Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Double Trouble in Systemic Sclerosis: Complete Heart Block and Systolic Dysfunction Akshyaya Pradhan, Sameer Ganpat Vankar, Pravesh Vishwakarma, Rishi Sethi A 26-year-old female, a known case of diffuse systemic sclerosis present with multiple episodes of syncope and progressive dyspnoea over six months. Her electrocardiogram revealed complete heart block and left ventricular systolic dysfunction with Ejection fraction of 42%. She underwent single chamber permanent pacemaker implantation and systolic dysfunction was managed medically. This case exemplifies a unique case of diffuse systemic sclerosis presenting with two rare primary cardiac manifestations namely complete heart block and systolic dysfunction, which occurred simultaneously. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OD01-OD02&id=11968 https://doi.org/10.7860/JCDR/2018/36125.11968 Penicillin Resistant Pneumococcal Meningitis in Paediatric Trauma Patient Vijeta Bajpai, Aishwarya Govindaswamy, Sushma Sagar, Purva Mathur Pneumococcal meningitis is a life-threatening infection, requiring prompt diagnosis and effective treatment. The approach to therapy in patients with pneumococcal meningitis has changed considerably over the past 20 years because of emerging penicillin resistant pneumococcal meningitis. We report a case of Penicillin resistant pneumococcal meningitis in a six-year-old child after skull trauma injury. The patient responded well to injection ceftriaxone and injection vancomycin therapy and recovered completely without sequelae. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=DD01-DD02&id=11962 https://doi.org/10.7860/JCDR/2018/36718.11962 Metachronous Pancreatic Adenocarcinoma in Patient with Renal Cell Carcinoma: A Case Report Satya Prakash Jindal, GK Adithya, Varun Madaan, Vivek Tandon, Deepak Govil Multiple primary tumours in a single individual are reported in the literature with incidence which varies from 1% to 20%. Few common combinations are labelled as the syndrome and showed a common genetic association; however, sporadic cases of multiple primaries are relatively rare. Such a combination of Renal Cell Carcinoma (RCC) with pancreatic carcinoma is sparingly being reported in the literature. Here, we present a case of pancreatic carcinoma in a patient who was treated for renal cell carcinoma, 10-years-back. A few cases, which have been published before also could not establish any specific reason for this combination. We recommend considering a possibility of the second primary in any patient with unusual symptoms different from primary lesion and research for genetic association in these patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=PD01-PD02&id=11978 https://doi.org/10.7860/JCDR/2018/34297.11978 Isolated Sacral Extradural Hydatid Cyst with Posterior Paravertebral Extension Presenting as a Cauda Equina Syndrome Bigyan Bhandari, Binod Bijukachhe, Prashant Adhikari, Yogesh Acharya Hydatid disease is a ubiquitous parasitic zoonotic disease caused by Echinococcus granulosus. Humans are the accidental intermediate host and it primarily affect the liver and lungs. Isolated primary spinal hydatid disease is an uncommon variant of the musculoskeletal echinococcosis. Dorsal and lumbar spines are commonly affected. We present a rare case report of sacral intraspinal, extradural and posterior paravertebral hydatid cyst with soft tissue extension presenting as a cauda equine syndrome. The patient was started with on oral albendazole and surgery planned. Histopathological examination was consistent with hydatid cyst. The patient showed significant improvement in symptoms after the surgery with an uneventful postoperative course. There were no signs of recurrence in an interval Magnetic Resonance Imaging (MRI). Hydatid disease of the spine possesses a diagnostic and therapeutic challenge due to its varied presentation and difficult approach. Despite a significant advancement in diagnostic techniques and available pharmacological and non-pharmacological treatment modalities, it is associated with a high recurrence rate and increased morbidity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=RD03-RD05&id=11979 https://doi.org/10.7860/JCDR/2018/36178.11979 Scrub Typhus Complicated by Acute Respiratory Distress Syndrome and Haemophagocytic Lymphohistiocytosis in a Young Patient Shveta, Kiran Agarwal, Bhavika Rishi, Khushboo Scrub typhus is an endemic rickettsial disease causing vasculitis involving the small vessels of the body. Haemophagocytic Lymphohistiocytosis (HLH) is a hyperinflammatory syndrome characterised by excessive unbalanced cytokine release. An 11-year-old child presented with high grade fever with chills and rigors with respiratory distress. Chest X-ray showed right-sided consolidation. Serological tests for H1N1, Immunoassay for HIV, Montoux test were negative, BACTEC was sterile and CBNAAT of gastric aspirate was normal. Anti Nuclear Antibody and Anti ds-DNA tests were also negative. Rickettsial serology was positive for Scrub typhus, by IgM ELISA. The bone marrow examination showed macrophages with phagocytosis of erythrocytes, lymphocytes and platelets. A diagnosis of HLH was given. Flow cytometry revealed CD4 expression by 42.6% of T-cells and CD8 expression by 99.4% of T-cells leading to a reversal of CD4/CD8 ratio of 1:2. The patient did not respond to treatment and died soon after. Early diagnosis of scrub typhus and its complications is essential as prognosis of the patient depends on time to start of treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=SD01-SD03&id=11982 https://doi.org/10.7860/JCDR/2018/30980.11982 Encountering a Rare Implant in the Hip-A Case Report Surendra Umesh Kamath, Monesh Kengeri Basavaraj, Shaila Surendra Kamath Hip fractures are common injuries in the elderly population. Present day management is stabilisation of these fractures as early as possible. The use of internal fixation devices in the treatment of hip fractures has proved to be a major advancement in modern surgical therapy. Implants used for the fixation of hip fractures have evolved in the last two to three decades. Many complications of internal fixation have been described. Failure or complications following fixation of hip fractures include secondary osteoarthritis or avascular necrosis which may result in great disability and pain. Hip arthroplasty is a helpful reconstructive procedure in these patients who had complications following primary fixation surgery. In addition to technical problems of reconstruction in them, there may be associated difficulties of removal of metal work which has been used for previous surgeries. This is a case report of a patient who had complication following a hip fracture surgery about 33 years ago, now presented with secondary hip arthritis and a rare implant portion in situ. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=RD01-RD02&id=11966 https://doi.org/10.7860/JCDR/2018/36156.11966 Carcinosarcoma of the Uterus with Microcystic Elongated and Fragmented Pattern: A Rare Histopathological Entity Sujata Raychaudhuri, Sheetal Arora, Nimisha Sharma, Deepshikha Rana Carcinosarcomas of the uterus are rare, highly aggressive forms of biphasic tumours. These are monoclonal in origin with disproportionate percentage of mortality. This entity comprises of admixture of carcinomatous and sarcomatous elements. There are two histological subtypes based on the the sarcomatous components which can be either hetrerologous or homologous. In majority of uterine carcinosarcomas both the carcinomatous and sarcomatous elements are high grade. These can be associated with mesenchymal epithelial transition presenting as Microcystic Elongated and Fragmented Pattern (MELF) which is a rare and potential mimicker of vascular invasion. A, 62-year-old, female presented with complaints of vaginal bleeding and discharge for three months with a polypoidal mass in the cervix. Histopathology revealed a biphasic tumour consisting of epithelial and mesenchymal elements. Immunohistochemistry for PAN-CK, CK 19, p63, CEA, EMA, vimentin, ER, PR, Desmin, S100, SMA, CD 34 and CD10 along with HPV DNA on cervical swab was performed. Final diagnosis of carcinosarcoma with MELF was conferred. The case was highlighted due to its rarity and unique histological pattern. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ED01-ED03&id=11995 https://doi.org/10.7860/JCDR/2018/35986.11995 A Rare Urinary Tract Infection by <i>Salmonella Paratyphi</i> A Rohit Gupta, KL Shobha, Gowrish S Rao Urinary Tract Infection (UTI) caused by Salmonella is very rare and occurs mainly in immunocompromised patients, infants and those over 60 years of age. A 12-year-old patient admitted with history of fever, burning micturition and suprapubic abdominal pain, diagnosed with a rare variant of Salmonella from UTI which had showcased abnormal biochemical reaction unlike typical Salmonella paratyphi A reactions. Here, we are communicating the rare H2S variant Salmonella paratyphi A, causing UTI which caused clinical and microbiological confusion in the diagnosis. A high suspicion is required for adequate diagnosis and treatment when non-lactose fermenting colonies are seen in the culture plate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=DD03-DD04&id=11996 https://doi.org/10.7860/JCDR/2018/37206.11996 Perforation Repair Using Absorbable Collagen Sponge and Biodentine Haripriya Subbaiyan, P Ajitha Perforation is an artificial communication between the root canal system and supporting tissues of the teeth. Root perforation complicates the treatment and deprives the prognosis if not properly managed. A wide variety of materials and techniques are available to seal the perforations. Literature shows many reviews on diagnosis, treatment plan and factors affecting the prognosis of perforation repair. Nonsurgical perforation repair should be first sort but difficulties such as extrusion and inadequate sealing of the repair material are encountered. Internal matrix concept for perforation repair provides advantage, as it helps in packing of repair material and also controls the haemorrhage from perforation site. Hydroxyapatite, collaplug, collagen are some of the materials used as matrix for perforation repair. The purpose of this case report was to describe the treatment of subcrestal perforation using absorbable collagen sponge as an internal matrix and biodentin to seal the perforation site. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZD01-ZD02&id=12005 https://doi.org/10.7860/JCDR/2018/36397.12005 Osseous Metaplasia in Oesophageal Leiomyoma-A Rare Case Report K Mamatha, BR Yelikar, Deepthi Chandrika Chintalapudi, Anil Reddy Konduru Benign mesenchymal tumours of the oesophagus, leiomyomas are the commonest. Leiomyomas account for about two-thirds of all benign lesions in oesophagus. Oesophageal leiomyoma of more than 5 cm in diameter is a rare condition. In symptomatic patients surgical resection is recommended and in asymptomatic patients with small lesions observation is the policy. Extensive calcification or ossification within leiomyoma of oesophagus is an extremely rare finding. As per our knowledge there is no report of osseous metaplasia in oesophageal leiomyoma in literature so far. We present here a case of large oesophageal leiomyoma with osseous metaplasia diagnosed on histopathology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ED04-ED06&id=12027 https://doi.org/10.7860/JCDR/2018/36206.12027 Retroperitoneal Lipoblastoma-A Rare Entity Suhitha Gajanthody, Harshavardhan Gowda, Ashraf Ahamed, Anuradha CK Rao, MR Shashidhar Lipoblastomas are uncommon tumours which can achieve enormous size and volumes occurring in young paediatric population predominantly. Retroperitoneal locations of these tumours are very rare and only a few cases have been noted in the literature. In spite of their large size and at times infiltrative nature, they can be surgically excised successfully with low complication rates. They usually present due to pressure effect on adjacent structures or due to mass effect with no malignant potential. We describe a case of large retroperitoneal lipoblastoma and review the current literature and management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=PD05-PD06&id=12058 https://doi.org/10.7860/JCDR/2018/36532.12058 Subcutaneous Cryptococcosis Mimicking Cold Abscess Ranjeev Bhagat, Vinisha Bansal, Uma Handa, Reetu Kundu, Jagdish Chander Cryptococcosis is a fungal infection caused by the yeast belonging to the Cryptococcus species which includes broadly two categories Cryptococcus neoformans and Cryptococcus gattii. It most commonly affects the lungs and central nervous system, particularly in immunocompromised patients. Other sites of dissemination include skin, ends of long bones, joints, liver, spleen, kidneys, prostate and other tissues. A 32-year-old male patient came to surgical OPD with complaints of a right posterior thigh swelling extending up to knee measuring approximately 8x6 cm. There was a past history of receiving Anti-Tubercular Treatment (ATT) for three months but without any improvement in symptoms. MRI of the thigh suggested a possibility of cold abscess or chronic haematoma. Fine Needle Aspiration Cytology (FNAC) of the thigh showed numerous spherical encapsulated yeast cells with only few macrophages in the background. Special stains like Periodic Acid–Schiff (PAS) highlighted the fungus while mucicarmine highlighted the capsule of fungi. Ziehl Neelsen stain for acid fast bacilli was negative. A final cytological diagnosis of cryptococcosis was given which was confirmed by the culture reports. In developing countries like India where there is high incidence of tuberculosis, fungal infection like cryptococcosis is likely to be missed particularly if high index of clinical suspicion for tuberculosis is present. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ED07-ED08&id=12065 https://doi.org/10.7860/JCDR/2018/36543.12065 The ‘Laterally Inverted’ Laparoscopic Cholecystectomy: Unlearning the Learning Curve Helps, but Old Habits Die Hard Sukumar Santosh Kumar, Anamika Sinha Situs Inversus is a rare condition (1 in 5000-10000 hospital admissions) and Laparoscopic Cholecystectomy (LC) for symptomatic gallstones in such patients is even rarer. Only about 70 cases have been reported so far. This otherwise commonly performed surgery takes on a whole new avatar due to the unique challenges of disorientation induced by the ‘mirror image’ positioning of the viscera and its attendant ergonomic difficulties. The instincts and habits acquired by a laparoscopic surgeon after climbing the learning curve, though definitely an advantage in this situation, can serve as a handicap as well. Our experience of managing such a case is presented in this article. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=PD11-PD13&id=12066 https://doi.org/10.7860/JCDR/2018/37476.12066 Radio-Diagnostic Dilemmas of Submandibular Calcification-An Incidental CBCT Finding Kavitaa Nedunchezhian, Nalini Aswath Heterotrophic Calcifications (HC’s) are often encountered as incidental findings in dental radiographic examinations. Inexperienced clinicians may misdiagnose these tame calcifications and levy unnecessary treatments to patients. Awareness and information regarding the prevalence and the nature of these calcifications are necessary to interpret any dental radiographic examination. We are reporting one such incidental finding of HC in right submandibular region of a 65-year-old patient in Cone Beam Computed Tomography (CBCT) and Orthopantomographic (OPG) evaluation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZD06-ZD08&id=12062 https://doi.org/10.7860/JCDR/2018/32612.12062 A Rare Coexistence of Papillary Carcinoma, Warthin’s Tumour and Oncocytosis Nitin Sharma, Dushyant Mandlik, Purvi Daxesh Patel, Shubhada Apoorva Kanhere, Kaustubh D Patel This is the rare case where bilateral parotid glands, bilateral submandibular glands; both lobes of thyroid gland were involved synchronously. Patient was operated for bilateral superficial parotidectomy, bilateral submandibular gland excision and total thyroidectomy. Histopathology report suggested oncocytoma of bilateral parotid glands and one submandibular gland, nontoxic multinodular goiter of thyroid gland and simple cyst of other submandibular gland. This histopathology report was reviewed and reported as oncocytosis of ipsilateral parotid gland, submandibular gland and thyroid lobe, while solid variant of Warthin’s tumour of other parotid gland and papillary thyroid carcinoma of contralateral thyroid lobe. The mass of contralateral submandibular gland was reported as simple salivary duct cyst. On reviewing the literature we found that this type of association was rarely reported and there may be some histopathological relation between oncocytoma, oncocytosis, warthin’s tumour and papillary carcinoma thyroid. Although we do not have any conclusive evidence till date but reporting of more such cases may establish some relation between these entities in future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=PD07-PD10&id=12063 https://doi.org/10.7860/JCDR/2018/34347.12063 Fungal Pericarditis due to <i>Aspergillus nidulans</i>: A Rare Case Report Sarika P Kombade, Kumar S Abhishek, Vijaya Lakshmi Nag Disseminated Aspergillosis though rare is usually seen among immunocompromised and neutropenic patients. Aspergillus spp are usually considered to be a laboratory contaminants until its association with the disease is established on repeated isolation. The present is of Aspergillus nidulans associated with pericarditis post Anti-Tuberculous Treatment (ATT) initiation in a 67-year-old male patient with known case of Pulmonary Tuberculosis (PTB). Aspergillus nidulans was identified on the basis of culture on Sabouraud Dextrose Agar (SDA) and Lacto-Phenol Cotton Blue (LPCB) wet mount preparation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=DD05-DD06&id=12071 https://doi.org/10.7860/JCDR/2018/37176.12071 Pseudo-bartter Syndrome as the Initial Presentation of Cystic Fibrosis in Infants: A Series of Three cases and Review of Literature Prawin Kumar, Neeraj Gupta, Daisy Khera, Kuldeep Singh Cystic Fibrosis (CF) is predominantly a disease of Caucasians, but it is increasingly being recognised in India. The typical presentations of CF are recurrent pneumonia and malabsorption. Atypical presentations are also increasingly being reported from India due to the differences in genotype and environmental factors. Pseudo-Bartter syndrome (PBS) is one of these atypical presentations which can present at any time after the diagnosis of CF but its presentation as an initial manifestation is rare. We hereby report three infants who presented with dehydration without obvious external losses. The investigations revealed metabolic alkalosis with hypochloraemia. A stepwise approach towards metabolic alkalosis revealed possibility of cystic fibrosis which was confirmed by sweat chloride test. All infants completely recovered with initial fluid and electrolyte therapy, following which supportive therapy for CF was started and subsequently they were discharged from the hospital. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=SR01-SR03&id=11965 https://doi.org/10.7860/JCDR/2018/36189.11965 Hypoglycemic Effect of 70% Ethanolic Extract of Tinosporacrispa L. (Bratawali) Stem from Indonesia in Wistar Rat Induced by Alloxan Em Sutrisna, Ligar Hervian, Fahrizal Arrio Sahadewa <b>Introduction:</b> Indonesian people often use Bratawali (Tinosporacrispa L.) to treat Diabetes Mellitus (DM) empirically. Based on literature, the active compound in the plant is thought to initiate insulin secretion by modulating the ß-cell of Ca2+ concentration. <b>Aim:</b> The aim of the present study is to evaluate hypoglycemic effect 70% ethanolic extracts of Tinosporacrispa L. (EETC) in Wistar rats induced by alloxan. <b>Materials and Methods:</b>Twenty five rats were divided into 5 groups. The group I was negative control treated by aqua bidest, group II was positive control treated by glibenclamide at dose of 0.63/kg bw/day, group III was treated by EETC at dose of 500 mg/kgbw/day, group IV was treated by EETC at dose of 1000 mg/kgbw/day and group V was treated by EETC at dose of 2000 mg/kgbw/day. The fasting Blood Glucose Level (BGL) of all rats were measured and then they were injected by alloxan at dose of 150 mg i.p. On fourth day BGL were re-measured. All rats with BGL>200 mg/dL were treated by extract/medicine appropriated their group. This treatment was for ten days. The Fasting BGL between groups was analysed using ANOVA followed by LSD. <b>Results:</b> The results of this research shows that the EETC at dose of 500 mg/kgbw/day and 2000 mg/kgbw/day can reduce fasting BGL in Wistar rats induced by alloxan significantly (p<0.05). The percentage of reduction of fasting BGL at dose of 500 mg/kgbw/day and 2000 mg/kgbw/day are 44.78±5.27 and 43.12±4.25 respectively. EETC at dose of 500 and 2000 mg/kg bw/day allegedly able to repair the pancreatic islet cell. <b>Conclusion:</b> It is concluded that the EETC reduce fasting BGL in Wistar rats induced by alloxan. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=FF01-FF03&id=12102 https://doi.org/10.7860/JCDR/2018/35710.12102 A Case of Infective Pulmonary Endarteritis in a Young Male Surender Deora, Pawan Garg https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OJ01-OJ02&id=11998 https://doi.org/10.7860/JCDR/2018/37008.11998 An Adult with Bowel Sounds in the Chest Karanam Gowrinath, Manam Gayatri https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OJ03-OJ04&id=11999 https://doi.org/10.7860/JCDR/2018/37135.11999 The Virtual Patient Technology for Medical Education Yahya Safari, Seyyed Mohsen Azizi, Arash Ziapour https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=JL01-JL02&id=11980 https://doi.org/10.7860/JCDR/2018/36378.11980 Prospective Study of Complications Following Surgery for Thyroid Malignancy: A Tertiary Cancer Care Centre Experience Virendra Kumar Tiwari, Jency Mathews, PG Balagopal, Nebu Abraham George <b>Introduction:</b> Surgery is the backbone for treatment of thyroid malignancy. Total thyroidectomy with or without neck dissection is standard of care. Thereafter adjuvant treatment, usually radioiodine, depends upon risk stratification of the patient. Common complications of total thyroidectomy are hypocalcaemia and voice change. <b>Aim:</b> To find out incidence and risk factors for hypocalcaemia and voice change after surgery for carcinoma thyroid. <b>Materials and Methods:</b> The present study was a prospective observational study. It included all patients who had undergone total thyroidectomy with or without neck dissection for carcinoma thyroid within a period of October 2010 to June 2011. Fifty patients were included in the final analysis. Complications, mainly hypocalcaemia, voice change, following surgery were studied. <b>Results: </b>The present study included a total of 50 patients, 34 were female and 16 male. Hypocalcaemia was seen in 24 patients. Twenty one had temporary and three had permanent hypocalcaemia. Central compartment neck dissection was found to be significantly associated with hypocalcaemia. Six week, after surgery 14 patients complained of perceptual voice dysfunction, of these 11 had complained of fatigue. At the end of one year, only one patient had voice dysfunction. <b>Conclusion: </b>Most of the complications following thyroidectomy are temporary; usually patients recover well from hypocalcaemia and voice changes. Incidence and severity are said to be more with malignant thyroid compared to thyroidectomy for benign aetiology. Most studies in literature regarding complications of the thyroidectomy include both benign and malignant cases. The present study includes all patients with proven or suspicious of malignancy, in an attempt to have, a homogenous group with regard to aetiology. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=XC01-XC04&id=11981 https://doi.org/10.7860/JCDR/2018/33880.11981 Recovery Profile Using Modified Aldrete Score in Post Anaesthesia Care Unit After Sevoflurane or Desflurane Anaesthesia: A Prospective Randomised Study Sunil Kumar Valasareddy, Siva Kumar Segaran, Sagiev Koshy George, RV Ranjan, Oommen George Titu, Pillai Radhakrishnan Anil <b>Introduction:</b> General Anaesthesia should provide rapid smooth induction and optimal conditions during the perioperative period. It should also provide rapid recovery and minimum monitoring period to meet discharge criteria in Post Anaesthesia Care Unit (PACU). <b>Aim: </b>To assess the efficacy of sevoflurane and desflurane with regards to emergence and recovery in surgical procedures lasting less than 120 minutes when used as maintenance anaesthetic agents. <b>Materials and Methods:</b> This was a hospital based prospective randomised study. After obtaining informed and written consent, 60 patients belonging to ASA I or II scheduled for surgery under general anaesthesia were recruited and distributed to two groups each of 30 to receive sevoflurane or desflurane for maintenance of anaesthesia after randomization with computer generated numbers. Unpaired t-test and chi-square test were used for qualitative data, ANOVA for quantitative data and Mann-Whitney test was used for Modified Aldrete Score (MAS). <b>Results:</b> The mean duration of surgery was 92.83±25.820 minutes in desflurane and 92.67±28.062 minutes in sevoflurane groups, the time for spontaneous eye opening on verbal commands was 5.17±1.48 minutes in desflurane group compared to sevoflurane group which was 8.96±1.58 minutes with mean difference of 3.79±0.1 minutes, p-value<0.001, 95% confidence interval 3.7 (2.703 to 4.953). A median MAS of 10 was attained at five minutes in desflurane group and 15 minutes in sevoflurane group, in PACU and was statistically significant (p<0.001). <b>Conclusion:</b> Desflurane had faster emergence and early recovery from anaesthesia with clear-headedness than sevoflurane. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=UC01-UC04&id=11963 https://doi.org/10.7860/JCDR/2018/35345.11963 Genetic Diversity of Rotavirus Strains in the Era of Vaccination: A Pilot Study from Central Kerala, India Sincy George, Ozhiparambil A Jagan, Sushama Bai, Sara Chandy <b>Introduction:</b> Rotaviruses cause Acute Gastroenteritis (AGE) in children. Characterisation of rotavirus VP7, VP4 and VP6 genes revealed novel genotypes circulating in the region. <b>Aim:</b> To characterise the circulating rotavirus genotypes in Central Kerala and compare the genotypes with vaccine components to assess the genetic variability. <b>Materials and Methods:</b> We analysed VP6, VP4 and VP7 genes of rotavirus strains from hospitalised children (January-December 2013) by amplification, sequencing and phylogenetic analysis.VP4 and VP7 antigenic epitopes of G1P8 strains were compared with vaccine strains to determine the genetic variations. <b>Results:</b> G1P8 was the predominant strain, G9P8, G1P6, G9P4 were also encountered in the study. VP6 gene analysis revealed that 91.30% of strains belonged to genotype I1 and 8.7% to genotype I2. G1 and G9 strains show low nucleotide and amino acid homology with corresponding vaccine strains. Comparison between the vaccine strain and G1 study strains, eight substitutions were observed in the VP7 epitope region. In the VP4 gene (VP8 region) 22 and 12 substitutions were observed compared to Rotarix with RotaTeq vaccine strains respectively. <b>Conclusion:</b> Study strains clustered closely with other Indian strains, indicating common ancestral link. G1P8 strains showed low homology with vaccine strains, suggesting genetic variability to escape vaccine-derived immune response. This study helped to identify the circulating rotavirus genotypes in the region and explored possibility of emergence of divergent strains. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=DC01-DC06&id=11964 https://doi.org/10.7860/JCDR/2018/35403.11964 The Effect of Anterior Palatal Surface Modifications of Complete Denture on Speech Intelligibility Saurabh Chaturvedi, Narendra Kumar Gupta, Ashok Kumar Verma, Amrit Tandan <b>Introduction: </b>The conventional design of maxillary complete denture covers entire palate and hinders the direct contact of the tongue with palate. Thus, adversely affect speech intelligibility. <b>Aim:</b> The purpose of this study was to compare the speech intelligibility of complete dentures wearers having small opening in an anterior palatal base, with the conventional complete denture, without denture and with functionally contoured palatal base. <b>Materials and Methods:</b> The study was conducted in four phases (phase one without denture, phase two with conventional complete denture, phase three with functionally contoured palatal base denture and phase four with dentures having small opening in the anterior part of the palatal base) and in each phase sound samples were recorded. Forty healthy edentulous individuals, divided in two groups. Group A: 60 to 70 years and Group B: Above 70 years, participated in the study. The sound samples recorded from each subject were assessed both quantitatively (by speech analysis software) and qualitatively (by team of speech specialist). The recorded data was analysed using a one-way ANOVA for repeated measurements followed by the Bonferroni post-Hoc test for multiple comparisons (p=0.05) and Mann-Whitney U test for Likert’s scale rating. <b>Results:</b> A significant difference was observed in pitch and intensity of sound samples among 4 phases (p < 0.001). Highest speech intelligibility was found in phase 4 in both groups A and B (pitch-187.93±24.22 and 191.48±23.98, intensity-75.84±6.34 and 74.99±6.74 respectively) with maximum score by experts 3.18 and 3.20 respectively. <b>Conclusion:</b> The small-opening type of palatal coverage improved speech intelligibility. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZC01-ZC06&id=11556 https://doi.org/10.7860/JCDR/2018/30053.11556 Sex Determination from Talus among Gujarati Population of Anand Region by Discriminant Function Analysis Sumati, Ajay Gajanan Phatak <b>Introduction: </b>The three most vital determinations that must be made when dealing with skeletal remains are sex, age and race. Many skeletal features vary by gender, thus determination of sex is prerequisite for the identification of an individual. The success in sex determination from bones is limited by the availability of bones in fragments. The talus is apt for studying sexual dimorphism as it is often well preserved due to its durability. <b>Aim:</b> To determine accuracy of talus in sex determination and to derive sex discriminant function equations specific for Gujarati population of Anand region. <b>Materials and Methods:</b> Seven measurements of 58 adult human tali (36 male and 22 female) have been taken by digital sliding vernier caliper. The seven measurements taken in the present study are talar length, width of the talus, head-neck length, length and breadth of the trochlea, transverse and antero-posterior diameter of the posterior articular surface for the calcaneus. Data has been statistically analysed by discriminant function analysis. <b>Results:</b> Univariate analysis showed that the mean (SD) values of all the parameters of talus are significantly greater in males as compared to females (p<0.001 indicating good discrimination). Discriminant function analysis with stepwise method revealed that length of the trochlea, head-neck length and transverse diameter of the posterior articular surface for the calcaneus emerged as the most significant discriminating parameters with correct classification rate of 96.6%. <b>Conclusion:</b> The sex discriminant function equations derived in the present study can be used for sex determination studies on the tali obtained specifically from Gujarati population of Anand region. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=AC01-AC05&id=11960 https://doi.org/10.7860/JCDR/2018/35399.11960 Formative Assessment Classroom Techniques (FACTs) for Better Learning in Pre-clinical Medical Education: A Controlled Trial Tripti K Srivastava, Vedprakash Mishra, Lalitbhushan S Waghmare <b>Introduction:</b> Formative Assessment Classroom Techniques (FACTs) can serve as a useful and timely diagnostic and therapeutic mechanism for tiding over learning issues created during classroom instructions. <b>Aim: </b>Present study explored the efficacy of FACTs for better learning by diagnosing learning issues, timely instructional adjustments and feedback. <b>Materials and Methods:</b> Experimental study with first year professionals in faculty of Medicine (n=200) were assigned to experimental group (n=100) and control group (n=100) by non probability convenience sampling. Seven methods of FACTs viz., Classroom quiz, Exit ticket, One minute paper, Logic model for regulation of physiological mechanisms, One sentence summary, Directed paraphrasing and Muddiest point were undertaken for seven Physiology lectures. Based on FACTs responses, subsequent seven instructional activities were revised to close the learning gaps. Conventional instructional method was adopted for controls. A p-value, Absolute Learning Gain (ALG) and Effect Size for pre test and post test of both groups were calculated. Learner’s perception was recorded. <b>Results:</b> Unpaired t-test revealed significant differences (p<0.01). ALG was 68.5-75% in experimental and 51.8-57.1% in controls. Effect size (Cohen’s D) was 1.12. <b>Conclusion: </b>FACTs can serve as a useful and feasible mechanism for diagnosing learning issues, tailor instructional modifications and facilitate timely feedback to improve learning. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=JC01-JC08&id=11969 https://doi.org/10.7860/JCDR/2018/35622.11969 Effect of Height, Weight and BMI on Foot Postures of Young Adult Individuals Ganapathy Arthi, T Sadeesh, Kuppusamy Raghuram <b>Introduction:</b> The foot posture is maintained on three bony arches: the medial longitudinal, the lateral longitudinal and the transverse arch. It varies as the age of an individual advances. Abnormalities in the arches of foot lead to various kinds of foot deformities and predisposes to injury. <b>Aim:</b> To find the relation of different types of foot (normal, low and high arch) with Body Mass Index (BMI) in young individuals if any. <b>Materials and Methods:</b> Foot prints of 250 students of Mahatma Gandhi medical college, Pondicherry, India, between the age group of 18-24 years were taken and classified into different foot postures using Staheli’s arch index. Height, weight and BMI of the individuals were recorded. The data collected was analysed using SPSS software version 16.0. Kruscal Wallis H test, Chi-square test and ANOVA was done for calculating the statistical significance. <b>Results:</b> There was a significant relation between weight of the individual with the type of foot (p=0.05) but that with height and BMI was not statistically significant. <b>Conclusion:</b> The type of foot posture may not be significantly influenced by the BMI of an individual. However young adults with more weight have a tendency to develop low arch foot indicating that weight alone might be an important variable for development of low arch foot. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=AC06-AC08&id=11970 https://doi.org/10.7860/JCDR/2018/30914.11970 Effect of Age and Hypertension on Cognition: A Cross-sectional Study Deepalakshmi Kaliyaperumal, Vijayabas Karan Shanmuga Varadharajan, Varsha Viswanathan, Murali Alagesan <b>Introduction:</b> Cognitive impairment has evolved as major health and social issue. As age advances cognitive tasks involving processing speed, working memory and executive function get affected. Cognitive impairment is also influenced by modifiable risk factors such as hypertension, diabetes mellitus and hypercholesterolemia. <b>Aim:</b> To find out the effect of age and hypertension on cognition. <b>Materials and Methods:</b> The total study participants were divided into three groups based on their age as group I (18-29) group II (30-59) and group III (above 60) with 20 participants (n= 20) in each group. Their cognition was assessed using Mini Mental State Examination, Picture word Learning test, Stroop colour word test, Letter digit coding test, Verbal fluency and Logic memory tests. Disease history and known co morbidities (hypertension) were noted. Post-hoc test (Bonferroni) was employed to assess age-wise comparison of cognition and Pearson’s chi-square test was used to compare cognition between hypertensive and normotensives. <b>Results:</b> Group II had impaired cognition when compared with group I (p-value- 0.000). Group III had impaired cognition when compared with group I (p-value- 0.000) and group II (p-value 0.001). The hypertensives in group II and III had statistically significant impairment in cognition when compared with normotensives (p-value -0.001) in the same group. <b>Conclusion: </b>Cognitive functions are impaired as a result of increase in age. Furthermore, there is also a significant decrease in cognitive functions amongst those suffering from hypertension. Hence, we conclude there is decrease in cognitive function as age advances and the co-existence of hypertension hastens this decline. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OC05-OC08&id=11971 https://doi.org/10.7860/JCDR/2018/32597.11971 A Study of Progesterone Receptor (PR) Expression in Meningiomas, and its Correlation with Clinicopathological Parameters Shenbagam Jeevakarunyam Muthukanagarajan <b>Introduction:</b> Meningiomas are the most common benign Central nervous system neoplasms with higher prevalence in women. Clinical and epidemiological data reveal that meningiomas are hormone sensitive tumours and they have been found to express hormonal receptors. Though majority of meningiomas are benign, they lead to significant morbidity and mortality. <b>Aim:</b> This study deals with the immunohistochemical expression of Progesterone Receptor (PR) in meningiomas in correlation with various clinicopathological parameters and behaviour of the tumour. <b>Materials and Methods:</b> This was a retrospective and prospective study carried out at neuropathology department in a tertiary care hospital during a consecutive period of three years from 2013 to 2016. The antibodies to PR were used for 60 randomly selected cases of meningioma operated during a consecutive period of three years. The PR expression in relation to age and sex of patient, site and various histopathological grades of the tumour and their rates of recurrence were studied. Statistical analysis was carried out using SPSS software version 17. Various tests used in the study were the chi-square test for discrete variables and the t-test for continuous variables. <b>Results:</b> Immunohistochemical analysis revealed PR expression in 66.7% of cases. In comparison with grade I meningiomas the PR expression in high grade (grade II and III) meningiomas were found to be from weak to absent. This shows a positive association between low rates of expression of PR and increased tumour aggressiveness. <b>Conclusion:</b> It is concluded that expression of PR by the tumour in correlation with other histopathological features especially histological grade of the tumour has been considered as a useful prognostic tool in assessing the behaviour of meningiomas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=EC01-EC05&id=11972 https://doi.org/10.7860/JCDR/2018/34338.11972 Case Series of Peripheral Nerve Sheath Tumours: Schwannoma Rajat Kapoor, Bharat Rajivkumar Saxena Schwannoma or Neurilemoma is a benign peripheral nerve sheath tumour which can affect any nerve in the body. Painless swelling or paraesthesia over the sensory distribution of the affected nerve are the usual symptoms. Audit of 12 cases operated for solitary schwannoma involving the various nerves in the extremity operated at Sir JJ group of Hospital, Mumbai from January 2013 to July 2017. Out of the 12 cases operated for solitary schwannoma 10 were males and two were females. These cases were in the age group from 28 years to 66 years. Seven cases involved the upper limb and five cases affected the lower limb. Preoperative evaluation with ultrasonography and MRI was done. Nerve preserving enucleation was done in all the cases except one which required nerve grafting. Following nerve grafting there was temporary anaesthesia over the medial thigh which recovered in three months. Postoperated neuropraxia was noted in one case which spontaneously recovered in six weeks. None of the patients had any other local or regional complications on a follow up period of 28 months. Schwannoma can be a challenging tumour because of its proximity to the nerve. At our institute immediate postoperative complication rate was 9% with no long term neurological deficit or recurrence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=PR01-PR03&id=11973 https://doi.org/10.7860/JCDR/2018/35340.11973 Single Nucleotide Polymorphism of Thyroid Hormone Receptor a Gene can be a Risk of Atherogenic Dyslipidemia Satwika Sinha, Kaushik Kar <b>Introduction:</b> Dyslipidemia and atherosclerosis are common occurrence in hypothyroidism. Not all patients suffering from hypothyroidism present alteration of lipid profile pertinent to atherogenesis characterised by high cholesterol, triglyceride and low HDLc levels. Genetic predisposition may play a vital role in developing dyslipidemia among hypothyroid patients. Some association studies have identified the variations in thyroid hormone receptor a gene in developing complications like obesity, dyslipidemia, and coronary atherosclerosis in hypothyroid patients. <b>Aim:</b> To find the association between Thyroid Hormone Receptor (THR) a gene variations and atherogenic dyslipidemia. <b>Materials and Methods:</b> This cross-sectional, observational hospital based study was conducted to examine the status of atherogenic lipid profile in hypothyroid state, the study analysed the genotyping of rs 939348 Single Nucleotide Polymorphism (SNP) in normolipidemic and dyslipidemic hypothyroid patients. The study compared THR a polymorphism genotype and allele frequencies in above mentioned two groups with unpaired t-test and ANOVA (Odds ratio, p<0.05). Furthermore the study compared the serum triglyceride and HDLc levels between different genotype and allele groups (p<0.05). <b>Results:</b> The study observed rs939348 SNP was associated with significantly high fasting triglyceride and low HDLc levels (p<0.05). Furthermore the study observed the trend of increase in mutant T allele in dyslipidemic hypothyroids. <b>Conclusion: </b>The study proved the role of THR a genotyping in predicting atherogenic dyslipidemia among hypothyroids. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=BC01-BC04&id=11974 https://doi.org/10.7860/JCDR/2018/34904.11974 Comparison of Accuracy of Bracket Placement by Direct and Indirect Bonding Technique using Digital Processing - An In-Vitro Study Ravneet K Kalra, Sanjay Mittal, Chandrashekhar Gandikota, Vikas Sehgal, Rajiv Gupta, Zarina Bali <b>Introduction:</b> Accuracy of bracket positioning is an essential part of successful orthodontic treatment. Ideally placed brackets help in treatment mechanics and improve consistency of the result. The current study compares the accuracy of bracket placement using direct and indirect bonding. <b>Aim:</b> The aim of the present study was to compare the accuracy of bracket placement by Direct and Indirect Bonding techniques using digitally captured and processed images. <b>Materials and Methods:</b> Brackets were bonded on thirteen sets of duplicated orthodontic models, six sets each for Direct and Indirect bonding and one set as predetermined “ideal” bonding. Ideal bonding was achieved through repeated revision of bonding till it was found to be ideal by a group of five experienced orthodontists. This is a standard procedure followed by historic studies for achieving ideal bonding. Accuracy of the bracket placement through direct and indirect method was compared against ideal bonding on three dimensions – bracket height, mesiodistal position and angulation. Digital processing was used to compare the twelve sets against the ideal bracket positioning. A student’s t-test was used to determine whether statistically significant differences existed among ideal and experimental groups. <b>Results:</b> Overall, the difference in accuracy in bracket placement between Direct and Indirect bonding was statistically insignificant. Indirect bonding yielded more accurate results on selected teeth (p=0.05)- Bracket height on 34, mesiodistal position on 13 and 34 and angular placement on 44 and 14. Coefficient of variation for direct bonding was 0.855, 0.750, and 0.719 for bracket height, angulation and mesiodistal position respectively. Corresponding values for indirect bonding were 0.853, 0.799 and 0.445 respectively. <b>Conclusion:</b> Neither technique yielded ideal bracket placement. Overall, Indirect bonding was better in terms of accuracy more often (70% for vertical & 60% for horizontal positioning), but the difference was statistically insignificant indicating high variability. Hence, the advantage wasn’t consistent. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZC07-ZC11&id=11975 https://doi.org/10.7860/JCDR/2018/32466.11975 The Prevalence and Profile of Mycobacterial Infections in Liver Diseases from Tertiary Care Hepatobiliary Centre Pratibha Kale, Vikas Khillan, Pradheer Gupta, Shiv Kumar Sarin <b>Introduction:</b> There is paucity of data regarding mycobacterial infections in liver diseases. Guidelines do not exist for diagnosis, monitoring of patients and modification of the treatment. <b>Aim: </b>Our aim was to elucidate demographic characteristics, profile of mycobacterial infection and comparison of diagnostic methods in liver diseases. <b>Materials and Methods: </b>We studied liver disease patients from January 2012 to December 2016, screened for Tuberculosis (TB) if having fever, cough for >2 weeks, haemoptysis, unexplained weight loss, increasing ascites, unresponsive to diuretics, unexplained bowel symptoms, radiological lesions and past or family history of TB. TB diagnosed if there is: (i) histological caseating granulomas; (ii) smear Acid Fast Bacilli; (AFB) positivity; (iii) growth on Mycobacterial Growth Indicator Tube (MGIT) culture; or (iv) positive quantitative polymerase chain reaction for Mycobacterium tuberculosis (MTB qPCR). Mycobacteria other than tuberculosis (MOTT) were identified by negative MPT64 assay. <b>Results:</b> Of the 118/816 positive samples, 31/260 (11.92%) were pulmonary and 87/556 (15.65%) were extra-pulmonary TB (EPTB). There was a male preponderance (66.1%), median age 53 years in pulmonary and 37 years in EPTB. Thirty two samples (27.11%) were smear positive, low in EPTB 13/87 (14.9%) as compared to 19/31 (61.2%) pulmonary. MGIT was positive in 108/118 (91.52%) and 97/118 (82.2%) were MTB qPCR positive. MTB was isolated from all pulmonary samples and 72/87 (82.75%) of EPTB. MOTT was identified in 15/118(12.71%). Sensitivity and specificity of MTB qPCR was 90.3% and 100% respectively in pulmonary and 76.6% and 97.9% respectively in EPTB. <b>Conclusion: </b>There is predominance of smear negative, EPTB and MOTT in liver diseases. MGIT culture and TB PCR have additive advantage over either test alone. MOTT should be ruled out in all cases as treatment varies. High index of suspicion and good screening methods are needed to identify TB and MOTT owing to similar presentation and anti-tubercular drug toxicity issues. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=DC07-DC10&id=11976 https://doi.org/10.7860/JCDR/2018/36773.11976 Efficacy of Antibiotic-loaded Poly (Methyl Methacrylate) Beads in Orthopedic Infections Kaushik Bhowmick, Chandrasekeran Gunasekaran, Viju Daniel Varghese, Abel Livingston, Thilak Samuel Jepegnanam, Alfred Job Daniel, PRJVC Boopalan <b>Introduction:</b> Bone infections are associated with morbidity and mortality. Infection control is achieved by surgical debridement and microbial-specific antibiotic administration. Antibiotic Loaded Bone Cement (ALBC) has been accepted as a mode of treatment since systemic antibiotics alone are associated with higher recurrence and reoperation rates. <b>Aim: </b>To assess the efficacy of ALBC in the treatment of orthopaedic infections. <b>Materials and Methods:</b> A retrospective case series of 59 patients, treated for chronic musculoskeletal infections between January 2007 to December 2013, were included. They were divided into five groups; 1) Open fractures (21 patients); 2) Closed fractures (5 patients); 3) Infected nonunion (26 patients); 4) Infected implants (6 patients); and 5) Chronic osteomyelitis (1 patient). <b>Results:</b> The median age at presentation was 34.8 years (range, 18.0-58.0). Five patients were lost to follow-up. In the 54 patients analysed, infection was controlled in all patients (100%) with debridement/implant exit and antibiotic beads. 31 patients (57%) united or were infection free with the primary procedure. This included all the patients in Group 4 and 5, six patients in Group 1 and 18 patients in Group 3. 23 patients (43%) underwent additional procedures to achieve bony union after the infection control. Gram-Negative Organisms (GNB) were isolated in 36% (21 cases), whereas Methicillin Resistant Staphylococcus Aureus (MRSA) was found in 12% (7 cases). The average healing time for GNB and MRSA infections was 19.4 months and eight months respectively. <b>Conclusion:</b> The ALBC is effective in controlling infection. Infections caused by gram-negative bacteria are becoming common and they resolve later than MRSA infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=RC01-RC04&id=11977 https://doi.org/10.7860/JCDR/2018/35222.11977 Breast Cancer Susceptibility Gene in Base Excision Repair Pathway in a Southern Indian Population Andrea Mary Francis, R Ramya, Nalini Ganesan, Solomon FD Paul, AK Munirajan, P Kumarasamy, G Dicky John Davis <b>Introduction:</b> Breast cancer, the most complex multifactorial disease, one of the most common malignancies seen in females over the world. Single-Nucleotide Polymorphisms (SNPs) that occur in DNA repair genes are the contributors to cancer development as they lead to alteration in protein function, impair DNA damage responses, and result in loss of efficiency of DNA repair pathways. <b>Aim:</b> To determine the association of the two polymorphisms (rs25487 and rs1799782) of the gene XRCC1 involved in the Base Excision Repair (BER) pathway with breast cancer risk. <b>Materials and Methods:</b> In the present study, 200 breast cancer cases and 200 healthy age-matched controls were analysed with regard to the genotype distribution of XRCC1rs1799782 and rs25487 polymorphism using Taqman allelic discrimination assay by Real time PCR. Chi-square test was the statistical method used, and compliance of the genotype frequencies with Hardy-Weinberg equilibrium was verified. The relative risk was assessed by determining the Odds Ratios (OR) and 95% Confidence Intervals (CI). Insilico studies were carried out for identifying the possible functional and deleterious nsSNPs in XRCC1 gene. <b>Results:</b> With regard to SNPs involved in the genes that play a role in the BER pathway, a significant association was found for the G/A heterozygous genotype of the XRCC1 (rs25487) (OR; 1.79; 95% CI, 1.17-2.73; p-value: 0.006) with the risk of breast carcinoma. Also, an association was observed between the A/A homozygous genotype of the XRCC1 (rs25487) (OR; 2.08; 95% CI, 1.08-4; p-value 0.02) and breast carcinoma risk. There was a lack of association of the CT/TT genotype of the XRCC1 (rs1799782) (OR, 1.12; 95% CI, 0.69-1.80; P 0.63) with breast carcinoma risk. The insilco studies revealed structural variation in XRCC1 gene with respect to rs25487. <b>Conclusion:</b> The variant rs25487 of XRCC1 gene was associated with the risk of breast carcinoma, but no association was found with regard to frequency of the rs1799782 variant in the XRCC1 gene. The stability prediction and pathogenicity analysis with computational tools revealed the nsSNPrs25487 interfering with function and structure of the XRCC1 protein. The data suggest that the variant of XRCC1 (rs25487) may contribute to breast cancer susceptibility, extensive study linking DNA repair, environmental factors and ethnicity are needed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=GC01-GC06&id=12000 https://doi.org/10.7860/JCDR/2018/36975.12000 Hypolipidemic Effects of Fenugreek and Atorvastatin-Comparative Study on High Fat Fed Dyslipidemic Rats Hemavardhini Chennappan Sekar, GV Lathadevi <b>Introduction:</b> Dyslipidemia is the current medical problem of utmost concern with an increased prevalence among the males between 31-40 years. Various extracts from fenugreek (Trigonellafoenum-graecum), methi (in Hindi), have known to have effect on the metabolic parameters, lipid lowing properties being one of them. <b>Aim:</b> The objective of this study was to evaluate the efficacy of fenugreek, one of the commonest Indian spice in lowering the serum lipid levels and comparing its efficacy with lipid lowering properties of a pharmacological agent-atorvastatin so that it could be incorporated as a part of life style modifications among the dyslipidemic individuals. <b>Materials and Methods:</b> Twenty four adult male Wistar rats were divided equally into four groups. Group A was kept as the control and fed on normal diet. Hyperlipidemia was induced in Groups B, C and D with high fat diet containing groundnut oil cake and dried coconut for 12 weeks. The hyperlipidemic rats were then subjected to the various hypolipidemic regimens. Group B- 2mL emulsion of fenugreek (1 gm/kg/day) orally, Group C- 2mL emulsion of atorvastatin (30 mg/kg/day) orally, Group D- 4mL emulsion of fenugreek and atorvastatin combined. The serum samples were analysed for lipid profile at the beginning and end of four weeks. The statistical analysis for the data collected was done using One-way Anova analysis in the software- SPSS Version 20.0. <b>Results:</b> Administration of fenugreek to hyperlipidemic rats (Group B) showed a significant reduction of serum triglycerides, cholesterol and body weight (p<0.05) and a significant increase in the serum High Density Lipoprotein (HDL) levels (p<0.05). The serum Low Density Lipoprotein Cholesterol (LDL-C) values showed a statistical reduction in Group C (p<0.01) administered with atorvastatin monotherapy. In Group D the combination therapy with fenugreek and atorvastatin showed a statistical significant increase of High Density Lipoprotein Cholesterol (HDL-C) p<0.01. <b>Conclusion:</b> Fenugreek is proved to be a potent hypolipidemic agent. Lifestyle modification with dietary supplement of fenugreek can be taken as an effective hypolipidemic element initially to combat the increasing risks of dyslipidemia. If they do not respond then the individuals can switch over to pharmacological agents like atorvastatin along with fenugreek to control dyslipidemia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=CC01-CC04&id=11997 https://doi.org/10.7860/JCDR/2018/35372.11997 Marital Quality and Erectile Dysfunction among Chronic Obstructive Pulmonary Disease: A Cross-sectional Study Thomas M Sinoj, Mohan K Manu, Johnson Alex, Aswini Kumar Mohapatra, Asha Kamath <b>Introduction:</b> Erectile Dysfunction (ED) is one of the distressing comorbidities associated with Chronic Obstructive Pulmonary Disease (COPD). There is a paucity of literature on the association of erectile function and marital quality in Indian COPD population. <b>Aim:</b> To find out whether Erectile Dysfunction (ED) affects the marital quality in COPD subjects. <b>Materials and Methods:</b> This cross-sectional study included 87 stable COPD patients, aged more than 40, who were married and staying with their partners. The patients were screened for psychiatric comorbidity using General Health Questionnaire- 28 (GHQ) and Hospital Anxiety and Depression Scale (HADS). Erectile dysfunction was assessed using International Index of Erectile Function (IIEF) questionnaire. The patients were grouped into those having and not having ED. ‘Marital quality’ and ‘relationship and sexuality’ scales were used to compare the groups. <b>Results:</b> Among the 87 study participants, 37 had ED while 50 were non-ED. The ‘Marital Quality’ and ‘Relationship and Sexuality’ scores were significantly lower in the non-ED group and ED group respectively (p-value = 0.001). Age had no significant correlation to IIEF (0.164), ‘Marital Quality’ (0.14) and ‘Relationship and Sexuality’ (-0.094). There was a significant positive correlation between FEV1 values and ‘‘Relationship and Sexuality’ scores (0.228), but none to ‘Marital Quality’ (0.58) and IIEF (-0.204) scores. <b>Conclusion: </b>The study confirms that erectile function is a significant predictor of marital quality in COPD. The marital relationship and sexuality are found to be related to lung function. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OC01-OC04&id=11967 https://doi.org/10.7860/JCDR/2018/36255.11967 Pre and Post Dialysis Variations in Serum Lipid Profile among End Stage Renal Disease Patients Karra Madhu Latha, Bhongir Aparna Varma <b>Introduction:</b> Chronic Kidney Disease (CKD) is a devastating disease and 50% of CKD patients die from Cardiovascular Disease (CVD) rather than End Stage Renal Disease (ESRD). Dyslipidaemia is a major contributor of CVD in these patients. The exact effect of Renal Dialysis (RD) on lipid parameters in ESRD is not clearly elucidated. <b>Aim:</b> To assess the variations in serum lipid profile and study the pattern of lipoproteins by agarose gel electrophoresis before and after RD. <b>Materials and Methods:</b> In this case-control study, 30 ESRD patients (15 male and 15 female) receiving maintenance renal dialysis were taken as cases and 30 age and sex matched healthy individuals were recruited as controls. Lipid profile parameters were estimated in Siemens automated analyser. Lipoprotein electrophoresis was done on Sebia Semi automated analyser. The data were analysed using GraphPad prism. Student’s t-test for normally distributed data, Mann-Whitney U test for non-normally distributed data and ANOVA for comparison of more than two groups was done. A p-value <0.05 was considered statistically significant. <b>Results:</b> In ESRD cases there was a significant increase (p <0.001) in Total Cholesterol (TC), Low Density Lipoprotein Cholesterol (LDL-C), High Density Lipoprotein Cholesterol (HDL-C) after RD compared to the values before RD (151.4±38.92 versus 183±57.18 mg/dL; 75.3±24.66 mg/dL versus 84.23±29.74; 31.9±9.74 mg/dL versus 35.57±12.49 mg/dL); respectively. Triglycerides (TG) and Very Low Density Lipoprotein (VLDL) values decreased after RD compared to the values before RD (123.6±50 versus 121.4±49.26; 24.73±10 versus 24.29±9.85); (p>0.05). Fractionation of lipoproteins reveals a significant increase in lipoprotein a {Lp(a)} as compared to controls (21.20±17.46 versus 12.38±10.63, p<0.05). The values of alpha and beta lipoproteins in electrophoresis didn’t correlate well with the values obtained from automated enzymatic lipoprotein measurements in ESRD cases after dialysis (r=0.22, p=0.18). <b>Conclusion:</b> There is a remarkable increase in atherosclerotic risk after RD noted due to significant increase in TC, LDL-C and Lp(a) which might increase the risk of CVD in RD subjects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=BC05-BC09&id=11983 https://doi.org/10.7860/JCDR/2018/35432.11983 Association of Dental Caries and Oral Health Impact Profile in 12-Year-Old School Children: A Cross-Sectional Study Vijay S Kumar, Vineetha Karuveettil, Joe Joseph, Sravan Kumar Yeturu, Rakesh P Suseela, Chandrashekar Janakiram <b>Introduction:</b> The healthcare today is undergoing a paradigm shift from biomedical to biopsychosocial approaches. This holds true for dentistry as well, as the ultimate goal of oral health does not mean the mere absence of disease, rather the patients mental and social well-being. Oral health status in children is traditionally assessed by oral examination. But with the emergence of psychosocial factors affecting oral health and vice-versa, it is necessary to assess the subjective component of oral health in order to get a complete picture. Oral health related quality of life questionnaire can be used as a tool for the assessment of the impact of oral health on various dimensions of subjective well-being. <b>Aim:</b> To determine the association between dental caries and oral health impact profile among 12-year-old school children in Ernakulam. <b>Materials and Methods:</b> A cross-sectional study was conducted in 2017 on a representative sample of 281 school children aged 12 years from Ernakulam district. The data regarding caries experience were collected through oral examination using DMFT and deft indices. Oral health related quality of life was evaluated using a self-administered Child Oral Health Impact Profile questionnaire (COHIP). Descriptive statistics were computed for continuous data, whereas for categorical data, the respective frequencies were taken. Pearson’s correlation was used to test the correlation between each domain of questionnaire and decay (D) component of DMFT. <b>Results:</b> The mean COHIP score obtained for this population was 101.58±15.66. The prevalence of dental caries in this population was found to be 71.5%. The mean DMFT and deft scores did not have any significant correlation with the domains of the COHIP questionnaire. The association between the domain school environment and decay component (D) of DMFT was found to be significant (p-value – 0.024). <b>Conclusion:</b> The results are conclusive that dental caries has a negative impact on the oral health related quality of life, thereby leading to loss of school hours and adversely affecting the student’s academic performance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZC12-ZC15&id=11984 https://doi.org/10.7860/JCDR/2018/35029.11984 Glycosylated Haemoglobin as a Risk Predictor of Coronary Artery Disease in Patients with Stable Angina Deepak Uppunda, Ranjan K Shetty, Pragna Rao, Abdul Razak, Kiran Shetty, Prasad Narayan Shetty, Ravishanker, Ajit Singh <b>Introduction:</b> Glycosylated HaemoglobinA1c (HbA1c) is a time-integrated marker for glycaemic control. It also helps in predicting the risk of Coronary Artery Disease (CAD) among diabetic patients. <b>Aim:</b> To determine the association between HbA1c and severity of CAD in patients with stable angina. <b>Materials and Methods:</b> A total of 144 patients with the positive cardiac stress test and stable angina who are undergoing a Coronary Angiogram (CAG) were enrolled. The patients were classified into three groups according to baseline HbA1c level (Normal group <5.6%, n=53; pre diabetic group 5.7-6.4%, n=62; diabetic group >6.4%, n=29). One-way ANOVA test analysed baseline characteristics of the study population. The association between HbA1c level and the risk of CADs was calculated by Pearson correlation. A p-value less than 0.05 considered to be significant. <b>Results:</b> The subjects who were pre diabetic have 1.77 times more odds of having CAD than the patients who are normal OR (95% CI)=1.77 (0.84,3.73). Patients who have diabetes have 3.13 times more odds of having CAD than the patients who are normal OR (95% CI)=3.13 (1.20,8.16), p=0.02. Higher HbA1c levels were associated with higher incidence of CAD. <b>Conclusion:</b> The study concluded that there was a significant association between raised baseline HbA1c levels and occurrence of CAD in patients with positive cardiac stress test/stable angina. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=BC10-BC12&id=11985 https://doi.org/10.7860/JCDR/2018/35654.11985 Clinical Profile of Congenital and Developmental Cataract in a Tertiary Care Centre of Southern India Sumana J Kamath, Tina Anne John, Kalary Jayanthi <b>Introduction:</b> Cataract is an important cause of preventable blindness in children. Early detection and management of congenital cataracts is of extreme importance due to the risk of amblyopia and visual morbidity. Cataracts of certain morphology are associated with better prognosis. <b>Aim:</b> To study the profile of congenital and developmental cataracts in our tertiary care centre and to evaluate the visual outcomes and complications following cataract surgery. <b>Materials and Methods:</b> A retrospective study was done in a tertiary care centre of Mangalore, Karnataka, of all cases of congenital and developmental cataract, operated by a single surgeon, from February 2012 to September 2017. <b>Results:</b> Bilateral cataracts were seen in 70.5% of patients. Lamellar cataract was seen in 44% of eyes. Phaco aspiration with posterior chamber intraocular lens implantation was done in 61.3% of eyes. Postoperatively, 44.4% of eyes achieved best corrected visual acuity of 6/6 to 6/12. There is a significant association between the age of the patient, the presence of nystagmus and the type of cataract with the postoperative best corrected visual acuity. <b>Conclusion:</b> The age of the patient, the presence of nystagmus and the type of cataract are significantly associated with the postoperative best corrected visual acuity in patients with congenital and developmental cataract. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=NC01-NC04&id=11986 https://doi.org/10.7860/JCDR/2018/36080.11986 A Retrospective Epidemiological Analysis of Fungal Infections of Skin and Soft Tissue in a Health Care Setup in Delhi Hena Butta, Raman Sardana, Leena Mendiratta, Vyoma Singh, Sanjiv Jasuja, Havind Tandon, Vikas Kashyap <b>Introduction:</b> Fungal infections of the skin and soft tissue can be an important cause of morbidity and mortality in both immunocompromised and immunocompetent patients and usually pose a major diagnostic challenge. <b>Aim:</b> The present study was done to study the type of fungal isolates from pus and soft tissue specimens and to clinically correlate these fungal isolates. <b>Materials and Methods:</b> A retrospective analysis of fungal isolates from pus and soft tissue specimens was done over a period of one year and their clinical history was studied from medical records department. The identification of yeast isolates was done by automated (MALDI-TOF-Vitek MS and Vitek-2) and conventional methods and mycelial fungi were identified by lactophenol cotton blue mount of growth and/or slide culture. <b>Results:</b> Out of 288 pus/tissue specimens received for fungal culture during the study period, 37 showed growth of fungi. Out of 37 fungi, 24 were yeast isolates and 13 were mycelia fungi. Candida albicans (24.3%) constituted the majority of the fungal infections followed by Candida glabrata (21.6%), Aspergillus sp. (18.9%) and Dematiaceous fungi (13.5%). All the Dematiaceous fungi were isolated from post-transplant patients. Out of 37 patients, 12 were immunocompromised and 22 had history of surgery. Antifungal resistance was not seen in C. albicans while Candida haemulonii/auris showed 100% resistance to amphotericin B and fluconazole. All the patients in our study had history of prior antibiotic intake for one or other reasons. In contradiction to leucopenia, many of the patients in our study had leucocytosis at the time of isolation of fungi. <b>Conclusion:</b> A variety of fungi may cause pus and soft tissue infections in both immunocompromised and immunoc-ompetent individuals. The results signify the importance of clinicomycological awareness, correlation, fungal speciation and trend of antifungal susceptibility pattern for the optimum treatment of the patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=DC11-DC16&id=11987 https://doi.org/10.7860/JCDR/2018/35798.11987 Haematological Alterations in Initially Diagnosed and Relapse/Recurrent Cases of Malaria: A Comparative Study Deepti Arora, Sanjay Kaushik, Sheenam Azad, Anupreet Kaur, Sanjeev Kishore <b>Introduction:</b> Malaria is endemic in India with an estimated 70-100 million cases each year. An alteration of haematological profile is one of the hallmarks in patients with malaria. A variety of haematological alterations like progressively increasing anaemia, leucocytosis or leucopenia, thrombocytopenia have been reported. <b>Aim:</b> To evaluate and compare the effect of initially diagnosed cases and cases of relapse/ recurrence of malaria on haematological parameters and their correlation with Parasitic Index (PI). <b>Materials and Methods:</b> This prospective study included 183 patients of initially diagnosed malaria cases and 64 follow-up cases of malaria. The diagnosis of malaria was confirmed on peripheral blood film and/or malaria antigen test. Complete blood counts were performed using automated Sysmex XN-1000. MP antigen test was done by Alere bioline SD malaria antigen kit. The Pearson’s Chi-square test was used for comparison of the patient’s data for association between distribution of severe anaemia in initially diagnosed cases of malaria and in cases with relapse/recurrence in relation to PI. The association of Grade III & IV thrombocytopenia in initially diagnosed cases of malaria and in cases with relapse/recurrence in relation to PI was evaluated using the paired Student’s t-test. <b>Results:</b> Out of 183 initially diagnosed malaria cases, 163 cases had P. vivax and 20 cases had P. falciparum. All the cases of P. vivax and 75% of cases of P. falciparum had anaemia. All the cases had thrombocytopenia. Among 64 follow-up cases, 57 had P. vivax and 7 cases had P. falciparum infection. Approximately 50% cases of P. vivax and 40% cases of P. falciparum had normal Hb levels. Normal platelet counts were observed in 14% of P. vivax and 28.5% of P. falciparum cases. Majority of the cases (? 85%) of both the groups had PI =10. <b>Conclusion:</b> Anaemia and thrombocytopenia are frequent findings in malaria with severity of thrombocytopenia related to PI. Thrombocytopenia is a constant finding in initially diagnosed cases of malaria but in cases of relapse/recurrence platelet counts may be normal. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=EC06-EC09&id=11989 https://doi.org/10.7860/JCDR/2018/35968.11989 Effect of Educational Program on Lifestyle of Myocardial Infarction Patients in Iranian Population Ali Khani Jeihooni, Zhila Fereidouni, Pouyan Afzali Harsini, Esmaeil Kavi, Hajar Haghshenas, Leila Akbari <b>Introduction:</b> Cardiovascular Diseases (CVDs) are among the top three causes of mortality and disability in the world. Applying Theory of Planned Behaviour (TPB) can be effective on changing lifestyle of patients with Myocardial Infarction (MI). <b>Aim:</b> To determine the application of theory of planned behaviour to change the lifestyle of myocardial infarction patients in Iranian population. <b>Materials and Methods:</b> The research was carried out at two stages; at first, a cross-sectional study was carried out to determine predictors of TPB (attitudes, subjective norms and perceived behaviour control) on 175 patients with MI. Then, a quasi-experimental study was conducted on 100 MI patients (50 experimental groups and 50 control groups) hospitalized in Valiasr Hospital of Fasa, Fars, Iran in 2016-2017. Data gathering tool was a questionnaire with three sections: 1) demographics (age, gender, education, job, marital status and smoking habits); 2) lifestyle inventory questionnaire; and 3) author-designed questionnaire based on TPB. The educational intervention was carried out in eight sessions (One session is of 55-60 minutes) including symptoms and risk factors of MI; healthy cooking methods; improving diet at work; weight loss methods; good effects of physical activity and exercising on the body; effects of exercising on MI; stress and managing it; heart rehabilitation; role of attitudes and beliefs in improving lifestyle and obstacles and facilitators found in the society to improve healthy lifestyle. The collected data was analysed in SPSS 22 using logistic regression, paired sample t-test, independent t-test, and chi squared test. <b>Results:</b> The results showed no significant difference between the experiment and control groups before the intervention in terms of attitudes, subjective norms, perceived behaviour control, intention and score of lifestyle. Three months after the intervention, however, the experiment group showed a notable increase and significant difference in terms of the mentioned variables comparing with the control group. <b>Conclusion:</b> Applying the TPB is very effective for developing an educational program for a healthy lifestyle among patients with MI. Besides such programs, follow-up education on monitoring is highly recommended. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=LC06-LC10&id=11990 https://doi.org/10.7860/JCDR/2018/36113.11990 Evaluation of Greater Sciatic Notch Parameters in Sex Determination of Hip Bone by Three-Dimensional CT Images Siamak Soltani, Maryam Ameri, Kamran Aghakhani, Soheila Ghorbani <b>Introduction:</b> Sex determination of an anonymous individual is one of the main objective when human skeletal remains are found, both in forensic investigation and archaeological studies. <b>Aim: </b>To evaluate the role of Greater Sciatic Notch (GSN) parameters in sex determination in the Iranian population by means of Three-Dimensional (3D) images reconstructed by multi-slice Computed Tomography (CT). <b>Materials and Methods:</b> In the present cross-sectional study, 237 cases (121 females and 116 males) who received Pelvic CT in radiology department of Rasoul-e-Akram Hospital were included. The GSN parameters including the width, depth and posterior segment were applied to measure the 3D-CT radiographs of participants hip bone using digital instruments with an accuracy of 0.01º and 0.01 mm. SPSS version 21 was used to analyse the data using the independent sample t-test, chi-square test, Pearson’s correlation test and Roc curve. <b>Results:</b> Among the GSN parameters, depth had no difference among males and females, in both right and left sides (p=0.767 and p=0.561, respectively); thus, was not useful in sex determination. GSN parameters including Depth (p=0.008), Post segment (p=0.017), and Index 2 (p=0.015) were different in right and left sides and cannot be considered for sex determination without considering the sides. Moreover, Post angle (90.3%) and Post segment (89.5%) were found to have the most accuracy in sex determination. <b>Conclusion:</b> Most of the parameters of GSN except for depth were useful for sex determination. Application of 3D-CT micrographs in the present study helped us to easily quantify sexual dimorphism in the GSN, suggesting 3D-CT can be considered as one of the valuable tools in practical forensic osteology investigation due to the great accuracy to measure the sex differences. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=HC01-HC05&id=11991 https://doi.org/10.7860/JCDR/2018/36428.11991 The Effects of Oxymorphone on Biochemical Parameters of Male Rats Jamil Kheirvari Khezerloo, Tahereh Dianat, Mohsen Tabasi, Ali Salimi <b>Introduction:</b> Oxymorphone is similar in structure to morphine. It is used for the relief of pain and was approved by the Food and Drug Administration (FDA) in 2006. But may have some side effects. <b>Aim:</b> To illustrate the changes in biochemical parameters in response to the injection of oxymorphone in adult male rats. <b>Materials and Methods:</b> This research was carried out on 50 male adult Wistar rats which were divided into five groups that included 2, 4 and 6 mg/kg of Oxymorphone received groups, control group and normal saline received group. Injections were administered intraperitoneally via a catheter once a week for 56 days. After eight weeks, blood samples were collected using cardiac puncture method. Following serum preparation, enzymes and hormones levels were quantified using standard automated spectrophotometer especially photometric kinetic methods. All values were presented as mean±SEM. Statistical significance was evaluated by one-way analysis of variance (ANOVA, t-test) using IBM SPSS Statistics 20.0 for Windows. <b>Results:</b> The results demonstrate that serum levels of Adrenocorticotropic Hormone (ACTH), cortisol, aldosterone and Thyroid-Stimulating Hormone (TSH) increased in all groups which received oxymorphone. The serum levels of Creatine Kinase (CK) had significant decrease in all exposed groups. Oxymorphone had no statistically significant impact on the serum levels of Alkaline Phosphatase (ALP). Serum levels of Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), T3 and T4 had a significant change in group which received 6 mg/kg of oxymorphone. No definite changes in other groups. <b>Conclusion:</b> Exposure to 2, 4 and 6 mg/kg of oxymorphone may lead to short and long-term side effects. These effects can be therapeutic for a range of patients and can also be very deadly for a group of patients with unbalanced serum levels of special enzymes or hormones. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=FC01-FC04&id=11992 https://doi.org/10.7860/JCDR/2018/36746.11992 Evolving a Structural Model in Type 2 Diabetes Mellitus: Influence of Knowledge, Attitudes, and Self-Management Practices on Glycaemic Control Matpady PrabhathKalkura,Shashikiran Umakanth,Arun Gundmi Maiya,Shreemathi Sureshramana Mayya,Krish¬nanda Prabhu Renjala Vasudeva,Mamatha Shivananda Pai,Pallavi PrakashSaraswat,Balkudru Kiran Aithal <b>Introduction:</b>Regularity in diabetes self-management practices among people with Type 2 Diabetes Mellitus (T2DM) is a predictor of glycaemic control. Knowledge and attitude have linear relationships with diabetes self-management, and hence exert a positive influence on glycaemic control. <b>Aim:</b> The study aimed to develop and examine a structural model describing the inter-relationship between diabetes knowledge, attitude, self-management practices, and glycaemic control {demonstrated by glycated haemoglobin (HbA1c) levels}. <b>Materials and Methods:</b> A cross-sectional study was conducted among people with T2DM in Udupi taluk, Karnataka, India. A total of 432 participants, selected by simple random sampling and fulfilling the inclusion criteria, were included in the study. Descriptive, correlative and comparative analysis of data was done using Statistical Package for the Social Sciences (SPSS) version 16.0. The Structural Equation Modelling (SEM) technique was used for the model; and path analysis was performed using Analysis of Moment Structures (AMOS) version 25.0 software. <b>Results:</b> Diabetes knowledge was a significant predictor of attitude, which in turn were a significant predictor of diabetes self-management and HbA1c. Importantly, diabetes self-management was a significant predictor for HbA1c. The final model reflected good fit (?2 (5) =5.849, p=0.321, RMSEA= 0.019, CFI= 1, NFI=0.997). <b>Conclusion:</b> The present study strongly indicates that attitude and self-management practices can have a direct impact on HbA1c levels of people with T2DM. Knowledge has an indirect impact on self-management and HbA1c through attitude. Developing a self-management intervention model (which can be tailored to suit the needs of the individual with T2DM) encompassing knowledge, positive attitude and diabetes self-management practices, might result in improved glycaemic control among people with T2DM, and it will be more sustainable than other interventions since it would work at the community level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=LC01-LC05&id=11993 https://doi.org/10.7860/JCDR/2018/36584.11993 Granular Cell Tumour: A Clinicopathological Study with Review of Literature Geetha Vasudevan, Padmapriya Jaiprakash <b>Introduction:</b> Granular Cell Tumours (GCTs) can occur in any part of the body. Many a times, they occur as a small swelling, clinically suspected to be a benign process. Histologically, they are characterised by the presence of cells with abundant granular cytoplasm. <b>Aim:</b> To study the clinicopathological spectrum of GCTs diagnosed. <b>Materials and Methods:</b> Data were collected from the archives of the Department of Pathology, on diagnosed cases of GCTs for a period of five years; from 2012 to 2017 and a total of 22 cases were included in the study. The slides, including special stains and Immunohistochemistry (IHC), whenever performed, were retrieved and studied. The results were tabulated and analysed. <b>Results:</b> In the present study 22 cases of GCT were described, commonly involving skin and subcutaneous tissue. Most of the lesions were less than a centimeter in size. Females were more often affected. On follow-up, no recurrence was noted. <b>Conclusion:</b> Granular cell tumours should be a part of the diagnostic differentials whenever lesions with granular cells are encountered. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=EC10-EC12&id=12004 https://doi.org/10.7860/JCDR/2018/36320.12004 Prognostic Significance of First Week NT-ProBNP Levels in Heart Failure SHOBHITENDU KABI, SIBA PRASAD DALAI, KAMAL KANT JENA, AKSHAYA KUMAR SAMAL, BAIKUNTHA NATH PANDA, SRIKANT KUMAR DHAR <b>Introduction:</b> Clinical history, signs and symptoms along with non-invasive imaging help in diagnosis and management of Heart Failure (HF). Limited data exists in evaluating the role of cardiac biomarkers in diagnostic and prognostic work up in cases with clinical evidence of HF in an Indian setup. <b>Aim:</b> The aim was to find out if first week N-Terminal -pro Brain Natriuretic Peptide (NT-proBNP) levels can be used as a prognostic indicator and to correlate with duration of hospital stay and mortality during the course of treatment and follow-up. <b>Materials and Methods:</b> A hospital based cross-sectional observational study was carried out for a period of two years and 160 patients with clinical evidence of HF according to Framingham’s criteria irrespective of aetiology and ejection fraction were included in the study. NT-proBNP were estimated at admission, at one-week interval and at discharge. NT-proBNP levels were correlated with duration of hospital stay and mortality during the course of treatment and follow-up. <b>Results:</b> Patients with Rheumatic Heart Disease (RHD) had the highest mean NT-proBNP levels even with higher ejection fractions. Mean NT-proBNP levels in patients with Cor-pulmonale were significantly lower (3634.8 pg/dL) than patients of HF with non-pulmonary cause (8418 pg/dL). Patients with NT-proBNP levels more than 15,000 pg/dL invariably stayed for more than two weeks. The decline of NT-proBNP levels more than 90% of the initial values in one week follow up were prognostic marker for recovery (p<0.01). Patients who had admission NT-proBNP levels of more than 10,000 pg/dL, and those cases with fall of NT-proBNP levels less than 50% after one week of therapy had increased duration of hospital stay and or higher risk of mortality. <b>Conclusion:</b> First week NT-proBNP can be used routinely in monitoring the response to therapy, prognosticate the duration of hospital stay, outcome in HF. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OC14-OC17&id=12009 https://doi.org/10.7860/JCDR/2018/35533.12009 Simple Spectrophotometric Method for Analysis of Serum Catalase Activity Mahmoud Hussein Hadwan, Haider Khabt <b>Introduction:</b> Catalase is a principal constituent of the antioxidant system that attenuates the oxidative stress, which is ubiquitously associated with several types of pathological disorders. <b>Aim:</b> This paper describes a discontinuous assay for the assessment of catalase activity using the titanium tetrachloride/sulfuric acid reagent. <b>Materials and Methods: </b>Samples containing catalase are incubated with hydrogen peroxide for three minutes prior to fast mixing of aliquots of the incubation mixtures with titanium tetrachloride/sulfuric acid reagent, which measures remaining hydrogen peroxide (H2O2). Absorbance is then read at 405 nm. Dissociation of hydrogen peroxide is proportional to catalase activity in the used sample. One-way analysis of variance (ANOVA) was used to analyse the resulted data. p-value <0.05 was considered to be statistically significant using SPSS Statistics 17.0 software. <b>Results:</b> The current method characterizes the use of a correction factor to exclude the interference that arises from the presence of a yellow background colour of serum and/or reducing agents that reduce titanium (IV) to titanium (III). The imprecision of the method was considered by calculating the coefficient of variation, which equals to 3.6% within run and 5.7% between run. The catalase assay measured using the kinetic method produced a good correlation (r=0.9771). <b>Conclusion:</b> The study explains a simple discontinuous method for catalase activity assessment which can be completed with few steps, and which allows catalase to be measured in the presence of high concentration of other molecules as well as at low levels of H2O2. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=BC13-BC16&id=12011 https://doi.org/10.7860/JCDR/2018/35014.12011 Effectiveness of Prenatal Education Regarding Practice on Antenatal Exercises and Minor Ailments among Pregnant Mothers AT Sajitha, Anju T Philip, TK Sarika <b>Introduction:</b> Antenatal excersises are essential aspect of antenatal care in most settings and these have a powerful and positive contribution to pregnancy when applied correctly. <b>Aim:</b> To find out the effectiveness of prenatal education regarding practice of antenatal exercises and prelevance of minor ailments during the third trimester among pregnant mothers. <b>Materials and Methods:</b> A Quasi experimental pre-test–post-test control group study was conducted among 60 antenatal women (30 in control and 30 in experimental) between 28-30 weeks of gestation attending obstetrics and gynaecology OPD, Amrita Institute of Medical Sciences and research centre, Kochi, Kerela, India. The antenatal women were selected by using non-probability convenience sampling technique and the data was collected using a self reported checklist to assess the practice of exercise and a self administered rating scale to assess the level of minor ailments experienced by antenatal mothers. On day-1, pre-test measure of minor ailments were done. Then prenatal education regarding antenatal exercises was given to the mothers in experimental group. During follow up visit, on day-14, re-teaching was given. The practice of antenatal exercise was assessed using a self reported check list and the minor ailments of antenatal mothers was assessed using rating scale on day-28. Statistical Analysis was done by using mean, frequency, percentage and paired t-test. <b>Results:</b> Out of 60 antenatal mothers, majority of the mothers were within the age group of 18-25 years. The mean post-test score of practice in control group was (24.63+4.5) and the mean post-test score in experimental group was (66.3+8.4) and it is significant at the level of p-value <0.001. The mean post-test score of minor ailments in control group was (33.1±1.47) and in experimental group (25.27±2.12). Noticeably the comparison between mean post-test score of minor ailments shows statistically significant difference at the level of p< 0.001 . <b>Conclusion:</b> Performing exercise during pregnancy helps the mother to be healthy and free from minor ailments. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=QC01-QC04&id=12012 https://doi.org/10.7860/JCDR/2018/36344.12012 Is There Over Use of Computed Tomography Scan in Paediatric Head Injury Patients? Sushant Agarwal, Pradipta Ray Choudhury, Abhamoni Baro, Prabahita Baruah <b>Introduction:</b> Paediatric Computed Tomography (CT) utilisation has increased now-a-days; but its use comes with risks. The ionising radiation doses delivered by CT are much higher and are linked with cancer risks. <b>Aim:</b> This study was conducted to observe whether there is unnecessary use of CT scan in paediatric head injury patients. <b>Materials and Methods:</b> Retrospective study based on the CT brain reports of paediatric patients (less than 18 years age) of last three years from September 2014 to September 2017. Various particulars of the patients like age, sex etc. along with normal or any findings of CT reports were recorded, tabulated and statistically analysed. <b>Results:</b> Total of 1056 paediatric head injury patients, CT scan reports were collected and thoroughly reviewed. Among 1056 cases, 690 were male and 366 were female paediatric patients. It was found that 526 paediatric patients had normal CT head findings with percentage of 49.81%. <b>Conclusion: </b>Thus half of the head injury paediatric patients could be managed without CT scan exposure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=TC01-TC04&id=12013 https://doi.org/10.7860/JCDR/2018/36638.12013 Validity and Reproducibility of Digital Models Obtained by Cone Beam Computed Tomography Imaging Apurva Bariar, Fidha Nazeer, Nidhin Philip, Siddarth Shetty <b>Introduction:</b> Impression making and fabrication of plaster models serve as a basis for documentation, diagnosis and treatment planning. Model analysis is used routinely in orthodontics and is a key factor for treatment planning and review of orthodontic progress. Recently newer technologies in imaging and digitalisation have made it possible to obtain 3-Dimensional (3D) virtual models. Virtual models score over plaster models with respect to accessibility, storage and long life. However, there are concerns over its accuracy and reproducibility. <b>Aim: </b>To evaluate the accuracy of three dimensional digital models obtained from Cone Beam Computed Tomography (CBCT). <b>Materials and Methods: </b>This was an ex-vivo study. Thirty dental models of patients were selected and scanning of these models were done using CBCT. Means and standard deviations of the space analysis measurements were calculated by using both plaster and digital models. Statistical analyses were used to investigate the accuracy and repeatability of the methods studied using Statistical Package of Social Sciences (SPSS) 20.0. Paired t-tests for both mean and standard errors were calculated. <b>Results:</b> The results for all 30 maxillary and mandibular models were similar. There was a statistically significant difference in calculating sum of ten teeth for both maxillary and mandibular teeth between the plaster and dental digital models and in mesio distal measurements between digital and plaster dental models. <b>Conclusion:</b> Digital models provide a more accurate measurement of mesio distal width of tooth with a statistically significant difference of (p-value=0.002). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZC16-ZC19&id=12015 https://doi.org/10.7860/JCDR/2018/35616.12015 Evaluation of Analgesic and Anti-Inflammatory Activity of Ibuprofen-Pregabalin in Animal Models Chidambarann Suthakaran, Gopalakrishnan Senthil <b>Introduction:</b> Despite an enhanced recognition of the molecular mechanisms of nociception, existing analgesic drugs continue to remain restricted in terms of efficacy. Since all single analgesic drugs are not effective in all patients at all times, there is a need either to develop new and more effective drugs or to identify favourable combinations of drugs that are already available. <b>Aim:</b> To evaluate the analgesic and anti-inflammatory activity of combined use of ibuprofen and pregabalin in animal models of pain and inflammation. <b>Materials and Methods:</b> The animals (Swiss albino mice and Wistar rats) were randomly divided into eight groups with six animals in each group. Analgesia was assessed by acetic acid induced writhing and tail immersion methods in mice and hot plate method in rats. Paw oedema model in rats after induction with 0.1 mL of 1% carrageenan was used to assess the anti-inflammatory activity. The percentage inhibition of writhes and prolongation of reaction time were used for assessing analgesic activity and reduction in paw volume was used for assessing anti-inflammatory activity. The results obtained were analysed by ANOVA followed by Tukey HSD Post-hoc Test. <b>Results:</b> There was a significant diminution in the amount of writhing in all the groups tested when compared to the control group and the highest percentage inhibition of pain was seen with high dose combination group. There was a statistically significant increase in reaction time at all time points compared to baseline values in all treatment groups in the hot plate and tail immersion methods. A notable observation was that the degree of inhibition of paw oedema was greater in the combination groups than ibuprofen alone or the standard anti-inflammatory drug diclofenac while pregabalin alone exhibited negligible anti-inflammatory activity. <b>Conclusion:</b> The present study displayed prominent analgesic effect and serves as a proof-of-principle study for considering the combination of ibuprofen and pregabalin as a lead for the development of new dual-action analgesic drugs. If confirmed, in additional models of acute and/or chronic pain this combination might be useful in the clinical management of pain associated with inflammation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=FC05-FC08&id=12016 https://doi.org/10.7860/JCDR/2018/37032.12016 Causative Agents of Mycobacterial Diseases in Aquarium Fish and their Importance for Human Health Mahdi Seyfahmadi, Seyyed Reza Moaddab, Azar Sabokbar <b>Introduction:</b> The isolation of Non-Tuberculous Mycobacteria (NTM) from human and fish mycobacteriosis specimens increasingly has turned to be a major concern. NTM can cause opportunistic infections in elderly and immunocompromised patients; it is not only difficult to treat but also requires long course of therapy. <b>Aim:</b> To isolate and identify the species of non-tuberculous mycobacteria in aquarium fish and to study the importance of their opportunistic infections to the general health of society. <b>Materials and Methods:</b> Fifty-three common freshwater aquarium fish were included in the study for the diagnosing of mycobacteria by culture and Ziehl-Neelsen staining methods. The Mycobacteria species were identified by morphological characteristics of colonies and biochemical tests. Drug susceptibility tests were also performed using the proportional method on Lowenstein-Jensen media. <b>Results:</b> Among 53 ZN-stained specimens, 13.2% gave positive direct microscopic results for mycobacteria. Using the bacterial culture method, Mycobacterium spp.colonies was observed in 28.3% Lowenstein-Jensen agar tubes. Identification of different species of mycobacterium from 15 isolates obtained by culture based on phenotypic characteristics and biochemical tests was as follows: M. fortuitum, 6 cases; M. marinum, 3 cases; M. smegmatis, 3 cases; M. terrea, 1 case; M. flavescens, 1 case; and M. asiaticum, 1 case. The resistance rates of isolates were 93.33%, 80%, 80%, 66.66%, 60%, 40% and 20% against streptomycin, isoniazid, rifampin, ethambutol, kanamycin, amikacin and ciprofloxacin, respectively. <b>Conclusion:</b> In this study, some isolated mycobacteria which have been considered as potential pathogens in fish and humans were identified, such as Mycobacterium marinum, M. fortuitum, M. smegmatis and M. flavescens. All of them were found to be resistant to the most of tested drugs. It’s important to be aware of the contamination of some aquarium fishes with mycobacteria species to reduce the risk of bacterial transmission to humans. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=DC17-DC21&id=12017 https://doi.org/10.7860/JCDR/2018/36568.12017 Short-Term Effect of “Mechanical Diagnosis and Therapy” in the Management of Sacroiliac Joint Pain Saumya Srivastava, Dhanesh KU Kumar, Harramb Mittal, Snehil Dixit <b>Introduction:</b> Sacroiliac Joint (SIJ) is a familiar nociceptive source of Low Back Pain (LBP). Patients with SIJ pain commonly present with tenderness around the Posterior Superior Iliac Spine (PSIS) which can be recorded by using pressure pain algometer. Mechanical Diagnosis and Therapy (MDT) is a manual therapy technique which uses repetitive movements to assess and treat the dysfunction. MDT is found to be effective in treating SIJ pain; however, its effect on Pain Pressure Threshold (PPT) is not yet determined. <b>Aim:</b> To determine the effect of Mechanical Diagnosis and Therapy on Pain Pressure Threshold in Sacroiliac Joint pain. <b>Materials and Methods:</b> A total of 25 subjects with unilateral LBP of age group 20-65 years participated in the study. Subjects with the direction of preference, pain around the PSIS, positive on two out of four pain provocation tests were included in the study. These patients were given 30 repetitions of either anterior or posterior rotation of the innominate, for four sessions. PPT and Visual Analogue Scale (VAS) were used to measure the effect of treatment. Data were analysed by using paired t-test. <b>Results:</b> There was a significant improvement seen (p<0.01) in PPT and VAS after four consecutive sessions of treatment. <b>Conclusion:</b> A significant statistical difference was seen in PPT and VAS with p-value <0.01 at the end of four sessions of MDT treatment. The study suggests that MDT can be used effectively in managing SIJ tenderness around the PSIS and pain. However, future studies should focus on comparing MDT with a control group or with other manual therapy techniques. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=YC01-YC04&id=12020 https://doi.org/10.7860/JCDR/2018/36200.12020 Effect of Gong’s Mobilisation versus Muscle Energy Technique on Pain and Functional Ability of Shoulder in Phase II Adhesive Capsulitis Yuvarani Gopinath, Santhosh Krithika Seenivasan, Senthil Nathan Celambakkaam Veeraraghavan, Rajalaxmi Viswanathan, Mohan Kumar Govindaraj <b>Introduction:</b> Adhesive capsulitis is a self-limiting condition of unknown aetiology. It is characterised by painful and limited active and passive range of motion. Women are more commonly affected than men. This condition is defined as spontaneous onset of pain and limitation of shoulder range of motion. Manipulation, soft tissue mobilisation techniques, electrotherapy have proved effective in reducing pain, improving the range of motion, thereby increasing the functional ability of shoulder. <b>Aim:</b> The present study focuses on the effectiveness of Gong’s mobilisation versus muscle energy technique on pain and functional ability of shoulder in phase II adhesive capsulitis. <b>Materials and Methods:</b> The present cross-sectional study included 50 subjects with the history of adhesive capsulitis (phase II) selected based on the inclusion and exclusion criteria. They were randomly allocated into two study groups. The duration of the treatment intervention was 6 sessions per week for the duration of two weeks. The Gong’s mobilisation (Group A) pull was maintained for about 10-15 seconds and a rest period of 5 seconds was given. This technique was performed for about 2-3 minutes. Maitland’s grade 3 and 4 was performed to increase the range which was then followed by sustained stretch at grade 4 for about 5-7 seconds. Muscle energy technique was applied for 5 repetitions per set, 5 sets per session, 1 session per day, 5 days a week for 2 weeks with each repetition maintained for the duration of 7–10 seconds. The outcome measures for the range of motion was goniometer, pain was assessed by using VAS, functional ability by Shoulder Pain And Disability Index (SPADI), after six sessions of treatment for about two weeks. <b>Results:</b> The post-test mean value of range of motion for Group A was 155.56 and for Group B it was 135.40. The mean post test value for VAS for Group A was 2.12 and Group B it was 3.24. The post mean value for SPADI in Group A was 25.28 and Group B 34.80. Based on the above data analysis it is evident that Group A showed significant improvement than Group B. This implies that Gong’s mobilisation is more beneficial in improving ROM, reducing pain, improving functional ability. <b>Conclusion:</b> The present study concludes that Gong’s mobilisation is more effective than muscle energy technique in subjects with phase II adhesive capsulitis.. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=YC05-YC08&id=12021 https://doi.org/10.7860/JCDR/2018/34725.12021 Three-Dimensional Assessment of Pharyngeal Airway Space by MRI in Class II Division 1 Patients Treated by Twin Block Appliance Ram Gopal, Tulika Tripathi, Priyank Rai, Anup Kanase <b>Introduction:</b>A close relationship exists between pharyngeal airway and dentofacial structures. Retrognathic mandible is an anatomic predisposing factor for narrow pharyngeal airway. Twin Block appliance improves the patency of pharyngeal airway by correction of mandibular retrognathia in growing patients. <b>Aim:</b> To assess changes in pharyngeal airway space by MRI in Class II Division 1 subjects treated by twin block appliance. <b>Materials and Methods:</b> A total of 12 patients (two females and ten males) in the age group of 12-14 years were treated by Twin-Block appliance for correction of Class II Division 1 malocclusion. All the orthodontic records and MRI were collected at two stages, T1 (Pre-treatment) and T2 (Post-treatment). Three-dimensional analysis of pharyngeal airway space was performed. Normality of the data was checked by Kolmogorov Smirnov test. Paired-t test was performed to compare the means at T1 and T2. <b>Results:</b> Following Twin Block treatment, MRI showed statistically significant increase in pharyngeal airway space in all three dimensions. Maximum increase in volume was seen in oro-pharynx (240±92.75 mm3, p<0.05) followed by hypo-pharynx (207±139.62 mm3, p< 0.01) and naso-pharynx (111.51±137.03 mm3, p< 0.05). Laterally and sagitally, maximum increase of 1.61±.55 mm and 1.92±0.89 mm respectively was seen in oro-pharynx (P<0.001). Vertically, total increase of 3.73 mm was observed in pharyngeal airway with the highest increase in hypo-pharynx (1.421mm, p< 0.05) followed by oro-pharynx (1.392 mm) and naso-pharynx (0.917 mm). <b>Conclusion:</b> There is a positive impact of Twin Block treatment on pharyngeal airway dimensions. When narrow airway is suspected clinically or on cephalograms, MRI is useful for dynamic pharyngeal airway space analysis, as transverse and volumetric changes cannot be appreciated by two-dimensional imaging. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZC20-ZC23&id=12022 https://doi.org/10.7860/JCDR/2018/32552.12022 Morphometric Study of Proximal and Distal End of Radius and its Clinical Significance A Brite Saghaya Rayna, Yuvaraj Maria Francis, Sujatha B Baskaran, Priyadarshini Gouthaman, Zareena Begum, Karthikeyan Guruswami, PK Sankaran, Gunapriya Raghunath <b>Introduction:</b> Radius is the bone of the forearm that is present on the lateral side. The proximal and distal end of radius are commonly susceptible to trauma, about 2-6% of fractures occur in the proximal end and neck of radius and the distal end of fracture is about 8-20% which is more commonly seen in geriatric population. If the fracture is severe then the person should undergo radial head prosthesis. <b>Aim: </b>To determine the morphometric parameters of proximal and distal end of radius and its clinical significance. <b>Materials and Methods:</b> The present observational study was conducted at Saveetha Medical College, Chennai, Tamil Nadu, India between February 2017 to August 2017. The morphometric parameters of proximal and distal end of radius were measured and observed using digital vernier caliper, divider, normal ruler, inch tape and inelastic thread. The mean and the standard deviation of the morphometric parameters were assessed. <b>Results:</b> The mean length of radius bone in medial side (22.7 cm) and lateral side (23.7 cm), circumference of the head (6.3 cm), length of the head from medial side (0.6 cm) and lateral side (0.32 cm), distance between the radial head and the radial tuberosity (0.75 cm), length of the radial tuberosity (3.36 cm), circumference of the radial neck (4.64 cm). The mean width of the ulnar notch (1.41 cm), length of the ulnar notch from anterior aspect (0.30 cm) and posterior aspect (0.62 cm), length of the styloid process (1.01 cm), circumference of the distal end of the bone (8.40 cm), circumference of the distal end of the shaft (5.63 cm), scaphoid and lunate fossa from anterior (2.79 cm), posterior (2.50 cm), and base (1.32 cm). <b>Conclusion:</b> The length of the radius on the medial and lateral aspect, circumference of radius head, diameter of the radius, Length of the radial head on the medial and lateral aspect, distance between the radial head and the radial tuberosity, circumference of the radial neck, length of the radial tuberosity, length of styloid process, length of ulnar notch on the anterior and posterior aspect, width of the ulnar notch, inferior articular facet of radius in anterior, and posterior aspect the following parameters will be useful for orthopaedic surgeons in case of severe fracture and oncologist in case of tumour in distal end for the purpose of making prosthesis for the radial head and distal end of radius and for reconstruction of bicipital tendon. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=AC09-AC12&id=12028 https://doi.org/10.7860/JCDR/2018/35071.12028 Metabolic Syndrome and Cardiovascular Disease Risk in patients with Depressive disorder on Antidepressive Medication Bhavana Singhal, Suresh Gupta, Vijay Choudhary, Shakuntala Saini <b>Introduction:</b> Depression and Metabolic syndrome both are the two major public health issues. The depressive patients are at higher risk for Cardiovascular Disease (CVD). The use of antidepressant medication has been linked to CVD. Major depression is associated with activation of the inflammatory response. <b>Aim:</b> To investigate the presence of metabolic syndrome, cardiovascular risk and inflammatory marker levels in depressed patients and compare it with healthy population without depression. <b>Materials and Methods:</b> Cross-sectional analysis was undertaken on 94 patients with the diagnosed depressive disorder from Department of Psychiatry, Sawai Man Singh Medical College Jaipur, Rajasthan, India and 50 healthy controls from the general population. The Body Mass Index (BMI), waist circumference, blood sugar, lipid parameters and high sensitive C-Reactive Protein (hs-CRP) were measured in both groups. Depressive symptoms were measured using Montgomery-Asberg Depression Rating Scale (MADRS), antidepressant medication use {Selective Serotonin Reuptake Inhibitor (SSRI)} was also reported. Metabolic syndrome prevalence was assessed based on International Diabetes Federation (IDF) guidelines. <b>Results:</b> The depressive subjects showed statistically significant increased blood glucose (p=0.007), and decreased High Density Lipoprotein Cholesterol (HDLC) (p=0.001) values. There were statistically significant increased hs-CRP values (3.30±2.61 mg/L) in users of SSRI antidepressant medication compared to healthy controls (1.96±0.70 mg/L). The prevalence of metabolic syndrome in depressed patients was 42.36%. <b>Conclusion:</b> Depressive patients are at higher risk for CVD due to a high prevalence of metabolic syndrome. These patients should be regularly monitored for CVD risk factors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=BC17-BC20&id=12029 https://doi.org/10.7860/JCDR/2018/28702.12029 A Study to Assess Awareness and Attitudes of Teachers towards Primary School Children with Stuttering in Dakshina Kannada District Arya S Kumar, Aiswarya Liz Varghese <b>Introduction:</b> Stuttering, a fluency disorder causes a negative impact on an individual’s educational, occupational, and social experiences. Based on the review of the previous literatures it was found that the school population exhibited 5% lifetime incidence and 1% stuttering prevalence. <b>Aim: </b>To assess the awareness and attitude of teachers towards primary school children with stuttering. <b>Materials and Methods: </b>This cross-sectional study was conducted in primary schools in Dakshina Kannada, Mangalore, Karnataka, India, using Convenient sampling. A total of 70 teachers who are currently teaching primary school children were selected. A questionnaire was developed which had three sections. For the purpose of validation, the developed questionnaire was given to seven experienced speech language pathologists. Later, these speech language pathologists were asked to rate the relevance of each section and questions on a 5-point rating scale. Based on the average ratings, content validity index was calculated. Later each of the participants was given a copy of the questionnaire and was asked to rate it based on the response format provided. On the basis of obtained scores, internal consistency and test-retest reliability was estimated by using the statistical test Cronbach’s alpha and analysis was conducted by using SPSS version 20.0. <b>Results:</b> Questions regarding the teachers’ awareness towards stuttering received an average score of 63.16%. For teachers’ attitude, a score of 55.7% and a score of 48.5% for the teacher’s perception regarding the students’ interaction with the children who stutter were obtained. <b>Conclusion:</b> The present study indicates that teachers are aware about the development of speech and language patterns, the common errors that can occur during the developmental period which in turn helps them to differentiate stuttering from normal non-fluency. Therefore, understanding teacher’s attitudes resolve them in mounting special consideration and making appropriate referral for intervention of the children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=JC09-JC13&id=12030 https://doi.org/10.7860/JCDR/2018/35202.12030 Effect of Atorvastatin on Serum Levels of Lipase and Amylase in Patients of Hyperlipidemia in a Tertiary Care Hospital Vipul Navadiya, Anita Sinha, Asif Barejia, Nidhi Gohil, Prakash Malam, Aashal Shah <b>Introduction:</b> Hyperlipidemia is quite prevalent all over the world. Statins, which is the most common group of drugs used in its treatment is generally well tolerated. Recently, several cases of pancreatitis have been reported in patients taking statins. <b>Aim:</b> To evaluate changes in serum levels of lipase and amylase, the reliable markers of pancreatitis, in patients who were newly started on atorvastatin. <b>Materials and Methods:</b> The present study was a prospective and observational study carried out over a period of one year in the New Civil Hospital, Surat, Gujarat, India. Newly diagnosed patients of hypercholesterolemia started on atorvastatin therapy were enrolled in the study. The baseline serum levels of lipase and amylase were measured at the onset of atorvastatin therapy. Patients were prescribed tablet atorvastatin 20 mg once a day at bedtime for 90 days. The serum levels of both the enzymes were again measured after 90 days only in the patients who were compliant with their therapy. Statistical analysis was done using paired sample student’s t-test. <b>Results:</b> A total of 60 patients were evaluated in the study. All the patients were suffering from one or more concurrent illness apart from hyperlipidemia. After 90 days of atorvastatin therapy, there was a significant fall in serums levels of total cholesterol, Low-Density Lipoprotein (LDL), Very Low-Density Lipoprotein (VLDL) and triglycerides. There was a modest increase in serum High-Density Lipoprotein (HDL) levels which was also statistically significant. Serum lipase level was found to be significantly increased after 90 days (p=0.016) as compared to baseline. Serum amylase was also significantly increased 90 days later as compared to baseline with p=0.038. <b>Conclusion:</b> Atorvastatin therapy causes an increase in serum levels of lipase and amylase. This may be due to some kind of unfavourable effect on the pancreas. Further studies are required to evaluate effects of other statins as well as to understand possible mechanisms behind this. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=FC09-FC12&id=12031 https://doi.org/10.7860/JCDR/2018/36524.12031 Prevalence and Spectrum of Congenital Anomalies in Multiple Births with Analysis of Demographic and Obstetric Risk Factors Asaranti Kar, Sony Nanda, Tushar Kar, Ipsita Dhal, Bidyut Prabha Satpathy, Kirtirekha Mohapatra <b>Introduction:</b> Recently, there is an increase in incidence of Congenital Anomalies (CA) more so in case of multiple births. But literature regarding the prevalence of congenital anomalies in combination with multiple births, the association of maternal and demographic risk factors and exact typing and proportion of congenital anomalies are few. <b>Aim:</b> The present study was done to compare the prevalence of CA in singleton and multiple births, document major anomaly subtypes, analyse demographic and maternal risk factors. <b>Materials and Methods:</b> Study was conducted in a referral care centre from September 2015 to August 2016. Total number of the live births, still births, and abortions> 20 weeks were collected. Consecutive cases of multiple births with CA and similar number of multiple births without CA during this period (taken as control) were included in the study. Type of anomalies were classified according to World Health Organisation (WHO). Different maternal risk factors and demographic factors were collected and analysed. <b>Result:</b> There were total 278 multiple births out of 10817 total births and 15 congenitally anomalous babies among multiple births. The prevalence of CAs in multiple births was 4 to 5 times higher than that of singleton births and was statistically significant. Commonest malformation among multiple births was twin-associated anomalies and was found to be more among same sex twins, especially female pairs. Association of occurrence of birth defects was observed with increased paternal age, lower socioeconomic status, rural habitat, history of addiction, fever in first trimester. <b>Conclusion:</b> The incidence of anomalies is more in multiple births and especially in monozygotic twins. Early screening of birth defects by biochemical and level two anomaly scan should be emphasised, which can help the normal infant in cases of the co-occurrence of multiple births and birth defects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=QC05-QC09&id=12032 https://doi.org/10.7860/JCDR/2018/32531.12032 Anatomical and Morphometric Study of the Pes Anserine Tendons in the Knee Marcelode Azevedoe Souza Munhoz, Fernando Bento Cunha, Gliuliano Mestriner, Fauzi Carvalho Ferreira, Rafael Vicentino Leme, Ewerton Alexandre Galdeano, Arthur Marques Alcaraz, Marcelo Rodrigues Cunha <b>Introduction:</b> The anatomical and topographical study of insertion of the pes anserinus is of fundamental importance for obtaining autogenous grafts in knee ligament reconstruction. <b>Aim:</b> To evaluate the topographical parameters of insertion of the pes anserinus in the medial region of the knee. <b>Materials and Methods:</b> Seven cadavers were selected for bilateral analysis of the knees. The following measurements were obtained with a digital caliper: 1) bilateral distance from the articular surface of the medial tibial plateau to the superior border of the pes anserinus tendons; 2) bilateral distance from the anterior tuberosity of the tibia to the insertion of the pes anserinus; 3) bilateral distance from the insertion of the pes anserinus tendons to their respective vínculas tendíneas. The data were analysed statistically by ANOVA and Tukey’s test using the BioEstat 5.3 software. <b>Results:</b> There was no significant difference in the measures of the pes anserinus tendons in relation to the medial joint line. Bilateral analysis showed variation in the distance between the anterior tuberosity of the tibia and insertion of the pes anserinus (p=0.2923), as well as in the distance between the insertion of the tendons and their respective vínculas (p<0.01). <b>Conclusion:</b> The distance between the flexor tendons and medial tibial articular surface is a safe anatomical parameter. In this respect, the tendon of the semitendinous muscle exhibits less anatomical variation and greater reliability for providing autogenous grafts in knee ligament repair. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=RC05-RC07&id=12033 https://doi.org/10.7860/JCDR/2018/34937.12033 Clinical Competency in Pulse Oximetry among Medical Professionals and Nursing Personnel in a Tertiary Care Hospital Somashekhar Marutirao Nimbalkar, Satvik Chaitanya Bansal, Chintan Labhubhai Patel, Dipen Vasudev Patel, Karamchand Hukumchand Patil, Archana Somashekhar Nimbalkar <b>Introduction:</b> Pulse oximetry is used for monitoring of patient care with early and reliable detection of hypoxemia. Inadequate knowledge amongst medical and nursing personnel can lead to reduced patient safety . <b>Aim: </b>To assess competency in pulse oximetry among the residents and nursing personnel. <b>Materials and Methods:</b> This was a cross-sectional study conducted at a tertiary care teaching hospital, Karamsad, Anand, Gujarat, India. The survey had 34 questions based on principles and correct interpretation of pulse oximetry. Data were entered into the Android mobile devices. Descriptive analysis, univariate analysis, and Students t-test were used. <b>Results:</b> A total of 264 subjects participated in the study-155 nursing personnel and 109 residents. The number of correct responses was low overall, with a mean (SD;CI) of 13.76 (2.56; 13.45-14.07) out of 26 for the “True/False” questions; and a mean (SD;CI) of 3.27 (1.57; 3.08-3.56) out of 8 for the “Multiple Choice” questions. The overall score of residents was significantly higher than nursing personnel (p<0.001). No significant difference was observed to be made by any formal training, work experience and working in acute care setting. <b>Conclusion:</b> There is marked deficiency in the knowledge of pulse oximetry in the healthcare professionals. Strategies directed at improving the competency correct interpretation of pulse oximetry are urgently needed, to improve patient care and safety. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OC09-OC13&id=12007 https://doi.org/10.7860/JCDR/2018/35696.12007 Profile and Causes of Low Vision and Blindness in Children from Two Schools for the Blind in Tamil Nadu, Southern India Deepa John, Padma Paul, Lekha Abraham, Malavika Babu, Visalakshi Peravali, Thomas Kuriakose <b>Introduction:</b> World Health Organisation’s (WHO) “Vision 2020” right to sight programme gives high priority towards control of Child Hood Blindness (CHB). Blind school screening provides data on the causes of CHB to focus on health care programmes towards prevention of CHB. <b>Aim:</b> To determine the causes of CHB seen in local schools for the blind, to compare these with reports from India and focus on changes in the causes of CHB over the years. <b>Materials and Methods:</b> A cross-sectional study was conducted in two schools for the blind in Tamil Nadu, India. Children less than 18 years were included. Best Corrected Visual Acuity (BCVA), anterior segment and dilated fundus examination was done for all children. Information was gathered as per WHO prevention of blindness (WHO/PBL) form. <b>Results:</b> BCVA in the better eye was 6/24 to 3/60 in 31 children (16.8%), <3/60 to no perception of light in 154 children (83.2%). The causes of blindness based on anatomical site were retina 77(41.5%), whole globe 59(32%), cornea 14(7.5%), optic nerve 14(7.5%), lens 10(5.7%), refractive error in 7(3.8%) and uvea in 4(2%). Hence, 14(7.5%) of the causes were preventable and 21(11.4%) were treatable; thus 35(18.9%) were avoidable causes of blindness. <b>Conclusion:</b> Retinal dystrophies were the major cause of CHB in our study. Posterior segment anomalies contributed to 50% of the causes for CHB. Our study showed that one-fifth of children had avoidable blindness. Regular screening in well baby clinics, schools and in the community is needed for early identification of avoidable blindness in children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=NC05-NC07&id=12024 https://doi.org/10.7860/JCDR/2018/36884.12024 Quality of Sleep among Medical Students: Relationship with Personality Traits Anurag Rathi, Ramdas Sarjerao Ransing, Kshiord Kumar Mishra, Neena Narula <b>Introduction:</b> Sleep quality affects the academic performance and interpersonal relationship of students and predisposes them to mental illnesses. Personality traits are one of the known factors contributing to the sleep architecture of an individual. <b>Aim: </b>The present study investigated the relationship between sleep quality and personality traits among medical students. <b>Materials and Methods:</b> The index study was a cross-sectional, self-administered, and questionnaire-based study. The medical students were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Eysenck Personality Questionnaire-Revised Short Scale for sleep quality and personality traits, respectively. <b>Results: </b>Among 166 medical students, 54 (32.53%) reported poor sleep quality. Students with poor sleep quality had higher scores on neuroticism (6.24±3.08) than those with good sleep quality (4.23±2.52, p<0.001). Neuroticism was positively correlated with the global score on the PSQI (r=0.39, p<0.001), whereas extraversion was negatively correlated with the global score (r=-0.16, p<0.05). <b>Conclusion:</b> Neuroticism and extraversion are associated with poor sleep quality among medical students. The effect of sleep disorders on academic performance may be improved by exploring these personality traits in future studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=VC01-VC04&id=12025 https://doi.org/10.7860/JCDR/2018/24685.12025 Cone-Beam Computed Tomography Evaluation of Vertical Bone Thickness of Midpalatal Suture Area in Young Patients: A Pilot Study Guilherme Neumann, Daniela Daufenback Pompeo, Ossam Abu El Haje, Gláucia Helena Faraco de Medeiros, A´lvaro Furtado, Henrique Damian Rosario, Luiz Renato Paranhos <b>Introduction:</b> Miniscrews are devices used when absolute anchorage is required. They are easy to install and recommended for all ages. <b>Aim:</b> The aim of this study was to assess bone thickness of midpalatal suture area in young patients and a potential difference between genders. <b>Materials and Methods:</b> Sixteen patients (11 girls and 5 boys) aged 9 to 15 years who sought orthodontic treatment in an Orthodontic clinic were included in this study. A cone beam computed tomography was performed and three tomographic images were obtained: axial, coronal, and sagittal. Four measurements were made through the RadiAnt™ DICOM Viewer software in predefined regions: mesial of the first upper premolar (P1), mesial of the second upper premolar (P2), mesial of the first upper molar (P3), and distal of the first upper molar (P4). The ANOVA test was used to analyse the difference between genders at 5% significance level. <b>Results:</b> The average bone thickness in midpalatal suture area was 12.18 mm, 6.6 mm, 4.97 mm, and 6.36 mm for regions P1, P2, P3, and P4, respectively. There was no statistically significant difference between genders. <b>Conclusion:</b> Considering the limitations of the present study, we may conclude that vertical bone thickness of midpalatal suture area of young patients is greater in the mesial region of first premolars, and although patients of the male gender have presented greater thicknesses, they were not statistically significant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZC24-ZC26&id=12026 https://doi.org/10.7860/JCDR/2018/32491.12026 Role of Shear Wave Elastography in Diagnosis of Benign and Malignant Thyroid Nodules Khamis Hassan Bakari, Khamis Abdulrahman Simai, Fabian Pius Mghanga, Henry Anselmo Mayala, Xie Mingxing <b>Introduction:</b> The role of Virtual Touch Imaging Quantification (VTIQ), a non-invasive Shear Wave Elastography (SWE) mechanism for analysing Thyroid Nodule (TN) elasticity, in differentiating benign from malignant thyroid nodules has been little studied. <b>Aim:</b> To evaluate the role of VTIQ in distinguishing between benign and malignant thyroid nodules. <b>Materials and Methods:</b> A total of 54 selected patients with thyroid nodules who were planned for surgical treatment were included in this prospective study. Seventy-eight TNs in these patients were scanned by conventional B-mode ultrasound, colour doppler ultrasound and SWE ultrasound. Histopathological examination of the TN was also performed. Tissues stiffness was calculated by VTIQ which was used in shear wave velocity approximation. The greater the shear wave velocity means the greater the tissue stiffness measured in meter per second (m/s) and the higher the probability of malignancy. The summary Receiver Operating Characteristic curve (sROC) was used to calculate the diagnostic accuracy of SWE in diagnosing malignant nodules. <b>Results:</b> The surgical cytology results defined 54 (69.23%) and 24 (30.77%) thyroid nodules as malignant and benign, respectively. The ROC curve stated a single cut-off of 3.49 m/s of a Shear Wave Velocity (SWV) for predicting the diagnostic accuracy of the Thyroid Cancer (TC). The diagnostic accuracy was 62.96%; the Positive Predictive Values (PPV) for malignant and benign tumours was 95.12%, and 59.46%, respectively. Compared to B-mode ultrasound features for predicting the diagnostic accuracy of the thyroid cancer, SWV =3.49 m/s indicates a higher diagnostic accuracy of the thyroid cancer in this study (p<0.0001). <b>Conclusion:</b> The Shear Wave Elastography (SWE) has a high diagnostic accuracy in the diagnosis of malignant and benign thyroid nodules of diameter more than 1 cm and can be used as a standard diagnostic tool for distinguishing between benign and malignant thyroid nodules. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=TC05-TC08&id=12038 https://doi.org/10.7860/JCDR/2018/35238.12038 Correlation of Ultrasound Acoustic Radiation Force Impulse Elastography with Sonographic Severity Grading of Fatty Liver Disease Varsha P Rangankar, Priya R Bhole, Sarang S Gosavi, Sarang R Rathod <b>Introduction:</b> Fatty liver is one of the commonly encountered incidental finding in routine ultrasonography practice. The fatty liver has been divided into three grades according to severity based on the degree of increased liver echotexture on ultrasonography. Ultrasonic elastography technique which measures liver stiffness is being used in quantitative and semiquantitative assessment of various liver conditions with few studies available on its role in fatty liver disease. <b>Aim:</b> To investigate the correlation of Acoustic Radiation Force Impulse (ARFI) elastography with ultrasound grading of the fatty liver disease. <b>Materials and Methods:</b> One hundred and nineteen patients were examined using B-mode ultrasonography and ARFI elastography and were divided in grade 0 (control group) and grade 1, 2, 3 according to severity of fatty liver. Ten successive ARFI readings were obtained from right lobe of liver and mean was considered the final ARFI value. Statistical analysis was performed using SPSS software, Version 20.0 with application of ANOVA test and t-test. <b>Results:</b> Total 119 patients, 68 males and 51 females were included in the study. Out of 79 patients of fatty liver, 39 patients had Grade 1 fatty liver, 29 patients had Grade 2 fatty liver, and 11 patients had Grade 3 fatty liver. Forty patients with normal liver were included in the control i.e., grade 0 group. The mean ARFI was 0.97±0.10 in grade 0, 1.24±0.14 in Grade 1, 1.38±0.16 in Grade 2 and 1.74±0.50 in Grade 3 groups. The difference between mean ARFI values between the control group and fatty liver group and also across various grades of fatty liver was found to be significant (p<0.001). The patients with a higher grade of fatty liver showed higher values on ARFI elastography. The difference between ARFI values in alcoholic and non-alcoholic fatty liver patients were not statistically significant. <b>Conclusion:</b> There was significant difference in ARFI elastography velocity measurements between normal and fatty liver patients. The difference between the mean ARFI values across the severity grades of fatty liver was also significant with higher ARFI elastography values seen in higher grades of fatty liver. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=TC09-TC12&id=12039 https://doi.org/10.7860/JCDR/2018/36232.12039 Identification of Skin Tumours using Statistical and Histogram Based Features TR Thamizhvani, RJ Hemalatha, Bincy Babu, A Josephin Arockia Dhivya,Josline Elsa Joseph, R Chandrasekaran <b>Introduction:</b> Skin tumour is uncontrolled growth of cells in skin. Skin tumour is becoming predominant in different parts of the world. Basal carcinoma, squamous carcinoma and melanoma are the skin cancer types common in India. The rate of survival depends on the cancer stages, if diagnosed early it can be treated completely. Statistical and histogram features can be defined as part of image processing algorithm used to identify the type of skin tumours based on the probabilistic occurrence and intensity of pixel values respectively. <b>Aim:</b> The aim was to illustrate easy identification process of skin tumours from dermal images using statistical and histogram features. <b>Materials and Methods:</b>Dermal images were obtained from the PH2 database for identification of two different types of skin tumours such as melanocytic nevi and malignant melanoma. Colour Histogram was used to differentiate the two categories. Pre-processing and segmentation was performed for extraction of statistical and histogram based features from the lesion. From the extracted features, mean and standard deviation values were calculated for proper identification of skin tumours. Further to improve the accuracy of the identification, neural network classifiers were used which defines more enhanced efficiency in detection of skin tumours. <b>Results:</b> Colour histogram was used to differentiate the two categories of skin tumours. Malignant melanoma possesses high peaks of channel pixels at both extremities of the histogram. Histogram and statistical based features derived from the lesion describes that malignant melanoma has higher values of mean and standard deviation of features derived from segmented lesions. Neural network classifiers were used for further accuracy of identification which distinguishes the two different categories of skin tumours. <b>Conclusion:</b> Colour histogram, statistical and histogram based features were derived for differentiation and identification of two categories of skin tumours. Thus, a simple and effective technique for description of skin tumours was determined. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=LC11-LC15&id=12040 https://doi.org/10.7860/JCDR/2018/36258.12040 Is Preoperative Anthropometric Data Assessment Reliable Indicator for Estimating Femoral Tunnel Length in Anterior Cruciate Ligament Reconstruction? Nagamanickam Rajendran Sutharsen, Prem Kotian, Rajendra Annappa, Srikanth Mudiganty, Sharan Mallya, Nabeel Mohammed <b>Introduction:</b> Correct length of the femoral tunnel is required for adequate length of graft inside the femoral canal. Length of femoral tunnel depends on mass, height, dimensions of lateral femoral condyle and amount of flexion of knee intraoperatively. Increasing weight and BMI affects the length of femoral canal since they affect positioning of limb in maximal knee flexion. <b>Aim:</b> To measure tunnel length in independent femoral tunnel drilling using the medial portal and to correlate the tunnel length with anthropometric data (height, weight, BMI of patient) and with width and depth of Lateral Femoral Condyle (LFC) based on MRI. <b>Materials and Methods:</b> The present prospective study including 40 patients were conducted. Participants were selected by a non-random convenience sampling methodology. Complete details of patients were collected by verbal communication with the patients and their attendees, clinical examination, baseline investigations, radiological investigations and surgical findings. Radiological investigations included preoperative assessment of LFC in MRI. Surgical findings were determined by measuring the femoral tunnel length after initial drilling through the medial portal using a depth gauge placed through the medial portal. SPSS version 17.0 was used for data analysis. <b>Results:</b> A total of 40 patients, 30 males and 10 females were included. Mean BMI was 24.22 kg/m2 with the range of 18 to 30. Mean width of LFC was 32.9 mm with range of 26.2 mm to 37.3 mm and depth of LFC was 58.79 with range of 50.7 mm to 66.2 mm. Mean femoral tunnel length was 38.4 mm with range from 32 mm to 44 mm. <b>Conclusion:</b>Average femoral tunnel length in Anterior Cruciate Ligament (ACL) reconstruction was 38.4 mm for assessed 40 patients. This correlated positively with height and weight of the patient. It also correlated positively with the width (p=0.027) and depth (p=0.029) of lateral femoral condyle. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=RC08-RC10&id=12041 https://doi.org/10.7860/JCDR/2018/36107.12041 Prevalence of Vitamin D Deficiency and its Associated Risk Factors during Early Pregnancy in a Tropical Country: A Pilot Study Muhammad Azfar Shairazi Mohd Ariffin, Fatin Norhafizah Fazil, Nursabrina Mohd Yassin, Nurul Syahida Junaida, Poh Vien Gan, Rahana Abdul Rahman, Kok-Yong Chin, Nor Haslinda Abdul Aziz <b>Introduction:</b> Vitamin D deficiency (circulating 25-hydroxyvitamin D level <50 nmol/L) is a major health problem especially among pregnant women because it can affect the health of both mother and foetus. This problem is prevalent even among pregnant women living in tropical countries despite the abundance of sunlight. <b>Aim:</b> This study aimed to determine vitamin D status in pregnant women at 11-16 weeks of gestation and its associated risk factors. <b>Materials and Methods:</b> A pilot descriptive cross-sectional study was carried out among 57 pregnant women at early pregnancy at a tertiary medical centre in Kuala Lumpur, Malaysia. The subjects answered physician-guided questionnaire consisting of demographic information, medical history, dietary intake. Information regarding sun protection regime was included and duration of sunlight exposure was calculated using the formula: minutes of sunlight exposure per day multiply by days of sunlight exposure per week. Skin colour was assessed by using Fitzpatrick classification. Blood of pregnant women at 11-16 weeks of gestation was collected to determine the circulating 25-hydroxyvitamin D level. All results were analysed using SPSS software and results were considered significant when the p-value was <0.05. <b>Results:</b> The subjects (mean age 32.88±4.52 years) were predominantly Malay (85.96%). The prevalence of vitamin D deficiency among these women was 91.23%. Vitamin D status of the subjects was not associated with working status (p=1.00), dietary vitamin D intake (p=0.90), skin colour (p=0.42), attire choice (p=0.22) and duration of sun exposure (p=0.09). The total daily vitamin D dietary intake of the subjects taking supplements containing vitamin D was significantly higher than non-users (p<0.05). The other dietary sources did not influence the total dietary intake of vitamin D significantly (p<0.05). <b>Conclusion:</b> Prevalence of vitamin D deficiency is high among urban Malaysian women at early pregnancy. The associations between risk factors and vitamin D status in these women are generally not significant. Consuming supplements containing vitamin D at early pregnancy could improve the daily vitamin D intake of these vitamin D deficient women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=QC18-QC22&id=12104 https://doi.org/10.7860/JCDR/2018/36585.12104 The Relationship between Perineural Invasion, Peritumoural Inflammation, and Cervical Lymph Node Metastases in Laryngeal Squamous Cell Carcinoma Mecdi Gurhan Balci, Mahir Tayfur, Tülay Basak <b>Introduction:</b> Amongst all the malignant tumours, laryngeal cancer is found in 2.2% of males and 0.4% of females. Histopathologically, 90-95% of all laryngeal cancer is Squamous Cell Carcinoma (SCC). Tumour stage and cervical lymph node metastases are the most influential factors in determining a worsening prognosis. <b>Aim:</b> To investigate the relationship between perineural invasion, peritumoural inflammation, other commonly used prognostic parameters such as tumour stage, and cervical lymph node metastases in laryngeal SCC which contribute to the follow-up and treatment of patients. <b>Materials and Methods:</b> The pathology archive at Istanbul Sisli Hamidiye Etfal Education and Research Hospital was utilised for this research. Retrospective analysis of data on 110 cases of laryngectomy and neck dissection specimens was performed. Cases diagnosed as SCC were included in the study. Histopathologic analysis was conducted on the paraffin-embedded tissue sections of 110 cases. The data were encoded, transmitted to a computer, and analysed using SPSS® 20.0. The Kruskal-Wallis H test was used to compare the groups. Statistical significance was considered to be p-value=0.050. <b>Results:</b> The rate of cervical lymph node metastases was higher in the presence of perineural invasion, mild peritumoural inflammation, and advanced tumour stage. A statistically significant relationship was identified between perineural invasion, peritumoural inflammation, tumour stage, and the rate of cervical lymph node metastases in case of SCC of the larynx. <b>Conclusion:</b> Cervical lymph node metastases should be carefully investigated in the presence of perineural invasion and mild peritumoural inflammation in case of SCC of the larynx. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=EC13-EC16&id=12105 https://doi.org/10.7860/JCDR/2018/36699.12105 The Effect of Position Change on Arterial Oxygen Saturation in Cardiac and Respiratory Patients: A Randomised Clinical Trial Samane Najafi, Shirin Madadkar Dehkordi, Mahdi Basirimog Haddam, Mohsan Abdavi, Mohammad Memarbashi <b>Introduction:</b> Measuring arterial blood gas, which is performed in different parts of the body, plays an important role in clinical evaluation. <b>Aim:</b> The present study was conducted to determine the effect of position change on arterial oxygen saturation in different parts of the body, in cardiac and respiratory patients. <b>Materials and Methods:</b> The present randomised clinical trial was conducted on 169 hospitalised patients admitted to 22 Bahman Hospital of Gonabad in 2016. Patients were selected through convenient sampling, then were randomly assigned into three groups of cardiac patients, respiratory patients and control. Initially, the patient was placed in a semi-fowler’s position for 15 minutes; then, arterial oxygen saturation was measured at three points i.e. the auricle, fingertip and tip of the greater toe simultaneously. Then, the patient was placed in the supine and prone positions and the arterial oxygen saturation was measured following the same protocols of the former position. Collected data were analysed at a significance level, p-value less than 0.05 by SPSS-version 20 through the analysis of variance with repeated measures, independent t-test and Pearson correlation coefficient. <b>Results:</b> The mean oxygen saturation percentage has statistically significant difference at different positions (p=0.016). It was also found that there was a significant difference between the mean oxygen saturation on three different points i.e. fingertip, auricle and the tip of the greater toe (p<0.001). <b>Conclusion:</b> The arterial oxygen saturation in the semi-fowler’s position and the auricular point were higher in the three groups of patients with and without cardio-respiratory disorder than other positions and body points. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OC33-OC37&id=12130 https://doi.org/10.7860/JCDR/2018/36282.12130 Staining Ability of Turmeric-Persica Solution and Turmeric-GC-MI Plus Paste on Remnant Adhesive Resin after Bracket Debonding Hossein Aghili, Mahmood Golzarian, Soghra Yassaei, Zahra Ebrahiminik, Zahra Moradi <b>Introduction:</b> Cleanup, the tooth-coloured adhesive used in orthodontics is time-consuming which may cause the iatrogenic enamel damage. Various techniques have been proposed to reduce the operator-sensitivity of the composite detection procedure. Applications of ink dye and 0.2 brilliant green solutions and articulating paper are some examples. <b>Aim:</b> To compare the staining effects of Turmeric-Persica solution and Turmeric-GC-MI Plus paste on remnant adhesive on teeth after bracket debonding. <b>Materials and Methods:</b> Forty metal brackets were bonded to 40 caries-free extracted premolars. After debonding, teeth were randomly divided into two groups of 20 each. Teeth in Group 1 (G1) were immersed in Turmeric-Persica solution while in Group 2 (G2) Turmeric-GC-MI Plus paste was applied to the buccal surface of the teeth. After rinsing and drying, all the specimens were photographed under standard situations and analysed by MATLAB software to evaluate the colour differences between enamel and adhesive. Collected data were statistically analysed by SPSS version 16.0 and compared by Mann-Whitney U test. The significance level was considered to be 0.05. <b>Results:</b> The mean cross-border yellowness was significantly higher in G2, turmeric-GC-MI Plus paste, than G1, turmeric-persica solution. (with a p-value: 0.005). <b>Conclusion: </b>Turmeric powder mixed in GC-MI Plus paste could be used as a disclosing material for adhesive resin applied to tooth surface. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZC34-ZC36&id=12131 https://doi.org/10.7860/JCDR/2018/35475.12131 The Role of Mother's Early Maladaptive Schema in Predicting Early Maladaptive Schemas and Loneliness of Children Aged 8 to 15 Years in Amol City, Iran Fatemeh Rasuli Moghadam, Arezoo Davarinia Motlagh Quchan, Sadighe Khalili Shomia <b>Introduction:</b> Early maladaptive schemata which are emotional, cognitive self-harm patterns have placed in the mind since the beginning of transformation growth and repeat in the course of life. As cognitive infrastructures, maladaptive schemata lead to development of irrational beliefs. Loneliness in children is failure and weakness of interpersonal interaction with their peers as a consequence of which unhappiness with social relations occur. <b>Aim:</b> The present study was carried out in order to investigate the role of early maladaptive schemata of mothers in predicting early maladaptive schemata of children and their feeling of loneliness in the city of Amol. <b>Materials and Methods:</b> The present correlational study was conducted among 150 girls and 150 boys with their mothers, selected through simple random sampling. The research tools consisted of Yangs early maladaptive Schema (1998), Rijekabour and Debo Schema Questionnaire (2010) and Ashers Loneliness Questionnaire (1985). Data were analysed by descriptive and correlational tests using SPSS 20.0. <b>Results:</b> There was a significant relationship between the domains of marginalization, exclusion, autonomy, and the impaired performance of the mother with the childs loneliness, between the marginalization and exclusion of the mother with mistrust and child abuse, between self-regulation and the impairment of mother performance with the failure of the child, and between other aspects of mothers behaviour and the undeveloped self of the child. However, there was no significant relationship between mothers excessive readiness with childs vulnerability or between the inhibition and the limitations of mother with child defect. <b>Conclusion:</b> Some parent schemata play a role in loneliness of children and some in their maladaptive schemata; therefore, it is suggested that parents should be provided with training courses in the beginning of their children’s entrance to school in order to improve the level of mental health of the future generation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=IC01-IC03&id=12072 https://doi.org/10.7860/JCDR/2018/36369.12072 Students’ Satisfaction about the Performance of Advisor Professors Fahimeh Moghadam, Somayeh Bagheri <b>Introduction:</b> Advice and guidance by counselors during the course will help students to overcome problems, achieve educational goals and succeed. <b>Aim:</b> The present study was to evaluate the students opinion about educational guidance and counseling in School of Health of Zabol University of Medical Sciences. <b>Materials and Methods:</b> In this cross-sectional descriptive and analytical research, viewpoints of 242 students were collected by a questionnaire. In this questionnaire, the first section contained demographic characteristics of students and advisor. The second section encompassed of 25 items, score using a five-choice format. The statistical tests such as independent t-test, one-way ANOVA, and Tukey’s test are used to compare the findings. <b>Results:</b> The highest mean scores were allocated to the evaluation of academic status and fluctuations in grades of students by the advisor, signing and controlling the unit selection form and other forms, announcing the counseling hours, evaluating the requests for permanent transfer, or transfer as guest, or medical certificates by academic advisor and knowledge of the advisor about the fields of study of students, respectively. Mean of perspective of students towards the performance of advisor was 3.91. Significant relationship between student perspectives and variables of gender, marital status and place of residence (p<0.05) was found. However, no significant association was found between the last academic degree and gender of advisor and perspective of students (p<0.05). <b>Conclusion:</b> The perspective of students toward the performance of the advisor was moderate. Therefore, improvement of the counseling services by equipping the consultant professors with sufficient knowledge through training courses and workshops is possible. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=JC14-JC18&id=12064 https://doi.org/10.7860/JCDR/2018/36142.12064 EBUS-TBNA-Initial Experience from a Tertiary Care Center in Southern India Arun Nair, Nithya Haridas, Subin Ahmed, Pallavi Vijay Borkar <b>Introduction:</b> Conventional trans bronchial needle aspiration is associated with a low diagnostic yield in mediastinal adenopathy. Ultra sound guidance improves the diagnostic yield in these cases. Though linear probe EBUS was introduced in southern India as early as 2008, there is a dearth of literature in South Indian population on the utility of this diagnostic modality. <b>Aim:</b> To analyse the diagnostic yield, sensitivity, specificity of real time endo bronchial ultrasound guided trans bronchial needle aspiration (EBUS-TBNA). <b>Materials and Methods: </b>A prospective observational study was carried out from April 2014 to October 2016. Patients referred for evaluation of medisatinal lymphadenopathy were evaluated with computed tomography of the thorax and EBUS-TBNA was done under conscious sedation. Rapid on site examination was done. A sample that was positive for malignant cells/ granuloma was considered to be diagnostic. A non-diagnostic procedure was followed up with definitive surgery or a six month clinicoradialogical follow up. <b>Results: </b>The study included 78 patients (48 males) with mean age 55.9 years. EBUS-TBNA detected 237 enlarged mediastinal nodes with average diameter of 20.48±8.55 mm. A total of 125 lesions were sampled of which sub carinal lymph node was the most common station (44.8%). Average of 1.6 lymph nodes was sampled per patient with 2.92 passes per lymph node. The procedure had a diagnostic yield of 91.02%, with sensitivity of 89.55% (79.65-95.70%), specificity of 100% (71.51-100%), Negative likelihood ratio of 0.10 (0.05-0.21), positive predictive value of 100% (94.04-100%), negative predictive value of 61.11% (32.75-82.70%). Majority of the patients were diagnosed with non small cell cancer with tuberculosis constituting the major diagnosis among the patients with clinical suspicion of a non malignant aetiology. There were no complications associated with the procedure. <b>Conclusion: </b>EBUS guided TBNA is a safe procedure with a good diagnostic yield. It is a useful procedure in lymph nodes which remain inaccessible by conventional TBNA or mediatinoscopy based on size or location. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OC29-OC32&id=12067 https://doi.org/10.7860/JCDR/2018/37037.12067 Risk Factors Associated with Major Neonatal Birth Injuries During Caesarean Section in a Tertiary Care Hospital in Southern India over a Year: A Retrospective Analytical Study Deepti Pinto Rosario, Liji Sarah David, Neeraj Kulkarni, Manisha Madhai Beck <b>Introduction:</b> Neonatal birth injuries are commonly associated with instrumental vaginal deliveries, but have also been known to occur at uncomplicated vaginal or caesarean deliveries. Caesarean section confers some amount of protection against injuries at birth, but these can still occur with an incidence of 1.1%. Most common injury noted has been scalp lacerations followed by cephalohaematoma, others are fractures, brachial plexus injury, etc. <b>Aim:</b>This study was carried out to find the incidence of and risk factors associated with major neonatal injuries sustained during Lower Segment Caesarean Section (LSCS) done in the Department of Obstetrics and Gynecology, Christian Medical College, Vellore, a tertiary level hospital in Southern India, over a period of one year. <b>Materials and Methods:</b> The hospital numbers of babies who had sustained major birth injuries during LSCS from June 1st 2015 to May 31st 2016 were retrieved from the sentinel events register, being maintained by the charge nurse in the operation theatre. The details of the mothers, including details of LSCS, intraoperative findings, and their babies were then retrieved from the medical records. Major birth injuries were defined as lacerations or cuts requiring suturing; fracture of bones; intracranial haemorrhage; skull fracture, facial nerve injury and intra-abdominal injury. The data was entered into clinical proforma and analysed using SPSS software (IBM, version 23). Descriptive measures like mean, median and standard deviation were computed for all continuous variables. <b>Results:</b> There were a total of 12,430 deliveries in the period from June 1st 2015 to May 31st 2016, out of which 35% (4,375) were caesarean deliveries. Out of 4,375 caesarean deliveries, there were six cases of major neonatal birth injuries, incidence being 0.13%. Of the six birth injuries, 66.6% were lacerations and remaining were femoral fractures (33.3%). We found that primiparous women carrying singleton pregnancies in cephalic presentation, undergoing LSCS following onset of labour were at increased risk of having major neonatal birth injuries. Presence of oligohydramnios intraoperatively, incision to delivery interval <5 minutes and surgery carried out by surgeons with mid-level expertise during “risk hours” (12am-8am) were also at risk. We did not find an increased risk with J or U shaped uterotomy incisions. Neonatal risk factors included prematurity and female gender. We did not find any correlation with very low birth weight and/or macrosomia. The average birth weight in this cohort was 2.35 kg . <b>Conclusion:</b> Presence of risk factors like foetal prematurity, presence of oligohydramnios intraoperatively; incision to delivery interval <5 minutes and delivery during the “risk hours” increases the risk of major birth trauma at LSCS. However, our numbers are small to measure the exact correlation. Hence, prospective studies with larger sample size are needed to study the risk factors. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=QC14-QC17&id=12068 https://doi.org/10.7860/JCDR/2018/36449.12068 Assessment of eGFR, using Cystatin-C and Creatinine Based Equations for the Early Detection of Renal Injury in Diabetic and Non Diabetic Patients S Sangeeta, Jeevan Ambekar, Tunguthurthi Sudhakar, Mohd Shannawaz, Nilima Dongre <b>Introduction:</b> Assessment of renal function in individuals with Type-2 diabetes is very important as diabetic nephropathy is the major cause of Chronic Kidney Disease (CKD) which leads to the most frequent cause of End Stage Renal Disease (ESRD) in diabetic patients. Glomerular Filtration Rate (GFR) can be considered as best index for assessment of renal function. <b>Aim:</b> To assess the eGFR using Serum Cystatin-C and compare with Serum creatinine based equations for the early detection of renal injury in Diabetic and Non Diabetic patients. <b>Materials and Methods:</b> The present cross-sectional study was carried out after getting approval by institutional human ethical committee. A total of 150 participants were part of the study after obtaining the informed consent. Group-I included 50 Normal healthy controls, Group-II included 50 Chronic Kidney Disease Patients without Diabetes Mellitus (CKD-ND) and Group-III included 50 patients of Chronic Kidney Disease with Diabetes Mellitus (CKD-DM). Serum Cystatin-C, Creatinine, Urea and Glucose were estimated in the serum sample. eGFR was calculated by using Creatinine and Cystatin C based CKD-EPI equation. Data was analysed by SPSS 20.0. Correlation analysis was done using Karl Pearson’s correlation coefficient. A p-value less than 0.05 were considered as significant. <b>Results:</b> Serum Cystatin-C and serum creatinine were significantly increased in Non diabetic patients with CKD, a considerable decrease in eGFR was observed in Group-II compared to Group-III. Serum Cystatin-C showed a significant negative correlation with eGFR among the groups. There was a strong correlation of serum Cystatin-C with eGFR in Group-II and Group-III compared to Controls. <b>Conclusion:</b> Serum Cystatin-C can be used as an alternative marker to creatinine in CKD patients without diabetes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=BC30-BC33&id=12069 https://doi.org/10.7860/JCDR/2018/36698.12069 Post-marketing Safety and Efficacy Evaluation of a Novel Drug CSE-1034: A Drug-use Analysis in Paediatric Patients with Hospital-acquired Pneumonia Manu Chaudhary, Shiekh Gazalla Ayub, Mohd Amin Mir <b>Introduction:</b> Hospital-Acquired Pneumonia (HAP) is one of the common and frequently reported nosocomial infections with potential life-threatening complications in paediatric group. One of the drugs approved for treatment of various bacterial infections in all age groups is CSE-1034 (Ceftriaxone+Sulbactam+Disodiumedetate). <b>Aim:</b> To investigate the efficacy of CSE-1034 in paediatric HAP patients and identify the associated adverse events in real clinical settings. <b>Materials and Methods:</b> This Post-Marketing Surveillance (PMS) study on CSE-1034 was carried out on 450 paediatric HAP patients across 17 centres in India. Based on age, the patients were divided into three groups including infants, children and adolescents. The following information was recorded- demographic, clinical and microbiological parameters, dosage and treatment duration, concomitant medications and evaluation outcome events of treatment in terms of efficacy and Adverse Events (AEs). The statistical analysis was performed using chi-square test. The p-values were two-tailed and a value of <0.05 was considered statistically significant. <b>Results:</b> In terms of drug efficacy, 400 patients were cured, 27 showed clinical improvement and 23 were reported as clinical failure. The mean treatment duration varied from 5-7 days. The total number of AEs reported was 55. The common AEs included pain at injection site (3.6%), fever (2.7%), vomiting (2.2%), nausea (1.8%), thromophlebitis (1%), itching (0.4%) and localised pain (0.4%). About 17 AEs were reported in infant group, 18 in children and 20 AEs were reported in adolescent group. <b>Conclusion:</b> From this PMS study, it can be concluded that CSE-1034 is an effective option for the management of paediatric patients with HAP under routine clinical settings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OC25-OC28&id=12059 https://doi.org/10.7860/JCDR/2018/31549.12059 Evaluation of Genetic and Environmental Risk Factors for Deep Vein Thrombosis in Sudanese Nadir Ahmed Ibrahim, Fathelrahman M Hassan Gameel, Mahmoud Mohamed Elgari, Sana Eltahir Abdalla <b>Introduction:</b> Thrombophilia is a multi-factorial hypercoagulability disorder. The predisposing factors may be inherited, acquired or both. Factor V Leiden prothrombin 20210G>A mutations are the most common inherited factors. <b>Aim:</b> This study was aimed to investigate the prevalence of Factor V Leiden (1691G>A) and prothrombin 20210G>A mutations in Deep Vein Thrombosis (DVT) patients and to investigate the role of non-genetic risk factors in the manifestation of DVT. <b>Materials and Methods:</b> A total of 192 Sudanese subjects were examined, including 100 DVT patients and 92 healthy controls. Demographic and clinical data were collected using a specific questionnaire. Citrated blood samples of patients and controls were used for coagulation assays, and DNAs isolated from Ethylenediaminetetraacetic Acid (EDTA)-blood samples were used for the detection of Factor V Leiden and prothrombin 20210G>A mutations using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) analysis. <b>Results:</b> Out of all the subjects, none of the 192 subjects carried the Factor V Leiden or prothrombin 20210G>A mutations. No significant differences were detected in the prevalence of DVT between males and females. The prothrombin fragment 1+2, Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), and D-dimer levels were significantly elevated in DVT patients than in healthy controls (p<0.05). Immobility status and cardiovascular disease were most significantly associated with age (p<0.0001). <b>Conclusion:</b> Factor V Leiden and prothrombin 20210G>A mutations were not accountable for DVT in the Sudanese population examined in this study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=GC07-GC10&id=12060 https://doi.org/10.7860/JCDR/2018/36923.12060 Osteochondroma in Jordanian Patients: Clinical Manifestations and Management Ziyad M Mohaidat, Abed-Allah A Saleh, Mamoon H Al-Omari, Ahmad A Obeidat, Ruba A Khasawneh <b>Introduction: </b>Osteochondroma is the most common benign bone tumour which can be solitary or multiple. Although usually asymptomatic, its associated deformities and secondary malignant transformation potential might be associated with significant morbidity and mortality. There are significant variations of different clinical aspects of osteochondroma among different populations, which might be related to different population characteristics including genetic variance. <b>Aim:</b> To review the clinical features and management characteristics of Osteochondroma among Jordanian patients and to compare these features with other populations. <b>Materials and Methods:</b> This was a retrospective study in which the medical records of all osteochondroma patients who had undergone surgery for one or more lesions over the period from March 2004 till June 2017 were reviewed. A total of 88 patients with a confirmed histopathological diagnosis of osteochondroma were included. The following information was collected; age, gender, location, imaging studies, indications for surgery, operative procedure, complications and recurrence. <b>Results:</b> Solitary Osteochondroma (SO) was four times more common than Multiple Osteochondromas (MO). In SO, male/female ratio was 2/1, 69% (48/70) of patients presented before the age of 20 years. 4.3% (3/70) had recurrence after excision, 1.4% (1/70) had corrective osteotomy. In MO; male/female ratio was 1.25/1, 89% (16/18) presented before the age of 20 years, 2.2 (39/18) was the average number of tumours per patient, 50% (9/18) had a positive family history, 5.6% (1/18) had corrective osteotomy and none had a recurrence. Tumours around the knee were the most common location in both groups. X-ray was the only imaging study in two-third of tumours. Common indications for surgery included mass (49/109) and pain (39/109). Rare indications included; vascular claudication (1/109), soft tissue osteochondroma (1/109), and bursa formation (2/109). Neither group had a post-resection fracture nor a secondary chondrosarcoma transformation. <b>Conclusion:</b>In this series, there was a low over all risk of recurrence, post-resection fracture and secondary malignant transformation. Compared to other populations, Jordanian Osteochondroma patients presented a mild form of MO with low number of tumours in each patient (p-value =0.01) and low risk of associated deformities (p-value=0.025). Hence, we recommend a conservative resection approach for osteochondroma especially in anatomically inaccessible locations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=RC11-RC15&id=12061 https://doi.org/10.7860/JCDR/2018/36210.12061 Assessment of Stress and Strain in Alveolar Bone during Upper Midline Diastema Closure using Finite Element Method Sonal K Javali, Roshan M Sagarkar, Silju Mathew, Prashantha Govinakovi Shivamurthy, Sharanya Sabrish, Madhavi Naidu <b>Introduction:</b> Application of orthodontic forces to a tooth is characterised by extensive macroscopic and microscopic changes during remodelling which occurs in the Periodontal Ligament (PDL), alveolar bone and gingiva. This occurs mainly due to the local stresses and strains subjected on the supporting tissues. As direct measurement of these parameters is almost impossible, Finite Element Method (FEM) is an effective method for calculating stress and strain distribution on the alveolar bone. <b>Aim:</b> To assess the stress and strain distribution in the cortical and cancellous bone around maxillary central incisors during the process of diastema closure with a constant force using FEM. <b>Materials and Methods:</b> A three-dimensional computer model of anterior segment of the maxilla simulated from a CBCT scan was reproduced using MIMICS software and they had varying width of midline diastema of 4 mm, 3 mm and 2 mm. Each tooth was designed with a bracket on the labial surface and a 0.019×0.025 orthodontic stainless steel wire. A 1.5 N of force was applied on the labial surface of the brackets. Stresses and strains around the two central incisors on the alveolar bone were calculated. <b>Results:</b> In the cortical bone, maximum compressive stress (Von-Mises stress) was concentrated at the mesial side and tensile stress (principle stress) on the distal side near the cervical region of the central incisors in all the 3 models. Maximum stress was seen in the 2mm midline diastema model. In the cancellous bone, both these stresses were concentrated along the roots of central incisor cavity more towards the middle of the tooth in all the 3 models. In the longitudinal section, stress and strain was more concentrated at the cervical region gradually decreasing as they reached apex of the tooth in cortical bone and in the cancellous bone maximum stress was observed in the middle third. <b>Conclusion:</b> Stresses in the cortical bone increases when the diastema gap is small while strain in cancellous bone increases when the midline diastema width is large. The stresses in cancellous bone remain constant in all the 3 models. Graphically the strains were more concentrated near cervical region of the teeth in both the cortical and in cancellous bone maximum stress was observed in the middle third. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZC30-ZC33&id=12052 https://doi.org/10.7860/JCDR/2018/35434.12052 Effect of Ketamine and Fentanyl in Combination with Midazolam and Propofol during Outpatient Colonoscopy-A Randomised Controlled Trial Madhusudan Upadya, S Neeta, Gagan Brar, Anand Kulkarni, Jose Chacko <b>Introduction:</b> There are various methods for sedation in colonoscopy and ketamine has been found to be an effective alternative drug for sedation. <b>Aim: </b>To compare the efficacy and haemodynamic stability of lower dose of ketamine and fentanyl co-administered with midazolam and propofol for colonoscopy. <b>Materials and Methods:</b> Sixty American Society of Anaesthesiologists (ASA) I-II patients undergoing colonoscopy were randomised into two groups. Group I (n=30) (Fentanyl group) was assigned to receive midazolam 20µg/kg, propofol and fentanyl 2µg/kg. Group II (n=30) (Ketamine group) was assigned to receive midazolam 20µg/kg, propofol and ketamine 0.5mg/kg. The parameters measured include haemodynamic stability, recovery, pain scores and endoscopists satisfaction. All statistical analysis was carried out using Medcalc Statistical Software version 11.0 (Medcalc Software bvba, Belgium). <b>Results:</b> The time to full sedation in the ketamine group was significantly less than that in the fentanyl group (18.3±2.7 seconds Vs 22.4±2.2 seconds). Patients belonging to the ketamine group had a significantly shorter recovery time compared to those in the fentanyl group (5.8±1.4 Vs 8.0±1.9 minutes). Overall patient satisfaction was significantly higher with the use of ketamine. Patients were haemodynamically more stable with a lower incidence of hypotension in ketamine group. <b>Conclusion: </b>The present study shows that midazolam/ketamine /propofol combination provides adequate levels of analgesia and sedation, quicker recovery and has “propofol sparing” effect. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=UC05-UC09&id=12053 https://doi.org/10.7860/JCDR/2018/25815.12053 Analysis of Exhaled Breath Condensate pH in Asthma among Indian Population: A Pilot Study Manjit Sharad Tendolkar, Amita Athavale, Jairaj Nair, Sneha Tirpude, Rajwardhan Ghatge, Rahul Kendre, Anurag Deshpande, Aditi Punwani <b>Introduction:</b> Asthma is an inflammatory disorder of lungs and analysis of Exhaled Breath Condensate (EBC) pH may give insights on control of asthma. To the best of our knowledge, this is the first study of EBC pH among Indian population. <b>Aim:</b> To study EBC pH among asthmatics in Indian population. <b>Materials and Methods:</b> In this cross-sectional study, EBC pH was compared with the control of asthma as well as severity of obstruction. There were 17 males and 33 females of bronchial asthma without exacerbation in a tertiary care hospital of a metro city. EBC pH was measured without deaeration using the Arterial Blood Gas (ABG) analyser and a pH electrode. Severity of asthma was defined as per Global Initiative of Asthma (GINA) guidelines into mild, moderate and severe based on treatment required to maintain control over asthma. <b>Results:</b> Mean age of participants was 36 years. Mean EBC pH of the study participants was 7.341. Mean EBC pH in males was 7.391. Mean EBC pH in females was 7.316. Mean EBC pH among well controlled asthmatics was 7.330. Mean EBC pH among partially controlled asthmatics was 7.354. There was no significant correlation between EBC pH in well controlled and partially controlled asthmatics (p=0.71). Among subjects with normal spirometry, mean EBC pH was 7.34. Mean EBC pH among patients with moderate obstruction was 7.30. There was a consistent difference in pH of EBC when measured by a pH electrode as compared to ABG machine. Samples measured by pH electrode were acidic by pH difference of 0.8. <b>Conclusion:</b> We found no correlation of EBC pH with asthma control. Method used for testing pH of EBC affects the result and has to be considered while interpreting studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OC22-OC24&id=12054 https://doi.org/10.7860/JCDR/2018/32206.12054 Relative Leg Length as a Risk Factor for Hypertension and Diabetes in Egyptian Adults Azza Sarry El-Din, Moushira Erfan Zaki, Wafaa Kandeel, Sanaa Mohamed <b>Introduction:</b> Studies from developed societies have shown that individuals with short legs relative to height have higher risk of association with the components of the metabolic syndrome such as glucose intolerance, insulin resistance and hypertension. This has been much less explored in Egypt where influences of relative leg length may differ. <b>Aim:</b> To evaluate the impact of relative leg length on the presence of Hypertension and Type 2 Diabetes in a sample of Egyptian adults. <b>Materials and Methods:</b> This was a cross-sectional study on 4308 Egyptian adults aged between 20 and 75 years. The study evaluated the presence of prediabetes or type 2 diabetes and hypertension. The study compared anthropometric parameters in both sexes according to leg length index, using one-way ANOVA for multiple comparisons among the groups followed by independent t-test. Chi-square or Fisher’s-exact test were used for comparison of the qualitative data. Correlations were done using Pearson correlation. <b>Results:</b> Hypertension was more prevalent in cases with low leg index than with high leg length in both sexes. Significant negative correlations between leg length index and blood pressure levels were also observed. <b>Conclusion: </b>The study emphasises the potential correlation between leg length and leg length index, anthropometric parameters, body composition and hypertension among Egyptians. The study suggests that the analysis of both anthropometric measurements and body composition might be clinically important for the estimation of risk factors for type 2 diabetes and hypertension. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=BC26-BC29&id=12055 https://doi.org/10.7860/JCDR/2018/35528.12055 Nucleic Acid Amplification Testing Detects HIV Transmission Risk in Serologically-Tested Blood Donor Units Isaac Dadzie, Shemau Muniru, Patatrick Adu, Obed Cudjoe <b>Introduction:</b> Blood transfusion is an essential life-saving intervention in the healthcare delivery. Mandatory screening of donor units helps prevent transfusion-transmissible infections, such as Human Immunodeficiency Virus (HIV). <b>Aim:</b> The purpose of this study was to use Nucleic Acid-Amplification Testing (NAAT) to screen for the presence of HIV-1 in blood-banked samples labelled as “safe for transfusion” per serological testing algorithm. <b>Materials and Methods:</b> This hospital-based cross-sectional diagnostic study was conducted in May 2016 on serologically tested donor blood units in the Koforidua Regional Hospital blood bank. One hundred (100) donor samples were analysed using the COBAS® AmpliPrep/COBAS® TaqMan® HIV-1 Qual Test for the detection of HIV-1 RNA and proviral DNA. <b>Results:</b> Of the 100 donor samples that tested sero-negative for HIV-1 and 2 using the antibody screening kit, four (4) samples (4%) were reactive by NAAT. Blood donors who came for donation were only males and majority (90%) were between the ages of 17-27 years. Additionally, all the NAAT HIV-1 positive samples were from participants in the 17-27 year group. <b>Conclusion: </b>NAAT demonstrated that a significant number of HIV-infected individuals are misdiagnosed at Ghanaian points-of-care. This finding has necessitated the need for inclusion of NAAT in donor blood screening in areas prevalent for HIV-1 in Ghana, considering the risk involved in using the licensed antibody test provided by the health authorities. In cases where NAAT screening may not be feasible, newer tests that have greater sensitivity compared to the FDA-licensed 3rd generation EIA which only detects HIV antibodies can be adopted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=DC22-DC24&id=12056 https://doi.org/10.7860/JCDR/2018/36141.12056 Validation of Malaria Antigen Detecting Rapid Diagnostic Test Kit: A Study from Highly Endemic Area in Coastal India Nitin Joseph, Aditya Karanth Uchila <b>Introduction:</b>Malaria Rapid Diagnostic Test (MRDT) is widely used for diagnostic purposes in endemic areas and resource-constrained settings. However, concern about the accuracy of RDTs has made its wide-scale usage a debatable issue. <b>Aim: </b>To assess the validity of antigen detecting MRDT kits by comparing the test results with that of conventional Peripheral Smear (PS) examination used for diagnosis of malaria. <b>Materials and Methods:</b> The present cross-sectional study was done in Mangalore city which is highly endemic for Plasmodium vivax and falciparum malaria. It was conducted from May to September 2017 which corresponds to the peak season of malaria in Mangalore. The validity of antigen detecting MRDT kit namely SD Bioline Malaria Antigen test kit (Standard Diagnostics Inc., India) as a screening test was compared with a gold standard test namely Giemsa stained thick and thin blood film microscopy. <b>Results:</b> Out of the total 309 cases, 210 (68%) tested positive by PS examination. MRDT showed a sensitivity of 98.6%, specificity of 86.9%, Positive Predictive Value (PPV) of 94.1% and Negative Predictive Value (NPV) of 96.6%. False Positive (FP) rate of the test was 13.1% and False Negative (FN) rate was 1.4%. The accuracy rate of the screening test was 94.8%, positive likelihood ratio was 7.53, negative likelihood ratio was 0.016 and Diagnostic Odds Ratio (DOR) was 470.6. Sensitivity and specificity of the screening test were higher in the age group of less than 18 years compared to higher age groups. Sensitivity and NPV of the screening test were higher while PPV was lesser for diagnosing Plasmodium falciparum malaria compared to Plasmodium vivax malaria. Area under receiver operating characteristic curve for MRDT was 0.927 when compared with the gold standard test. <b>Conclusion:</b> Antigen detecting MRDT showed good performance as a screening test and hence can be recommended for wide-scale usage at this settings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=LC16-LC20&id=12043 https://doi.org/10.7860/JCDR/2018/36880.12043 Variations in Levels of Intercellular Adhesion Molecule-1 with Disease Course in Rheumatoid Arthritis Patients Vijaya Jawahar Sarithala, Pavel Koroy, Alexander Yagoda <b>Introduction:</b> Adhesion molecules play an important role in the migration of leukocytes, process of inflammation and in remodeling of tissue. Intercellular Adhesion Molecule-1 (ICAM-1) is expressed along the luminal, intercellular, and subluminal surface of endothelial cells and their expression increases after stimulation by cytokines and TNF-a in Rheumatoid Arthritis (RA). <b>Aim:</b> To study the serum concentration of ICAM-1 in patients with rheumatoid arthritis. <b>Materials and Methods:</b> Levels of ICAM-1 in 134 patients with rheumatoid arthritis (30 male, 104 female) aged 20 to 66 years were studied. Control group constituted of 70 healthy individuals of age 22 to 55 years. Concentration of ICAM-1 was determined by ELISA. Statistical analysis of the data was performed using two sample Student’s t-criterion, criteria of Newman-Keuls and correlation n analysis with application of Pearson (r) and Spearman (rs) criteria. <b>Results:</b> Index DAS28 scored up to 5.49 (4.88-6.01) in the patients. Most of the patients were diagnosed with III x-ray stage, II and III functional class of the disease. In patients with rheumatoid arthritis significantly increased (p<0.05) concentration of ICAM-1 were observed when compared to controls. Increased concentrations of ICAM-1 were not related to the sex of the patient, presence or absence of rheumatoid factor and antibody to the cyclic citrullinated peptide. In patients with late clinical stage of the disease indicators of adhesion molecules were more (p<0.05) than those of early or progressive stage of the disease. In cases with highly active inflammatory process, by index DAS 28, serum levels of ICAM-1 were relatively higher (p<0.05) than in moderate activity of the disease. Values of intercellular adhesion molecules were independent of severity of x-ray stage including that of presence or absence of erosions and were not correlated with the functional class of rheumatoid arthritis. Presence of systemic effects of the disease was characterised by high serum concentrations of ICAM-1. The appearance of complications had no effect on adhesion dynamics. In patients with thrombocytosis, indicators of adhesion molecules were higher (p<0.05) than in patients with the normal range of thrombocytes. <b>Conclusion:</b> In rheumatoid arthritis increased serum concentrations of (ICAM-1) were observed, mostly expressed in the form of high activity of inflammatory process and the presence of systemic effects, which shows pathological significance of adhesion molecules and progression of the disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OC18-OC21&id=12044 https://doi.org/10.7860/JCDR/2018/35302.12044 Impact of High Levels of Pregnancy Associated Plasma Protein-A on Pregnancy Krupa Shah, Ruby Sultana, Rajeshwari Bhat, Parvati Bhat, Shashikala Bhat <b>Introduction:</b> Routinely performed aneuploidy screen takes into account free beta human chorionic gonadotrophins (ß-hCG), Pregnancy Associated Plasma Protein-A (PAPP-A), nuchal translucency, and various maternal characteristics. Incidental finding of extreme level of PAPP-A can generate anxiety. Association of low PAPP-A has been established with chromosomal anomalies and adverse pregnancy outcome. The effect of high PAPP-A on feto-maternal outcome has not been widely studied. <b>Aim:</b> The aim of the study was to analyse pregnancy outcome in the group with high maternal PAPP-A, that is >95th centile at the first trimester aneuploidy screen test. <b>Materials and Methods: </b>The prospective observational study was conducted at Dr. TMA Pai hospital, affiliated to Manipal Academy of Higher Education, Manipal. Each patient visiting antenatal OPD was counselled for first trimester aneuploidy screening during the study period of two years (November 2015 to November 2017). All patients who were registered for delivery at the hospital were taken into the study. Blood samples were taken at 11-13+6 weeks of pregnancy. A total of 1500 consecutive pregnancies having first trimester screening were followed up with PAPP-A levels, expressed in Multiple of Medians (MoM). The study group was formed by patients with PAPP-A of more than 95th centile. Only euploid foetuses were considered for the analysis. The pregnancy outcomes were determined in PAPP-A levels of >95th percentiles (3.11 MoM and more) with respect to threatened abortion, preterm delivery, foetal malformations, hypertension in pregnancy, gestational diabetes and growth abnormalities. It was compared with matched control group of PAPP-A between 5th to 95th centile (PAPP-A >0.49 to 3.10). Statistical analysis was performed using Statistical Package for Social Science (SPSS) software version 16 and p-value <0.05 was considered statistically significant. <b>Results:</b> For our grouped data, the incidence of high PAPP-A was 4.6%, and 95th centile value for PAPP-A was 3.10 MoM. The maximum value of PAPP-A recorded was 8.6 MoM. We found no statistically significant difference in the incidence of threatened abortion, preterm delivery, foetal malformations, large for gestation foetuses, gestational diabetes, and hypertension in pregnancy. The incidence of small for gestation was significantly different across the two groups (p-value<0.05). <b>Conclusion:</b> High PAPP-A values are seen less frequently. The pregnant woman with structurally normal foetuses should be informed that there is no reason to be anxious for adverse pregnancy outcome due to high PAPP-A. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=QC10-QC13&id=12045 https://doi.org/10.7860/JCDR/2018/37145.12045 Saliva as Forensic Evidence using Fluorescent Spectroscopy: A Pilot Study Charan K Raj, Komali Garlapati, P Karunakar, Rajkumar Badam, Pratima Soni, Reddy Lavanya <b>Introduction:</b>Saliva lacks the drama of blood, the sincerity of sweat and the emotional appeal of tears, yet it is the ‘sine qua non’ of the oral cavity and can prove to be the most important fluid playing a vital role in forensics. Saliva deposited on the skin by the act of biting and licking can be an important source of forensic evidence. Saliva has an enzyme a-amylase, containing tryptophan which is an important aromatic amino acid constituent. This when excited at 254 nm gives a characteristic emission spectrum at 345-355 nm. Fluorescent spectroscopy method was used to detect enzyme a-amylase in forensic identification. <b>Aim:</b> To detect dried saliva on the human skin by fluorescent spectroscopy. <b>Materials and Methods:</b> This study was planned and conducted at IICT (Indian Institute of Chemical Technology) Hyderabad. It includes 20 saliva samples of volunteers, where in the investigator took a swab from the skin of the ventral surface of forearm deposited by licking on the arm and was diluted in 0.1M Potassium Chloride (KCl), which were randomly selected from the population. A control sample of water was deposited on the contralateral arm. Each sample was excited at 254 nm and emission spectrum of both saliva and water samples were recorded. <b>Results:</b> The emission spectra of 20 swab samples taken from dried saliva were characterised at the primary peak of 340 to 350 nm whereas the emission spectrum of water as a control was recorded at 360 nm. <b>Conclusion:</b> The presence of emission spectrum at 340–350 nm with excitation at 254 nm proves to be a strong indicator of saliva detection by Fluorescent Spectroscopy, deposited on the human skin and hence detection of saliva helps in further forensic investigation for identification of suspect. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZC27-ZC29&id=12035 https://doi.org/10.7860/JCDR/2018/35796.12035 Therapeutic Effect of Momordica charantia on Blood Glucose, Lipid Profile and Oxidative Stress in Type 2 Diabetes Mellitus Patients: A Randomised Controlled Trial Suchitra Kumari, Ipsita Dash, Kishore Kumar Behera <b>Introduction: </b>Momordica charantia (Bitter Melon) is known to have anti-diabetic property. Animal studies have documented its hypoglycaemic and lipid lowering effect. However, clinical trials with human subjects are very few and the effective dose of Momordica charantia is not studied in type-2 diabetes mellitus patients. <b>Aim:</b> To investigate the effect of Momordica charantia (1 gm and 1.5 gm) on glycaemic profile, insulin resistance, lipid profile, oxidative stress and Body Mass Index (BMI) in type-2 diabetes mellitus patients. <b>Materials and Methods:</b> A randomized controlled trial was conducted in the Department of Biochemistry, AIIMS, Bhubaneswar, Odisha, India, during Apr 2017 to Feb 2018. Seventy five uncomplicated type-2 diabetes mellitus patients were enrolled. Group A patients were supplemented with 1 gm of Momordica charantia tablets with oral anti-diabetic agents and Group B with 1.5 gm of Momordica charantia tablets along with oral anti diabetic agents, daily for eight weeks. Group C were treated with oral anti diabetic agents only (Control group). Fasting plasma glucose, Post prandial blood sugar, HbA1C, insulin resistance, lipid profile and Malondialdehyde (MDA) levels were compared between baseline and eight weeks Post supplementation. <b>Results:</b> Control group had reduced blood sugar levels but it was not significant. A 1 gm of Momordica charantia along with oral anti-diabetic agents had significantly reduced blood sugar, HbA1C, Total cholesterol, LDLc in group A, without improving insulin sensitivity and oxidative stress (MDA). A 1.5 gm of Momordica charantia add on treatment along with stable dose of oral anti-diabetic improved glycaemic profile along with insulin resistance (p<0.05) in type-2 diabetes patients. It reduced total cholesterol, LDLc and increased HDLc levels. It significantly decreased the MDA levels. However, Momordica charantia had no significant effect on Triglycerides and TAG/HDLc ratio in type-2 diabetes mellitus patients. <b>Conclusion: </b>Add on treatment with 1.5 gm/day of Momordica charantia is effective in glycaemic control, lowering Total cholesterol and oxidative stress. It improves HDLc and insulin resistance in type-2 diabetes mellitus patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=BC21-BC25&id=12036 https://doi.org/10.7860/JCDR/2018/36354.12036 Variations in the Drainage Pattern of Middle Hepatic Vein and Left Hepatic Vein in the Left Lobe of Liver Poonam Shilal, Sneh Agarwal, Anitatuli, Smita Kakkar <b>Introduction:</b> The Left Hepatic Vein (LHV) and the Middle Hepatic Vein (MHV) presents with wide variations, the knowledge of which is very important during various surgeries of the left lobe as well as right lobe of liver. <b>Aim: </b>To study about the variations in the branching pattern of LHV and the MHV draining the left lobe of liver. <b>Materials and Methods:</b> A total of 60 adult human livers were dissected manually. The LHV and the MHV were typed into five types. Further, few of these types were again divided into subtypes. <b>Results:</b> The incidence of presence of common trunk of LHV and MHV was 76.6% (n=46). In 20% (n=12) livers these veins were present as separate trunks. In 3.33% (n=2), no trunk of the LHV was seen and the left medial vein and the left lateral vein were found to drain independently into the Inferior Vena Cava (IVC). <b>Conclusion:</b> Appropriate knowledge of the anatomy of liver is very important, for different surgical procedures for treatment of malignancies or other ailments of liver. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=AC13-AC17&id=12049 https://doi.org/10.7860/JCDR/2018/36930.12049 Lymphocyte Apoptosis in Third Trimester of Pregnancy Hanan L Al-omary, Zainab M Alawad, Shoub Yassin Hussein <b>Introduction:</b>During pregnancy, the female’s body undergoes many adaptations, including changes in the number and survival of White Blood Cells (WBCs). Programmed deaths of the cells are an important regulatory process that happens under a variety of physiological and pathological conditions. <b>Aim:</b> To measure the percentage of apoptosis of lymphocytes in peripheral blood of pregnant females and healthy non pregnant females, and to compare lymphocytes apoptosis between them in term of blood pressure and blood sugar. Also, to relate this apoptosis to blood sugar levels and blood lead levels. <b>Materials and Methods:</b> Fourty two pregnant females in their third trimester had been enrolled in the prospective study and were considered as the patients group. They were recruited from the labour room of the Baghdad Teaching Hospital, Baghdad, Iraq. The control group consisted of 15 healthy non pregnant women with matched age. Blood samples were collected from both groups and subjected to lymphocytes apoptosis estimation; blood sugar level and blood lead level measurements. Blood lead level was measured using blood lead analyser kit. Lymphocytes examination and separation was done. Data analysis was done using SPSS version 20.0. ANOVA test, Independent sample t-test and Pearson correlation test were also used. <b>Results:</b> There was no significant difference in age and blood lead level between patients and control groups. Lymphocyte apoptosis was significantly higher in the patients group than the control group (3.50±2.24 vs. 1.49±0.66). Lead level correlated positively and significantly with lymphocyte apoptosis in both groups. Apoptosis level was not significantly higher in hypertensive patients however, it was significantly higher in diabetic patients. <b>Conclusion:</b>Lymphocytes apoptosis is significantly higher in third trimester of pregnancy and it is higher in diabetic and hypertensive pregnant women than healthy non pregnant women. The increase in blood lead level may cause a significant increase in lymphocytes apoptosis in pregnant and non pregnant women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=CC05-CC08&id=12050 https://doi.org/10.7860/JCDR/2018/37181.12050 Dermato-Lymphangitis in Filariasis Resembles Infected Chronic Venous Insufficiency: Two Case Reports and Review of Literature Dwijesh Kumar Panda, Devi Prasad Mohapatra Chronic lower limb swelling is frequently encountered in clinical practice. Secondary lymphoedema and chronic venous insufficiency are two frequent causes of chronic lower limb swelling. The most common form of secondary lymphoedema worldwide is filariasis, due to Wuchereria bancrofti. Chronic inflammation and fibrosis are histological hallmarks of lymphoedema. Chronic venous insufficiency refers to venous dilation and venous reflux of long duration. The classical signs include minimal superficial dilation with associated skin changes and ulceration. Both the conditions mimic each other although the treatment is different. The diagnosis need to be confirmed prior to institution of treatment. We present below two cases of chronic lower limb swelling with a review of literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=PE01-PE04&id=12046 https://doi.org/10.7860/JCDR/2018/37460.12046 Caesarean Section: Mortality and Morbidity Mamta Gupta, Vandana Saini Caesarean Section (CS) is the most common obstetric surgery performed today. With advancement of anaesthesia and technique resulting in improved outcome and safety, its rate has been rising. Nevertheless, it carries risk of complications resulting in morbidity and sometimes mortality. Therefore, CSs done without medial indications, remains questionable. Maternal mortality and morbidity after caesarean birth is nearly five times than vaginal births, especially the risks of haemorrhage, sepsis, thromboembolism and amniotic fluid embolism. In a subsequent pregnancy, CS increases the risks of placenta previa and adherent placenta which may further result in higher risk of haemorrhage and peripartum hysterectomy. Technical difficulties due to adhesions increase the risk of injury to bladder and bowel. Though CS can be life saving for a foetus in jeopardy, yet in countries with high caesarean rate increased neonatal mortality and morbidity is seen i.e., iatrogenic pre-term births and respiratory morbidity. Risk of rupture uterus and stillbirths in women with previous CS also increase perinatal mortality. Neonatal adaptations is delayed in caesarean babies i.e., maintenance of body temperature, glycaemia and pulmonary respiration. Development of neonatal immune system is also affected in babies born by CS. Hence, CS should be done only if medically indicated. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=QE01-QE06&id=11994 https://doi.org/10.7860/JCDR/2018/37034.11994 Role of a Prosthodontist in Forensic Dentistry- A Step towards Evolution Dikshita Ray Barua, Arindom Changmai, Amit Gaurav In Forensic odontology, dentistry plays a significant role in the identification of victims in the process of law and order. Dental identification serves as a primary mean for the identification of victim when other means such as fingerprints fail. Role of a Prosthodontist in forensic dentistry comes into play in cases where the victim has lost natural dentition and has been wearing prosthesis. Thus forensic identification by using prosthodontic appliances such as labeling of dentures and other appliances is gaining popularity as it could provide important identification clues. This paper presents a review of available literature emphasizing the fact that how a prosthodontist can play a vital role in identification of a deceased individual. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZE01-ZE03&id=11988 https://doi.org/10.7860/JCDR/2018/35881.11988 Afghan Refugees and Immigrants Health Status in Iran: A Systematic Review Nasibeh Roozbeh, Ali Sanati, Fatemeh Abdi <b>Introduction:</b> Iran, as one of the most concentrated destination of immigrants, has hosted around three million Afghan refugees in the recent decades. Due to inappropriate healthcare, and improper life style of Afghan refugees, Iran witnesses the spread of both physical and psychological disorders. Evaluating the health needs of this population is necessary for health policymakers to develop appropriate strategies. <b>Aim:</b> To provide reliable information on Afghan refugees’ health status in Iran, by conducting a systemic review on the available literature. <b>Materials and Methods:</b> Electronic databases and gray literature were searched up to July 2017. Mesh key terms were formed by combining “Afghan refugees” OR “Afghan immigrants” OR “Afghan populations” with at least one of the following terms: “health status” AND “health service”. <b>Results:</b> A total of 198 articles were extracted of which 50 were finally reviewed for the study. The present study findings demonstrate high prevalence of both communicable and non-communicable disorders as well as psychological problems in this population. Although, the risk for adverse health consequences has decreased as a great part of the immigrant population has returned to their country. <b>Conclusion:</b> In consequence of low socioeconomic status, poor health condition, improper dietary behaviours, and lack of proper immunization coverage, high incidence of physical and mental disorders is expected in Afghan immigrants in Iran which led to high economic burden and healthcare issues. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=LE01-LE04&id=12001 https://doi.org/10.7860/JCDR/2018/34869.12001 Inclusion of Forensic Odontologist in Team of Forensic Facial Approximation-A Proposal and Technical Note Aman Chowdhry, Priyanka Kapoor, Deepika Bablani Popli, Keya Sircar, Ragini Miglani Forensic Facial Approximation (FFA) or forensic facial reconstruction is a three-dimensional recreation of face of an entity from skull remains which adequately resembles deceased person to allow identification of individual. FFA involves an assimilation of anatomy, forensic science, anthropology, osteology and above all craftsmanship to artistically recreate the identity of the deceased. The aim of the present study was to highlight skills and attributes of dentist/forensic odontologists qualifying him to be part of FFA team. By careful appraisal using various search engines and hand search, we discuss to propose inclusion of a dental expert (preferably a forensic odontologist) to be a part of FFA team based on their sound scientific knowledge about human anatomy, musculature as well as exposure to various hard tissue and soft tissue landmarks that are taught as a part of undergraduate dental curriculum all over the globe. Practical training, material knowledge, artistic handiwork with adept use of various hand instruments given to dentists/forensic odontologist may be extremely beneficial when working on the skull, hence qualifies him/her as an expert to include in team of FFA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=HM01-HM04&id=12003 https://doi.org/10.7860/JCDR/2018/35863.12003 Bouveret’s Syndrome: A Rare Case Presentation Dhvani Bharat Shah, Hiranya Deka, Priyanka Gopal Chilbule, Rajesh Kumar C Mahley, Divakar Jain Gall stone ileus is a rare complication of gall stones. A rarer entity is Bouverets syndrome which causes gastric outlet obstruction due to migration of gall stones into duodenal bulb through cholecystoduodenal fistula. Bouverets syndrome constitutes 1–3% of the cases of gall stone ileus which in turn complicates only 0.3–4% cases of cholelithisasis. Bouverets syndrome is managed surgically. The present case is of a 66-year-old man who presented with gastric outlet obstruction and was diagnosed with Bouveret’s syndrome later. Bouverets syndrome is an uncommon condition whose awareness is essential as it may pose a difficulty in diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=PD03-PD04&id=12008 https://doi.org/10.7860/JCDR/2018/34662.12008 Rehabilitation of a Hemimandibulectomy Patient with an Overlay Denture- A Case Report Siva Prakash Dhanaraj, H Annapoorni Prosthetic rehabilitation of hemimandibulectomy patient, with an overlay denture, restores missing skeletal, dental structures, muscle imbalance, maxillomandibular relationship and occlusion. Conventional management with an acrylic ramp or guide plane guides only the non-resected side of the mandible to occlusion. This case report describes rehabilitation of a 13-year-old, hemimandibulectomy patient with tooth supported transitional overlay denture. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=ZD03-ZD05&id=12034 https://doi.org/10.7860/JCDR/2018/34939.12034 A Case Report of Rituximab Induced Angioedema Dhaivat Shukla, Karan Shah, Sapan Pandya, Supriya Malhotra, Pankaj Patel Rituximab is a genetically engineered chimeric murine/human monoclonal IgG1 kappa antibody directed against the CD20 antigen. It has been approved for rheumatoid arthritis and is a promising new agent in the treatment of several autoimmune neurological disorders and also Sjögren’s syndrome. Common adverse reactions to treatment with Rituximab include infusion reactions including angioedema and hypersensitivity reactions. In the present case, we observed severe angioedema after low dose of Rituximab therapy. Clinicians should be vigilant when using Rituximab for such hypersensitivity phenomenon occurring despite pre-medicating with glucocorticoids. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OD03-OD04&id=12023 https://doi.org/10.7860/JCDR/2018/35585.12023 Treatment of Insomnia by Pranic Healing Rajani Aithal, Srikanth Nagaraja Jois, Prabhu Prasad Mahadevaiah Insomnia is a sleep disorder where people have trouble sleeping. This case pertains to a working, married female, aged 27 years with insomnia, complaining of irritability, low energy, daytime sleepiness and depressed mood. Pranic Healing (PH) is a natural healing technique that uses prana to treat illness. It is a non-touch, drugless, complementary therapy that corrects imbalances in the body’s energy field. Insomnia was measured using the Athens Insomnia Scale (AIS). On self-assessment before PH, AIS score was 16, indicating insomnia condition in the subject. A total of six pranic healing sessions, of 20 minutes each were applied on the subject. After six PH sessions AIS score was two, indicating a normal sleeping pattern. During the healing sessions, the subject expressed unique experiences of tingling sensation in hands, heavy energy moving out of the body and lightness of the body. At the end of the healing process, the subject experienced a sense of calmness, well-being and being energetic. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=KD01-KD02&id=12006 https://doi.org/10.7860/JCDR/2018/35961.12006 Bilateral Pneumothorax-rare Manifestation of Melioidosis Allen Aloysius D’silva, Jayasenan Jayannan, Ali Hazan Karnam, Sanjay R Nair, Natarajan Vasanthi Melioidosis is caused by gram negative bacilli called Burkholderia pseudomallei. It is an infectious threat to southeast Asian population. It predominantly affects the diabetic people who have got exposure to the contaminated soil. As it affects multiple organs, it mimics other disease like-tuberculosis. Here we report an unusual pulmonary manifestation of Burkholderia infection in a diabetic patient. A 46-year-old male presented with neck swelling and bilateral pulmonary nodules with pneumothorax. His blood culture and pus culture from neck swelling confirmed Burkholderia pseudomallei. He was managed with bilateral intercostal drainage, sensitive antibiotics and showed improvement. Melioidosis causing bilateral pneumothorax with nodules and its complete recovery was not reported earlier. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OD05-OD06&id=12057 https://doi.org/10.7860/JCDR/2018/37171.12057 Systemic Lupus Erythematosus Presenting with Finger Drop Marjan Rahimi Farahani, Samira Alesaeidi Systemic Lupus Erythematosus (SLE) is an autoimmune disease with multiple organ involvement that can affect joints, skin, heart, lungs, kidneys and nervous system. SLE is a multisystem disorder resulting from abnormal immunological function. SLE affects women more than men. It affects both the central and the peripheral nervous system. Severe acute peripheral neuropathy in SLE is quite rare and it is always accompanied by evidence of active disease in other organs, including the central nervous system. The recognition of neurologic symptoms in SLE remains a clinical problem for physicians. Neurological manifestations are frequently present in SLE patients, although the peripheral nervous system involvement is rarer than the central one. Peripheral neuropathy is a known but uncommon presentation of SLE and the aim of this study is to report various forms of lupus-related neuropathies that may present as finger drop and discusses one of the rare neurological manifestations of lupus which remains a diagnostic challenge. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OD07-OD09&id=12107 https://doi.org/10.7860/JCDR/2018/36196.12107 Typhoid Diagnostics: Looking Beneath the Surface Tarang Sharma, Shinjini Bhatnagar, Ashutosh Tiwari Typhoid fever is a systemic life-threatening infection caused by S. typhi, which specifically infects humans. It is a major public health concern in the developing world. The clinical symptoms of typhoid often overlap with other febrile infections, affecting timely and accurate diagnosis. The current gold standard, blood or bone marrow culture is used for definite diagnosis, however its utility is limited due to the requirement of dedicated culture facilities, technical expertise and prior antibiotic use. The existing serological tests demonstrate variable and suboptimal sensitivity and specificity, because of cross-reactivity exhibited by the conserved, somatic antigens of Lipopolysaccharides (LPS) and terminal regions of flagellin. The lack of accurate detection further leads to imprudent antibiotic use, causing complications and morbidity, and even contributes to drug resistance. This emphasises the need for superior tests for efficient typhoid diagnosis. The need has propelled the pursuit of infection-specific markers using high-yield approaches like proteomics, metabolomics, transcriptomics and potential markers have been enumerated. Bio-marker discovery serves as a start point in diagnostic development and the subsequent assessment of the diagnostic tests must be governed by pre-defined metrics to determine their accuracy and field-feasibility. The evaluation of sensitivity and specificity in endemic regions is particularly important. In the present review, we discuss the existing diagnostic modalities; their challenges and the novel approaches being utilised for the discovery of specific biomarkers. We also review the new diagnostic tests under development while also discussing the important metrics to be considered during development of improved tests. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=KE01-KE07&id=12048 https://doi.org/10.7860/JCDR/2018/36358.12048 Imaging in Carcinoma Pancreas: A Review of Literature Soumil Singhal, Nirmal Kumar Prabhu, Srikanth Moorthy Carcinoma of pancreas is a highly aggressive tumour which has shown rising trends in developing countries like India due to the rapid rate of urbanization. The tumour is associated with high morbidity and mortality rates. Imaging has played a very crucial role in the diagnosis and management of this condition over the years. This review article shows the evolution of imaging with respect to imaging and diagnosis of carcinoma pancreas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=TE01-TE05&id=12037 https://doi.org/10.7860/JCDR/2018/36707.12037 Effect and Mechanisms of Medicinal Plants on Dry Eye Disease: A Systematic Review Ezatollah Memarzadeh, Tahra Luther, Saeid Heidari-Soureshjani <b>Introduction:</b> Dry Eye Disease (DED) is one of the most common problems and reasons for referring to ophthalmology clinics, which has been exacerbated by the increased use of computers and mobile phones. <b>Aim:</b> The purpose of the present systemic review was to review the effects and mechanism of medicinal plants in DED treatment. <b>Materials and Methods:</b> The key words “Dry eye” or “Keratoconjunctivitis sicca” or “keratitis sicca” in combination with “medicinal plant”, “herb”, and “phyto” were used to conduct the review. Clinical and experimental published articles in English language between 2000-2018 were retrieved from databases including the Institute for Scientific Information (ISI), PubMed and Scopus. <b>Results:</b> Totally, 199 articles were retrieved from the electronic database and finally 17 articles were included in the final analysis. Various plants such as Buddleja officinalis, Aristotelia chilensis, Prunus armeniaca, Hippophae rhamnoides, Lycium barbarum, and Rhynchosia volubilis Lour are effective in treating DED through different mechanisms. Herbal derivatives such as curcumin, antioxidant glasses, phytoestrogen, ferulic acid, and kaempferol can be used as food supplement independently and in some cases along with chemical drugs. Chinese herbal formulations and compounds such as ‘Chi-Ju-Di-Huang-Wan’, ‘TriphalaGhritaNetratarpan’, and ‘ShengJinRunZaoYangXue’ granules can play a role in inducing anti-oxidant and anti-inflammatory properties in the treatment of the disease. <b>Conclusion:</b> Generally, medicinal plants reduce tear film stability by decreasing osmolarity and increasing tear production. Several mechanisms, including the reduction of Reactive Oxygen Species (ROS) (antioxidant activity), the prevention of cell apoptosis, the modulation of inflammatory factors, and the regulation of androgens, can affect lacrimal glands and membrane cells, thereby helping to treat DED. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=NE01-NE04&id=12042 https://doi.org/10.7860/JCDR/2018/36409.12042 Molecular Mechanisms of Antifungal Drug Resistance in <i>Candida</i> Species Lakshmi Krishnasamy, Sharanya Krishnakumar, Govindasamy Kumaramanickavel, Chitralekha Saikumar Invasive Candidal infections have emerged as one of the major threats to the world. Although, many new antifungal drugs have been developed in the recent years, the emergence of drug resistance has become a major deterrent in the antifungal therapy. Candida develops several molecular mechanisms to resist the exposure to antifungal drugs. Prolonged treatment in patients may trigger development of resistance to the prescribed drugs. Most of the antifungal therapeutic agents being fungistatic rather than fungicidal are the key reason for selection of resistant Candida strains. Overexpression or mutation of the target enzymes as well as transcriptional activation of genes encoding the drug efflux pumps of ATP Binding Cassette (ABC) and Major Facilitator Superfamilies (MFS) are some of the factors implicated in the development of drug resistance. Basic understanding of the underlying molecular mechanisms of antifungal drug resistance and their clinical impact is vital in planning of the effective management of Candidal infections. There is an interesting possibility of antifungal resistance in Candida becoming a marker in the assessment of the outcome of antifungal therapy in the future. This review describe and summarises the molecular mechanisms of drug resistance in candida species. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=DE01-DE06&id=11961 https://doi.org/10.7860/JCDR/2018/36218.11961 Dysphagia Lusoria in Twins R Hariharaprakash, Padma Badhe, Amit Dey https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=SJ01-&id=12018 https://doi.org/10.7860/JCDR/2018/36635.12018 Umbilical Pilonidal Sinus-Experience at a Peripheral (Rural) Hospital Piyush Gupta, Pallavi Gupta https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=PL01-PL02&id=12051 https://doi.org/10.7860/JCDR/2018/37595.12051 C-Reactive Protein in Bipolar Disorder in an Indian Clinical Setting Aparna Sundaresh, Ravi Philip Rajkumar, Rajagopal Krishnamoorthy, Marion Leboyer, Vir Singh Negi, Ryad Tamouza <b>Introduction:</b> Serious psychiatric illnesses like bipolar disorder lack specific biomarkers of diagnosis or prognosis. However, association between Bipolar Disorder (BD) and various inflammatory markers has been consistently demonstrated by earlier studies pointing to underlying inflammation/dysimmunity. Often implicated in particular is the acute phase C-Reactive Protein (CRP) of hepatic origin, a generic marker of inflammation which is robust and very easy to test even in field settings without the need for a laboratory. <b>Aim:</b> To study the status of CRP, a generic marker of inflammation, in a well-characterised south Indian Tamil BD cohort, and investigate whether it can be a specifier of disease state. <b>Materials and Methods:</b> CRP was qualitatively estimated by latex agglutination method in the serum of 145 BD patients and 151 healthy controls. Statistical analyses were performed to test the association of CRP with the disease state. <b>Results:</b> It was found that, after controlling for age, gender, BMI and smoking status, CRP positivity (>0.6 mg/dL) was: (i) significantly higher among BD patients compared to healthy controls; (ii) significantly higher among patients having an acute mood episode (both mania (n=85), and depression (n=9) combined) compared to patients with residual symptoms or in remission, as well as compared to healthy subjects; (iii) not significantly different between patients in acute mania versus acute depression, but significantly higher in both acute mania and in acute depression compared to patients with residual symptoms or in remission. <b>Conclusion:</b> CRP, a robust generic inflammatory marker is significantly higher among BD patients as compared to normal controls, pointing to underlying inflammation operating in the disease. Also, it can differentiate between patients in acute phase and those in remission or having residual symptoms. If validated in longitudinal follow-up studies, these results could be helpful in Point Of Care (POC), as well as field settings especially in low income countries to identify patients whose symptoms are progressing towards relapse, at low costs, and without the need for a sophisticated laboratory. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=VM01-VM03&id=12014 https://doi.org/10.7860/JCDR/2018/37177.12014 Systemic Lupus Erythematosus with Acute Pancreatitis as an Initial Presentation Indira Bairy, Anupam Berwal, Mukhyaprana Prabhu, Lokvendra Singh Budania Systemic Lupus Erythematosus (SLE) is an autoimmune, chronic inflammatory disorder affecting mainly the women. Almost half of the SLE patients have gastrointestinal involvement. SLE associated gastrointestinal symptoms are life-threatening, therefore they should be treated immediately. Acute pancreatitis is considered as one of the rarerest complications of SLE. Here we report our experience on three cases of SLE who had acute pancreatitis as the primary presentation. Three women who presented with acute pancreatitis as an initial complaint belongs to the age group of 19 to 27 years. Later on, the diagnosis of SLE associated pancreatitis was established. Diagnosis was confirmed based on clinical, biochemical and abdominal CT findings. Though, it is a life-threatening condition, early diagnosis and prompt treatment with corticosteroids will have a good prognosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=OR01-OR03&id=12019 https://doi.org/10.7860/JCDR/2018/35404.12019 Rosai-Dorfman Disease: A Clinico-pathological Presentation of Three Cases and Review of Literature Francis Ikechukwu Ukekwe, Uchechukwu Obiora Ezomike, Osita Uchenna Ezenwosu, Christopher Bismarck Eke, Chibueze Onyekachi Nwokoro Rosai-Dorfman Disease (RDD) or Sinus Histiocytosis with Massive Lymphadenopathy (SHML) is a rare histiocytic disorder of unknown aetiology which presents as a benign, self-limiting disease of phagocytic histiocytes occurring mainly in the first and second decades of life. A good knowledge of the clinicopathological features and a high index of suspicion are required for prompt and accurate diagnosis of RDD, which commonly masquerades as lymphoid malignancy. We report the clinicopathological features of three patients with RDD, aged five years, 14 years and seven years, who presented with progressive painless neck swellings. The diagnosis was made by histopathology and treatment with oral prednisolone tabs produced varied outcomes over a therapy period of two years, 1 1/2 years and one year respectively. Relapse was observed in first case, full recovery in second case and partial recovery in third case, who was lost to follow-up one year later. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=SR04-SR08&id=12106 https://doi.org/10.7860/JCDR/2018/37302.12106 Traumatic Abdominal Wall Hernias-An Uncommon Case Series G Vijayalakshmi, L Arun Kumar A case series of abdominal wall hernia following blunt injury is essential for the understanding of its varied clinical presentation. The purpose of this paper is to emphasise on the fact that abdominal wall hernia is seemingly benign yet completely treatable condition and can be easily missed without proper clinical examination. A timely intervention with proper intraoperative assessment and decision making is needed. Immediate primary tissue repair is the preferred mode of management. Laparoscopic intervention in these scenarios is possible with better knowledge of the mechanism of injury and probable outcomes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2018&month=September&volume=12&issue=9&page=PR04-PR05&id=12070 https://doi.org/10.7860/JCDR/2018/36902.12070