlates better with total GFR than GFR calculated by CG and MDRD formulae. <b>Conclusion:</b> The Herts formula based GFR correlated well with estimated GFR values and may be used in circumstances were access to DTPA renograms is expensive or unavailable. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=PC01-PC05&id=12077 https://doi.org/10.7860/JCDR/2018/36688.12077 Comparison of Microleakage and Shear Bond Strength (SBS) of Dyad Flow and Tetric Flow in Primary Molars: An In-vitro Study Ramya Chowdary Mandava, Deepa Gurunathan, Mahesh Ramakrishnan, EMG Subramanian <b>Introduction:</b> Early diagnosis combined with conservative adhesive treatment of occlusal caries may preserve the integrity of the remaining tooth and increase its longevity. <b>Aim:</b> To compare microleakage and Shear Bond Strength (SBS) of Dyad flow and Tetric flow in primary molars. <b>Materials and Methods:</b> Microleakage test: Eighteen samples were utilised separately for SBS and Microleakage. Standard Class I tooth cavity were prepared on occlusal surface of all teeth. The samples of Group 1 group were restored with Dyad flow restorative material; Samples of Group 2 were restored with Tetric flow and subjected to thermocycling in customized thermocycling device. Further, the samples were soaked in freshly prepared 2% Rhodamine B dye solution for 24 hours. The samples were then sectioned in bucco-lingual direction with hard tissue microtome under constant water flow and were observed under confocal microscope at 4× magnification and evaluated for die penetration. Eight out of nine samples were graded III, where as the other sample was graded as II based on ISO microleakage scoring system. Shear Bond Strength Test: A 2 mm high cylindrical polyethylene tube with an internal diameter of approximately 2 mm was placed on the dentin surface of each specimen. No etching or bonding was done for samples of Group 1 (Dyad flow), Optibond bonding agent was applied to the prepared buccal surface of the specimens in group 2 (Tetric Flow) and cured for 20 seconds. Flowable resin composite was injected into the tube and polymerized for 40 seconds using an LED curing unit. All specimens were subjected to thermocycling from 5°C and 55°C for 500 cycles. SBS testing was done following thermocycling. Specimens were secured in the holder of a universal testing machine and sheared with a knife-edge blade at a crosshead speed of 1.0 mm/minute. Independent t-test was performed for statistical significance. <b>Results:</b> Microleakage Test: There was no significant difference in microleakage between Dyad Flow and Tetric flow (p<0.05). Inter-examiner reliability was done between the accessors and the probability was 0.65 and 0.73. Shear bond strength test: No statistical significance was observed between the groups (p=0.51). The highest mean SBS value was recorded for group 2 in Tetric flow (29.83±21.4 MPa), whereas the lowest value was recorded for group 1 in Dyad flow (24.15±3.5 MPa). <b>Conclusion:</b>Dyad flow and Tetric flow had similar microleakage. Whereas, Mean SBS of Dyad flow was lower than Tetric flow. With the results of this study, Dyad flow can be used for class I cavities of primary molars. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZC01-ZC05&id=12101 https://doi.org/10.7860/JCDR/2018/31567.12101 Comparative Assessment of Validated Prognostic Models in Estimation of 30 Day Mortality in Alcoholic Hepatitis Sree geetha, RK kollipara, KP rao <b>Introduction:</b> Alcoholic Hepatitis (AH) is a clinical syndrome seen in those with heavy alcohol intake and carries a very high mortality risk despite therapy. Patients with Severe Alcoholic Hepatitis (SAH) are currently advocated therapy with either Corticosteroids (CS) or Pentoxifylline (PTX). Various prognostic scores have been validated to assess for mortality risk. Studies comparing these validated prognostic scores for prediction of early mortality risk in Indian patients with SAH have been scarce. <b>Aim: </b>To assess and compare utility of various prognostic scoring systems in predicting short term (30 day) mortality in patients with SAH. <b>Materials and Methods: </b>This was a prospective comparative study and was approved by in house Ethics Committee of the Osmania general hospital, Hyderabad, Telangana, India. Patients 18 years or older with clinical alcoholic hepatitis, Aspartate Aminotransferase (AST)/Alanine Aminotransferase (ALT) ratio >2 with an AST level <500 U/L and Maddrey’s Discriminant Function (MDF) =32 were included in the study. Patients underwent clinical evaluation and investigations for severity assessment, presence of complications and associated infection. Various prognostic scores including Model for End-Stage Liver Disease (MELD), Child-Turcotte-Pugh (CTP) score, MDF, Albumin-Bilirubin-International Normalised Ratio (INR)-Creatinine (ABIC) score, Glasgow Alcoholic Hepatitis Score (GAHS), United Kingdom End Stage Liver Disease (UKELD) and Sodium-MELD (Na-MELD) scores were calculated at admission while MELD, MDF and CTP were documented at day seven in patients who received therapy. The Area Under Receiver Operating Characteristic (AUROCs) for all the scores at the time of admission and for MELD, MDF and CTP at day seven were calculated and compared for 30 day mortality assessment. <b>Results:</b> The 30 day mortality of SAH in the current study was 40%. Hepatorenal Syndrome (HRS), Liver Function Tests (LFTs), Prothrombin Time (PT), urea and creatinine and all scores including CTP, MELD, MDF, GAHS, ABIC, sodium-MELD and UKELD showed significant association with 30 day mortality on univariate analysis while UKELD and CTP showed most significance on multivariate analysis. At higher than current validated cut-off values, the specificity and Positive Predictive Value (PPV) of the scores was significantly increased with most scores having >90% specificity for 30 day mortality while sensitivity and the AUROCs of all scores were also increased, ranging from AUROC of 0.933 for UKELD at a value of 65.6 to an AUROC of 1.00 for a MELD score of 25.9. MELD at day seven at a cut-off of 28 showed 100% specificity with a PPV of 100 while MDF at day seven with best cut-off of 59.7 had 100% sensitivity and a Negative Predictive Value (NPV) of 100. However, CTP did not show significant dynamic change at day seven. <b>Conclusion: </b>All evaluated scores at the time of admission and on day seven showed good sensitivity and specificity for assessment of 30 day mortality risk in patients with SAH. UKELD, CTP calculated on day one showed most significance on multivariate cox-regression analysis for 30 day mortality. At higher cut-off values, MDF, MELD, UKELD and GAHS can be used to stratify risk and identify patients with very high risk of 30 day mortality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OC09-OC13&id=12108 https://doi.org/10.7860/JCDR/2018/36974.12108 Virtual Reality Therapy for Mental Stress Reduction Vishal Sudha Bhagavath Eswaran, Mahesh Veezhinathan, Geethanjali Balasubramanian, Atul Taneja <b>Introduction:</b> Mental stress is a perilous condition seen in students that is often overlooked in the daily course of life. With the advent of Virtual Reality Technology (VRT) and older techniques being cumbersome and hazardous, Virtual Reality Therapy is coming to the fore as a possible replacement in the field of rehabilitation and psychiatry. <b>Aim:</b> To understand the role of VRT and its effectiveness in mitigating mental stress in students. <b>Materials and Methods:</b> A sample size of 20 from a study population of 65 healthy, right-handed, and non-placed participants in their final year from the department of Biomedical Engineering were separated equally into normal and mildly stressed groups based on their DASS scores. A custom made Virtual Environment was used for therapy and an experimental protocol was employed. The Electroencephalogram (using RMS SuperSpec) and Mathematical Go-NoGo Task Performance results before and after the therapy were used to quantify the effectiveness of the therapy. The Mann-Whitney U Test was used for independent sample analysis of the DASS scores between the Normal and Mildly Stressed Groups, and the Post-hoc Wilcoxon Signed-Rank Test was used for related sample analysis of EEG and Task Performance during Rest, Task before therapy and Task after therapy. <b>Results:</b> Though there was no significant difference in the DASS scores between the two groups, there was a sense of relaxation being imbibed into each group after therapy, by virtue of increased mean alpha and decreased mean theta band power in the EEG signals and also an increase in their task performance after therapy. <b>Conclusion:</b> Thus, this study shows the possible ability of VRT in mitigating stress in the participants, and further studies between various levels of stress and using various environments could help establish VRT as a staple in the field of psychiatry for years to come. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=JC11-JC16&id=12109 https://doi.org/10.7860/JCDR/2018/36055.12109 Association of Serum Vitamin D Levels and Recurrent Wheezing in Children Afreen Khan, Jogender Yadav, Pradeep Debata, Jagannath Mohapa Apatra, Bhaskar Kabi <b>Introduction:</b> Wheezing is quite frequently observed in preschool children. There are many risk factors responsible for the development of recurrent wheezing; recently, vitamin D has gained significant interest. <b>Aim:</b> To study the association of serum vitamin D (25(OH) D) level and recurrent wheeze in children less than three years of age. <b>Materials and Methods:</b> This was a Case-control study conducted at a tertiary care hospital in New Delhi. Children less than three years with recurrent wheeze along with age matched controls were subjected to analysis of serum vitamin D, calcium, phosphate and alkaline phosphatase levels. The data was analysed to find out an association between the serum levels of vitamin D and recurrent wheezing. <b>Results:</b> A strong association between the low serum Vitamin D levels and the recurrent wheeze (p=0.001) was found. Also, high levels of serum alkaline phosphatase were seen among the children with recurrent wheezes (677 vs 317 IU/L, p<0.001) and it had an inverse relation with serum vitamin D levels (k-0.688). <b>Conclusion:</b> Low serum vitamin D level is strongly associated with recurrent wheezing in preschool children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=SC06-SC09&id=12110 https://doi.org/10.7860/JCDR/2018/36994.12110 Age Related Timed Up and Go Test Values and Its Analysis among Elderly Kanchipuram District Population VPR Sivakumar, Balakrishnan Doraisami, Venkataraman Prabhu, Ponmathi Paramanandam <b>Introduction:</b> TUG (Timed Up and Go test) test is widely used in elderly to assess fall and balance among community and institution dwelling elder population. Many studies have given the reliability and validity of the test and the uses of the test in elderly population. So far no studies had recorded the TUG values for middle and young population which may be important to frame preventive measures to improve balance and to prevent fall as they approach older age. <b>Aim:</b> To find the TUG scores mean values among different age group and analyse its difference among various age group. <b>Materials and Methods:</b> A Cross-sectional study was done in which subjects with no neurological deficit and no recent fractures or congenital deformities and who could walk without walking aid were selected. About 413 subjects among different age groups from 19 years to 70 years were recruited based on inclusion and exclusion criteria of the study, The age groups are divided as 19-20 (95 subjects), 21-30 (81 subjects), 31-40 (29 subjects), 41-50 (24 subjects), 51-60 (84 subjects), 61-70 years (100 subjects) respectively. The subjects were made to complete TUG test and the time duration was documented and analysed with One way Anova and Tukey HSD. <b>Results:</b> There was a Significant difference in TUG test scores between 19-20 age group and above 40 age group up to 70 years, whereas no significant difference exist between 19-20 years age group and 20-40 age groups (p<0.05). <b>Conclusion:</b> TUG scores differs with age groups and even middle age population has mobility impairments and they might have a risk of fall in future so middle aged population also should be screened for mobility impairments to improve their mobility and balance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=YC06-YC08&id=12111 https://doi.org/10.7860/JCDR/2018/37054.12111 Assessment of Vitamin D Receptor Gene Polymorphism in Iraqi Women with Polycystic Ovary Syndrome Rana Ali Hamdi, Zina Hassan Abdul-Qahar, Shayma Jamal Ahmed, Raneen Khaleel Tawfeeq <b>Introduction:</b> Polycystic Ovary Syndrome (PCOS) is the most common hormonal disorder in women that occurs mainly in the reproductive age. It is suggested to be highly complex and heterogeneous disorder with an uncertain cause. Genes included in vitamin D metabolism have been assumed as candidate genes for the PCOS susceptibility. Vitamin D receptor gene polymorphisms are suggested to have an influential role in insulin metabolism in women with PCOS. <b>Aim:</b> To investigate the possible association between Cdx2 (G/A) Single Nucleotide Polymorphism (SNP) of vitamin D receptor gene and the risk of polycystic ovary syndrome. <b>Materials and Methods: </b>The present Case-control study involved 88 women from 18 to 34 years of age in which Group 1 consisted of 45 newly diagnosed women with PCOS while Group 2 consisted of 43 women without PCOS that acted as controls. DNA samples were amplified and analysed for the Cdx2 (G/A) SNP of vitamin D receptor gene. Genotypic frequency distribution of Cdx2 polymorphism of vitamin D receptor gene was calculated in women with PCOS and controls. From each serum sample 25-hydroxy vitamin D, calcium, LH, FSH, free testosterone, insulin, and glucose was calculated according to AA, GA, and GG genotypic distribution. <b>Results:</b> There was no significant difference in genotypic distributions of Cdx2 polymorphism of vitamin D receptor gene between patients and controls. In addition, the results of patients group were found to be significantly lower for fasting serum glucose (p=0.02), insulin (p=0.01), and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) (p<0.001) inindividuals with AA genotype than individual with GA and GG genotype. While, significantly higher levels of LH (p=0.002) and LH/FSH ratio (p=0.003) inindividual with GG genotype than individual with GA and AA genotype, and no significant difference in mean value of FSH (p=0.148) and free testosterone (p=0.091) between GG, GA, and AA carriers. Likewise, the results were observed significantly lower levels for serum 25-hydroxy vitamin D in GG carriers than GA and AA carriers for both patients (p<0.001) and controls (p<0.001), with no significant difference in mean value of calcium levels between GG, GA and AA carriers for patients (p=0.949) and controls (p=0.46). <b>Conclusion:</b> Cdx2 polymorphism of vitamin D receptor gene has an association with severity of clinical features in PCOS; however, not with risk of development of the disease meaning that genetic variation is not directly linked to risk of this syndrome but may indirectly affect disease development via regulation of vitamin D levels. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=BC27-BC30&id=12084 https://doi.org/10.7860/JCDR/2018/37349.12084 Modelling the Frequency of Depression using Holt-Winters Exponential Smoothing Method Payam Amini, Ali Ghaleiha, Elaheh Zarean, Majid Sadeghifar, Mohammad Ebrahim Ghaffari, Zahra Taslimi, Saeid Yazdi-Ravandi <b>Introduction:</b>Depression is a worldwide concern causing lots of adverse social consequences. <b>Aim:</b> To assess the stochastic processes of depression frequency through statistical modelling. <b>Materials and Methods:</b> The data contained the processes of depression frequency in Hamadan from April 2008 to March 2016. A total of 3252 patients, according to psychiatrist diagnosed based on DSM-IV criteria, were accounted. To model and forecast the depression incidence frequency, the time series analysis method, Holt-Winter exponential smoothing, was applied. <b>Results:</b> After a considerable decrease in the last months of 2010 which was followed by an increase in early 2011, a constant series of frequencies happened until 2015. The first months of 2015 are the beginning of the increase in the development of depression. <b>Conclusions:</b> Present findings demonstrated an increase in the incidence of depression during 2016-2018. The Holt-winter exponential smoothing method can be used as an appropriate statistical tool to analyse and forecast such data. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=VC24-VC27&id=12085 https://doi.org/10.7860/JCDR/2018/35765.12085 Does Lifestyle of Medical Students have a Role in Determining Body Mass Index and Body Fat Percentage? Vineetha Vijayan, Pallavi Panchu, Biju Bahuleyan <b>Introduction:</b> Due to increased awareness, we assume that doctors would have a good health status. But highly stressful education system along with the adoption of urban lifestyle has resulted in poor lifestyle leading to the development of substandard levels of body compositions. Assuming young medical students to be leading a good and healthy lifestyle, we decided to investigate whether lifestyle has any influence on Body Mass Index (BMI) and Body Fat Percentage (BFP). <b>Aim: </b>To find out the prevalent existing lifestyle in medical students and to find out if lifestyle influences the BMI and BFP. <b>Materials and Methods:</b> A cros-sectional study was conducted among 100 first-year medical students in Jubilee Mission Medical College and Research Institute, Kerala. Validated lifestyle questionnaire and body fat analyser (OMRON–HBF–375) was used for determining BMI and BFP respectively. Data were analysed using bivariate analysis and Fisher’s-Exact test through cross-tabulation using SPSS version 20.0. <b>Results:</b> Out of 100 students, 28% had good lifestyle and 72% had a poor lifestyle. On analysis, lifestyle influence on BMI and BFP was found to be statistically insignificant but BMI and BFP were found to be positively correlated. <b>Conclusion:</b> Young medical students who were supposed to be healthy were found to have poor lifestyle showing an alarming sign of a decline in the quality of health status. Even though lifestyle was found to be influencing BMI and BFP, there was no significance in the present study which raises a question in our mind about the other contributing factors such as youth, genetic factors and other hidden hormonal factors to be playing a role in the BMI and BFP, which needs to be further, investigated. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=CC04-CC07&id=12086 https://doi.org/10.7860/JCDR/2018/36519.12086 A Novel “Over the Wire” Technique for a Case of Difficult Percutaneous Transvenousmitral Commissurotomy Akshyaya Pradhan, Pravessh Vishwakarma, Monika Bhandari, Rishi Sethi, Varun Shankar Narain Percutaneous Transvenous Mitral Commissurotomy (PTMC) is the preferred treatment for isolated rheumatic valvular mitral stenosis if the valve has suitable anatomy. Following transseptal puncture, entry into left ventricle is the crucial step. This may be difficult in patients with large left atrium and very severe mitral stenosis. We are reporting a case of 23-year-old female suffering from mitral stenosis in which the mitral valve could not be crossed with standard technique, so a novel “over the wire technique” was used to cross the mitral valve and successful valvotomy was performed without any complication. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OD01-OD02&id=12087 https://doi.org/10.7860/JCDR/2018/36955.12087 The Association between Helicobacter Pylori Infection and Parkinson's Disease: A Case-Control Study Tahereh Babajani Roshan, Ali Bijani, Seyed Reza Hosseini, Mojgan Bagherzade, Payam Saadat, Mohammad Zamani <b>Introduction:</b> Conflicting results have been reported about the association between Helicobacter pylori infection and Parkinsons disease. <b>Aim:</b> To evaluate the relation between H. pylori infection and Parkinsons disease in patients living in northern Iran. <b>Materials and Methods:</b> In this case-control study, 99 consecutive patients with Parkinsons disease visiting a Neurology Clinic were included. Also, 297 controls were chosen from the participants of the Amirkola Health and Ageing Project, who were matched to the patients with Parkinsons disease for sex, age and educational level. H. pylori infection was assessed by IgG Enzyme-Linked Immunosorbent Assay. The severity of Parkinsons disease was assessed by using the Unified Parkinsons Disease Rating Scale (UPDRS) and the Hoehn and Yahr Scale (HYS). <b>Results:</b> A rate of 66.7% (n=33) of the patients with Parkinsons disease were positive for H. pylori infection, while it was 79.5% (n=236) in the controls {Odds Ratio (OR)=0.52, 95% Confidence Interval (CI)=0.31-0.86, p=0.01}. Scores of UPDRS and HYS were less in H. pylori-positive Parkinsons disease patients than in those who were not infected, however, the differences were not significant. <b>Conclusion:</b> The results of this study suggest that H. pylori infection may protect people from Parkinsons disease. More definitive studies are necessary to confirm this finding. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OC05-OC08&id=12088 https://doi.org/10.7860/JCDR/2018/37178.12088 Prediction of Difficult Laparoscopic Cholecystectomy during the First Conversation with the Patient Kumar Nishant, Varun Kumar Singh, Phuchungla Bhutia, Bikram Kharga, Barun Kumar Sharma, Nitin Jain <b>Introduction:</b> Laparoscopic Cholecystectomy (LC) is the gold standard now for symptomatic cholelithiasis. Any unexpected turn of events intra-operatively has significant implications which get multiplied many fold due to high number of procedures. If degree of technical difficulty could be predicted before starting the procedure, concerned team can be better prepared and adverse outcomes can be potentially minimised or forestalled. <b>Aim:</b> To study clinical factors responsible for technically difficult laparoscopic cholecystectomy during the first visit of the patient to outdoor. Materials and Methods: This prospective analytical study, based on convenient sampling method, was used to select 125 patients sequentially, who underwent LC. Difficulty assessment was done by a Likert type questionnaire. Weighted Difficulty Score (WDS) was calculated and compared against pre-operative parameters. <b>Results:</b> Difficulty of doing surgery increased with age, history of diabetes mellitus and hypertension and obesity. No difference was found in difficulty score for gender and previous history of surgery. Recurrent cholecystitis, prior-hospitalisation, length of hospital-stay and duration since first episode predicted a difficult LC but not duration since last episode. Icterus and palpable gall bladder were also found to increase the difficulty but presence of tenderness and Murphy’s sign had no relation with the difficulty score. <b>Conclusion:</b> Our results demonstrate that difficult LC can be predicted based on parameters on history and physical examination alone at the first visit of the patient to OPD. Both the patient and surgical team can, therefore, be better prepared for the possible complications and conversions in an environment of confidence and mutual trust. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=PC06-PC09&id=12089 https://doi.org/10.7860/JCDR/2018/28496.12089 Catalysing Public Healthcare Efficacy: Striking the Right Cords of Leadership Ravinder Nath Bansal, Meenakshi Malhotra <b>Introduction:</b> Leaders’ behaviour significantly influences the job satisfaction of the employees. Hospital experience and patient outcomes relate to job satisfaction of employee’s working therein. <b>Aim:</b> Current research was aimed to identify key leader behavioural aspects that can catalyze job satisfaction of employee working at tertiary level public healthcare medical colleges to recommend solutions for better leadership. <b>Materials and Methods:</b> Research was conducted at a public sector medical college and hospital covering all the skilled employees (275 doctors, 282 nurses, 143 paramedics, 96 non-medicos). Unskilled staffs (e.g., housekeeping and general duty helpers) were excluded from the study considering their inability to understand the defined tool. A structured questionnaire was formed using validated instruments like Job Satisfaction Survey (JSS) by Spector PE (1994) and Leader Behaviour Description Questionnaire (LBDQ) Form XII by Stodgil RM and administered to all the eligible staff members. Data collected was analysed using pearsons correlation and regression analysis. <b>Results:</b> Responses were received from 621 respondents including 243 nurses, 207 doctors, 72 non-medicos and 99 paramedics. Overall demand reconciliation behaviour was found to have highest and significant correlation with job satisfaction. <b>Conclusion:</b> Results show that leader behaviour practices must be accustomed to professional groups of employees. Such profession specific leader behaviour aspects have been identified and described in the article with recommendations on enhancement in leadership practice. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=IC01-IC06&id=12090 https://doi.org/10.7860/JCDR/2018/31233.12090 Comparison of Mobilisation with Movement and Cryotherapy in Shoulder Impingement Syndrome-A Randomised Clinical Trial Saumya Srivastava, Charu Eapen, Harramb Mittal <b>Introduction:</b> Shoulder Impingement Syndrome (SIS) is one of the common cause of shoulder ailment which leads to pain and restriction of the movements. Though Mobilisation with Movement and cryotherapy, both are found to be effective in managing SIS, there is no comparison done between the two treatments. <b>Aim:</b> To compare the effectiveness of Mobilisation With Movement (MWM) and cryotherapy in SIS. <b>Materials and Methods:</b> A randomised clinical trial was conducted on 22 subjects who aged between 18-64 years, and those who had a positive painful arc, three positive tests out of five i.e., Neer’s Impingement, Hawkin’s Kennedy, Jobe’s, Speed and Gerber test. These subjects were randomised using block randomisation method and allocated to one of the two groups receiving treatment of MWM or cryotherapy, along with impairment based exercises for six sessions. Outcome measures included reporting of pain on the Visual Analogue Scale (VAS), Range of Motion (ROM) and Shoulder Pain and Disability Index (SPADI). A blinded assessor inscribed the outcome measures prior to the intervention, immediately after the intervention on the first day (except SPADI) and also on the sixth-day posts the intervention. The data were analysed using Wilcoxon Signed-rank test for within the group analysis and Mann-Whitney U test was used to analyse data between the groups. <b>Results:</b>There was a significant reduction in pain and disability scores and improvement in ROM in both the groups after six treatment sessions (p<0.05). There was also an immediate improvement in pain and ROM in MWM group. <b>Conclusion:</b> There was an improvement in pain and ROM immediately after the application of MWM. However, there was no significant difference between MWM and cryotherapy at the end of six sessions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=YC01-YC05&id=12091 https://doi.org/10.7860/JCDR/2018/34624.12091 Histochemical Study of Inflammatory Lesions of Gall Bladder with Reference to Metaplastic Conditions Biparnak Haldar, Anadi Roy Chowdhury, Malay Sarkar, Manas Talukdar, Sukla Mitra <b>Introduction:</b> Cholelithiasis and asymptomatic gallstones may produce pathological changes like hyperplasia and metaplasia of the gall bladder mucosal epithelium. It has been suggested that metaplastic epithelium is more susceptible to malignant transformation than the normal mucosa and the intestinal metaplasia-dysplasia-carcinoma sequence exists in the gall bladder. So, it is essential to detect metaplastic lesions of gall bladder early and mucin histochemistry study may be useful in this regard. <b>Aim:</b> To find out if mucin histochemistry can be used for early detection of metaplastic lesions of gall bladder as metaplastic epithelium is more prone to malignant transformation. <b>Materials and Methods:</b> A total of 1153 formalin-fixed paraffin-embedded surgically resected gallbladder tissue samples were sectioned. All sections were stained with Haematoxylin-Eosin (HE), Alcian Blue (AB) and Periodic Acid-Schiff (PAS) stain. <b>Results:</b> A total of 1153 cholecystectomy cases were observed. Maximum cases were of chronic cholecystitis with gall stones (841 cases). Metaplasia was found in 201 out of 1153 cases. Mucin histochemistry in metaplastic group showed only PAS positivity in 52 cases (neutral mucin), both PAS and AB positivity in 122 cases (acidic mucin) and only AB positivity in 27 cases (acidic mucin). <b>Conclusion:</b> The gastric and intestinal metaplasia showed positivity more with acidic mucin than neutral mucin. Study of mucin histochemistry in metaplastic cases can lead to early detection and early diagnosis of carcinoma gallbladder. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=EC01-EC04&id=12092 https://doi.org/10.7860/JCDR/2018/37270.12092 Is Luteal Phase Estradiol Supplementation Beneficial in Long Agonist IVF-ET Cycles? First Prospective Randomised Controlled Study from Indian Subcontinent Aishwarya Kapur, Sudha Prasad, Ashok Kumar <b>Introduction: </b>The role of addition of estradiol to progesterone as luteal phase support in women undergoing In Vitro Fertilization (IVF) is not yet clear. <b>Aim:</b> To determine the efficacy of oral estradiol valerate in the luteal phase of IVF cycles. <b>Materials and Methods: </b>The randomized controlled study was done in the IVF centre of a Medical college. Total 150 women undergoing IVF were recruited, randomized in two groups, study (n=75) and control (n=75) using computerized randomization. Luteal phase support was started on day of Embryo Transfer (ET) : Study group-Estradiol valerate, 2mg bid orally+ Micronized progesterone, 400mg, bid vaginally and Control group: only Micronized progesterone, 400mg, bid vaginally. Blood samples for estimation of serum E2 were collected on day of oocyte retrieval, day of ET, three days after ET and on the day of confirmation of biochemical pregnancy. Statistical analysis was done using SPSS 16.0, p<0.05 was considered significant. <b>Results:</b> Overall pregnancy rate was 38.7% (58/150): study group (41.3%), control group (36%) (p-value = 0.50). Significantly higher E2 levels were found in women who conceived as compared to those who did not conceive. <b>Conclusion:</b> Although estradiol supplementation did not improve pregnancy rates significantly, but it certainly improved the hormonal profile in the study group compared with the control group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=QC01-QC03&id=12093 https://doi.org/10.7860/JCDR/2018/37348.12093 Comparative Study on Estimation of Acenocoumarol Levels in Blood in Patients with Extremes and Normal INR Values after Valve Replacement Surgery D Jeyalakshmi, S Bhuvaneshwari, Periyanarkunan Ramaiya Murugesan, M Siva Selva Kumar <b>Introduction:</b> Acenocoumarol is an oral-anticoagulant which is commonly used but with narrow therapeutic index and there is no relation between dose and adverse effects. The response of acenocoumarol varies according to individual. Adverse effect like bleeding occurs even when INR is in normal range. Therapeutic drug monitoring of acenocoumarol is essential to prevent life threatening complication. <b>Aim:</b> To study the association between plasma concentration of acenocoumarol at trough and Cmax levels with their corresponding Internalized Normalised Ratio (INR) values in patients who have undergone valve replacement. <b>Materials and Methods:</b> After Human Ethics Committee approval, 56 patients were enrolled for the study. Participants who were taking acenocoumarol 2 mg with low INR, normal INR and high INR was included. Blood samples were taken for estimation of trough and Cmax concentrations of acenocoumarol was analysed by High Performance Liquid Chromatography (HPLC) method. <b>Results:</b> The was no statistically significant correlation between INR of all the three groups and their respective plasma concentration of acenocoumarol taken at trough and Cmax by Pearson’s correlation (p-value=0.187). And the plasma concentration of acenocoumarol taken at trough and Cmax of all the three groups of participants was not statistically different by ANOVA (p-value=0.164). <b>Conclusion:</b> The present study concludes that measuring INR alone will have limited value for dose adjustment of acenocoumarol as proved by other studies for warfarin. Hence, estimation of plasma concentration of acenocoumarol will be ideal and appropriate for the dose adjustment of acenocoumarol. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=FC01-FC04&id=12094 https://doi.org/10.7860/JCDR/2018/31465.12094 Relation of Vitamin D Supplementation, upto six months of age with Total and Bone Specific Alkaline Phosphatase: A Randomised Control Trial Hemlata Singh, Arti Maria, Amlin Shukla, Neera Sharma, Kalaivani Mani, Manoj K Das <b>Introduction:</b> Vitamin D deficiency is an issue of concern in the Asian population. In the light of the fact that breast milk is an inadequate source of vitamin D, supplementation becomes essential for all term healthy babies for healthy peak bone mass. However, there is a lack of guidelines and research on this issue in India. <b>Aim:</b> To document change in Total Alkaline Phosphatase (TALP) and Bone Specific Alkaline Phosphatase (BSALP) levels in babies receiving 400 IU/day vitamin D from zero to six months (primary objective) and change in vitamin D, PTH, calcium, phosphorus levels and anthropometry (head circumference, length, weight and mid-arm circumference) (secondary objectives). <b>Materials and Methods:</b> Hundred eligible babies were randomised into two groups by block randomisation using alternate sizes of block four and six and allocation concealment was done through serially numbered opaque sealed envelopes. Both groups were followed over six months at intervals of 2, 6, 10 and 14 weeks to compare the change in levels of BSALP and TALP and also vitamin D, PTH, calcium, phosphorus and anthropometry. <b>Results:</b> There was a statistically significant difference in levels of TALP (p<0.001) however, not in BSALP between two groups at six months (p=0.62). There was a significant rise in vitamin D levels in the supplemented group at the end of six months as compared to control group. 60% babies were vitamin D deficient (<20 ng/mL) at birth in the vitamin D group and 34% in the control group while at six months 40% babies were vitamin D deficient in the supplemented group while 76% in controls (p<0.05). No significant difference in anthropometric indices was seen between the two groups. None had vitamin D toxicity. <b>Conclusion:</b> Vitamin D supplementation in newborns for the initial six months led to a significant change in TALP compared to the control group. However, it did not cause a statistically significant change in BSALP. Prevalence of vitamin D deficiency was almost universal in all the mothers. More than half of the newborns delivered to these mothers were also deficient in vitamin D. Vitamin D supplementation significantly reduced the percentage of vitamin D deficient babies in the supplemented group compared to the control group at the end of six months. Vitamin D supplementation in a dose of 400 IU/day was safe and did not lead to any toxicity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=SC01-SC05&id=12095 https://doi.org/10.7860/JCDR/2018/34751.12095 Depression, Perceived Loneliness and Partial Functional Impairment among Older Adults P Susheela, Blessy Prabha Valsaraj, Savitha <b>Introduction:</b> Depression is a significant public health problem among aged in all over the world. The researchers were keen to understand whether the elderly residing in rural areas of South Karnataka are affected with depression and if so whether it is correlated with their feeling of loneliness and health/activity levels. <b>Aim:</b> The study aimed to determine the prevalence of depression, perceived loneliness and partial functional impairment among older adults and to find out the relationship between these variables. <b>Materials and Methods: </b>A cross sectional study was conducted among 600 older adults aged 60 years and above from three villages of Udupi Taluk, Udupi district of south India. Demographic proforma, Geriatric Depression Scale, University of California Los Angeles loneliness scale and Activities of daily living assessment scale were used to collect the data. Descriptive (frequency and percentage) and inferential (Karl Pearson correlation and Chi-square association) statistics were used to analyse the data. <b>Results:</b> The prevalence of depression was 40.16%. A 23 (3.8%) subjects perceived low degree of loneliness, and 6 (1%) subjects perceived moderately high degree of loneliness. It was also found that 20(3.3%) subjects required minimum help and 1(0.2%) subject was completely dependent on their activities of daily living. There was modest negative correlation between loneliness and partial functional impairment (r=-0.018) but, no significant correlation was found between depression and perceived loneliness. <b>Conclusion:</b> Study concluded that the elderly living in rural India also might be affected with depression and the depression may not be related to their perception of loneliness and partial functional impairment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=VC01-VC05&id=12096 https://doi.org/10.7860/JCDR/2018/34086.12096 Effect of Group Religious Intervention on Spiritual Health and Reduction of Symptoms in Patients with Anxiety Masoud Nikfarjam, Kamal Solati, Saeid Heidari-Soureshjani, Parvin Safavi, Elham Zarean, Elham Fallah, Iraj Goudarzi <b> Introduction:</b> Anxiety is a disease which, in addition to the complications affecting the health of patients, imposes a high burden on health care systems. <b> Aim:</b> To determine the effectiveness of a group religious intervention on spiritual health and reduction of symptoms in patients with anxiety. <b> Materials and Methods:</b> In the present clinical trial, 72 patients with anxiety were included in the study with convenience sampling. Patients were randomly divided into two groups; Group I underwent drug therapy alone, and Group II underwent drug therapy+religious intervention. The religious intervention group attended 5 sessions of 90 minutes at 3-week intervals and was administered with routine drug therapy. Then, the participants filled out the demographic questionnaire, Spiritual Well-being Scale and the Spielberger State-State anxiety Inventory. After data collection, the data were analysed by SPSS 18. <b> Results:</b> There was no significant difference between the demographic characteristics of patients (p>0.05). The mean scores of religious and existential aspects of spiritual wellbeing and general spiritual health after intervention were significantly higher in Group II than in Group I (p<0.05). The mean scores of trait anxiety scores, state anxiety, and general anxiety after intervention were significantly lower in Group II than in Group I (p<0.05). <b> Conclusion:</b> Religious intervention, in addition to increasing the level of spiritual health of the patients, improves their anxiety symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=VC06-VC09&id=12097 https://doi.org/10.7860/JCDR/2018/36291.12097 A Review on Association of Air Pollution and Biomass Fumes on Respiratory System Pravallika Pagadala, Sharvani Nerella, Nandini Chandrashekhar, Murikipudi Ramesh Babu World Health Organization (WHO) reported that indoor air pollution is one of the ten avoidable risk factors. People believe that air pollution is an outside urban phenomenon, but some of the uppermost concentration occurs in the opposite situation i.e., countryside and in the house. Such levels are due to the high proportion of countryside/less developed countries population relies on unprocessed biomass fuels (like wood, crop residues, dung) which have high pollutant emission factors, in simple small scale burning devices such as household cooking. Domestic cooking is one among the major activities of the rural Indian house wives. Cooking is carried out in an enclosed space with poor ventilation and inefficient stoves. Long duration of exposure to biomass fuel mostly affects women, young girls and children. In most of the developing countries biomass fuel is used for cooking. Girls start cooking at very early age and spend minimum 4-6 hours daily in kitchen for almost 30-40 years which is equivalent to 60,000 hours of exposure. Indoor air pollution occurs primarily by usage of biomass fuels which attributes 1.5-2 million deaths/year. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=CE01-CE04&id=12098 https://doi.org/10.7860/JCDR/2018/37226.12098 Review of Infrared Carbon-Dioxide Sensors and Capnogram Features for Developing Asthma-Monitoring Device Om Prakash Singh, MB Malarvili <b> Introduction:</b> Asthma is one of the most common heterogeneous respiratory chronic diseases and fourteenth most imperative illness in the world in terms of duration and extent of disability. The existing method for early identification of asthma is based on health care provider’s physical assessment and spirometer or peak flow meter which is manual and unreliable if patients are non-cooperative. Therefore, capnography, which measured the respired carbon dioxide concentration, has been proposed as a patient independent method for the assessment of asthma. <b> Aim:</b> This study aims to critically review, investigate, and compare the specifications of different infrared CO2 sensors and capnogram features to develop an asthma-monitoring device. <b> Materials and Methods:</b> A rigorous and extensive search was carried out on Google scholar, the Web of Science, PubMed, and Scopus and several index terms (CO2 sensor, infrared sensor, CO2 measurement, asthma detection, capnograph, and capnogram) were employed to identify appropriate CO2 sensors, technology, and capnogram features to develop asthma monitoring device. <b> Results:</b> The review revealed that the COMET CO2 sensor is the most suitable and reliable for developing a capnograph device owing to its weight (7 g), output range (0-99 mmHg), warm-up time (2-15 s), and response time (0.028 s). Furthermore, slope and time-frequency components measured from alveolar phase and complete breath cycle respectively are found the most significant features to screen asthma severity level. Further, the effects of pressure and temperature on CO2 values were tested using Proteus software. Finding reveals that the CO2 values changed drastically from 17,835.19 parts per million (ppm) to 86,321.29 ppm as the pressure changed from 16.53 kPa to 81.53 kPa at a constant temperature (25°C). With a change in temperature from 25 to 27°C, the CO2 values were found to change from 16,812.19 ppm to 17,249.13 ppm at a constant pressure (16.53 kPa). Based on the review, a CO2 measurement device using COMET equivalent CO2 sensor was developed. <b> Conclusion:</b> The developed device is capable of the assessment of cardiorespiratory condition instead of asthma severity level due to lack of significant capnogram features, which still remains to be integrated into the device. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OE01-OE06&id=12099 https://doi.org/10.7860/JCDR/2018/35870.12099 The Role of Prophylactic Diverting Loop Ileostomy in Preventing Leaks in High Risk Intraperitoneal Colonic Anastomosis: A Literature Review Yusuf Afaque, Mohammad Riyaz, Mohammad Aslam , Amjad Ali Rizvi <b> Introduction:</b> The anastomotic leak occurs in approximately 3-15% of patients who undergo colon and rectal surgery and can lead to significant morbidity and mortality. Prophylactic Diverting Loop Ileostomy (DLI) is done at times to prevent the anastomotic leak in high risk intraperitoneal colonic anastomosis. The role of DLI to prevent intraperitoneal colonic anastomosis leak is not well defined and we present the first review of literature to address this subject. <b> Aim:</b> To do a literature review and study the role of prophylactic DLI for intraperitoneal colonic anastomosis. <b> Materials and Methods:</b> We searched the PubMed, Google Scholar and Cochrane Library database and also searched the reference of the relevant articles. After the extensive search, we got nine articles on this subject for review. <b> Results:</b> For destructive colon injury with hypotension requiring more than four units of packed red blood cells or with significant co-morbidities, the high risk anastomosis becomes safer with a prophylactic DLI. For patients with pathological perforations, DLI can be added to safeguard colonic anastomosis if there are two or more risk factors for anastomotic leak. Patients not falling in above groups may not require prophylactic DLI for intraperitoneal colonic anastomosis. <b> Conclusion:</b> Prophylactic DLI should be done to safeguard intraperitoneal colonic anastomosis only when there are multiple risk factors for the anastomotic leak. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=PE01-PE03&id=12100 https://doi.org/10.7860/JCDR/2018/36467.12100 An Update on Recurrent Early Pregnancy Loss: Causes, Controversies and Cure Krupa Shah, Parvati Bhat, Rajeshwari Bhat, Ruby sultana Recurrent Pregnancy Loss (RPL) is an important reproductive issue, affecting 1-5% of couples. It is characterised by repeated miscarriage, impairing the ability to have a live birth. The proven causes are diverse, such as cytogenetic abnormality, uterine anomalies, antiphospholipid antibody, metabolic and endocrine abnormalities, and about 50% cases of RPL remain still unexplained. To facilitate the diagnosis, different screening tests have been recommended, such as antiphospholipid antibody tests, thyroid stimulating hormone, glucose tolerance test, chromosomal assessment, ultrasound testing etc. RPL is associated with psychological trauma and financial burden. An evidence-based treatment is available for the majority of causes and it is seen that most of the women eventually become pregnant with an appropriate treatment plan, regardless of the cause. It has also been shown that patients presenting no abnormality on various tests may achieve a good rate of live births without special treatment. This study also includes certain controversial aetiologies and unconventional tests. This review touches on the management of various abnormalities in brief. Recurrent pregnancy loss has a significant negative life impact due to its repetitive nature; however, emotional care along with appropriate management improves chances of future pregnancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=QE01-QE05&id=12078 https://doi.org/10.7860/JCDR/2018/36703.12078 Metabolic Healthy Obesity-A Paradoxical Fallacy? Sourya Acharya, Samarth Shukla In the era of modern medicine, obesity has become the most catastrophic non communicable burden. It is pandemic and is the root of all non communicable disease risks. Again to make things more complicated, it shows great variability in different races as far as pin pointing the cut-off for its appropriate definition. Body Mass Index (BMI) is still followed as a sole parameter for its definition, though; it has failed to mathematically show its correlation with the consequences of obesity related complications. Other terminologies like, Metabolic Healthy Obesity (MHO), Metabolic Obesity Normal Weight (MONW) is now in use still complicating the current burden of risk stratification. It is this “MHO” subgroup that has created lot of debate, just because two paradoxical words (“healthy” and “obesity”) are simultaneously associated, meaning that sometimes obesity can be healthy. Initially some researchers concluded the same, but new researchers are coming forward with convincing results that actually MHO is not healthy at all. This review tries to summarise the basic concepts of MHO and the current scenario of MHO research as far as development of cardiovascular risks is concerned in this so called subgroup of population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OE07-OE10&id=12165 https://doi.org/10.7860/JCDR/2018/36809.12165 Immunopathological Concepts Behind Autoimmunity Soma Susan Varghese, Sreenivasan Bargavan Sarojini, Philips Mathew, Jayan Jacob Mathew Autoimmunity is the failure of self-tolerance of an organism, which empowers immune response against its own cells and tissues generating autoimmune diseases. Autoimmune diseases are exceeding 100 million people globally. Autoimmune mechanisms underline many diseases, some are organ-specific and others are systemic in distribution. Aberrations in central and peripheral tolerance, molecular mimicry, bystander activation, cryptic antigenic and super antigenic exposure are found to be associated with immune response against self-antigens. As the molecular biology behind autoimmune diseases is obscure, an insight on immune pathways, impaired immunity and evolution of autoimmune diseases can supplement on the therapeutic modalities of immunological diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZE01-ZE04&id=12143 https://doi.org/10.7860/JCDR/2018/36199.12143 The Role and Scope of Research in Undergraduate Medical Curriculum Sapna S Patil, Ameya A Hasamnis A continual enhancement of research capacity remains the cornerstone of modern medicine. Medical students need to understand, learn and apply the principles of research to practice of medicine. The best time to instill these principles in students is during the undergraduate medical course. This initiative can help to generate interest in medical students to develop cutting edge innovations for the benefit of all. Strategic planning and step-wise implementation of research module is possible without much alteration in conventional medical curriculum. The goal of the module is to give research insight to undergraduate medical students through meaningful ethical research. The research module may also help in inculcating other attributes like self-discipline, problem solving, critical thinking and life-long learning in medical students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=LI01-LI02&id=12135 https://doi.org/10.7860/JCDR/2018/36808.12135 Internal Jugular Venous Ectasia in an Adult Female Bharathguru Nedumaran, Arunkumar Krishnasamy Jugular phlebectasia refers to a saccular or fusiform dilatation of the neck veins. Phlebectasia involving the jugular veins is an entity which is diagnosed more commonly in children presenting with neck swellings, after ruling out other common causes. It is also called a venous aneurysm, venous ectasia or essential venous dilatation. This can affect all neck veins-internal jugular, external jugular, anterior jugular and superficial communicating veins in order of decreasing frequency. Although, various theories have been proposed, there is no general consensus among various authors regarding the cause for its occurrence. It is predominantly congenital in origin. The diagnosis is based on clinical presentation aided by non-invasive imaging modalities. The venous ectasia is being increasingly recognised due to advances in radiographic imaging. Management is mainly conservative and surgery is required only when complications arise. Here, authors present a case of venous ectasia in an adult female who presented with complaints of the presence of a vague swelling in her neck. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=PD07-PD08&id=12129 https://doi.org/10.7860/JCDR/2018/37443.12129 Giant Osteoma of the Mandible: Ultrasonography Guided Surgery Poyzan Bozkurt, Cansu Görürgöz, Umut Seki, Kaan Orhan Osteomas are rare, benign osteogenic neoplasms arising from the bone surface or medullary bone. They are most commonly encountered on the craniofacial skeleton. Complaints including pain and facial asymmetry are managed by surgical excision. The present study presents a case of mandibular osteoma in close relation to the mental nerve and discusses the use of ultrasonography guidance during excision surgery. USG guidance may be used intraoperatively as a cost-effective technique during surgeries of osteomas with close relations to vital structures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZD04-ZD06&id=12126 https://doi.org/10.7860/JCDR/2018/36727.12126 Full Mouth Rehabilitation of a Patient with Bruxism using Implant and Tooth-supported Monolithic Zirconia with Feldspathic Veneers André Moreira, Filipe Freitas, João Nabais, João Caramês Complete oral rehabilitation in patients with bruxism is often challenging as a result of the loss of tooth structure and loss of occlusal vertical dimension. This case describes the management of a 70 year old man with a history of bruxism and excessive wear, loss of the occlusal vertical dimension, limited space for restoration, esthetic complaints and compromised dental function due to reduced tooth structure. A multidisciplinary approach was applied with tooth and implant-supported full-ceramic restorations. The patient used two full arch provisional bridges during the osseointegration of the dental implants. Maxillary and mandibular teeth and implants were restored with monolithic zirconia crowns with feldspathic veneers. An occlusion mouth guard was given to protect the restorations. After 36 months of function, no major complications were registered. The restoration of worn dentition in cases of bruxism requires proper planning and a multidisciplinary approach in order to ensure the prognosis and the success of prosthetic treatment. Partially veneered monolithic zirconia appears to be a reliable treatment option with satisfactory clinical results and minimal technical complications. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZD07-ZD11&id=12127 https://doi.org/10.7860/JCDR/2018/37209.12127 An Interesting Case of Virilising Malignant Steroid Cell Tumour in a Post Menopausal Female: A Case Report Shivanjali Raghuvanshi, Vanshika Shahi, Preeti Agarwal, Sameer Gupta, Madhu Mati Goel The present case is of a rare malignant steroid cell tumour which accounts for less than 0.1% of ovarian tumours. Symptoms of virilisation on presentation were noted and patient had an ovarian tumour which turned out to be malignant steroid cell tumour. The present case is unique because presentation in post menopausal age group is rare and the case being malignant is unusual. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ED01-ED03&id=12162 https://doi.org/10.7860/JCDR/2018/36617.12162 Acute Native Valve Endocarditis by <i>Granulicatella adiacens</i> Suman Susan Prakash, Deepashree Rajshekar, Akshatha Ravindra, R Sneha, Apurba Sankar Sastry Infective Endocarditis (IE) is an uncommon but a life-threatening infectious disease. Approximately 3% to 5% of cases of streptococcal infective endocarditis is caused by Nutritionally Variant Streptococci (NVS). Granulicatella species is one of the rare causes of IE. Here, authors are reporting a case of native valve endocarditis, without any pre-existing cardiac lesions, caused by Granulicatella adiacens. The patient presented with low grade intermittent fever for three months and had pan-systolic murmur with hepatomegaly and multiple vegetations in the echocardiogram. All the blood cultures were positive for Granulicatella adiacens. The patient was successfully treated with intravenous ceftriaxone and gentamycin for six weeks. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=DD01-DD02&id=12163 https://doi.org/10.7860/JCDR/2018/37113.12163 Outcome of Drug Resistant Severe Atrial Tachycardia During Pregnancy treated with Catheter Ablation Gamze Aslan, Omer Yildiz, Hale Bengisu, Ferit Onur Mutluer, Remzi Karaoguz A 24-year-old primigravid woman at 28 weeks of gestation was admitted to the hospital because of drug-refractory atrial tachycardia and heart failure. The arrhythmia did not respond to drug therapy and electrical cardioversion. Since tachycardia was intractable and had potentially life-threatening consequences for mother and foetus, it was decided to ablate the tachycardia after a multidisciplinary meeting. During the procedure, maternal hypotension occurred, consequently causing persistent foetal heart rate reduction. Radiofrequency ablation was immediately cancelled and emergency caesarean section was carried out. After 72 hours after the caesarean-section, successful RF ablation could be performed. Mother was discharged on the seventh postoperative day. The newborn was hospitalised until having reached 2500 g and he was discharged in good condition. Mother’s left ventricle systolic function significantly improved and no atrial tachyarrhythmia was observed on the sixth month follow-up visit. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OD11-OD13&id=12164 https://doi.org/10.7860/JCDR/2018/37350.12164 Systemic Lupus Erythematosus Presenting as Knee Joint Effusion Basavaraj Baligar, Uday S Bande, BE Kalinga, Y Chethan Systemic Lupus Erythematosus (SLE) is a chronic, autoimmune, connective tissue disorder which has multi-organ involvement. Patient might rarely present with major joint sterile inflammatory effusion and evaluation of such patients for connective tissue disorders helps in the early diagnosis and treatment. We hereby, present the case of 35-year-old female with left knee joint effusion subsequently diagnosed to have SLE with lupus nephritis Class IIIa. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OD03-OD05&id=12121 https://doi.org/10.7860/JCDR/2018/36063.12121 Prevention of Severe Tongue Biting in a Mentally Challenged Patient: A Clinical Report Filiz Aydogan, Aynur Medine Sahin Saglam Orofacial dysfunctions and habits are the main factors which influence the development of malocclusion and perioral disease. In this context, Orthodontics, a field of Dentistry, is closely associated with the diagnosis and treatment of injuries stemming from oral habits and parafunctions. This rare case report presents the treatment of a mentally challenged 23-year-old male patient who had a tongue biting habit for four years. Underlying causes of tongue biting must be investigated and the most appropriate treatment should be performed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=ZD12-ZD14&id=12169 https://doi.org/10.7860/JCDR/2018/37381.12169 Ureteric Avulsion following Blind Attempts at Retrieval of Intrauterine Contraceptive Device: A Clinical Lesson to Primary Care Givers Divya Shrimal, Akhila Vasudeva, Shripad Hebbar, Arun Chawla Intra Uterine Contraceptive Device (IUCD) is the most popular method of reversible contraception in India because of their high efficacy for fertility regulation, low-risk, low-cost, and lack of required maintenance. Uterine perforation remains one of the most serious complications, with an incidence 0.87 per 1000 insertions. The IUCD strings are used to monitor and remove the device. Missing IUCD strings are observed in about 5% of the users. Such patients require localisation of the device using Transvaginal Scan (TVS) and X-Ray, and combined hysterolaparoscopic approach for its retrieval. Hereby we report a case of young primipara, who consulted a local practitioner requesting IUCD removal, as she was planning to conceive her second child. On examination, Cu-T threads were not found. A plain X-Ray of the pelvis was reported as: Cu-T limbs seen in the left side of the pelvis, “in the region of uterus”. Blind attempts led to damage to ovary and uterus along with the ureter. By reporting this case, we hope to raise awareness on the management of misplaced IUCD, among primary care givers; and the need for set protocols on the management of such cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=QD01-QD03&id=12176 https://doi.org/10.7860/JCDR/2018/37278.12176 Effect of Wharton’s Jelly Derived Mesenchymal Stem Cells on the Expression of NLRP3 Receptor and Neuroinflammation in Experimental Spinal Cord Injury Yousef Mohamadi, Mahboubeh Mousavi, Seyed Mohammad Hossein Noori Moogahi, Farid Abolhassani, Sahar Ijaz, Gholamreza Hassanzadeh <b>Introduction:</b> The NOD-Like Receptor (NLR) family, pyrin domain-containing protein 3 (NLRP3) inflammasome plays a major role in inflammation process. Structurally, the inflammasome consists of a receptor (NLRP3), an adaptor protein, and precursor of the enzyme caspase-1. Inflammasome activation in central nervous system injuries can activate caspase-1. This enzyme mediates the maturation and secretion of interleukin-1ß (IL-1ß) and IL-18, initiating inflammatory responses. Mesenchymal stem cells have shown immune modulation features and have been extensively used for treating inflammatory diseases. <b>Aim:</b> To investigate the effect of intracisternal transplantation of Wharton’s Jelly-Derived Mesenchymal stem Cells (WJMSCs) on the NLRP3 inflammasome in Spinal Cord Injury (SCI) rat model. <b>Materials and Methods:</b> Male wistar rats were divided into four groups (n=7) as following: laminectomy group, spinal cord injury group, vehicle group (the rats received phosphate-buffered saline), and WJMSCs treated group. Gene expression and protein production of NLRP3 receptor was evaluated by real time-PCR and western blotting. Serum concentration of IL-1ß and IL-18 was measured by ELISA. Data were analysed using one-way ANOVA test followed by Tukey’s test. <b>Results:</b> The results showed that both gene and protein expressions of NLRP3 receptor were significantly increased in the SCI rats in comparison to the uninjured rats (p<0.05). In addition, the serum levels of IL-1ß and IL-18 had upward trends in the SCI group compared to the laminectomy (p<0.05). On the other hand, WJMSCs significantly reversed the rises in both NLRP3 expression and interleukins amounts in comparison to the SCI group (p<0.05). <b>Conclusion:</b> It can be concluded that MSCs may modulate the inflammation process via inflammasome suppression. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=AF01-AF04&id=12168 https://doi.org/10.7860/JCDR/2018/37321.12168 Modification of <sup>99m</sup>Tc-Thyroid Scan Protocol to Decrease the Radiation Dose to Salivary Glands Wadah M Ali, Entesar Zawam Dalah, Lana Haider Ahmed, Mohamed M Abuzaid <b>Introduction:</b> The pharmacokinetics pathway of 99mTc-pertechnetate, used for thyroid scan, involves the absorption of 99mTc in normal non-pathologic salivary glands. <b>Aim:</b> To modify the original protocol used for thyroid scan for the purpose of decreasing radiation absorbed dose to the non-target organ (Salivary Gland). <b>Materials and Methods:</b> Thirty-one patients of different age, gender, and thyroid function test were gathered and analysed. Each patient underwent two thyroid scans, the first scan was performed using the original protocol, and the second scan was obtained with a slight modification to the original protocol, where patients were instructed to chew a gum and drink a cup of water before acquiring the second thyroid scan which started 5 minutes after completing the original scan protocol. Images of the original and modified protocols were acquired using SPECT scanner with the first scan starting 20 minutes post 99mTc injection. Patients lay in a supine position while undergoing both scans. The percentage of the net administrated activity localised in the thyroid and salivary glands were measured. <b>Results:</b> The absorbed dose values of the thyroid and salivary glands from the original protocol and the modified protocol were estimated. There was no significant change in the thyroid gland absorbed dose between the two protocols, whereas a significant (t-test) reduction was found in the salivary gland absorbed dose using the original and modified protocol with values being 0.77±0.39 mGy and 0.28±0.09, respectively. <b>Conclusion:</b> Using the modified chew gum phase protocol in imaging of the thyroid gland with 99mTc result in decreasing the absorbed dose of the salivary gland. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=TC01-TC04&id=12128 https://doi.org/10.7860/JCDR/2018/37216.12128 Conjugate Gaze Palsy-The Sole Presentation of Acute Stroke Neera Chaudhry, Kamakshi Dhamija, Santosh P Kumar, Ashish Kumar Duggal, Geeta Anjum Khwaja https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=October&volume=12&issue=10&page=OJ01-OJ02&id=12167 https://doi.org/10.7860/JCDR/2018/35763.12167