Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Persistent Slow Ventricular Tachycardia following AICD-A Shocking Dilemma! Akshyaya Pradhan, Dhananjay Kumar, Pravesh Vishwakarma, Rishi Sethi, Varun S Narain Implantable Cardioverter and Defibrillators (ICD) prolong lifespan in patients at high risk of tachyarrhythmia, by their ability to appropriately detect and terminate it on the basis of Tachycardia Detection Rate (TDR). However, ICD patients often have Slow ventricular tachycardia (VT) defined as those below the detection limit of ICD. Such Slow VT’s are not entirely benign, leading to frequent emergency visits, in-hospital admissions, rate-induced cardiomyopathy and rarely death. Lowering the TDR to detect such arrhythmias has the potential of increasing inappropriate shocks which can be catastrophic. Although such slow VT’s are usually terminated by anti-tachycardia pacing, it is not always so. Here, the authors describe two such cases of resistant Slow VT’s in post ICD patients which ultimately necessitated ICD shocks. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OD01-OD03&id=12531 https://doi.org/10.7860/JCDR/2019/38477.12531 Subcutaneous Basidiobolomycosis in an Immunocompetent Child Kiran Aggarwal, Aruna Chhikara, Taru Garg <i>Basidiobolus ranarum</i> is a fungus belonging to <i>Basidiobolus</i> genera, Entomophthorales order and Zygomycetes class. It is present in soil, decaying vegetable matter, intestines of amphibians, reptiles, fish and insectivorous bats. In humans, it presents generally as a subcutaneous infection involving trunk and limbs in immunocompetent hosts from endemic areas. We present a case of a two-year-old male who presented with two hard subcutaneous swellings since one month. FNAC smears from the swellings showed granulomatous inflammation with many eosinophils. However, no fungal elements were identified. Incisional biopsy was done and on histopathological examination, many fungal hyphae were identified which were broad, thin-walled with sparse septations which were surrounded by many granulomas along with presence of giant cells, eosinophils, lymphocytes and plasma cells in the subcutis. Splendore-Hoeppli phenomenon was also seen in subcutis. Periodic Acid Schiff (PAS) stain and Silver Methanamine (SM) stain for fungus was positive. Fungal culture was negative. A final diagnosis of basidiobolomycosis was made. Subcutaneous basidiobolomycosis, is an emerging infection that leads to diagnostic confusion, morbidity and mortality. Diagnosis requires a high index of suspicion and awareness of histomorphology of this rare fungal infection. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ED01-ED02&id=12532 https://doi.org/10.7860/JCDR/2019/37759.12532 Recurrent Stroke in a Young Adult due to Antiphospholipid Antibody Syndrome-A Case Report Siraveni Thirupathi, Dinesh Ragav, Nasreen Begum Antiphospholipid Syndrome (APS) is an autoimmune disease characterised by arterial thrombosis, venous thromboembolic complications, mild to moderate thrombocytopenia and/or pregnancy morbidities in the presence of persistently positive levels of antiphospholipid antibodies (aPL) such as Lupus Anticoagulant (LA), anticardiolipin (aCL), and anti-ß2-glycoprotein-I (aß2GPI) antibodies. Many mechanisms create a prothrombotic state, it is prone to complication like abortions, preterm deliveries, foetal loss, cerebral stroke, acute coronary syndrome, venous thromboembolic and peripheral vascular occlusive disorders, intracerebral haemorrhage, encephalopathy and infections. Here, the case of a 42-year-old female is being reported, who was diagnosed with APS, treated with warfarin. The available knowledge about this disease and its relevance to the symptoms of the patient is also summarised. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OD04-OD05&id=12534 https://doi.org/10.7860/JCDR/2019/38468.12534 Situs Inversus Totalis with Chronic Respiratory Ailment in a Fertile Male Muneeb Mohammed, A Sundaramurthy, KP Ajeesh, Jereen Varghese, Venketesh Rathinavel Primary Ciliary Dyskinesia (PCD) is a rare ciliopathic autosomal recessive genetic disorder that causes defect in the action of cilia lining the respiratory tract. In a total of 50% cases of situs inversus totalis fertility is preserved. Here, we report a case of situs inversus totalis with chronic respiratory ailment in a fertile male. A 60-year-old non smoker male, father of four children presented with recurrent episode of infection for past five years. Investigation was done which showed situs inversus totalis (Dextrocardia) with right lower lobe bronchiectasis. He was managed with antibiotics, mucolytics, bronchodilators and chest physiotherapy. Patient status improved well with above mentioned treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OD06-OD07&id=12538 https://doi.org/10.7860/JCDR/2019/38038.12538 A Rare Case of Primary Hydatid Cyst of Right Thigh Esheet Shah, Shailesh Shah Hydatid cyst is a parasitic infestation caused by Echinococcus granulosus commonly affecting liver and lung. Hydatid disease of the soft tissue is uncommon. Here, we present a case of 48-year-old male with multicystic hypoechoic lesion seen deep to muscular layer in the posteromedial region of the right thigh. The initial diagnosis was made based on Ultrasonography (USG) and Magnetic Resonance Imaging (MRI). Complete surgical excision of the mass was done and the patient had an uneventful postoperative recovery. Hydatid cyst should be diagnosed with USG and MRI. Complete excision of the hydatid cyst is recommended. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PD01-PD02&id=12541 https://doi.org/10.7860/JCDR/2019/39525.12541 Compound Odontoma with Aesthetic Complaint in a Paediatric Patient Aline Dos Santos Letieri, Fabio Ribeiro Guedes, Bruno Augusto Benevenuto De Andrade, Oswaldo Costa Neto, Laura Guimarães Primo Odontomas are benign mixed odontogenic tumours that are detected during routine radiographs since they are asymptomatic and present a very low growth rate. However, when such lesions are not detected early, it can lead to several alterations. Thus, the present case describes a nine-year-old boy presenting an aesthetic complaint related to the prolonged retention of the primary upper central incisors and slight facial oedema. After clinical and radiographic examination, extracting the retained teeth and completely excising the lesion was proposed. After laboratory tests, the diagnosis confirmed a compound odontoma. During the follow-up, a conservative approach was taken, and the spontaneous eruption of the permanent upper central right incisor was observed. According to the patient’s report, there was an increase in self-esteem and satisfaction with his smile. This case highlights the importance of routine exams to detect issues early and to effectively treat dental changes, such as compound odontoma, reducing the risk of sequelae and improving its prognosis. It is important to note that even paediatric patients can complain about dental aesthetics, which can affect their well-being and emotional state. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZD01-ZD03&id=12545 https://doi.org/10.7860/JCDR/2019/39826.12545 Cluster Headache in a Case of Ophthalmic Cysticercosis Animesh Das, Robin Bansal Cluster headache is considered to be a primary headache. A lot of literature has been published for apparent cluster headache like conditions arising out of organic pathologies like tumours, dissection and infection in the craniofacial area although the causal relationship still needs to be proved convincingly. In certain cases, treatment of the primary pathology like sinusitis or otitis media leads to alleviation of the symptoms of headache. Neuroimaging has been recommended in cases of cluster headache with atypical symptoms and signs or those not responding to treatment. Neuroimaging in the present case of cluster headache was suggestive of ophthalmic cysticercosis. To the best of present authors’ knowledge, cluster headache in ophthalmic cysticercosis has never been described. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OD08-OD09&id=12547 https://doi.org/10.7860/JCDR/2019/39561.12547 Primary Epidural Intraspinal Haemangiopericytoma Ameen Abdul Mohammad, Bala Balaji Vosuri, KVN Srikanth Here, authors present a case report of a 25-year-old male who reported with low back pain with left lower limb radiculopathy for two years. Neurological examination revealed no focal neurological deficits, except for a positive Straight Leg Raise Test (SLRT) at 30°. Plain radiographs of the lumbar spine showed mild scalloping of the L3 vertebral body and Magnetic Resonance Imaging (MRI) lumbar spine showed an extradural space occupying lesion at the level of L3 vertebral body compressing the thecal sac and the left L3 nerve root. He underwent L2-4 median laminectomy without fusion and en bloc resection of the tumour. The histopathology was reported as a Haemangiopericytoma (HPC). Patient was referred for postoperative radiation therapy in view of high incidence of recurrence. Post radiation, at one year follow-up, MRI scan showed no signs of recurrence. Complete surgical removal of the tumour, followed by postoperative radiation therapy, appears to be the treatment of choice for such primary intraspinal haemangiopericytomas. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PD03-PD05&id=12555 https://doi.org/10.7860/JCDR/2019/31413.12555 Mediastinal Nodular Ganglioneuroblastoma in an Eight-Year-Old Child Bouvier Francis D`SA, Nazima Haider, Bala Krishnamoorthy Adiga, Sohaila Fatima The nodular variant of Ganglioneuroblastoma (GNB) is a rare histologic subtype in a spectrum of neuroblastic tumours, which are common in children of less than four years, characterised by one or more macroscopic nodules of neuroblastoma within a ganglioneuromatous component. The histopathological classification of GNB is difficult as many classifications have come up to evaluate the prognosis of this rare tumour. Here a rare tumour in a relatively older child is reported and the relevance of detailed histopathological study is discuss. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ED03-ED06&id=12556 https://doi.org/10.7860/JCDR/2019/38153.12556 Cone Beam Computed Tomography Analysis of Canalis Sinuosus in Association with an Osteolytic Lesion of Maxilla: A Case Report and Review of Literature Ritu Tiwari, Alfred Joseph Ravikumar, Abhishek Dubey Canalis Sinuosus (CS) is a frequent anatomical variation arising from the infraorbital canal. It is a neurovascular channel carrying the anterior superior alveolar nerve and vessels. Anterior maxilla is often the site for invasive procedures like implants, supernumerary teeth extraction, impacted canine extractions and periapical surgeries. Knowledge of anatomical variations in this area is of utmost importance to avoid iatrogenic surgical trauma and post-surgical distress to the patient. Although numerous unnamed accessory canals have been reported in the anterior maxilla, there is a lack of literature explaining the exact position, course and significance of CS. The purpose of this article is to increase awareness amongst the clinicians through a CBCT based case report in which CS was identified as an incidental finding in close proximity to an osteolytic lesion of the maxilla. Additionally, a Pubmed-Medline based analysis was also performed with select keywords which revealed 18 relevant results and eight reported cases from 1999 to 2018. This further emphasises the fact that CS is a significant structure that often gets misdiagnosed and conventional radiography fails to display these configurations accurately. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZD04-ZD06&id=12557 https://doi.org/10.7860/JCDR/2019/39927.12557 Retrosternal Goitre-An Anaesthetic Challenge Shaila S Kamath, Shilpa A Naik, NP Pratiksha Airway management of patients undergoing thyroidectomy for Retrosternal Goitre (RSG) poses a unique challenge. Associated co-morbidities, manipulation of the airway by the surgeons, airway compromise during induction, intubation, intraoperative and post-operative period can contribute to adverse events. We describe anaesthetic management of a patient with long standing goitre for 61 years with retrosternal extension with tracheal narrowing and compression for thyroidectomy. We secured the airway in an awake, spontaneously breathing patient under topical anaesthesia and sedation using direct laryngoscopy. Airway management of RSG is challenging at every phase of anaesthesia. Maintaining airway patency, vigilance and preparedness are keys to the success of intubation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=UD01-UD03&id=12565 https://doi.org/10.7860/JCDR/2019/38445.12565 Panhypopituitarism without Thrombosis due to Primary Antiphospholipid Syndrome Pulin Kumar Gupta, Subodh Kumar Mahto, Arjun Malasandra Balakrishna, Parikha Rampal, Narendra Kumar Sharma Hypopituitarism is a clinical syndrome in which pituitary hormones deficiency is seen in many conditions. Antiphospholipid Syndrome (APS) is an autoimmune disease characterised by antiphospholipid antibodies, commonly manifests as venous or arterial thrombosis with recurrent foetal loss. We here by report a case of 40-year-old female who presented with bilateral swelling of lower limbs with exertional breathlessness along with feeling of cold extremities, easy fatigability, lethargy and decreased appetite for six months which turned out to be hypopituitarism with APS. Hormone replacement was started and she experienced a good clinical improvement. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OD10-OD11&id=12566 https://doi.org/10.7860/JCDR/2019/40113.12566 Paraurethral Leiomyoma as an Uncommon Cause for Female Urethral Obstruction: Report of Two Cases Vilvapathy Senguttuvan Karthikeyan, Subramanian Ekambaram Sivanandam, Jeyaraj Veena, Venugopal Mohan, Aswathaman Karthikeyan Paraurethral leiomyomas (PL) are rare benign mesenchymal tumours. Here, authors, report two premenopausal women presenting with obstructive urinary symptoms and a paraurethral vaginal swelling. They had firm mobile paraurethral masses. On magnetic resonance imaging, they were well-defined and no urethral invasion was noted. Surgical excision was performed in both women and histopathological examination confirmed benign spindle cell neoplasm suggestive of leiomyoma. After catheter removal, the patients voided well with maximum flow-rate of 27 mL/second and 25 mL/second respectively. Long-term follow-up is required as late recurrences and transformation to leiomyosarcoma have been reported. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PD06-PD08&id=12567 https://doi.org/10.7860/JCDR/2019/37753.12567 Oesophageal Schwannoma: A Postoperative Diagnosis Aditya Sharma, Hirdaya Hulas Nag, Phani Kumar Nekarakanti, Vidya Sharada Bhat, Monika Sharma Oesophageal schwannomas are rare benign tumours with very few case reports in the literature. It is very difficult to diagnose these tumours preoperatively and is often confused with other benign tumours like leiomyomas and GIST. Hereby, a case of 42-year-old male is described who presented to us with the complaint of progressive dysphagia for the past two and a half year that posed a challenge regarding preoperative diagnosis. The patient was operated on the lines of oesophageal leiomyoma, later on which histopathology came out to be schwannoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PD09-PD10&id=12571 https://doi.org/10.7860/JCDR/2019/40178.12571 Spontaneous Intraperitoneal Bladder Rupture: A Rare Case Report Anwesa Chakraborty, Kaushik Mandal, Anirban Bhunia, Saikat Hasnat, Santanu Dutta Spontaneous Rupture of Urinary Bladder (SRUB) is an extremely atypical case (reported incidence of 1:126000) presenting to the emergency as an acute abdomen with other non-specific symptoms leading to high rates of misdiagnosis and mortality. A connection to urinary obstruction or bladder wall weakness is often elicited in retrospect. A case of a 70-year-old male with spontaneous bladder rupture secondary to a previously undiagnosed bladder growth was presented. He presented to us with gradual abdominal distension, vomiting and biochemical parameters suggestive of acute renal failure. Ultrasonography of the abdomen revealed loculated intraperitoneal collection and bladder wall thickening with growth on the anterior and posterior walls of the urinary bladder. Exploratory laparotomy revealed uroperitoneum resulting from a bladder growth that had fungated through the posterosuperior aspect of the urinary bladder. Primary repair was done and catheter was retained to provide adequate urinary evacuation per urethra. Postoperatively patient made a slow recovery complicated by occasional episodes of dyselectrolytemia and respiratory infection which could be successfully managed. He was discharged two weeks later with indwelling catheter to the departments of urosurgery and oncology with a histopathological diagnosis of Squamous Cell Carcinoma (SCC). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PD11-PD13&id=12581 https://doi.org/10.7860/JCDR/2019/39616.12581 Acute Liver Injury, Rhabdomyolysis and Acute Renal Failure in a Toddler due to Multiple Stings by <i>Vespa affinis</i> Neha, SR Ravikiran, Sharath Manya, Kiran Baliga, Kamalakshi G Bhat <i>Vespa affinis</i> stings are known to produce local as well as systemic toxic manifestations including haemolysis, rhabdomyolysis, renal injury, hepatic toxicity and encephalopathy. However, very few pediatric cases of <i>Vespa affinis</i> stings have been reported. We report an unusual case of a toddler with hornet stings (10 in number) who presented to our hospital 72 hours after the sting and met with a fatal outcome. At the time of presentation, child was in altered sensorium and shock with multiple necrotic sting marks. Blood investigations were suggestive of acute renal failure with dyselectrolytemia, rhabdomyolysis and toxic liver injury. Child was managed conservatively with intravenous fluids, renal sparing antibiotics, inotropes, fresh frozen plasma and intravenous high dose steroid (Methyl Prednisolone 30 mg/kg/dose). However, the child deteriorated and had a cardiac arrest the same day. She was resuscitated, intubated and connected to a ventilator. The condition worsened and the child succumbed to death. Since there is no specific treatment, a rare case of hornet bite with acute toxic liver injury and rhabdomyolysis could be a challenge to treat. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=SD01-SD03&id=12582 https://doi.org/10.7860/JCDR/2019/40239.12582 DRESS Syndrome: An Unusual Side Effect Kapil Bhalla, Sanjiv Nanda, Ashish Gupta, Deepak Nehra, Shuchi Mehra Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is often an overlooked entity manifesting as fatal hypersensitivity response associated with use of aromatic anti-epileptic drugs. This case report shows a case of a nine-year-old male child presenting with DRESS syndrome associated with the use of oral carbamazepine. The patient presented with high grade fever, rashes in exposed areas of face and all extremities not involving palms, soles, or oral mucosa, periorbital oedema, and cervical lymphadenopathy. Patient was managed with oral prednisolone 1 mg/kg/day. Later the drug was changed to oral Levetiracetam. Clinicians should always consider the possibility of DRESS syndrome with use of anti-epileptic drugs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=SD04-SD05&id=12584 https://doi.org/10.7860/JCDR/2019/40069.12584 Management of Occlusion in a Completely Edentulous Patient with Abnormal Jaw Relation VT Abdurahiman, M Shammas, M Quassem, Sanju John Jolly Complete edentulous patients are not an uncommon finding in day to day prosthodontic clinical practice. Retention and stability are important key factors in successful treatment of a complete denture patient. A practitioner must always plan his treatment depending on various situations encountered in the patient’s mouth. Maxillomandibular relation, which involve deviation from normal situations occurs with considerable frequency and are often quite challenging to the dentist in offering a good treatment plan. The importance of teeth arrangement with a stable occlusion in maintaining the stability of a denture is well documented. This presentation highlights a case with small maxillary arch and a wide mandibular arch which was managed successfully by a cross arch arrangement of artificial teeth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZD07-ZD09&id=12590 https://doi.org/10.7860/JCDR/2019/38427.12590 Partial Hypopituitarism Following Miscarriage: A Rare Presentation Monisha Priyadarshini Kumar, Nairmeen Haller, Daniela Ciltea Hypopituitarism is a rare disorder with a prevalence of 45.5 cases per 100,000 individuals. The term “Selective or Partial Hypopituitarism” refers to the loss of at least one, but not all pituitary hormones. Gravid women are at high risk of developing hypopituitarism due to significant increase in the size of pituitary gland during pregnancy, and thus high propensity to undergo pituitary necrosis following hypotension from any source including labour, miscarriage or major blood loss. Although, it is an uncommon condition, early recognition and management play a crucial role in patient care. Here, a rare case of a 23-year-old Caucasian female who developed partial hypopituitarism, predominantly central hypothyroidism and minor gonadal hormonal deficiencies due to haemorrhage, during an episode of miscarriage is reported. She was managed medically with appropriate hormone replacement therapy with clinical improvement in symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OD12-OD13&id=12591 https://doi.org/10.7860/JCDR/2019/39815.12591 Prosthodontic Rehabilitation of Patient with Mandibular Resection using Overlay Prosthesis: A Case Report Vikram M Belkhode, Sharayu V Nimonkar, Aashika Agarwal, SR Godbole, Seema Sathe The loss of continuity of the lower jaw following surgical excision destroys the balance and symmetry of mandibular functions. Prosthodontic rehabilitation has, therefore, become the treatment option to restore functions, aesthetics and to alleviate psychological status in such patients who deny further surgical intervention or in whom surgical reconstruction procedures are not indicated. This case report describes a prosthodontic rehabilitation of a patient who has undergone a hemimandibulectomy with the overlay denture lined with the silicone liner to fulfil the patient’s needs and requirements. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZD10-ZD13&id=12592 https://doi.org/10.7860/JCDR/2019/39527.12592 A Case Report of Ureteral Triplication with Contralateral Duplication-A Rare Anomaly with Difficult Diagnosis and Treatment Sandeep Gupta, Ankit Vaishnav, Dilip Kumar Pal Ureteral triplication is a rare congenital anomaly of the urinary tract with around 100 reported cases in English literature. Rarer is the presence of bilateral ectopic ureter with it. Here, a case of a young female patient who presented with continuous incontinence and right loin pain is reported. On thorough investigation she was found to have trifurcate right renal pelvis with right triple ureter forming single dilated right lower ureter, which was opening ectopically into vaginal vault; associated with hydronephrosis on right side. There was duplex moiety of left kidney with hydronephrosis of upper moiety with ectopic opening of upper ureter into vaginal vault. She was treated with laparoscopic right ureteric reimplantation with successful recovery. Multifarious presentations sometimes make it difficult to identify clinically and diagnose on imaging findings. The presentation of ureteral triplication and the features on diagnostic modalities like ureteroscopy, retrograde pyelography and magnetic resonance urography are hereby discussed with review of literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PD14-PD16&id=12586 https://doi.org/10.7860/JCDR/2019/40197.12586 Intramuscular Lipoma of the Pectoralis Major Simulating a Breast Lump Rajendra Benakatti, Dinesh Bangalore, Pavan Bhat Intramuscular lipoma is a deep-seated lipoma that arises in the muscle and is benign and relatively rare. Intramuscular lipomas of the pectoralis major muscle have been reported to mimic malignant breast tumours. Here, we present a 69-year-old female presenting with painless lump in right breast of three months duration progressively increasing in size. Examination revealed a soft, lobulated lump which was freely mobile with no fixity to surrounding structures. Mammogram revealed large radiopaque lesion noted in the retro glandular region with lucent linear striation in the centre. Correlated sonomammography showed a large hyperechoic lesion in retromammary region, anterior to the pectoralis major muscle. On Doppler study there was no vascularity, an ultrasound guided FNAC was done which showed adult adipocytes, suggestive of a lipoma. On exploration, a large encapsulated intramuscular lipoma of the pectoralis major was noted and excised, final histopathological examination also confirmed the diagnosis of lipoma. Lipoma can be considered as a rare differential diagnosis for breast lump. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PD17-PD18&id=12587 https://doi.org/10.7860/JCDR/2019/40049.12587 Pulmonary Infection Caused by <i>Achromobacter xylosoxidans</i>- Report of Two Cases Kalpana Chauhan, Anita Pandey, Saumya Srivastava, Ankita Gupta Immunocompromised patients are predisposed to a variety of infections due to both common and uncommon pathogens. <i>Achromobacter xylosoxidans</i>, is an opportunistic pathogen most commonly encountered among immunocompromised patients. The authors report two cases of pulmonary infection due to <i>A. xylosoxidans</i> for the first time from this geographical area. First case is a 55-year-old diabetic female with pulmonary tuberculosis and second case is a 67-year-old male with Chronic Obstructive Pulmonary Disease (COPD). Alertness and rapid diagnosis led to favourable outcome in both these cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=DD01-DD03&id=12598 https://doi.org/10.7860/JCDR/2019/39762.12598 Moving Ball in Left Atrium-Presenting as Recurrent Syncope Bhupendra Kumar Sihag, Basant Kumar, Neelam, Sanjeev H Naganur In patients with rheumatic mitral valve stenosis having atrial fibrillation, the “Ball valve thrombus” is an uncommonly encountered complication. A case of 42-year-old male with rheumatic severe mitral stenosis, mild aortic stenosis with moderate regurgitation presented with recurrent episodes of non-exertional syncope for seven days as chief symptom. He was in atrial fibrillation with controlled ventricular rate and echocardiography, showed a large ball valve thrombus in the left atrium. Thus, echocardiography facilitated for rapid diagnosis and earliest surgical intervention as a life saving measure https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OD14-OD15&id=12628 https://doi.org/10.7860/JCDR/2019/38389.12628 Isolated Fournier’s Gangrene of Penis: Case Series Niranjan Kumar, Meghraj Kundan, Chintamani, Abhishek Sharma, Aditya Ranot Penile gangrene is extremely rare. It spreads very rapidly to surrounding structure and have high mortality rate. Its aetiology can be infectious, traumatic or vasculogenic. Precipitating factors can be elicited with careful history and examination. Its management depends upon clinical presentation, which includes serial debridement, partial or total penectomy and treatment of underlying pathology. Here, we are reporting three cases of penile gangrene presented in emergency, one of which was managed by total penectomy, and other two by active debridement with supra-pubic catheter. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PR01-PR03&id=12614 https://doi.org/10.7860/JCDR/2019/38449.12614 Evaluation of the Vertical Bone Height of the Palate using CBCT for Placing Micro Implants- A Pilot Study Sunita Sugumaran, Ravindra Kumar Jain, Aravind Kumar, Sruthi Sinnadurai, Mary Shelonimissier <b>Introduction:</b>Determining an ideal anatomical location for mini-implant placement is very crucial for successful use of mini-implants in an orthodontic setup. Some of the factors that should be considered while selecting an ideal site for implant placement are soft tissue morphology, interradicular distance, sinus morphology, nerve location, buccolingual bone depth, and cortical thickness. In maxilla, implants are commonly placed in the buccal bone in the anterior and posterior inter radicular regions but in certain instances there is a need to place implants on the palatal side. Median and paramedian sites are recommended for placement of mini-implants in the hard palate. It is important that the measurement of the available vertical bone height is carried out to select the ideal location for placing a mini-implant since this will directly influence stability, and thus success. <b>Aim:</b> This study aims to evaluate the Vertical Bone Height (VBH) of the palate using a CBCT (Cone Beam Computed Tomography) at different coronal sections postero-anteriorly so as to determine the ideal location for implant placement. <b>Materials and Methods:</b> This is a cross-sectional study carried out in the department of Orthodontics, Kyungpook national university dental hospital, Daegu from February 2018 to march 2018. CBCT records of 12 patients referred to the department of orthodontics were selected. Sample consisted of 6 adults above 18 years (3 females and 3 males), and 6 children below the age of 18 years (3 females and 3 males). The images were analysed using InVivoDental (Anatomage Inc., San Jose, CA, USA), a volumetric imaging software. The CBCT analysis involves evaluation of series of coronal sections starting from the most posterior section of the palate extending up to the anterior section. In each section, the VBH of the palate was measured at a distance of 5 mm and 10 mm lateral to the midpalate suture on the right and left side. <b>Results:</b> In adults: the greatest bone height is seen in area mesial to the 1st premolar with a mean of 14.77 mm at a distance of 5 mm from the midline and mean of 17.53 mm at a distance of 10 mm from the midline. In children: the greatest bone height is seen in area mesial to the 1st deciduous molar with a mean of 14.04 mm at a distance of 5 mm from the midline and mean of 16.7 mm at a distance of 10 mm from the midline. The mean Palatal height is higher at 10 mm lateral to midline when compared to 5 mm lateral to midline at every coronal section. The mean palatal height is more in males than in females. No significant difference is seen between the palatal height on the right and the left side. <b>Conclusion:</b> The palate presents a site of choice for the insertion of miniscrews for orthodontic purposes as it acts as a safe haven for both novice and experienced orthodontists. The thickest part of the palate is the antero-lateral part of the palate. Further multicentric studies with larger sample size in different age ranges are required for better understanding of efficiency and success of palatal implants. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZF01-ZF04&id=12617 https://doi.org/10.7860/JCDR/2019/39692.12617 Effects of Antenatal Exercise Programme and Education on Health Related Quality of Life: A Randomised Controlled Trial B Sathya Prabha, Jaya Vijayaraghavan, Arun G Maiya, N Venkatesh, R Sivakumar <b>Introduction:</b> Women experience significant physiological and anatomical adaptations during pregnancy to meet the maternal and fetal demands. Most of the women stop exercising or reduce their routine physical activity during pregnancy. Sedentary lifestyle during pregnancy leads to maternal discomforts and complications. <b>Aim:</b> To evaluate the effect of structured antenatal exercise programme and education on health-related quality of life. <b>Materials and Methods:</b> In this randomised controlled trial 186 mothers were recruited for the study. A total of 94 Participants were selected as the study group samples and 92 were chosen as the control group as per block randomisation method. The study group received structured antenatal classes and education from 20-weeks of gestational age in addition to routine antenatal care where as the control group received routine antenatal care and antenatal exercises. SF 36 questionnaire-V2 was assessed at baseline and 32-weeks of gestation. Comparison of psychometrically-based Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were done using paired and unpaired t-test. <b>Results:</b> A significant difference in the PCS and MCS values between the groups at 32-weeks (p-value<0.05) was observed. The results showed that the exercise programme benefitted the study group. Exercise during pregnancy increased the ß endorphin levels and decrease the perception of pain and could contribute of better improvement in physical and mental health of the participants. <b>Conclusion:</b> The health-related quality of life of pregnant women were improved by the 12-week antenatal exercise programme and education. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=YF01-YF04&id=12575 https://doi.org/10.7860/JCDR/2019/38086.12575 A Unique Case of Mandibular Bony Extension in the Vicinity of Superior Pharyngeal Constrictor Leyla Berna Çagirankaya https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZJ01-ZJ02&id=12600 https://doi.org/10.7860/JCDR/2019/40072.12600 A Case of Functional Dystonia Nikhil Darak, Amit Baheti, Sourya Acharya, Parag Moon https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OJ01-OJ02&id=12551 https://doi.org/10.7860/JCDR/2019/40120.12551 Priapism- A Rare Presentation of Chronic Myeloid Leukaemia Unal Atas, Yunus Emre Meydanal, Utku Iltar, Turgay Ulas, Ozan Salim, Levent Undar https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OL01-&id=12612 https://doi.org/10.7860/JCDR/2019/39817.12612 Students Suicides-Can’t We Stop This? Sai Sailesh Kumar Goothy, Ravikanth Manyam, Venkata Rama Raju Alluri https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=CL01-&id=12621 https://doi.org/10.7860/JCDR/2019/40335.12621 Correspondence: Incidence and Risk Factors for Prolonged Stay in Children Hospitalised with Pneumonia Prawin Kumar, Jagdish Prasad Goyal https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=SL01-SL02&id=12690 https://doi.org/10.7860/JCDR/2019/39641.12690 Effect of 1800-2100 MHz Electromagnetic Radiation on Learning-Memory and Hippocampal Morphology in Swiss Albino Mice G Krishna Kishore, KV Venkateshu, NS Sridevi <b>Introduction:</b> With advancing technology the mobile phone with multiple features is used as a multipurpose device and attract people of all age groups. Increased usage of mobile phone raises the question of possible adverse effects on health. <b>Aim:</b> To assess the 1800-2100 MHz radiation effect on learning-memory and microscopic anatomy of hippocampal Cornu Ammonis (CA3) neurons in mice. <b>Materials and Methods:</b> A total of 18 albino mice were divided into 3 groups (6 Mice per group). Group-I: Control Group, Group-II: Exposed to Radio frequency-Electromagnetic radiation (RF-EMR) for 30 minutes/day for 3 months, Group-III: Exposed to RF-EMR for 60 minutes/day for 3 months. Followed by the exposure, learning memory was assessed by using Hebb-Williams maze in all the groups. The mice were then sacrificed, brains were dissected out and sections were taken at the level of hippocampus and then stained with Haematoxylin and Eosin for microscopy. The results were expressed in Mean&#177;SD and analysed by using one-way (analysis of variance) ANOVA followed by LSD (Least Square Difference) test for paired wise data. The p-value<0.05 was considered as statistically significant. <b>Results:</b> The time taken by the animal to reach the target chamber was significantly increased in Group-III (exposed 60 minutes/day for 3 months), whereas group-II (exposed 30 minutes/day for 3 months) showed no significant changes when compared to Group-I (control group). Microscopic anatomy of hippocampal CA3 neurons in exposed group shows less number of pyramidal cells with darkened nuclei, cytoplasm was vacuolated and cells were scattered. <b>Conclusion:</b> Exposure to 1800-2100 MHz radiation leads to damage and decrease of neurons in hippocampal region, which alters the learning and memory. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=AC14-AC17&id=12630 https://doi.org/10.7860/JCDR/2019/39681.12630 Evaluation of Sensorineural Hearing Loss as a Consequence of Conventional Radiotherapy in Head and Neck Cancer Abhay D Havle, MD Fazal Ahmed, Ganesh M Vihapure, Ganesh S Khairmode, Tripti <b>Introduction:</b> Sensorineural Hearing Loss (SNHL) is potentially disabling and yet overlooked, while subjecting patients of head and neck cancer to conventional ionising radiation at most tertiary care centers. The demand for cancer care, along with the rising cost of therapy using newer treatment technologies such as intensity modulated radiotherapy is a concern to the health care system in India. Cochlea often remains in the field of radiation and hence need to be shielded to prevent development of SNHL. <b>Aim:</b> To assess role of radiotherapy causing sensorineural hearing loss in patients of head and neck cancer. <b>Materials and Methods:</b> A prospective study was initiated on 110 cases with normal hearing requiring Radiotherapy (RT), for biopsy proven tumours of head and neck in the Department of Otorhinolaryngology. All cases were treated with external beam conventional radiotherapy using telecobalt machine and a shielding collimator. Out of 110 cases treated by either curative or palliative dose of RT which was around 60 Gray (Gy) and 30 Gray (Gy) respectively, 16 did not come for follow-up. The study was concluded with remaining 94 cases who completed the follow-up. Hearing acuity was assessed using 500, 1000 and 2000 Hz frequency before start of radiotherapy, immediately following radiotherapy and at first follow-up after six months in all cases. Quantification of the degree of SNHL was done using one-way analysis of variance (ANOVA). During follow-up the hearing loss noted was graded into mild and moderate. <b>Results:</b> The ototoxic effect after RT was found amongst the cases who received curative dose of 60 Gy, while none in cases who received palliative dose of 30 Gy. Out of 188 ears in 94 cases, 59 ears (31.38%) had SNHL, including newly developed SNHL in 44 ears during the 6 month post-RT follow-up period. The number of ears having SNHL was 18 at immediate post-RT which further increased to 59 at 6 month follow-up as compared to pre-RT normal hearing levels. <b>Conclusion:</b> In cases of head and neck cancer treated by conventional radiotherapy using telecobalt machine and shielding, the risk of consequent sensorineural hearing loss -SNHL was about just less than one third (31.38%). The tolerance of cochlea to total dose of radiotherapy was less than 60 Gray in cases of head and neck cancer treated by conventional radiotherapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=MC01-MC04&id=12632 https://doi.org/10.7860/JCDR/2019/39512.12632 Vitamin D Deficiency in Children with Chronic Kidney Disease Nasrin Esfandiar, Marjan Shakiba, Zahra Mirzaei <b>Introduction:</b> Vitamin D deficiency leads to defective mineralisation and in Chronic Kidney Disease (CKD) can contribute to renal osteodystrophy. <b>Aim:</b> To compare the serum level of vitamin D in children with CKD as compared to those with normal condition. <b>Materials and Methods:</b> This cross-sectional survey was performed on 68 consecutive children with CKD and 73 sex and age-matched healthy children who were referred to Mofid hospital in Tehran, Iran in 2016. Serum level of vitamin D was measured by immunoassay kits and was then categorised as =15 ng/dL (for vitamin D deficiency), 16-30 ng/dL (for vitamin D insufficiency) and >30 ng/dL (for normal condition). Also, the CKD stage was determined by measuring estimated Glomerular Filtration Rate (GFR). Quantitative variables were compared with the t-test, Mann-Whitney test, ANOVA test, or Kruskal-Wallis H test. Qualitative variables were also compared with chi-square test or Fisher&#8217;s-exact test. <b>Results:</b> Comparing serum level of vitamin D between CKD and control group showed a significant difference (14.3&#177;9.8 ng/mL versus 18.3&#177;10.9 ng/mL, p<0.001). To investigate relationship between level of vitamin D and stages of CKD, authors determined CKD stages. In CKD group, 5.9% were categorised as Stage I, 20.6% as Stage II, 19.1% as Stage III, 19.1% as Stage IV, and 35.3% as Stage V. In CKD and healthy children, vitamin D deficiency was revealed in 69.1% and 42.5%, and vitamin D insufficiency in 20.6% and 38.4% respectively (p=0.006). Interestingly, the serum level of vitamin D had an inverse association with the CKD stage. By increasing disease stage, the prevalence of vitamin D deficiency gradually increased (p=0.005). Authors found a direct association between CKD stage and serum level of parathormone. Also, the mean level of parathormone was higher in those children with vitamin D deficiency (376.6&#177;296.4 ng/L) as compared to those with vitamin D insufficiency (292.1&#177;259.5 ng/L) and those with normal level of vitamin D (61.4&#177;31.9 ng/L) (p=0.001). <b>Conclusion:</b> Vitamin D deficiency is a common problem among children with CKD compared to control group. In CKD patients vitamin D level is decreased with increasing CKD stage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=SC13-SC16&id=12633 https://doi.org/10.7860/JCDR/2019/38044.12633 Comparative Study for Detection of Carbapenemase Producers among Non-fermenting Gram Negative Uropathogens with Special Reference to Risk Factors and Fosfomycin Susceptibility Azza Z Labeeb, Asmaa M Elbrolosy <b>Introduction:</B> Urinary Tract Infections (UTIs) are among the commonest type of bacterial infections. Non-Fermenting Gram-Negative Bacilli (NFGNB) are now emerging as important uropathogens. Accurate detection of carbapenemase-producing NFGNB is essential to prevent their dissemination within healthcare settings. Fosfomycin would be an alternative treatment option for multidrug-resistant (MDR) NFGNB. <b>Aim:</b> To determine the incidence and variety of NFGNB associated with UTIs, to compare between different phenotypic methods for detection of carbapenemase-producing NFGNB as well as to address fosfomycin susceptibility against these isolates. <b>Materials and Methods:</b> A total of 52 <i>P.aeruginosa</i> and 43 <i>Acinetobacter</i> isolates were recovered from 403 urine samples collected from hospitalised patients of Menoufia University Hospitals (MUHs) with UTIs. The isolates were subjected to antimicrobial susceptibility screening by disk diffusion test and those with reduced zone diameters to carbapenems were phenotypically tested for carbapenemase production by the modified Carbapenem Inactivation Method (mCIM), modified Carpa NP (CNPt-direct) and CarbAcineto NP tests. The sensitivity, specificity and accuracy of each test were estimated in relation to PCR results. Fosfomycin susceptibility was determined by disk diffusion test. <b>Results:</b> 84.6% (44/52) of <i>P.aeruginosa</i> and 81.3% (35/43) of <i>Acinetobacter</i> isolates were carbapenem non-susceptible. The sensitivity and specificity of the mCIM were 90% and 91.7% with class B genes and 85.7% and 91.8% with class B+D genes for <i>P.aeruginosa</i> but the test performed poorly with <i>Acinetobacter</i> isolates. The CNPt-direct achieved excellent sensitivity (85.7%:100%) and specificity (88.2%:95.8%) for both <i>P.aeruginosa</i> and <i>Acinetobacter</i> isolates. For <i>Acinetobacter</i> spp., the CarbAcineto NP test was 100% sensitive. Fosfomycin retained good levels of in-vitro activity against the examined uropathogenic isolates. <b>Conclusion:</b> Both mCIM and CarbAcineto NP tests are reliable and affordable techniques for identifying carbapenemases in <i>P.aeruginosa</i> and <i>Acinetobacter</i> spp. respectively. Fosfomycin has shown promising activity against MDR urinary pathogens; however, clinical data are lacking. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=DC14-DC21&id=12635 https://doi.org/10.7860/JCDR/2019/39838.12635 A Study of the Growth of Human Foetal Lung in Relation with the Gestational Age Rajeev Mukhia, BP Powar, Anjali Sabnis <b>Introduction:</b> Lung is one of the organs of interest for researchers since a long time. Though detailed study about adult lung is there in the literature but study of lungs at different stages in the fetal period is far and few. <b>Aim:</b> The present study attempted to find out the relationship between the foetal lungs in relation with its development in different gestational weeks. <b>Materials and Methods:</b> The study was carried out on 40 spontaneously aborted human foetuses of known gestational age ranging from 10 weeks to 40 weeks. The anterior thoracic wall was dissected and the lungs were removed from the thoracic cage. The weight of the foetuses and foetal lung was measured in grams on digital weighing machine. The mean values of all parameters by gestational age were calculated. Data of the study were statistically analysed by using the Microsoft Excel 2007 program. <b>Results:</b> The average weight of right lung at 10<sup>th</sup> to 15<sup>th</sup> week and 36<sup>th</sup> to 40<sup>th</sup> week was 2.0 and 25.7 gm respectively. The average weight of left lung at 10<sup>th</sup> to 15<sup>th</sup> week and 36<sup>th</sup> to 40<sup>th</sup> week was 1.8 and 25.2 gm respectively. The body weight of foetuses showed gradual increase from 30 to 2712 gm at 10<sup>th</sup> week to 40<sup>th</sup> week of gestation. <b>Conclusion:</b> Evaluating body and lung weights and measurements against known standards is an important part of perinatal pathology. It also provides new insights to the anatomist and clinician for understanding and developing knowledge in both normal and pathological conditions of pulmonary tissue. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=AC18-AC20&id=12638 https://doi.org/10.7860/JCDR/2019/38174.12638 Association between Serum Visfatin, Oxidative Stress, Inflammation and Metabolic Syndrome in Obese Premenopausal Women Moushira Erfan Zaki, Sanaa Kamal, Eman Youness, Taghreed Shalabi, Jihan Hussein, Hanaa Reyad, Walaa Basha <b>Introduction:</b>Visfatin is an adipokine secreted by visceral fat tissue that has important effects on normal insulin secretion. An association has been found between visfatin and cardiovascular risk factors and obesity. Despite its role in the production of inflammatory cytokines, the role of visfatin in the Metabolic Syndrome (MS) is still a matter of debate. <b>Aim: </b>To evaluate the relation between serum visfatin levels, oxidative stress markers, Interleukin-6 (IL-6) and (MS) in premenopausal obese women. <b>Materials and Methods:</b> The study enrolled 150 premenopausal obese women and 80 age-matched healthy non-obese controls. Serum visfatin and IL-6 levels were measured by Enzyme linked Immunosorbent Assay (ELISA). Oxidative status was assessed by Total Antioxidant Capacity (TAC), Malondialdehyde (MDA), vitamins A and E and DNA damage was assessed by Comet assay. <b>Results:</b> Obese MS patients had significantly higher levels of visfatin, blood pressure levels, MDA and lower levels of TAC, A and E vitamins than the control group. DNA damage was significantly higher in obese women with MS and with a history of recurrent pre-eclampsia than controls. Multiple stepwise regressions analysis showed that log visfatin was positively correlated with MS components, IL-6 and MDA, serum lipids, DNA damage and negatively correlated with TAC and vitamin A and E. The log visfatin level of 1.56 had 76% sensitivity and 71% specificity for detecting MS in obese women with the area under the curve of 0.91. <b>Conclusion:</b> Significant positive correlations were observed between visfatin levels, oxidative and inflammatory markers with metabolic disturbance and pregnancy complications. These findings might emphasise the pathophysiological roles of these biomarkers in MS and pre-eclampsia and it may be useful to give treat to women in early pregnancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=BC10-BC14&id=12652 https://doi.org/10.7860/JCDR/2019/37783.12652 Role of Serum Vitamin D Level in Progression of Diabetic Foot Ulcer Farzad Najafipour, Naser Aghamohammadza, Neda Razzaghi Zonouz, Jalil Houshyar <b>Introduction:</b> Diabetes mellitus (DM) is a metabolic disorder characterised by hyperglycemia. Deficiency of vitamin D has been shown to interfere with insulin production and secretion and therefore contribute to type 2 diabetes development. It has also been noted that vitamin D plays a role in diabetic neuropathy development, which might lead to diabetic foot ulcers (DFU). Vitamin D boosts the immune system, helps in the elimination of bacteria and thus accelerates wound healing and prevents ulcer formation. However, different studies report conflicting results on the association of level of vitamin D with diabetic foot ulcers in DM patients. <b>Aim:</b> To evaluate the role of serum vitamin D levels with diabetic foot ulcer formation and progression. <b>Materials and Methods:</b> In this study, 70 diabetic patients with or without DFU either in inpatient section or referring to Imam Reza Hospital Endocrinology Clinic of Tabriz University of Medical Sciences were enrolled. Apparently healthy (n=35) individuals were recruited as the control group. The general characteristics of patients were assessed. The foot ulcers were examined and classified as per Wagner ulcer classification system. Serum biochemical markers including 25-Hydroxy Vitamin D (25(OH)D) were analysed using in-vitro chemiluminescent immunoassay (CLIA). ANOVA and post-hoc (Tukey) tests were employed to compare the means among the groups. Multiple linear regression and bivariate correlation analysis were also conducted to assess the association between all clinical variables and 25(OH)D. The p-value <0.05 was considered as statistically significant. <b>Results:</b> Serum 25(OH)D levels in diabetic patients with or without foot ulcers and healthy controls were 16.86&#177;10, 23.9&#177;15.24 and 27.11&#177;19.35 ng/mL, respectively. Significant differences in 25(OH)D levels were observed between patients and healthy controls (p=0.035), and between diabetic patients with and without foot ulcers (p=0.029). Furthermore, a negative correlation between serum cholesterol and 25(OH)D levels were observed among patient without DFU (-0.401, p-value =0.017). <b>Conclusion:</b> Low levels of vitamin D in diabetic patients may be related to DFU formation and development. Therefore, early estimation of 25(OH)D and prescription of appropriate vitamin D supplements are suggested in diabetic patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=BC15-BC17&id=12689 https://doi.org/10.7860/JCDR/2019/39974.12689 Paediatric Floating Elbow-A Prospective Study Pankaj Kumar Mishra, Anshul Khare, Sanjiv Gaur, Ashish Gohiya <b>Introduction:</b> Due to increased number of trauma cases, several injuries in the same limb are not an uncommon entity now. Literature describes the floating elbow as a forearm fracture and supracondylar fracture of humerus in same extremity. <b>Aim:</b> The purpose of the study was to evaluate our experience in dealing with such uncommon injury. <b>Materials and Methods:</b> This is a prospective interventional study of floating elbow in younger age group. All the cases were managed by K-wire fixation and followed up to the average of 20 months. All the patients were followed by clinical and radiological mean. Functional score were obtained by Mayo Elbow Performance Score (MEPS) and Khalfayan score. <b>Results:</b> Results are based on 17 cases with average age of 9.58 years. The fracture healing was noticed at average of 9 weeks with average range of movement of 95 degree. <b>Conclusion:</b> Floating elbow is a serious injury. Injury type is out of the way and treatment recommendations are polemical. In our experience, this injury can be best treated by aggressive surgical intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=RC12-RC15&id=12622 https://doi.org/10.7860/JCDR/2019/39579.12622 Cytoprotective Activity of <i>Neichitti (Vernonia cinerea)</i> in Human Embryonic Kidney (HEK293) Normal Cells and Human Cervix Epitheloid Carcinoma (HeLa) Cells against Cisplatin Induced Toxicity: A Comparative Study Arul Amuthan, Vasudha Devi, Chandrashekara Shastry Shreedhara, Venkata Rao, Richard Lobo <b>Introduction:</b> Traditional Siddha Medicine literatures suggest to use the decoction of <i>Vernonia cinerea</i> (VC) to alleviate toxic effects caused by metals. Cisplatin, a metal used in cancer treatment is known to cause nephrotoxicity. <b>Aim:</b> To evaluate and compare protective activity of aqueous extract and fractions of VC in Human Embryonic Kidney (HEK293) cells and Human Cervix Epitheloid Carcinoma (HELA) cell lines against cisplatin induced cytotoxicity. <b>Materials and Methods:</b> The Crude Aqueous Extract (CAE) was obtained from whole plant of VC. CAE was fractioned using nonpolar to polar solvents, and Butanol Fraction (BF) as well as Aqueous Fractions (AF) were obtained. The cell lines were exposed with the IC<sub>50</sub> dose of cisplatin, then treated with different doses of the extract or fractions. After 48 hours of incubation, viable cell growth was determined by MTT reduction assay in all the treatments by observing at absorbance of 540 nm. Dose response (% cell viability) curve was drawn and the values were statistically compared using One-Way ANOVA, followed by Dunnett’s (2-sided) post-hoc test. <b>Results:</b> Aqueous fraction showed 2.8 times higher cytoprotection (improvement in cell viability by 54%) than CAE against cisplatin induced toxicity in HEK293 cells. BF did not show protective activity in HEK293 cells. In HELA cells, AF showed 1.73 times higher cytoprotection than CAE and 1.55 times higher cytoprotection than BF against cisplatin, as evidenced by improvement in cell viability by 30%, 11% and 13% in AF, CAE and BF respectively. AF exhibited 80% higher cytoprotection against cisplatin cytotoxicity in normal HEK293 than cancer HELA cells. Whereas, CAE and BF showed lesser cytoprotective activity than AF. <b>Conclusion:</b> This study created scientific basis for using <i>Vernonia cinerea</i> against metal toxicities in Siddha system and suggests that the AF is suitable for further discovery of drug that selectively protect normal renal cell during cisplatin treatment in cancer patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=KC01-KC06&id=12624 https://doi.org/10.7860/JCDR/2019/40242.12624 Clinicopathological Spectrum of Nodal Peripheral T-cell Lymphomas: Observations and Inferences of Half a Decade Bidish Kumar Patel, Debdatta Basu, Rakhee Kar, Biswajit Dubashi <b>Introduction:</b> Nodal Peripheral T-Cell Lymphomas (NPTCL) are a rare and heterogeneous group of lymphomas seen to occur more often in Asian, including South Indian population. They have an overall poor prognosis. <b>Aim:</b> To document the varied spectrum of clinico-radiological, histopathological and follow-up parameters of NPTCL. <b>Materials and Methods:</b> This descriptive cohort study involved clinical, histopathological and haematological workup of NPTCL cases diagnosed from January 2008 to June 2013 in JIPMER, Puducherry, India. The cases were diagnosed as per World Health Organisation (WHO) 2008 classification. <b>Results:</b> NPTCL accounted for 25% of all Non-Hodgkin Lymphomas (80 cases). Peripheral T-cell Lymphoma-not otherwise specified (PTCL-NOS), Anaplastic Large Cell Lymphoma, ALK-positive (ALCL, ALK+), Anaplastic large cell lymphoma, ALK-negative (ALCL, ALK-) and Angioimmunoblastic Lymphoma (AITL) contributed to 51%, 29%, 10% and 10% of the cases respectively. A majority of patients (68%) had generalised lymphadenopathy, 26% had hepatosplenomegaly and 38% had marrow infiltration. Histomorphology showed wide variation within and in between the subgroups. Overall, necrosis, fibrosis and high mitosis were more common in ALCL while increased vascularity was seen prominently in AITL. At least 70% of the cases in each entity had advanced stage of disease. <b>Conclusion:</b> There is a three-fold increase in incidence of NPTCL lymphomas in JIPMER compared to WHO (2008). Most patients presented with advanced stage and in sixth decade, except ALCL. There was wide histomorphological variability among these cases. Awareness of the entity and its histopathological heterogeneity would be worthwhile in arriving at a conclusive diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=EC12-EC17&id=12625 https://doi.org/10.7860/JCDR/2019/37202.12625 Tackling Rheumatic Heart Disease: Prevalence and Antibiogram of <i>Streptococcus pyogenes</i> in Cases of Paediatric Pharyngitis Aditya Khandekar, Gargi Dangre-Mudey <b>Introduction: </b>An immune mediated post-streptococcal sequelae of Streptococcus pyogenes sore throat, Rheumatic Heart Disease-associated valvulopathy and carditis are a significant cause of morbidity and mortality in developing countries around the world. In view of this, children presenting with pharyngitis were screened for Streptococcus pyogenes at the OPD level of a rural Tertiary care centre. <b>Aim:</b> To find out the prevalence of Streptococcus pyogenes infection in sore throat cases among children, and study isolates for antimicrobial susceptibility including macrolide resistance. <b>Materials and Methods:</b> Throat swabs of 200 children aged 5 to 12 years presenting to the Paediatrics OPD of Acharya Vinoba Bhave Rural Hospital, Wardha, Maharashtra, India, with complaints of sore throat, were taken over a period of two months from June 1st 2016 to July 31st 2016. Samples were cultured on Blood agar and Crystal violet blood agar to isolate ß-Haemolytic, pinpoint, grayish colonies. Isolates were confirmed by gram staining, Bacitracin sensitivity and SXT (Trimethoprim 1.25 µg and sulfamethoxazole 23.75 µg) sensitivity. In vitro antibiotic susceptibility testing of isolates was carried out on Muller-Hinton agar with 5% sheep blood as per CLSI guidelines 2014. <b>Results:</b> A 11/200 (5.5%) of the children were found to be suffering from Streptococcal pharynigtis. An 11/11 (100%) isolates displayed sensitivity to Penicillin, Clindamycin, Ciprofloxacin and Cefotaxime but 2/11 (18.18%) isolates showed Macrolide resistance, 2/2 (100%) being MS phenotype. <b>Conclusion:</b> Even though the antibiogram pattern of Streptococcus pyogenes hasn’t changed significantly regarding susceptibility to Penicillin, the erythromycin resistance of two isolates obtained is a cause of concern that should be addressed urgently. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=DC11-DC13&id=12626 https://doi.org/10.7860/JCDR/2019/38486.12626 Factors Associated with Tobacco Use in Female Subjects: A Study from Eastern India Tushar K Bandyopadhyay, Kunal Som, Indranil Thakur, Rudrajit Paul <b>Introduction:</b> Tobacco use among females is a rising public health problem. This is especially true in developing countries of South-east Asia. Certain factors like illiteracy, poverty and changing social norms are associated with this rising trend. There is very little data on the factors associated with tobacco use among females in India. <b>Aim:</b> To document the pattern of tobacco use and also, some of the socioeconomic and demographic factors linked to tobacco use in females in Eastern India. <b>Materials and Methods:</b> This was a hospital-based survey, done simultaneously in an urban and a rural hospital. A total of 155 adult female patients who were consuming tobacco (either smoking or smokeless) were included in the study after proper screening and interviewed. The pre-tested and validated structured questionnaire was used to collect socioeconomic and demographic information, information on tobacco use pattern and also tobacco use in the family. Then, the relative distribution of these various variables in female tobacco users was analysed. <b>Results:</b> Authors had a total of 155 subjects (female tobacco users) in the study and the mean age was 27.6&#177;7.3 years. An 80% of the subjects belonged to some tribal group. A 57% were completely illiterate and >60% were home-makers. Only 20% were smokers and the rest used Smokeless Tobacco (SLT). Of the different forms of SLT, Khaini was the most popular (36.8%) followed by Zarda (31%). A 27% of the subjects used two forms of tobacco simultaneously. A 72% of the subjects had their partners using tobacco and 39% had their mothers using tobacco. <b>Conclusion:</b> Smokeless tobacco was much more common than smoking in female tobacco users. Factors associated with female tobacco use were illiteracy, poverty and familial tobacco use. Simultaneous use of more than one form of tobacco was present in around one-third. When tobacco control programs are devised for the females, stress should be placed on controlling smokeless tobacco. Also, the program must especially reach out to the illiterate and economically disadvantaged females. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=LC28-LC33&id=12627 https://doi.org/10.7860/JCDR/2019/38461.12627 Age and Genderwise Seasonal Distribution of Dermatophytosis in a Tertiary Care Hospital, Puducherry, India S Balamuruganvelu, Sreenivasalu V Reddy, Geethavani Babu <b>Introduction:</b> Superficial infections of skin, hair and nail are caused by dermatophytes due to its high affinity towards keratinized layers. Dermatophytosis is a progressing infection with an outer ring of active lesion and central healing. In recent years there is a worldwide increase in people getting affected by dermatophytic infections mainly due to increase in number of immunocompromised patients and widespread use of broad spectrum antibiotics. <b>Aim:</b> The present study was designed to investigate the age and genderwise seasonal prevalence of dermatophytosis visiting the tertiary care hospital, Puducherry. <b>Materials and Methods:</b> A total of 356 samples which comprises of 206 skin scrapings, 82 nail clippings and 68 hair samples were collected from 356 patients clinically suspected with dermatophytosis. The materials were subjected to direct microscopy (KOH mount) and cultured on to Sabouraud’s dextrose agar slopes and dermatophyte test medium for selective isolation of dermatophytes. A pre-structured questionnaire was designed to collect various socio-demographic profiles from the study population to assess the age and genderwise seasonal distribution of dermatophytosis. Frequency distribution was performed for analysis of results. <b>Results:</b> Dermatophytosis was found to be more prevalent in males 223 (62.6%) compared to females 133 (37.4%) with male to female ratio being 1.67:1. Tinea corporis was the common clinical presentation in males 71/223 and Tinea unguium was common in females 58/133. Maximum number of cases affected with dermatophytosis was in the age group 21 to 30 years, 98 (27.5%), with least number of cases 27 (7.6%) in above 50 years. Trichophyton mentagrophytes was the major isolate from hair and nail specimens 14/18 and 11/23 respectively, whereas Trichophyton rubrum was the common isolate from skin scrapings 41/98. Maximum prevalence 127 (35.8%) of dermatophytosis cases was recorded during the summer months April to June. <b>Conclusion:</b> Skin infection being the most common clinical presentation followed by nail and hair infection. Though all ages were found susceptible, dermatophytosis was more common in 3rd decade of life. Males predominated in all clinical types except in cases with Tinea manuum and Tinea unguium females predominated. Dermatophytosis was reported in all seasons, since Puducherry’s climatic condition is hot and humid all through the year which serves best for dermatophytes to establish an infection with increased prevalence during the months of April to June. Hence the present study emphasises that the population at risk in this locality needs to be awakened regarding the protective measures to cut down the prevalence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=WC06-WC10&id=12615 https://doi.org/10.7860/JCDR/2019/39515.12615 Prevalence of Intussusception after Rotavirus Vaccination: A Hospital Based Study from Odisha, India Manas Kumar Nayak, Manoj Kumar, Rajesh Kumar Nayak, Mirabai Das, Nirmal Kuma Rmohakud <b>Introduction: </b>Intussusception is a common cause of bowel obstruction in children and results in significant morbidity and mortality. Most recent evidence shows a slight increase in risk of intussusception after rotavirus vaccination. Following introduction of Rotavac®, an indigenous oral rotavirus vaccine, there is a need of continuous surveillance for intussusception. <b>Aim:</b> To examine epidemiology of intussusception in children aged <5 years admitted in hospital and the risk of onset of the disease during vaccination. <b>Materials and Methods:</b> A hospital based surveillance was conducted during period of September 2016-June 2018 to assess intussusception. In the case-control study, a total of 13 hospital admitted cases aged <5 years with intussusception according to Brighton level 1 criteria and 8 controls were included. Plasma VP6 level for presence of Rotavirus and hemi nested PCR for measuring VP7 and VP4 gene levels in cases and controls were performed. Age, sex and locality matched controls were considered for comparison. <b>Results: </b>The frequency of intussuception was 0.67% and 0.93% for children <5 years and <2 years of age, respectively. The median age of onset was 11.33+7.12 months in patients <2 years of age. Rotavirus was not detected in stool samples of cases, however, only one control (12.5%) was positive for the pathogen. Fifteen (88%) children with intussusception were managed conservatively and 2 cases (12%) required surgery, without mortality. <b>Conclusion:</b> Prevalence of intussuception among hospitalised children, aged <5 years, was 0.67%. In this study, we had observed the absence of rotavirus association among the cases of intussusception, either due to rotavirus vaccination or natural rotavirus infection. The study provides baseline information for epidemiology of childhood intussusception in children of Odisha during post rotavirus vaccination programme implemented by Government of India. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=SC09-SC12&id=12616 https://doi.org/10.7860/JCDR/2019/39517.12616 Effectiveness of Quadriceps Resistance Training on Physical Function of Elderly People Purushothaman Senthil, Raja Radhakrishnan, PG Mahesh Kumar, Subramanian Sudhakar <b>Introduction:</b> Aging is commonly associated with decreased muscle size, strength and less force production in elderly people. Loss of skeletal muscle mass, strength and quality have fatalistic impacts on their physical activity. Weakness of the lower extremities (especially quadriceps muscle) has been associated with difficulties in getting up from the bed and rising from the chair, slower walking, altered balance and increased risk of falls. These functional alterations can lead to decreased physical activity independence. The quadriceps force production is decreased with increase in age and affects the daily routine activity of elderly which creates much complication and thereby more socio-economic expenditure. <b>Aim:</b> To find out the effect of Quadriceps resistance with flexibility exercise on physical function of elderly subjects. <b>Materials and Methods:</b> A Pre and Post experimental study design with a total of 70 subjects with age of 60-85 year were divided into 35 participants in experimental group who received quadriceps resistance training with flexibility exercises and 35 participants in control group who received flexibility exercises alone for 12 weeks study duration. Pre-test and post-test Quadriceps strength was measured using isometric push pull dynamometer and also timed up and go test was done for physical function of participants in both the groups respectively. Paired t-test was used to examine the impact of intervention among the variables. <b>Results:</b> The quadriceps strength had pre-test values of 26.77±2.30 and post-test value of 42.17±5.56 in experimental group, pre-test value of 26.34±1.11 and post-test value of 28.00±2.47 in control group. The physical function with pre-test values of 17.69±2.63 and post-test value of 7.97±1.03 in experimental group, pre-test value of 17.37±2.30 and post-test value of 14.00±1.24 in control group. Experimental group showed significant changes (p<0.05) among the variables when compared with the control group. <b>Conclusion:</b> Quadriceps resistance exercise was shown to be more effective mode of intervention along with the flexibility exercise on physical function of elderly people. Thus, the implementation of resistance training of quadriceps will prevent the age-related sarcopenia and improve the physical function of elderly. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=YC06-YC08&id=12613 https://doi.org/10.7860/JCDR/2019/38499.12613 Evaluation of Pot’s Technique and Sodium Hypochlorite Concentration Technique in Smear Negative Sputum Samples for Increased Sensitivity of Sputum Microscopy Priya Singhania, Surender Kaur, Navinchandra M Kaore, Shantaram K Gautam, Shilpa N Kaore, Anwari Tayyaba <b>Introduction:</b> In developing countries, diagnosis of pulmonary tuberculosis is primarily based on microscopy owing to its simplicity, less cost and rapidity. Various ways to improve the sensitivity with multiple samples and concentration of sputum have been used. Simple methods which can be used in microscopic centers are desirable. <b>Aim:</b> This study was planned to evaluate the sensitivity of sputum smear examination by Pot’s technique and Sodium hypochlorite concentration technique over conventional Revised National Tuberculosis Program (RNTCP) method. <b>Materials and Methods:</b> A cross-sectional analytical study was carried out in all non-repetitive sputum smear negative samples obtained in Mycobacteriology laboratory after obtaining the Institutional Ethics Committee clearance with waiver of consent during a time period from 1<sup>st</sup> July to 31<sup>st</sup> August 2018. Two sputum samples (one morning and one spot) received from 47 outdoor and indoor patients in Mycobacteriology department of tertiary care hospital were included in study. All samples were first processed by routine Ziehl-Neelsen (ZN) staining. Sputum smear negative were subjected to Pot’s technique and Sodium hypochlorite concentration technique to evaluate the efficacy of these concentration techniques. All data was maintained in MS Excel and analysed using test of proportion and test of significance. <b>Results:</b> A total of 94 samples received from 47 patients were analysed. 04/94 (4.25%) samples were positive for AFB by routine RNTCP staining. With use of Sodium hypochlorite concentration method and Pots method, 05/94 (5.31%) and 06/94 (6.38%) samples were positive indicating a rise of 1.06% and 2.1% respectively over conventional. Additional two cases were detected compared to RNTCP, amounting to 100% rise in case detection which otherwise would have been missed. <b>Conclusion:</b> Concentration methods are easy to perform, safe for handlers without requirement of additional human resource. Good smear quality with less debris in microscopic field aids in improving detection rate over conventional methods. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=DC07-DC10&id=12599 https://doi.org/10.7860/JCDR/2019/40119.12599 Neutrophil-to-Lymphocyte Ratio (NLR) and its Correlation with Severity of Decompensated Liver Cirrhosis based on Child-Turcotte Pugh (CTP) Score Taufik Sungkar, Muhammad Fakhrur Rozi, Leonardo Basa Dairi, Lukman Hakim Zain <b>Introduction:</b> Neutrophil-to-Lymphocyte Ratio or NLR is a ratio used as a marker for ongoing inflammation process and is independently related to poor clinical outcomes among liver cirrhosis patients. <b>Aim:</b> To determine any significant correlation between NLR and Child-Turcotte Pugh (CTP) score among decompensated liver cirrhosis patients in a tertiary referral centre in Medan, Indonesia. <b>Materials and Methods:</b> The cross-sectional study involved patients diagnosed with liver cirrhosis in Haji Adam Malik General Hospital, Medan, Indonesia between May 2016-May 2017. The study enrolled 54 cirrhotic patients, regardless of aetiologic agent. CTP score was fulfilled by using two methods, bilirubin, albumin, and INR was noted from medical record registry and the rest, ascites and encephalopathy, were assessed using physical examination and interview process on the same day of the patient admission. Spearman correlation test was performed to determine the correlation between two variables, while the demographic characteristic was presented in a single table with mean or median and standard deviation in it. <b>Results:</b> A significant correlation between NLR and CTP score was obtained (p=0.008) and it was positively correlated (r=0.326). <b>Conclusion:</b> Shifting use of CTP score to NLR ratio still needs further study to acknowledge its potential as mortality and prognosis predictor independently. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OC29-OC31&id=12618 https://doi.org/10.7860/JCDR/2019/39895.12618 Comparative Evaluation of Apical Debris Extrusion Upon Use of Rotary Files and Hand Files for Root Canal Instrumentation in Primary Teeth Neethu Ann Preethy, Ganesh Jeevanandan, Lavanya Govinda Raju, EMG Subramanian <b>Introduction:</b> Endodontic flare-up is a common complication characterised by pain, swelling or both that occurs within a few hours or days after endodontic procedure and one of the major reasons is the apical extrusion of dental filings, pulp tissue fragments, necrotic tissue, micro-organisms and irrigant during chemo-mechanical preparation of the root canals. Thus, it is important to limit the amount of the debris extruded through the apical foramen into the peri-radicular region for a successful root canal treatment. <b>Aim:</b> To quantify and compare the amount of debris extruded apically during root canal preparation using conventional hand files, K3 and Kedo-S Rotary files in primary teeth. <b>Materials and Methods:</b> Thirty six extracted human primary canines were selected and randomly assigned to one of the three groups of twelve teeth each. Myers and Montgomery experimental model was used for instrumentation and debris collection. The teeth were then instrumented with the following file systems: Group 1: Hand files; Group 2: K3 files; Group 3: Kedo-S files. The apical debris which got extruded during instrumentation was collected in Eppendorf tubes which were pre-weighed. The tubes were then placed in an Incubator at 70&#176; Celsius for five days and weighed again to determine the post-instrumentation weight. The weight of the dry debris collected was measured by subtracting the pre-weight of the Eppendorf tubes from the post-instrumentation weight for all the three groups. The data were analysed using one-way ANOVA and Tukey&#8217;s post-hoc tests. <b>Results:</b> A statistically significant difference was observed between hand files and Kedo-S (p<0.05) and between hand files and K3 files (p<0.05). However, there was no statistically significant difference between K3 and Kedo-S files (p=0.069). <b>Conclusion:</b> Apical debris extrusion was found to be less with Kedo-S files compared to hand files. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZC23-ZC26&id=12619 https://doi.org/10.7860/JCDR/2019/39904.12619 Consistent Level IIa Node as a Surgical Landmark for Identification of Spinal Accessory Nerve Vidita Powle, Vishal Yadav, Sushma Mehta, Abhishek Ghosh <b>Introduction:</b> Treatment of Oral SCC requires a composite resection of the lesion and elective/therapeutic neck dissection, whenever a surgical option is being considered as a form of treatment. During neck dissection, one of the critical structures to be preserved is the Spinal Accessory Nerve (SAN). In our experience of operating on N+ necks for selective neck dissections, we found the presence of a constant lymph-node at the level of hyoid bone/digastric muscle tendon lateral to the internal jugular vein (level IIa). Direct deeper dissection exactly beneath this node led to the identification of the SAN. <b>Aim:</b> The aim of the study was to ascertain level IIa lymph node as a landmark for identification of SAN, during neck dissection procedures. <b>Materials and Methods:</b> In this prospective study, 100 consecutive selective neck dissection procedures done for patients with radiological N+ necks with resectable Oral SCC were included. <b>Results:</b> In 96% of cases identification SAN was done with the technique used alone. <b>Conclusion:</b> The purpose of this study was to establish this technique as a standard of care either alone or in adjunct with other established landmarks for identification of SAN,by trainees as has been a long established practice in our department. We even have a separate nomenclature for it, the ‘Trainee Node.’ https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=XC05-XC07&id=12620 https://doi.org/10.7860/JCDR/2019/40144.12620 Non-osseous Tubercular Lesions of Spinal and Paraspinal Region-Evaluation by MRI Jaiganesh Sivalingam, Anil Kumar, Konduru Varadarajulu Rajasekhar <b>Introduction:</b> Spinal tuberculosis is very common in developing countries like India and it has a wide spectrum of appearance on MRI ranging from simple marrow oedema to complete vertebral body collapse. Early diagnosis and intervention at initial period provide very good prognosis and very less morbidity. <b>Aim:</b> To demonstrate rare MRI features in cases of tubercular lesions in the spinal and paraspinal region without involvement of osseous components of the spine. <b>Materials and Methods:</b> This was a prospective descriptive study conducted in a Tertiary Care Hospital in India from June 2011 to December 2014 based on the MRI findings in patients with Tuberculosis of Spinal and Paraspinal region. Total 529 cases of tubercular spinal lesions were diagnosed. Out of which only 43 patients showed only extraosseous spinal and paraspinal lesions, these were included in the study. Patients with involvement of bony components or typical MRI pictures such as involvement of intervertebral disc and adjacent vertebral bodies were not included in the study. The diagnosis was confirmed by cytology, histopathology, serology and corroborative findings. <b>Results:</b> Various extraosseous changes involving spinal and paraspinal components in case of tubercular lesions, such as 27 cases of Paraspinal soft tissue lesions (62.8%)-Abscesses and Granulation tissue, 10 cases of Extradural and Intradural soft tissue component (23.2%), 4 cases of arachnoiditis (9.3%), 2 cases of Intramedullary Tuberculoma (4.6%) and 1 case of Spinal Cord Abscess (2.3%) were observed and the observed findings were tabulated. <b>Conclusion:</b> On MRI, Spinal Tuberculosis may have wide spectrum of appearance. Involvement of soft tissue without affecting the spinal bony component is quite rare. Hence, the possibility of tuberculosis should be considered even when the bony components are spared. Timely diagnosis and intervention will reduce the morbidity and avoids the complications. MRI plays key role in follow-up of patients to assess the response to treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=TC06-TC10&id=12552 https://doi.org/10.7860/JCDR/2019/40125.12552 Harnessing the Strengths of the Mentored Student Project to Compile a Handbook of Case Scenarios for Undergraduate Medical Students Maya Roche, Shashikiran Umakanth, Ronald A Roche, Farizal Bin Rizal, Jaslyn Yeap Wen Xin, Nuwani Pradeepika Serasinha Pathirana, Dan Chiu Ping, Kruthika Jaisankar <b>Introduction:</b> To be trained as problem-solvers, medical students need to be exposed to activities that integrate and apply knowledge. Student research projects in the medical curriculum are a means of achieving these objectives. At Melaka Manipal Medical College (MMMC), the Mentored Student Project (MSP) is a platform for research by students guided by a teacher-mentor. The MSP lends itself to innovative ideas to empower students for the future. <b>Aim:</b> To use the MSP as a platform, to compile a handbook of case scenarios for medical students. <b>Materials and Methods:</b> To construct the case scenarios, students (n=5) chose various medical topics (n=50), which were familiar to them from their curriculum of the first and second year. They were instructed to refer to authentic online and offline sources of medical literature. After &#8216;Turnitin&#8217; analysis to check for plagiarism, the case scenarios were vetted by a clinician based on a questionnaire and compiled into a handbook. Students also presented a poster about the MSP experience. MCQ test designed by the faculty was used to as certain learning of the participants of the MSP (n=5) and performance was graded. A questionnaire on a Likert&#8217;s scale was used to analyse the students&#8217; engagement with the MSP. Individual and focus group discussions to ascertain students&#8217; opinion were also held. <b>Results:</b> The study demonstrated that students were capable of designing case scenarios of good quality free of plagiarism. They scored between 60-70% in the MCQ test providing evidence of substantial knowledge retention. They felt that the experience had integrated their knowledge and would help them in problem-solving. <b>Conclusion:</b> The evidence from this study brings to light the multifaceted role that MSPs play in the personal and professional development of medical students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=JC05-JC09&id=12553 https://doi.org/10.7860/JCDR/2019/38473.12553 Hyponatremia in Elderly In-Patients Subhash Chandra Dash, Naba Kishore Sundaray, Beeravelli Rajesh, Trupti Pagad <b>Introduction:</b> Hyponatremia, the most common dyselectrolytemia, frequently occurs in elderly patients. Multiple aetiologies, association of comorbids play a major role in hyponatremia of elderly patients. Prolonged hospital stay and increased mortality are the consequences. <b>Aim:</b> To study the prevalence, common aetiologies, comorbids and clinical outcomes of hyponatremia in elderly in-patients. <b>Materials and Methods:</b> A prospective, observational study was conducted in a teaching hospital on 950 adults =60 years of age, admitted to the Post-graduate Department of Medicine, over a period of 12 months. Detailed history, clinical examination, outcomes, laboratory investigations, imaging studies, diagnoses and causes were recorded. For statistical analyses, histogram, Kolmogrove test for normality test and then Independent t-test, Wilcoxon rank sum test, Pearson&#8217;s chi-square test, Fisher&#8217;s-exact tests were used. <b>Results:</b> After excluding 32 patients of pseudo and hyper-natremia, 440 patients (47.9%) had hyponatremia (s. Na+ level of <135 mEq/L) and 478 patients (52.0%) had normal sodium (135-145 mEq/L). The mean age of hyponatremic patients was 69.87&#177;7.94 and 70&#177;8.18 in normonatremic patients (p=0.815). The mean Na+ level was 122.08&#177;8.68 mEq/L in hyponatremic patients and 138.05&#177;2.71 in normonatremic patients. Hypovolemic hyponatremia was most frequent (42.0%). The leading aetiologies were diuretics (28.8%), acute renal failure (27.9%), and severe sepsis (15.2%) but 61.8% of patients with hyponatremia had multiple factors. Hypertension was the most common comorbid (63%) and presence of multiple comorbid was significantly associated with hyponatremia (p<0.001). Hyponatremic group, though hospitalised for longer period (p<0.001), higher mortality rate could not be established (p=0.699); not also with the severity of hyponatremia (p=0.06). <b>Conclusion:</b> Elderly patients are highly predisposed to hyponatremia and are often dehydrated. Presence of multiple comorbid is a risk factor. Hyponatremia prolongs the hospital stay but severity of underlying illnesses may rather accelerate the mortality rate. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OC01-OC04&id=12554 https://doi.org/10.7860/JCDR/2019/39957.12554 Impact of a Publication Ethics Orientation Program on the Knowledge and Attitude of Postgraduate Students of Health Sciences Suchet Trigotra, Shikha Jaiswal, Anshu Mittal, Anu Bhardwaj <b>Introduction:</b> Pressure to publish and for better academic recognition, issues of publication misconduct like plagiarism, data fabrication and falsification, authorship disputes, conflict of interest, redundant and salami publications are on rise. A capacity building program on publication ethics for postgraduate students who are still young as researchers can be beneficial for them to get sensitised to ethical issues related to publishing. <b>Aim:</b> To assess the impact of orientation program on the knowledge and attitude of postgraduate students towards “Publication Ethics”. <b>Materials and Methods:</b> This is an educational interventional study where postgraduate students were given an orientation on “Publication Ethics”. A semi-structured questionnaire was designed to assess students’ level of knowledge and attitude regarding publication ethics which was administered before and after the program to assess its impact. Frequency and percentage of study participants’ demographic profile and participants’ responses to various statements was calculated. Chi-square test was used to compare the pre- and post-intervention knowledge of study participants regarding different aspects of “Publication Ethics”. <b>Results:</b> The mean age of 143 participants was 27.07±4.56 years and 105 (73.42%) were women. The percentage of participants providing correct responses for different statements used to assess knowledge and attitude of postgraduate students regarding publication ethics increased from 17.47-82.51% before attending the orientation session to 49.64-93% after attending the session. This increase in proportion of participants responding correctly was statistically significant (p<0.05) except for the statements where pre-intervention scores were already higher. <b>Conclusion:</b> A significant post-training improvement was observed in knowledge and attitude regarding publication ethics amongst postgraduate students. As publication misconduct is very common, good publication practices should be promoted in young researchers by conducting such kind of educational interventions regularly. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=LC04-LC09&id=12548 https://doi.org/10.7860/JCDR/2019/40008.12548 An Audit of Bone Mineral Density and Associated Factors in Patients with Lumbar Spinal Stenosis Arash Rahbar, Rahmatollah Jokar, Seyed Mokhtar Esmaeilnejad-Ganji <b>Introduction:</b> Osteoporosis is a major global health problem and is commonly observed with lumbar stenosis in older people. It is stated that osteoporosis may cause progressive spinal deformities and stenosis in elderly patients. <b>Aim:</b> To audit prevalence of low bone mineral density and associated factors in patients with lumbar spinal stenosis. <b>Materials and Methods:</b> Patients with symptomatic lumbar spinal stenosis were recruited in this cross-sectional study, who had been referred to Shahid Beheshti hospital in Babol, Northern Iran, between 2016 and 2017. Lumbar spinal stenosis was diagnosed based on clinical symptoms and a stenotic lesion in the lumbar spine confirmed by magnetic resonance imaging. Low bone mineral density was confirmed based on World Health Organisation and International Society for Clinical Densitometry criteria. Demographic and laboratory parameters of the patients were collected. The data were analysed using SPSS by descriptive, ANOVA, logistic regression and Pearson correlation tests. <b>Results:</b> Overall, 146 patients with lumbar stenosis were enrolled. Based on bone densitometry of spine and femur, 35 (24%) and 36 (24.7%) of the patients had osteoporosis. According to femoral densitometry, age (OR=1.311, 95% CI: 1.167-1.473), being a female (OR=3.391, 95% CI: 1.391-8.420) and being a homemaker (OR=3.675, 95% CI: 1.476-9.146) were found as risk factors for osteoporosis. Based on spinal densitometry, age (OR=1.283, 95% CI: 1.154-1.427) and being a female (OR=2.786, 95% CI: 1.106-7.019) were associated with osteoporosis. Significant correlations were observed between bone mineral density and red blood cell counts (r=+0.168, p=0.043) and vitamin D (r=+0.303, p<0.001). <b>Conclusion:</b> The prevalence of low bone mineral density was considerable in the patients with lumbar spinal stenosis. Control of modifiable associated factors by physicians and healthcare administrators should lead to a better outcome of the disease in these patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=RC01-RC07&id=12544 https://doi.org/10.7860/JCDR/2019/39690.12544 The Risk Factors for Development of Sepsis in Newborns with a Central Venous Catheter and their Association with the Serum Zinc Levels Lakshmi Jagath Kumar, Soundarya Mahalingam, Rukmini Mysore Srikantiah, Ali Kumble, Basavaprabhu Achappa <b>Introduction:</b> Neonates with indwelling central venous catheters are at risk of developing the infection. Serum zinc plays a major role in mounting an immune response. <b>Aim:</b> To analyse the risk factors for development of sepsis in hitherto aseptic neonates with a centrally inserted venous catheter and associate with their serum zinc levels. <b>Materials and Methods:</b> After Institutional Ethics Committee Approval, 132 neonates were included who required NICU admission and had an indwelling central venous catheter and their serum zinc levels were measured. Only neonates who were proven aseptic at admission were included and were followed up for development of signs of sepsis using the Clinical Sepsis (CSEP) criteria, baseline septic screen parameters and blood culture, at admission and on the Day 5 along with catheter site culture. This was then correlated with their serum zinc levels and analysed by Mann-Whitney’s test using SPSS 17.0. <b>Results:</b> Out of 132 neonates, 19 had low and 113 neonates had normal zinc levels respectively (Zn<55 µg/dL). A total of 25% neonates developed clinical sepsis by day 5 and 23.5% of neonates had positive catheter site culture. Neonates without clinical sepsis had slightly higher levels of zinc as compared to neonates who had clinical sepsis (147 µg/dL and 141 µg/dL). Neonates born to mothers without risk factors and neonates without perinatal asphyxia had higher zinc levels. Neonates with perinatal asphyxia (152.87 µg/dL, 94.2 µg/dL and 134 µg/ dL, 131.75 µg/dL respectively) showed statistically significant association with zinc deficiency. Neonates with significant band-neutrophil ratio on Day 5 had lower zinc levels than those with normal band-neutrophil ratio (107 µg/dL and 111 µg/dL). <b>Conclusion:</b> The risk factor for sepsis in neonates with indwelling catheters associated with zinc deficiency was perinatal asphyxia. Prematurity, low birth weight, maternal risk factors and clinically septic newborns had lower zinc levels, though statistically not significant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=SC01-SC04&id=12536 https://doi.org/10.7860/JCDR/2019/38387.12536 A Comparative Study on Quality of Life between Ileal Conduit Urinary Diversion and Orthotopic Neobladder Reconstruction after Radical Cystectomy Ranjan Kumar Dey, MD Dawood Khan, Ranjit Kumar Das, Vishnu Agrawal <b>Introduction:</b> Ileal Conduit (IC) urinary diversion and Orthotopic Neo Bladder (ONB) reconstruction may have an effect on the Health-Related Quality of Life (HRQoL) of patients. <b>Aim:</b> To compare the quality of life between patients who underwent IC urinary diversion or ONB reconstruction following radical cystectomy in patients with Muscle-Invasive Bladder Cancer (MIBC). <b>Materials and Methods:</b> This was a prospective longitudinal study conducted between January 2015 and August 2017. Patients of either sex aged more than 18 years who underwent radical cystectomy followed by IC or ONB for invasive bladder cancer were included in this study. Functional Assessment of Cancer Therapy-Bladder (FACT-BL) questionnaire was used to assess the HRQoL. The data obtained were tabulated, analysed and presented using descriptive statistics. <b>Results:</b> A total of 32 patients were included. Overall, the mean age was 55.63 and 54.46 years in IC and ONB, respectively. The mean time lag between Transurethral Resection of Bladder Tumour (TURBT) and radical cystectomy was slightly higher in patients from IC group (66.11 vs. 50.23 days; p=0.314) than ONB group. Preoperatively the mean Functional Assessment of Cancer Therapy: General (FACT-G) score in patients from IC group and ONB group was 61.11 and 61.54, respectively. The bladder cancer sub scale scores were similar in both groups. The patients from IC group had significantly higher physical well-being score than the ONB group at both 6 and 12 months. All the differences have been found to be statistically significant except the score of emotional well-being at six months. <b>Conclusion:</b> Results from this study demonstrated that ONB had a better QOL than IC group at 12 months. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PC01-PC04&id=12537 https://doi.org/10.7860/JCDR/2019/39729.12537 Variations in the Branching Pattern of the Radial Nerve Branches to Triceps Brachii Muscle Mythraeyee Prasad, Bina Isaac <b>Introduction:</b> The axillary nerve arises from the posterior cord of the brachial plexus and supplies the deltoid and teres minor muscles. Axillary nerve injuries lead to abduction and external rotation weakness. In such cases, branches to the heads of triceps brachii muscle have been transferred to the axillary nerve to establish reinnervation of the deltoid muscle. In addition, the triceps nerve branches can be nerve recipients to reinstitute elbow extension. <b>Aim:</b> To study the different branching patterns of the radial nerve branches to triceps brachii muscle. <b>Materials and Methods:</b> Twenty eight upper limbs from adult cadavers were dissected to record variations in the branching pattern of the radial nerve branches to triceps brachii. <b>Results:</b> The branching patterns seen were types A 1 (3.6%), B1 (1<sup>st</sup> pattern) 1 (3.6%), B2 (2<sup>nd</sup> pattern) 1 (3.6%), and C3 22 (78.6%). Two new patterns observed were: type B2 (6<sup>th</sup> pattern) 1 (3.6%) and type D (2<sup>nd</sup> pattern) 2 (7.1%). The long head had single innervation in 89.3% cases and the lateral and medial heads had dual innervation in 10.7% and 7.1% cases respectively. <b>Conclusion:</b> The knowledge of the different branching patterns that are present will help surgeons to identify the most suitable radial nerve branch to triceps brachii that can be used for nerve transfer to restore the motor function of the deltoid muscle or to reanimate the triceps brachii muscle. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=AC01-AC05&id=12533 https://doi.org/10.7860/JCDR/2019/39912.12533 A Randomised Controlled Trial on Haemodynamic and Intraocular Pressure Changes: A Comparison between Classic Laryngeal Mask Airway and Endotracheal Intubation Madhusudan Upadya, Gaurang Kothari, Julie C R Misquith, Shishir Upadya, Snighda Raja <b>Introduction:</b> Laryngeal Mask Airway (LMA) and endotracheal intubation are two methods of securing airway. Insertion of airway devices causes haemodynamic and Intraocular Pressure (IOP) changes. In the present study, authors compared the two devices and the changes they cause. The mechanism of IOP rise is secondary to increased sympathetic activity. In addition, adrenergic stimulation can also produce an acute increase in IOP, by increasing the resistance to the outflow of aqueous humour in trabecular meshwork between anterior chamber and Schlemn’s canal. <b>Aim:</b> To compare the effects of LMA placement and endotracheal intubation on haemodynamics and IOP. <b>Materials and Methods:</b> Sixty patients of American Statistical Association (ASA) Status 1 or 2 undergoing general anaesthesia were included in study. They were divided into two groups, Group 1 in which classic LMA was used and Group 2, in which endotracheal tube was used. All patients were given general anaesthesia following preoxygenation. Pre-airway manipulation haemodynamics and IOP were measured followed by measurement at one, two, three minutes post airway manipulation. The change in heart rate, systolic pressure, diastolic pressure, mean pressure and IOP was calculated by subtracting the actual values from those obtained post-induction. After the surgery, when the patient was fully awake trachea was extubated or LMA was removed whichever the case may be. <b>Results:</b> The change in haemodynamic variables at one, two, three minutes in the intubation group was more and was statistically significant. The maximum change in haemodynamics occurred at one minute after airway manipulation. Though there was an increase in IOP in both groups, this was comparable and hence statistically not significant. The IOP in both the groups remained within the normal range even after airway manipulation. <b>Conclusion:</b> In a patient who can tolerate the transient haemodynamic change an endotracheal intubation should not be a contraindication when minimal changes in IOP do not matter much. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=UC01-UC04&id=12528 https://doi.org/10.7860/JCDR/2019/38198.12528 Health Literacy and its Relationship with Quality of Life in Postmenopausal Women Zahra Mosallanezhad, Neda Poornowrooz, Shohreh Javadpour, Marzieh Haghbeen, Safieh Jamali <b>Introduction:</b> Menopause is considered as a unique event in women&#8217;s life. Women spend more than one third of their lives in postmenopausal period. Accordingly, paying attention to quality of life of women in terms of public health during menopause is crucial. Moreover, health literacy is one of the factors influencing the health of women. <b>Aim:</b> To evaluate the health literacy and its relationship with the quality of life of postmenopausal women. <b>Materials and Methods:</b> This cross-sectional descriptive study was carried out on 194 postmenopausal women admitted to health centres of Jahrom, Iran, in 2017. Data were collected using health literacy and quality of life questionnaires. After data collection, they were analysed using descriptive statistics, regression analysis and Pearson correlation coefficient and SPSS software. <b>Results:</b> The research results revealed that the mean age of the subjects was 59.67&#177;6.57. The mean score of quality of life and health literacy in postmenopausal women was 47.46&#177;19.48 and 81.29&#177;26.99, respectively. A significant relationship was found between the quality of life and health literacy (p<0.001, r=0.4). In addition, demographic variables of age (p<0.001), education (p<0.001), job (p<0.001), and living place (p=0.001) showed significant relationship with health literacy. <b>Conclusion:</b> Given the relationship between health literacy and the quality of life of postmenopausal women, paying more attention to health literacy in health promotion programs seems to be essential. Thus, health care providers should take interventions to improve the quality of life of these women. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=VC01-VC04&id=12529 https://doi.org/10.7860/JCDR/2019/38474.12529 Role of Diffusion Weighted Imaging in Differentiating Benign from Pathological Vertebral Collapse using ADC Values Ajit Mahale, Sairam Maruvaneni, Ashvini Kumar, Sonali Ullal, Merwyn Fernandes <b>Introduction:</b> Vertebral fractures are very commonly encountered in day to day practice. Diffusion Weighted Imaging (DWI) with Apparent Diffusion Coefficent (ADC) values is a novel technique to evaluate vertebral fractures. <b>Aim:</b> To establish the role of DWI in differentiating benign from pathologic vertebral fractures using ADC values in comparison with histopathology report as gold standard/laboratory evaluation and clinical follow-up. <b>Materials and Methods:</b> This was a prospective study of 45 adult patients. Echo Planar Imaging (EPI-DWI) with a max b-values of 600 and conventional MRI sequences were done in each of these patients. ADC values were calculated with Region Of Interest (ROI) in area of interest. Mean ADC of normal, benign and pathological vertebrae were calculated. Finally correlated with histopathological findings and clinical correlation was done. <b>Results:</b> Twelve cases of benign collapse either due to osteoporosis/trauma and 33 cases of pathological collapse were included in the study. Pathological collapse include 23 cases of metastasis and 10 cases of multiple myeloma. The mean ADC value in benign compression fractures was 1.466&#177;0.325&#215;10-3 mm2/s and in pathological collapse was 0.959&#177;0.288&#215;10-3 mm2/s. In the pathological group mean ADC in metastatic compression fractures was 0.970&#177;0.237&#215;10-3 mm2/s and in multiple myeloma was 0.936&#177;0.395&#215;10-3 mm2/s. The ADC was significantly higher in benign compression fractures than in pathological compression fractures (p<0.01), but the subtypes in pathological collapse between myeloma (10 cases) and metastasis (23 cases) showed considerable overlap and no statistical significance. Also, two false negative cases where ADC values were on the higher side but conventional imaging demonstrated pathological collapse. <b>Conclusion:</b> DWI with ADC values has considerable importance in distinguishing acute benign collapse from pathological collapse, but there is a significant overlap between metastatic collapse and multiple myeloma. Hence, we conclude that DWI with ADC maps should be a routine add-on sequence in a patient with collapsed vertebra to increase our diagnostic accuracy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=TC01-TC05&id=12530 https://doi.org/10.7860/JCDR/2019/37746.12530 Evaluation of the Discriminatory Abilities of Anthropometric Indices of Obesity in Prediction of Important Body Composition Parameters of Central Obesity Nazeem Ishrat Siddiqui, Ajay Soni, Mohammad Shoeb, Sukhwant Bose, Ravindra Wadhwani <b>Introduction:</b> Prevalence of obesity and its complications are reaching to epidemic proportions. For its early detection, various anthropometric indices like Waist Circumference (WC), Waist-To-Height Ratio (WHtR) and Conicity Index (CI) have been utilised. <b>Aim:</b> To determine the discriminative abilities among anthropometric indices (WC, WHtR, CI) in predicting excess fatness. <b>Materials and Methods:</b> Eighty seven (87) healthy adolescents of age between 17 to 25 years were enrolled for the study. Using standard protocol all the anthropometric and body composition parameters was recorded. Body Mass Index (BMI) was calculated by; Weight (kg)/Height (m<sup>2</sup>), Waist-to-Height ratio by dividing the waist circumference by the height and CI from mathematical equation CI=WC (m)/0.109vWeight (kg)/Height (m). Body composition parameters were determined using bio-impedance analysis technique. Mean, Standard Deviation (SD) and correlation coefficient (r) was calculated. Receiver operating characteristic curve analysis was used to determine predictive abilities of the anthropometric indices of obesity. <b>Results:</b> Body composition parameters have shown very strong correlation (p<0.0001) with all the indices of obesity. Waist to height ratio correlated maximally with total body fat (r=0.860) whereas waist circumference with body fat percent (r=0.867). CI has correlated maximally with body fat percent (r=0.503) followed by total body fat (r=0.464). BMI did not correlate with any of them. On comparison of AUC, Waist to height ratio and waist circumference has the highest percentage under curve for all the body composition parameters. Most accurate cut-off points of ROC curve revealed that WHtR, WC and CI at the cut-off value of 0.52, 87 cm and 1.3 (m<sup>2/3</sup>/kg<sup>1/2</sup>) respectively are better discriminators for all the body composition parameters. <b>Conclusion:</b> Strong correlation exists between body composition parameters and anthropometric indices of obesity except BMI. Waist to height ratio, waist circumference and CI emerged as most sensitive and specific indices to predict body composition, comparable to the values obtained from BIA analysis. However, BMI should be used with caution in assessment of central obesity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=CC01-CC04&id=12572 https://doi.org/10.7860/JCDR/2019/40147.12572 Electrolyte Disturbances among Diabetic Patients Admitted in a Multi-Specialty Hospital in Southern India Ashwin Karuppan, Melina I Sahay, Roshni Ravindranathan, Panguluri Haripriya, Damal Kandadai Sriram , Melvin George <b>Introduction:</b> Diabetes mellitus (DM) is one of the most common non-communicable diseases associated with high morbidity and mortality. Electrolyte disturbances are not uncommon among in-hospital patients with DM. However, there are limited data on the magnitude of electrolyte disturbances in the diabetic population. <b>Aim:</b> To identify the common electrolyte disturbances among diabetic in-patients and to determine if there is an association of blood sugar control with electrolyte disturbances. <b>Materials and Methods:</b> A cross-sectional study was performed among patients admitted with a diagnosis of diabetes and without any restriction of any concomitant illness. Fasting, post prandial blood glucose, HbA1c, serum sodium, potassium, chloride, urea and creatinine were measured. The frequency of electrolyte disturbances was compared between those patients with well controlled vs. inadequately controlled blood sugar. <b>Results:</b> A total of 342 subjects participated in the study, of which 195 (57%) had uncontrolled DM. The frequency of hyponatremia, hypokalemia, hyperkalemia, hypochloremia and hyperchloremia was 33%, 16%, 6%, 31% and 2.7% respectively. In diabetic patients, hyponatremia was seen more commonly in patients with uncontrolled DM than those with well controlled blood sugars (38.46 vs 27.73%, p=0.01). Hypochloremia was more common among subjects with uncontrolled DM (23.65% vs 17.55%, p=0.01). The proportion of patients with hypokalemia or hyperkalemia did not differ between the two groups. Patients on insulin therapy were more likely to have hyponatremia than non-insulin users (p=0.01). <b>Conclusion:</b> Diabetic patients have an increased predilection to develop electrolyte disturbances. The most common electrolyte disturbance seen was hyponatremia and hypochloremia and they were widely prevalent among patients with uncontrolled DM. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OC12-OC15&id=12573 https://doi.org/10.7860/JCDR/2019/38487.12573 Synchronous Approach versus the Sequential Approach in Laparoscopic Cholecystectomy with Endoscopic Retrograde Cholangiopancreatography in Patients with Gallstones and Suspected Common Bile Duct Stones Chaloemphon Boonmee, Ueamporn Summart, Niramon Arayajarernwong, Wattana Pareesri, Taungprart Srigulawong, Somsak Boonharn, Siphon Naowarungsri, Wipapun Watayajinda <b>Introduction:</b> Common Bile Duct Stone (CBDS) is concomitant with Gallstone (GS) in 10-18% of patients. The most common procedure to treat CBDS with GS is with Endoscopic Retrograde Cholangiopancreatography (ERCP) and Laparoscopic Cholecystectomy (LC) which has commonly been done using a sequential approach. Currently, the one-step synchronous approach is commonly practiced. However, superiority of one protocol over another is yet to be established. <b>Aim:</b> To compare the operative outcomes between synchronous approach LC followed by ERCP in the same anaesthetic time (group I) and sequentially separated LC and ERCP (group II). <b>Materials and Methods:</b> A retrospective review of 66 patients from May 2015 to June 2017. The patients were diagnosed as having GS and were suspected of also having CBDS. They were divided into two groups: Group I had 41 patients and Group II had 25 patients. The baseline characteristics, operative findings and outcomes including success rate, operative time, postoperative complications and the Length Of Hospital Stay (LOS) of the two groups were compared. <b>Results:</b> There were no significant difference between the operative outcomes of the two groups regarding the CBDS cannulation rate (95.1% versus 100.0%) and clearance rate (89.7% versus 80.0%). The cannulation rate difference was -5.0% (95% CI=-11.5to1.7; p-value=0.26) and the clearance rate difference was 9.7% (95% CI=-8.6 to 28.1; p-value=0.27). Postoperative complications showed no statistically significant difference, however the LOS was significantly lower in group I with a mean difference of -4.0 days (95% CI=-5.4 to -2.6; p-value <0.001). <b>Conclusion:</b> The synchronous approach is as safe and effective as the sequential ERCP and LC. Moreover, it has advantages for patients such as a reduction in the number of procedures and requiring a shorter LOS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PC08-PC11&id=12574 https://doi.org/10.7860/JCDR/2019/38413.12574 Non-milk based Local Therapeutic Feed Plus Home-based Diet as Compared to Home-based Diet Alone for Nutritional Rehabilitation of Severe Acute Malnutrition Following Discharge: A Randomised Clinical Trial Halak Hasmukhbhai Chauhan, Bakul Bhalchandra Javadekar, Ambika Vipulbhai Jayswal, Pareshkumar Amrutlal Thakkar, Niyati Takhatsinh Parmar <b>Introduction:</b> Recovery of Patients of Severe Acute Malnutrition (SAM) after discharge from Nutrition Rehabilitation Centre (NRC) is unsatisfactory on Home-based diet. Authors, therefore, compared recovery of children with SAM on discharge between patients given home-based diet with those given Local Therapeutic Feed (LTF) in addition to home-based diet. <b>Aim:</b> To compare weight gain between SAM children on discharge from NRC taking non-milk based LTF with home-based diet with those taking only home-based diet. <b>Materials and Methods:</b> Eighty Children of SAM were divided into two groups on discharge from NRC. One group was given non-milk based LTF in addition to home-based diet. Another group was given only home-based diet. Both groups were followed up for six weeks. Children with allergy to peanut protein, those likely to leave the study before six weeks and those having underlying heart disease or CNS malformation were excluded. Weight gain of the patient, height gain, Mid Upper Arm Circumference (MUAC) and Weight for Height were recorded. Data were analysed by applying unpaired t-test using MEDCAL C software (version 12.5.0). <b>Results:</b> Thirty-nine children in intervention (non-milk based LTF) group and 38 in the control group completed the follow-up. Rate of weight gain in intervention group was 5.48 g/kg/day (SD=0.55) while in the control group was 2.47 g/kg/day (SD=0.36). The difference was statistically highly significant (p<0.001). Gain of height during six weeks was 1.59 cm and 1.08 cm in intervention and control group respectively. (p<0.001) No patient in intervention group has MUAC of <11.5 cm. compared to 28.9% (n=11) in control group. An 89.4% patients had weight for height of > -2 SD compared to 44.73% of patients in control group at the end of study. An 87.5% (n=35) patients were labeled as cured after three follow-ups in intervention group compared to 43.5% (n=17) in the control group. <b>Conclusion:</b> Introduction of non-milk based LTF significantly improves post discharge weight gain and hastens recovery in patients of SAM. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=SC05-SC08&id=12568 https://doi.org/10.7860/JCDR/2019/29669.12568 Association of Manual Weight Lifting Tasks with Low Back Pain: A Pilot Study Kiran Mondal, Deepti Majumdar, Madhu Sudhan Pal, Tammanna R Sahrawat, Bhuvnesh Kumar <b>Introduction:</b> Manual Weight Lifting (MWL) and Low Back Pain (LBP) become closely interrelated when lifting tasks are performed without adhering to lifting norms. Maximum trauma during MWL is encountered by lower body joints which absorb force proportional to the weight being lifted. Therefore, quantification of the injury potential of such tasks in terms of kinetic responses would prove beneficial for further designing of MWL tasks with reduced incidences of LBP. <b>Aim:</b> To quantify the kinetic responses of lifting tasks using real-time data collection technique and to find out whether real-time kinetics data corroborated with 2D prediction kinetics data analysed using simultaneously recorded 2D images of MWL. <b>Materials and Methods:</b> This cross-sectional pilot study was conducted on eight healthy participants. Hand grip strength, videos for prediction kinetics and real-time kinetics data were recorded with hand grip calliper, Sony handy cam, and Kistler Force Plate, respectively. Prediction kinetics data from still photographs were extracted and analysed using ergonomics evaluation software ErgoMaster. Real-time Kinetics data were analysed with BioWare(R) software. Repeated measure Analysis of Variance (ANOVA) followed by Bonferroni post-hoc test was applied for statistical treatment. <b>Results:</b> Some of the real-time and predicted kinetics data (mean&#177;SEM) observed while lifting load at one lift per minute through different heights are given here. The Vertical component of Ground Reaction Forces (VGRF) while lifting 10 kg from Knuckle to Shoulder (K-S) height was 126.5&#177;9.4 N which increased to 157.2&#177;9.2 N for Floor to Knuckle (F-K) height and 178.4&#177;7.4 N for Floor to Shoulder (F-S) height. Other conditions remaining same, while lifting 20 kg load the values of VGRF were 188.5&#177;29.2 N, 270.6&#177;16.0 N and 374.5&#177;44.8 N, respectively. Under similar experimental conditions, the responses for Total Compression Force (TCF) while lifting 10 kg were 3095.22&#177;218.5 N, 3892.9&#177;204.1 N, 3886.1&#177;190.40 N, respectively and similar trend was seen for 20 kg load also. Similar trends of significant changes were observed for all real-time and prediction kinetics parameters reported for lifting both 10 kg and 20 kg loads through F-K and F-S heights involving bending postures as compared to lifting at K-S height. This might be due to overload on spine and requirement for higher magnitudes of force absorption by lower body joints while undertaking such tasks. <b>Conclusion:</b> The study indicates that, according to both real-time and prediction kinetics data, lifting of loads up to 10 kg from knuckle to shoulder height at one lift per minute is with in acceptable limit. The lifting tasks involving excessive bending may result in higher spinal load leading to LBP. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=LC10-LC15&id=12569 https://doi.org/10.7860/JCDR/2019/39691.12569 A Prospective Observational Study to Compare the Efficacy and Adverse Effects of Glimepiride and Vildagliptin Added to Metformin in Type 2 Diabetes Mellitus Biswanath Sharma Sarkar, Shuvankar Mukherjee, Manikanta Maji, Suman Biswas <b>Introduction:</b> In order to prevent the specific diabetes mellitus related macrovascular and microvascular complications, guidelines by American Diabetes Association recommend a reasonable glycosylated haemoglobin goal for non-pregnant adults to be less than 7% (53 mmol/mol). The common practice recently is to use a sulfonylurea like glimepiride or selective Dipeptidyl Peptidase-4 (DPP-4) inhibitor like vildagliptin as add-on therapy to metformin when the latter alone fails to achieve the target level of sugar control. Many randomized clinical trials have demonstrated the comparative efficacy of glimepiride and vildagliptin as add-on therapy to metformin. But their results might not always reflect what actually could be expected in clinical practice. <b>Aim:</b> To compare the efficacy and safety of glimepiride and vildagliptin as add-on therapy to metformin in achieving glycaemic control and also to compare the common adverse effects observed. <b>Materials and Methods:</b> This prospective observational study was conducted among adult type 2 diabetes mellitus patients who did not achieve adequate glycaemic control with metformin monotherapy. Patients were purposively selected in a way so that 30 patients received 2 mg of glimepiride once daily and 30 received 50 mg of vildagliptin twice daily as add-on therapy to metformin 1.5 to 2 gm in single or divided doses. Fasting, post-prandial sugar and glycosylated hemoglobin levels were re-examined after 4 to 6 months. Data were analysed using SPSS version 20.0. Paired and unpaired T-tests were applied to compare the parametric data and z-test was used to compare the difference between two proportions at 5% significance level. <b>Results:</b> In both the groups there was a significant reduction in mean FBS, PPBS levels and HbA1c% from the baseline (p<0.001). The mean of reduction in FBS and PPBS levels did not vary significantly between the two groups (p>0.05). However, glimepiride plus metformin reduced mean HbA1c% significantly more than vildagliptin plus metformin (p<0.001). The glimepiride group caused significantly more hypoglycaemia than the vildagliptin group (p=0.03) while vildagliptin group was significantly more associated with overall gastrointestinal symptoms (p=0.046). There was no significant difference in weight gain between the two groups (p=0.084). <b>Conclusion:</b> Glimepiride appeared to be superior to vildagliptin in reducing the HbA1c level but at the cost of significantly more episodes of hypoglycaemia than vildagliptin while latter added to metformin produced significantly more gastrointestinal side effects than the former. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OC09-OC11&id=12570 https://doi.org/10.7860/JCDR/2019/40224.12570 A Study of Correlation of Disease Severity with Antibody Titers in Rheumatoid Arthritis Praveen Singh Madan, Amarnath Dinakar Savur, Surendra Umesh Kamath, Shrikala Baliga, Sharan Mallya <b>Introduction:</b> Rheumatoid Arthritis (RA) is one of the most frequent autoimmune diseases in the world which affects about 1% of people. Anti-Cyclic Citrullinated Peptides (Anti-CCP) is shown to be more specific than rheumatoid factor in the diagnosis of RA. This test becomes positive in early stage of disease and it has a high predictive value. <b>Aim:</b> To correlate the relationship between anti-CCP antibody and rheumatoid factor titers and disease activity scores. <b>Materials and Methods:</b> A cross-sectional study was performed in 50 patients with RA for evaluating the relation between anti-CCP antibody titer and Disease Activity Score 28 (DAS28), Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI). A detailed examination of each patient including their demographic characteristics, duration of disease, number of tender and swollen joints, ESR and C-reactive protein, patient&#8217;s and physician&#8217;s global assessment by VAS (0-10) and titers of rheumatoid factor and anti-CCP antibody. Patients who fulfilled the ACR-EULAR 2010 criteria were included. The statistical analysis was done using Pearson&#8217;s correlation coefficient. A p-value of less than 0.05 was considered significant. <b>Results:</b> Of the 50 patients which were included (mean age, 44.82 range, 18-70), 38 were females and 12 were males. Mean ESR was 54&#177;27 mm/hr and Mean CRP was 17.277&#177;23.41 mg/dL. Mean DAS 28 was 5.955&#177;0.962; mean SDAI was 46.9&#177;27.1 and CDAI 28.9&#177;10.8. There was positive correlation (p<0.001) between DAS28 and SDAI (r=0.550) and CDAI (r=0.808). Anti-CCP level was associated with SDAI (r=0.317) and CDAI (r=0.282) (p<0.05). <b>Conclusion:</b> There was significant correlation in the titers of anti-CCP and disease activity indices-SDAI and CDAI. Patients with higher levels of anti-CCP antibody had greater activity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=RC08-RC11&id=12558 https://doi.org/10.7860/JCDR/2019/34558.12558 Adjuvant External Beam Radiotherapy with Concurrent Cisplatin after Resection of Gallbladder Cancer Sunil Choudhary, Neha Gupta, Avipsa Das, Nilesh Mani, Rumita Singh, Ritika Ranjan, Neelam Lader, Garima Jaiswal <b>Introduction: </b>Loco-regional failure is a serious problem in patients of gallbladder cancer following radical cholecystectomy. However, due to its rare occurrence the role of adjuvant chemo-radiotherapy is not well established. <b>Aim:</b> To evaluate the treatment outcomes of concurrent Cisplatin (CDDP) with External Beam Radiotherapy (EBRT) in patients of Gallbladder Cancer (GBC) after radical cholecystectomy. <b>Materials and Methods:</b> We retrospectively reviewed the medical records of 12 patients of GBC who were registered with us between January’2016 and January’ 2017 after curative cholecystectomy. Only stage II and III patients were selected. This cohort had adjuvant EBRT with 6 MV photon beam using 3D conformal radiotherapy technique. These patients were given concurrent CDDP 35 mg/m2 at a weekly interval. <b>Results:</b> The mean EBRT dose and CDDP cycle was 45 Gy and four respectively. All except one patient could complete the treatment completely. There were no major acute or late toxicities. The median follow-up period was 23.4 months for those who were alive. There were four failures: one local, one loco-regional and two distant. Overall Survival (OS) and Disease Free Survival (DFS) at 2-years were 75% and 72% respectively. <b>Conclusion:</b> Adjuvant EBRT with concurrent CDDP for stage II and III GBC was well tolerated and had survival outcome comparable to the previous studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=XC01-XC04&id=12559 https://doi.org/10.7860/JCDR/2019/40020.12559 Stromal Expression of CD10 in Colorectal Carcinoma and its Correlation with Lymph Node Metastasis and Other Prognostic Factors Malvika Magadhi, Ranjita Panigrahi, Jayasree Rath <b>Introduction:</b> Colorectal Carcinoma (CRC) is an important public health problem. The study has been one of the main pre-occupation for researchers worldwide and continuous research is going on to find out methods for the early detection, control and drugs for targeted therapy to improve the survival rate. <b>Aim:</b> To study the expression of stromal CD10 (sCD10) in colorectal neoplasia and to find out if there is any significant difference between sCD10 expression in adenomas versus carcinoma and association of sCD10 expression with age, tumour grade, depth of invasion and nodal status in CRC. <b>Materials and Methods:</b> The present study was a prospective and retrospective observational study conducted in the Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India, from August 2014 to July 2016. Expression of sCD10 in 71 cases including adenomas (12 cases) and adenocarcinomas (59 cases) were studied. Five tissues from proximal margin were included in the tissue microarray to study the pattern of sCD10 expression in the normal areas. <b>Results:</b> The age of patients ranged from 19-74 years with a male to female ratio of 1.62:1. The stromal expression of CD10 did not show any statistically significant association with any specific age group. In the present study, low grade adenoma was found to be negative for sCD10 but 50% (4/8) cases of high grade adenoma were positive for sCD10 expression. However, the values were not statistically significant. Of the total cases of CRC, 50.85% (30/59) cases showed no expression of sCD10 whereas 49.15% (29/59) cases were positive for sCD10 expression. Evaluation of sCD10 and lymph node status showed that 44.12% (15/34) node negative cases were sCD10 positive where as only 40.00% (10/25) node positive cases were sCD10 positive and these values were not statistically significant. <b>Conclusion:</b> In different grades of CRC sCD10 positivity did not show any statistically significant correlation, but the sCD10 expression was found to be increased with increased depth of tumour. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=EC01-EC05&id=12560 https://doi.org/10.7860/JCDR/2019/37679.12560 Hyponatremia as a Mortality Predictor of Severe Malaria: A Hospital Based Cross-sectional Study Manoj Parida, Pravat Kumar Thatoi, Anurag Choudhury, Subhas Bhuin, Sarita Behera, Rina Mohanty <b>Introduction:</b> It is well known that hyponatremia is common in severe malaria. However, there is scanty and conflicting literature regarding hyponatremia as a predictor of mortality in severe malaria. <b>Aim:</b> To determine the prevalence of hyponatremia in severe malaria and its association with mortality. <b>Materials and Methods:</b> It was a hospital based cross-sectional study conducted in a tertiary care referral hospital in the state of Odisha in India. Sample size was calculated to be 99 by using the prevalence of hyponatremia in severe malaria 55% with absolute precision of 10%. Taking into account of 10% drop out rates, the final sample size was determined to 109. Considering the prevalence of mixed plasmodium infection to be 13% and the proportion of falciparum to vivax infection to be 49:51, samples =45 in each group was adequate for comparison. Consecutive sampling was done over a period of two years. Severe malaria included either infection with <i>Plasmodium falciparum</i> alone or both <i>Plasmodium falciparum</i> and <i>Plasmodium vivax</i> along with any one feature of WHO criteria for severity. Patients aged more than 15 years with both smear positive and rapid card test positive were included. Vital parameters and electrolyte levels were measured for each patient. The data was analysed using SPSS and significance level was set at 95%. <b>Results:</b> Out of the total number of 110 cases of severe malaria, isolated falciparum malaria was 57.3% (n=63) vs. mixed falciparum-vivax infection of 42.7% (n=47); overall mortality was 6.3% (n=4) vs. 14.8% (n=7) respectively. Hyponatremia was observed in 63.6% (n=70) of the total cases. The difference in incidence of hyponatremia in both the groups was 133&#177;6 mEq/L vs. 127&#177;6.3 mEq/L respectively and was statistically significant. Among the hyponatremic group of patients, the difference in level of sodium in both the group was (128&#177;3.5 vs. 124&#177;3.2) mEq/L and was statistically significant. Overall mortality rate was 10% (n=11/110), however mortality rate among the hyponatremic patients was 15.7% (n=11/70; 12.1% vs. 18.9% in both the groups respectively). Hyponatremia at a cut-off of 126 mEq/L predicted mortality with a sensitivity of 81.8%, specificity of 78.8%, and negative predictive value of 97.5%. <b>Conclusion:</b> Hyponatremia was highly prevalent among the severe malarial patients. Higher degree of hyponatremia was observed in mixed plasmodium infection. Severe hyponatremia predicted mortality with high sensitivity and specificity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OC05-OC08&id=12561 https://doi.org/10.7860/JCDR/2019/39902.12561 Efficacy of Combined Interscalene Block and Superficial Cervical Plexus Block for Surgeries of the Clavicle: A Prospective Observational Study Seni Potsangbam, Jonan Puni Kay <b>Introduction:</b> Although there are regional anaesthetic techniques used to provide analgesia in fractures of clavicle, their routine use as a sole anaesthetic technique for surgical fixation of the same has not been well established. <b>Aim:</b> To assess the clinical efficacy of combined Interscalene Block (ISB) and Superficial Cervical Plexus Block (SCPB) as a sole anaesthetic technique in patients posted for routine clavicular surgeries. <b>Materials and Methods:</b> This was an observational prospective study of adult patients (n=12, 18-65 years of age) posted for routine clavicular studies, who opted for Regional Anaesthesia (RA) over General Anaesthesia (GA). Preoperative Visual Analogue Scale (VAS) scores were recorded for comparison. The regional anaesthetic technique performed was USG-guided combined ISB and SCPB using 30 mL of a local anaesthetic mixture (Bupivacaine 0.5% and lignocaine 1% in 1:1 ratio). Volumes used were 20 mL for ISB and 10 mL for SCPB. The onset of sensory anaesthesia was determined by loss of pain to pin prick along the area of incision to be made at the intervals of 5, 10, 15, 20, 25 and 30 minutes after the block. Intraoperative pain of VAS =4 was managed by rescue local anaesthetic infiltration. Perioperatively, patients were assessed for pain and other complications at 30 minutes,1 hour, 2 hours, 4 hours, 6 hours, 8 hours and 24 hours after the block. <b>Results:</b> All patients completed the study successfully under RA. Average duration for onset of anaesthesia was 15.41 minutes. Two patients required additional local anaesthetics of 2-3 mL each intraoperatively. Average duration of analgesia for all patients was 4.54 hours. No unwanted complications were observed. <b>Conclusion:</b> Combined ISB and SCPB as a sole anaesthetic technique is effective for clavicular surgeries. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=UC05-UC08&id=12562 https://doi.org/10.7860/JCDR/2019/39856.12562 Prevalence of Anal Fissure in Patients with Anorectal Disorders: A Single-centre Experience Ranjit Chaudhary, Chirag Shanti Dausage <b>Introduction:</b> Anorectal disorders including fissure and hemorrhoids are among the most common digestive complications. To our knowledge there is no literature available on the prevalence of anal fissure from our region of study (Bhopal, Madhya Pradesh, Central India). <b>Aim:</b> To estimate the prevalence of anal fissure among the patients of anorectal complaints. <b>Materials and Methods:</b> This was a cross-sectional observational study conducted from January 2014 to December 2015. All the patients visiting the Department of Surgery with anorectal complaints were screened. Patients of either sex, more than 18 years of age, with complaints of anorectal pain/bleeding/discharge or prolapse of rectum were included in the study. The diagnosis of enrolled patients was based on clinical findings of anorectal evaluation by digital examination and proctoscopy. <b>Results:</b> Overall, 629 patients were enrolled in the study. The mean (SD) age of patients was 38.27 (9.25) years and a total of 438 (69.63%) of patients were males. Around half of the patients (n=308; 48.97%) had normal BMI. A total of 112 (17.81%) of patients were diagnosed to have an anal fissure. Mixed dietary habits and history of constipation were found to be associated with the prevalence of fissure. Similarly, patients with no exercise or physical activity had more prevalence of fissure than patients who exercised on a regular basis (19.87% versus 11.54%). The majority of patients had bleeding and pain (n=326); out of these patients, 89 (27.30%) had an anal fissure. <b>Conclusion:</b> The prevalence of anal fissure among patients with anorectal complaint was found to be around 18%. Mixed dietary habits and constipation could be considered as risk factors for the anal fissure. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=PC05-PC07&id=12563 https://doi.org/10.7860/JCDR/2019/38478.12563 Pain on Injection of MCT/LCT Preparations of Propofol and Etomidate: A Double-blind Randomised Comparative Study Harsaprava Dutta, Suman Chattopadhyay, Rita PaPal <b>Introduction:</b> Propofol and etomidate are both very popular in routine practice as they have very rapid onset and offset of action when used as intravenous agents. Both these drugs have newer Medium Chain Triglyceride and Long Chain Triglyceride (MCT/LCT) preparations, which claim to decrease pain on injection. <b>Aim:</b> This study compared the pain on injection of etomidate and propofol when administered simultaneously in both the arms of same patients to avoid any subjective variation of pain sensation of the patients. <b>Materials and Methods:</b> Sixty five patients (i.e., total study arm is 130) were randomly selected, in between the age of 18 to 60 years, with American Society of Anaesthesiologists (ASA) physical status I or II, posted for elective surgical procedure under general anaesthesia for this study. Each subject received 5 mL of propofol-MCT/LCT i.v. through either right or left arm and simultaneously 5 mL of etomidate-MCT/LCT through the other arm. The incidence of pain on injection was observed on a 4 point rating scale (0-3) based on severity as well as haemodynamic variables in terms of systolic, diastolic and mean blood pressure at time of injection, at laryngoscopy and at intubation. The patients were also observed for any side effects. <b>Results:</b> Of the 65 patients 37 were males and 28 females. The average age of the patients was 35.1&#177;10.7 years. Propofol-MCT/LCT administration was associated with pain in 40.0% patients (Grade 1-35.4%, Grade 2-4.6%), whereas etomidate-MCT/LCT administration was associated with only Grade 1 pain in 9.2% of patients. The mean pain score with propofol administration was significantly more than etomidate administration (0.45 vs 0.09; p-value<0.001). There was significant increase in systolic, diastolic as well as mean blood pressure during laryngosopy and intubation compared to their baseline values (p<0.01). Myoclonus was observed in 19 patients (29.23%). <b>Conclusion:</b> To conclude, MCT/LCT preparations of propofol causes significantly more pain than MCT/LCT preparation of etomidate without any subjective variation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=UC09-UC12&id=12564 https://doi.org/10.7860/JCDR/2019/39507.12564 Assessing the Utility of Outlet Filters in the Ventilators of ICU Patients Akshita Lalendran, Aditya Lal Vallath, Abhijeet Mane, KK Lahiri <b>Introduction:</b> Intensive Care Units (ICU) host a large percentage of all nosocomial infections in any hospital. The air quality in such an environment plays a pivotal role in the dissemination of such infections. Ventilated patients expel aerosols containing nosocomial infectious agents from the ventilator. <b>Aim:</b> To assess the value of placing a Heat and Moisture Exchanger (HME) filter at the outlet of ventilators to reduce the Total Viable Count (TVC) in the air and improve air quality. <b>Materials and Methods:</b> The study was conducted in two phases, of which Phase I was conducted without a filter and Phase II was conducted after placing HME filters in the outlet of the ventilators; while sampling locations remained the same. In both phases, active and passive sampling was done on a total of 120 samples which included 60 samples from each phase. The index of microbiological air contamination (passive sampling) and surface air sample TVC (active sampling) were calculated to assess the level of microbiological contamination. <b>Results:</b> The mean results of passive sampling were 1547.41 CFU/dm2/hour in phase I and 761.49 CFU/dm2/hour in phase II. In active sampling, the mean results were 88.48 CFU/m3 in Phase I and 51.71 CFU/m3 in Phase II. <b>Conclusion: </b> The placement of HME filters at the outlet of ventilators has significantly reduced TVC counts in both active and passive sampling in Phase II using the filters as compared to Phase I. Other measures should be undertaken to further reduce TVC counts to accepted safety standards. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OC16-OC21&id=12601 https://doi.org/10.7860/JCDR/2019/39765.12601 Impact of Arm Length and Body Mass Index on Abductor Pollicis Brevis (APB) H-Reflex among Females D Rekha, B Suganthi <b>Introduction:</b> Hoffmann reflex (H-reflex) is an electrically induced reflex analogous to the mechanically induced spinal stretch reflex. H-reflex is useful clinically to diagnose nerve root lesions, particularly involving S1 radiculopathy and in proximal nerve lesions. H-reflex is affected by various physiological factors like age, height and gender. However, there are only few studies done to determine the effect of arm length and Body Mass Index (BMI) on latency and amplitude of Abductor Pollicis Brevis (APB) H-reflex among females. <b>Aim:</b> To determine the impact of arm length and BMI on APB H-reflex among females. <b>Materials and Methods:</b> The present cross-sectional study was done on 50 healthy adult female volunteers during early follicular phase between age group of 20-30 years. After measuring arm length and BMI, APB H-reflex was recorded by stimulation of median nerve. Data was analysed for correlation using SPSS version 20. <b>Results:</b> BMI has negative correlation with APB H-reflex latency and amplitude with “r” value -0.03 and -0.007 respectively. Arm length was found to be positively correlated with APB H-reflex latency and amplitude with “r” value 0.391 and 0.024 respectively. <b>Conclusion:</b> As BMI increases, APB H-reflex latency and amplitude decreases. With increasing arm length, APB H-reflex latency and amplitude increases. Hence, arm length and BMI should be taken into account while interpreting APB H-reflex among females to avoid misleading diagnosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=CC05-CC08&id=12602 https://doi.org/10.7860/JCDR/2019/39741.12602 Jigsaw Classroom: Is it an Effective Method of Teaching and Learning? Student’s Opinions and Experience Aliya Nusrath, Shilpashree Yeliyur Dhananjaya, Namitha Dyavegowda, Rajeshwari Arasegowda, Asharani Ningappa, Rafiya Begum <b>Introduction:</b> In this digital era with information overload it is important to train the students in a systematic approach to the information available and a positive interdependence for effective learning. Jigsaw is an active method of co-operative learning which focuses on learning in groups with a specific goal and has shown to improve the student&#8217;s academic performance. <b>Aim:</b> To analyse the learning experience of students in Jigsaw Co-operative Learning (JCL) technique and to explore the opinion of students towards the advantages/disadvantages of JCL technique. <b>Materials and Methods:</b> A cross-sectional study was conducted among first year MBBS students (n=152). The participants were subjected to JCL on folic acid and vitamin B12 during tutorial class after completion of the same topics during didactic lecture class. The participants answered pre-test and post-test for the above topic and feedback was taken using a pre-tested questionnaire. Descriptive statistics were used for analysis of the data. <b>Results:</b> Statistically significant difference between pre-test and post-test score (p<0.001) was observed. The overall mean score of the learning experience of participants was 4.14&#177;0.3 with the statement &#8216;the activity helped me in enhancing communication skill&#8217; having highest mean score of 4.59 and &#8216;the activity enabled in depth coverage of the topic&#8217; having lowest mean score of 3.58. Majority of the participants (83%) preferred JCL method of teaching learning. A number of advantages and disadvantages of this method were also opined by the participants in the open-ended questions. <b>Conclusion:</b> Based on the participants&#8217; opinions and positive approach, JCL can contribute to better understanding and comprehension of the concepts, improvement in communication, and analytical skills, making learning an enjoyable experience for the students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=JC01-JC04&id=12540 https://doi.org/10.7860/JCDR/2019/39613.12540 To Determine Tooth Discolouration After Treatment with Various Endodontic Materials using Spectrophotometric Analysis-An In-Vitro Study Geethu Francis, Shashi Rashmi Acharya, Sandya Kini <b>Introduction:</b> Various materials have been tried to minimise tooth discolouration over the years. Calcium silicate-based cements have been available for many years. These biomaterials have been used in various endodontic treatments including repair of tooth perforations, as root end restorations, in conditions of open apices, as pulp capping agent and in apexification procedures. Calcium-based materials have shown discolouration with time, minimising the discolouration has become a necessity especially in the teeth in the aesthetic zone. Biomaterial are non-viable material that can be implanted to replace or repair lost tissue, which can be bone substitute, collagen membrane and matrices which are commonly used in regenerative dentistry. Mineral Trioxide Aggregate (MTA) is a biomaterial which has shown discolouration over time. There are various radio-opacifiers like zirconium oxide, tantalum oxide which are been introduced to replace the bismuth oxide which is supposed to be the main reason for discolouration. The study is conducted to compare the rate of discolouration among three different materials over a period of three months. <b>Aim:</b> To determine the tooth discolouration between the ProRoot MTA, ENDOCEM-Zr, and EndoSequence Root Repair Material (ERRM) at baseline, one week, one month and three months using Spectrophotometric analysis. <b>Materials and Methods:</b> A total of 40 extracted human maxillary central incisors were collected for the in-vitro study. Experimental group consisted of ProRoot MTA (Group 1), Endocem-Zr (Group 2), ERRM (Group 3) and one control group. Three different root end filling materials (ProRoot MTA, Endocem-Zr, ERRM) were placed in retrograde pattern after chemomechanical preparation of root canal system whereas in the control group, the pulp tissue was extirpated from the teeth, which were then only sealed with composite resin. Colour assessment was done immediately after the placement of material in the cavity (baseline) and at one week (T1), one month (T2) and three months (T3). Colour values were recorded by a single operator using a spectrophotometer (X-rite i1 pro spectrophotometer). Repeated measures analysis of variance was carried out to determine the significant difference in the discolouration among the four groups namely, ProRoot MTA, ENDOCEM-Zr, ERRM and control across the three time points. <b>Results:</b> It was found that statistically significant difference existed between reading taken from baseline and 30 days, than 30 days to 90 days. MTA had shown steady increase in discolouration over a period of three months and showed statistically significant results whereas the other two materials had decreased discolouration over the period of three months and showed less distinct values. <b>Conclusion:</b> EndoSequence Root Repair Material and Endocem-Zr had shown lesser discolouration over a period of three months, Endocem-Zr showed lesser discolouration when compared to that of EndoSequence Repair material which showed rapid decrease in discolouration from one month to three months whereas MTA showed steady increase in discolouration with time. Endocem-Zr showed lesser discolouration than ERRM in a period of three months. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZC07-ZC12&id=12589 https://doi.org/10.7860/JCDR/2019/37553.12589 Impact of Glycaemic Control on the Pattern of Cutaneous Disorders in Diabetes Mellitus- A Hospital Based Case Control Study Balasubramaniyan Poorana, Pullabatla Venkata Siva Prasad, Pitchai Kaliaperumal Kaviarasan, Swaminathan Selvamuthukumaran, Kalyanasundaram Kannambal <b>Introduction:</b> The skin is the largest and the most visible organ of the body. It is a well known fact that it is referred to as window or mirror to the internal health of the body. Abnormalities of insulin and elevated blood glucose levels lead to metabolic, vascular, neurological and immunological abnormalities. Affected organs include the cardiovascular, renal, nervous system, eyes and the skin. The skin manifestations can be the first presenting sign of diabetes but more often appear in known diabetic patients during the course of the disease. <b>Aim:</b> To study the clinical profile of cutaneous lesions in diabetic patients and to compare the pattern of these dermatoses with HbA1C levels (glycosylated haemoglobin). <b>Materials and Methods:</b> Three hundred consecutive diabetic patients with cutaneous manifestations who attended dermatology OPD at Rajah Muthiah Medical College, Chidambaram from November 2013 to October 2015, constituted the study group. Hundred age and sex matched non diabetic patients who attended our OPD, constituted the control group. They were subjected to relevant investigations. Fasting blood sugar, post prandial blood sugar, glycosylated haemoglobin levels and renal function test were done for all patients. Potassium hydroxide mount and gram stain were done for relevant cases. Chi-square test was used for statistical analysis using software SPSS version 21. <b>Results:</b> The most common dermatological manifestation among diabetics was cutaneous infections, seen in 126 (42%) patients. Among the infections, fungal infections predominated in 89 (29.7%) patients, followed by bacterial infections in 31(10.3%) patients. There was a statistically significant correlation between infections and uncontrolled diabetes (HbA1C >7). <b>Conclusion:</b> Skin is involved quite often in diabetics, some of which can be a consequence or can be a clue for the diagnosis of underlying diabetes. Diabetic control is very important in reducing the morbidity and mortality of the diabetic patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=WC01-WC05&id=12604 https://doi.org/10.7860/JCDR/2019/36742.12604 Knowledge, Attitude and Practices regarding Dengue among Outpatients and their Attenders in Three Primary Health Care Centres in Coimbatore, Tamil Nadu, India Sk Senthil Kumar, P Kalidas, P Prithiviraaj, E Priyanka, S Priya, S Priyadarshini, S Priyanka <b>Introduction:</b> Dengue is an arboviral disease transmitted by Aedes aegypti Mosquitoes with incidence of 50 to 100 million infections annually worldwide. Since no effective vaccine for Dengue is commercially available as of now, vector control programmes are of utmost importance in controlling the disease for which assessment of community participation is crucial. <b>Aim:</b> To assess the knowledge, attitude and practices regarding Dengue among the outpatients and accompanying persons attending three Primary Health Centres in Coimbatore and to compare the knowledge scores between subjects based on their educational qualification. <b>Materials and Methods:</b> This was a cross-sectional community-based study conducted among 300 subjects within the age group of 18 to 75 years. The study was questionnaire-based and was conducted among the outpatients and accompanying persons visiting three primary health centres in the city within one month. The questionnaire had 20 questions (15 on knowledge, four on attitude and one on practices). Knowledge was scored from 0 to 23 and comparison of results were done between two groups (subjects who had studied below class 10 and subjects who had studied above class 10). Data analysis was done using SPSS software version 20.0 and independent t-test. The p-value<0.05 was taken as statistically significant. <b>Results:</b> Out of the 300 participants, 255 submitted completed questionnaires and the mean knowledge scores of individuals who had studied below class 10 and individuals with educational qualification above class 10 were 9.71 and 10.64 respectively and the difference in knowledge scores was statistically significant (p-value=0.014). It was found that persons with higher education tend to have better knowledge of Dengue; this signifies the need to focus health education efforts towards persons with lower education level by conducting awareness campaigns in the future. <b>Conclusion:</b> To conclude, majority of the present subjects had average knowledge of Dengue. The overall attitude and practices of the participants towards Dengue care, prevention and control are good. Thus measures to improve the community participation in Dengue prevention control and management has to be reinforced periodically through health education campaigns, mass media and creating awareness at individual level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=LC21-LC27&id=12605 https://doi.org/10.7860/JCDR/2019/38149.12605 Incidence and Association of HPV16 and 18 with Various Risk Factors in Cervical Cancer Patients in Population of Haryana Region, India Lokesh Kumari Kadian, Geetanjali Singhal, Shivkant Sharma, Preeti Chauhan, Smiti Nanda, Ritu Yadav <b>Introduction:</b> Cervical cancer is the most leading malignancy in women with the highest mortality rates in most of the countries and Human Papilloma Virus (HPV) 16 and 18 confer a greater risk of having cervical cancer than other genotypes. <b>Aim:</b> To assess the incidence of high risk type HPV 16 and 18 infections in cervical cancer patients and to study their association with various risk factors in females of Haryana, India. <b>Materials and Methods:</b> In present study, total 110 cervical cancer samples were collected from PGIMS, Rohtak, Haryana, India. These samples were screened to confirm the presence of HPV infection by using degenerate primers for L1 open reading frame of HPV genome. Samples found positive for HPV infection were further studied by type-specific PCR for HPV 16 and 18. Statistical analysis were performed by using Medicalc software version 18.9. Odd ratio (95% confidence interval) was calculated to study association of sociodemographic and histopathological grades with HPV type specific infections. <b>Results:</b> Out of 110 samples, 107 (97.27%) were recorded positive for HPV DNA. A total of 90 (84.11%) and 78 (72.89%) patients were found infected with HPV 16 and 18 respectively. Risk factors like elder age, age at marriage, post menopause and poor genital hygiene were found to be significantly associated (p=0.05) with HPV 18 infection and rural background showed significant association with HPV 16 infection in cervical cancer (p=0.05). <b>Conclusion:</b> Results suggest that HPV 16 and 18 infections are highly prevalent in the cervical cancer patients of Haryana. These results will be useful in establishing the future guidelines for reducing risk of cervical cancer with the help of screening programs and by providing proper vaccines targeting HPV16 and 18. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=QC10-QC13&id=12606 https://doi.org/10.7860/JCDR/2019/40007.12606 Foetal Echocardiography: A Novel Method for Detecting Congenital Heart Disease Sura Adnan Raheem, Ghazi F Haji <b>Introduction:</b> Management and outcomes of prenatal and postnatal cardiac diseases have been affected significantly by prenatal detection of foetal Congenital Heart Disease (CHD). Foetal echocardiography plays an important role in this diagnosis. <b>Aim:</b> To estimate the efficiency of echocardiography in detecting type and frequency of foetal CHD in a group of pregnant women regardless of presenting risk factors. <b>Materials and Methods:</b> In this cross-sectional study, 263 pregnant women undergoing foetal echocardiography with a gestational age of 20 to 40 weeks referred to the Echocardiography Unit at Baghdad Teaching Hospital, Iraq from April 2016 to June 2018 were included. The women were divided into high, low and no risk groups as per their referral for foetal echocardiography which is in accordance to the American Heart Association. Foetal 2D and Doppler echocardiography was done. Postnatal echocardiography was performed in cases diagnosed with foetal CHD. <b>Results:</b>A total of 263 pregnant women were included in the study. Fourteen cases of CHD were diagnosed based on abnormal foetal echocardiography. However, only nine of the 14 cases of CHD occurred in high risk mother while the remaining five occurred in mothers with no risk for developing foetal CHD. Twenty-two cardiac abnormalities were detected in those 14 fetuses in which eight fetuses were categorised as having a simple cardiac abnormality and six cases with complex cardiac abnormalities.Complete agreement between prenatal and postnatal diagnosis of CHD was observed in 80% of cases. <b>Conclusion: </b>From the present study, it can be concluded that foetal echocardiography should be recommended to be involved as a part of antenatal screening for all pregnant women regardless of the risk factors among the mother. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OC22-OC24&id=12607 https://doi.org/10.7860/JCDR/2019/38300.12607 Does Ear Morphology Establish Automatic Extraction of Soft Biometric Traits? Siow Jia Cheng, Tung Chia Hao, Khor See Ming, Kethan Skantha, Bincy M George <b>Introduction:</b> The external appearance of auricle varies between ethnic groups. However, there have been no studies on external ear morphometry correlating soft biometrics of the same individual. Therefore, a morphometric databank for the same appears to offer useful data to doctors and computer engineers working with documentation system. <b>Aim:</b> To correlate the external ear parameters (Total ear height, Lobular width and Lobular height) with biometric parameters (Height, Head circumference and shoulder breadth) of individuals of different Ethnic Group and to correlate the linear measurements of the external ear within individuals of different ethnic groups. <b>Materials and Methods:</b> From four of Asian ethnic group, 160 students aged between 19 and 25 volunteered for the study. The races include Malaysians, Malaysian Chinese (Chinese residing in Malaysia); Indians; and Malaysian Indian (Indians residing in Malaysia). Linear measurements of ear pinna, Height, Head circumference, and Shoulder breadth of every participant were measured. The data were analysed using SPSS software, through one-way ANOVA and non-parametric Pearson&#8217;s coefficient. <b>Results:</b> Except Indian males there was significant correlation existing between height of individuals and total ear height (Malaysian Male r=0.507, p<0.05; Malaysian Female r=0.452, p<0.04; Malaysian Indian Male r=0.463, p<0.05; Malaysian Indian Female r=0.583, p<0.007; Malaysian Chinese Male r=0.520, p<0.01; Malaysian Chinese Female r=0.514, p<0.05. Positive correlation was also found between total ear height and lobular height in Malay (Male; r=0.566, p<0.02; Female; r=0.507, p<0.009) and Malaysian Chinese (Male: r=0.717, p<0.001; Female: r=0.514, p<0.02) samples. The correlation between shoulder breadth and total ear height was not significant in both males and females of Malaysian Indian ethnic group. There was no positive correlation between head circumference and total ear height in Malaysian Chinese males and Indian females. <b>Conclusion:</b> From the present study, authors found that there exists a correlation between person&#8217;s height to his or her total ear height. Correlation of ear morphometry to the head circumference and shoulder length of an individual varied in various ethnic groups. Correlation between different linear measurements of the ear in different ethnic groups also varied. The knowledge of external ear morphometry to the physical characteristics of an individual is necessary for reconstructive surgeries. This knowledge may be used as supportive evidence in the forensic field as the identification landmarks varied in different ethnic groups. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=AC10-AC13&id=12608 https://doi.org/10.7860/JCDR/2019/39770.12608 Comparative Evaluation of Apical Microleakage of Retrograde Cavities Filled with Glass Ionomer Cement, Light-cured Composite, Mineral Trioxide Aggregate and Biodentine- ARTICLE RETRACTED Swadheena Patro, Satyajit Mohapatra, Sumita Mishra <b>Swadheena Patro, Satyajit Mohapatra, Sumita Mishra,</b> Comparative Evaluation of Apical Microleakage of Retrograde Cavities Filled with Glass Ionomer Cement, Light-cured Composite, Mineral Trioxide Aggregate and Biodentine (Published in Journal of Cilinical and Diagnostic Research. 2019 Feb: 13(2):). ZC18–ZC22 The article has been retracted due to serious authorship issue which could not be resolved among the authors. And corresponding author requested to retract the article. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZC18-ZC22&id=12609 https://doi.org/10.7860/JCDR/2019/32601.12609 Perinatal Outcome of Twin Pregnancies Compared based on Chorionicity and Antenatal Booking Status of Mother Sunita Dubey, Reeti Mehra, Poonam Goel <b>Introduction:</b> Twin pregnancy is considered a high risk pregnancy due to multiple maternal and foetal complications leading to adverse maternal and foetal outcome. <b>Aim:</b> This study was planned to know foetal outcome of twin pregnancy according to chorionicity and also tried to observe difference in outcome among foetuses born to booked patients at our institute and foetuses those were born to referred patients. <b>Materials and Methods:</b> A retrospective study of four years pertaining to twin foetuses was carried out at tertiary hospital. Foetal data was collected from the individual mother&#8217;s file from antenatal period till the time of birth. Foetal outcome was analysed according to chorionicity of placenta and data of whole study population was further stratified into those (298) born to booked patients (minimum 4 antenatal visits) and those (564) referred to our institute. Discrete categorical data were presented as n (%); continuous data were given as mean&#177;SD and range. Means of different parameters for three groups Diamniotic Dichorionic (DADC), Diamniotic Monochorionic (DAMC), Monoamniotic Monochorionic (MAMC) were compared using One-Way ANOVA followed by Post-Hoc Multiple Comparisons test. Proportions were compared between the referred and booked groups using the chi-square test. <b>Results:</b> Incidence of twin pregnancies was 22/1000 birth and 65% of them were born to referred patients. Out of 862 twin foetuses, 258 pair (59.8%) were Diamniotic Dichorionic (DADC), 162 (37.5%) were Diamniotic Monochorionic (DAMC) and 11 (2.5%) were Monoamniotic Monochorionic (MAMC) twins. Seventy percent of them were preterm delivered. In relation to chorionicity there was no difference in gestational age (34.9 weeks), however birth weight was significantly different (1.97&#177;0.42 kg, 1.783&#177;0.54 kg, 1.645&#177;0.57 kg in DADC, DAMC and MAMC group respectively, p<0.001). Gross foetal malformations were observed in 8/862 (0.9%) of twins. The discordant twins were observed in 8.9% of foetuses. The incidence of intrauterine foetal death was 35/862 (4.0%), (nine in DADC, 20 in MCDA and 6 in MAMC group (p<0.001). There was significant difference in gestational age, birth weight, discordant twin, intrauterine foetal death and Apgar score among referred and booked patients (p<0.05). <b>Conclusion:</b> This study revealed importance of specialised antenatal care in reducing foetal mortality in utero and emphasise us to increase the availability of more number of intensive care units to enhance the survival rate of these premature foetuses after birth to decrease perinatal mortality and morbidity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=QC14-QC17&id=12610 https://doi.org/10.7860/JCDR/2019/40055.12610 The Effect of Dialysate Temperature on Urea Reduction Ratio among Patients Undergoing Maintenance Haemodialysis: A Case Control Study Munusamy Sivasankari, Varadharajan Jayaprakash, Elayaperumal Indhumathi, Dhakshinamoorthy Jagadeswaran, Angraje Srivatsa, Matcha Jayakumar <b>Introduction:</b> Lowering the dialysate temperature in Intradialytic Hypotension (IDH) prone Maintenance Haemodialysis (MHD) patients, offers better haemodynamic stability. Evidence is lacking relating the effects of low dialysate temperature on urea clearance. <b>Aim:</b> To study the effect of dialysate temperature on dialysis adequacy in terms of urea reduction ratio in MHD patients. <b>Materials and Methods:</b> This experimental study was conducted on stable End Stage Renal Disease (ESRD) patients undergoing regular MHD in the age group of 18 to 65 years. The study population (n=118) was randomly divided into two groups. In the control group (n=59), the dialysate temperature was set at 37&#176;C and in the study group (n=59), the temperature was set at 35.5&#176;C. Urea Reduction Ratio (URR) and Online Clearance Monitoring (OCM) Kt/V of individual Haemodialysis (HD) sessions in both the groups were calculated and compared. <b>Results:</b> The mean pre and post Blood Urea Nitrogen (BUN) values of HD sessions in the control group were 49.95&#177;19.54 mg/dL and 14.17&#177;7.92 mg/dL respectively. The mean pre and post BUN values of HD sessions in the study (low dialysate temperature) group were 50.76&#177;17.67 mg/dL and 21.69&#177;10.96 mg/dL respectively. The mean URR of HD sessions of the control group was 69.08&#177;14.72 and in the study group, it was 56.93&#177;15.85. In the low dialysate temperature group, 43 (72.9%) patients achieved <65% URR and 16 (27.1%) patients achieved >65% URR. <b>Conclusion:</b> Dialysis with low dialysate temperature was associated with statistically significant reduction of URR. Low dialysate temperature can affect dialysis adequacy in stable MHD patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=OC25-OC28&id=12611 https://doi.org/10.7860/JCDR/2019/40295.12611 Effect of Spinal Manipulation on Pain Sensitivity, Postural Sway, and Health-related Quality of Life among Patients with Non-specific Chronic Low Back Pain: A Randomised Control Trial Kanchan Kumar Sarker, Jasobanta Sethi, Umasankar Mohanty <b>Introduction:</b> Spinal manipulation is a technique of specific directed manual thrust which has been effective in aligning a spinal segment, maintaining normal range of motion and reducing pain. Recent studies have reported on management of pain and improvement of quality of life of patients suffering from mechanical low back pain. <b>Aim:</b> To analyse the effectiveness of Spinal Manipulation-High- Velocity Low Amplitude Thrust (SM-HVLA) on pain sensitivity, postural sway and quality of life in patients with Chronic Non-Specific Low Back Pain (CNSLBP). <b>Materials and Methods:</b> This randomised controlled trial was conducted on a sample size of 90 patients with chronic non-specific low back pain (with duration of pain more than three months) recruited from Outpatient Department, Department of Physiotherapy, Lovely Professional University, Phagwara, Punjab, India. Participants were divided into three groups, namely Control Group, Study Group-1, and Study Group-2. Control group received supervised exercise with ergonomic advice (n=30), whereas SM-HVLA thrust with ergonomic advice (n=30), and study group-2 received core stability exercise with ergonomic advice (n=30). Primary outcomes were postural sways (centres of foot pressure) measured by Win Track Platform, and pain sensitivity measured by pressure pain threshold (digital algometer) and quality of life measured by EuroQoL questionnaire score at two weeks and four weeks. Univariate analysis of variance (ANOVA) with post-hoc Tukey&#8217;s multiple comparison tests was carried out to examine treatment effects and the relationship between groups changes across outcome measures. <b>Results:</b> For all three treatment groups, outcomes improved after two weeks of treatment. The group received spinal manipulation with ergonomic advice had slightly better outcome than the supervised exercise with ergonomic advice group at two weeks (between-group difference) in pain sensitivity (p=0.001); Postural sway (p=0.001); quality of life (p=0.01) as well as at four weeks (between-group difference): pain sensitivity (p=0.001); postural sway (p=0.001); quality of life (p=0.01). <b>Conclusion:</b> The spinal manipulation with ergonomic advice is effective in treatment of chronic non-specific low back pain. This is an economic model of back care in clinics can be practised widely. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=YC01-YC05&id=12578 https://doi.org/10.7860/JCDR/2019/38074.12578 Effect of Haemodialysis on Oxidative Stress in Chronic Kidney Disease Patients Ashok Kumar Jeppu , Sushith , Asha Augusty , Reshma Kiran Kumar, Prathima Mangalore Balakrishna , Prasanna Kumar Rao Jeppu , Kavitha Ashok Kumar <b>Introduction:</b> The progressive damage to the kidney by oxidative stress and depletion of nitric oxide have been pointed out in recent years. Oxidative stress has been implicated to various mechanisms leading to accumulation of superoxide anions. <b>Aim:</b> We have estimated serum levels of Superoxide Dismutase (SOD), Ceruloplasmin, Total Antioxidant (TAO) and Malondialdehyde (MDA) to study the oxidative stress in chronic kidney disease as well as compare it with its post haemodialysis status. <b>Materials and Methods:</b> The study group consisted of 96 individuals with chronic kidney disease (cases) and 60 age/sex matched healthy individuals (control). Blood sample was collected from cases before and after haemodialysis as well as from the control group. Blood sample was processed and estimated for MDA, SOD, TAO and ceruloplasmin. Student&#8217;s t-test was used to find the significance and Pearson correlation was used to find the degree of relationship between the study parameters. <b>Results:</b> A statistically significant (p<0.001) increase in serum MDA was observed in cases compared to controls. Serum SOD, ceruloplasmin and TAO levels were decreased in cases in chronic kidney disease compared to control group. The decrease in serum ceruloplasmin and TAO activity was statistically significant (p<0.001). After haemodialysis, statistically significant increase in serum MDA level (p=0.004) as well as ceruloplasmin (p<0.001) level were observed. However, serum SOD and TAO activity were decreased significantly (p<0.001). <b>Conclusion:</b> In chronic kidney disease oxidative stress is higher, which is further increased after haemodialysis as indicated by increased MDA levels and decreased SOD and TAO activity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=BC01-BC04&id=12579 https://doi.org/10.7860/JCDR/2019/38094.12579 Tobacco Usage and Serum Cotinine: A Hospital Based Study Vaishali Satyajeet Pawar, Ajit V Sontakke, Krishnaji L Garud, Satyajeet Krishnarao Pawar <b>Introduction:</b> Tobacco usage is mainly in the form of smoking and smokeless tobacco. Some studies commented that smokeless tobacco has high nicotine and toxic effect, but the studies with depictive data have been limited. Cotinine is one of the nicotine metabolite, which is used as a marker to quantify tobacco exposure. <b>Aim:</b> To estimate serum cotinine (CTN) levels in tobacco smokers and smokeless tobacco users and to compare them with tobacco non-users. <b>Materials and Methods:</b> This cross-sectional study was performed in 240 study subjects divided into four groups- only tobacco smokers (G1), only smokeless tobacco users (G2), dual tobacco smokers and smokeless tobacco users (G3), and tobacco non-users (G4). G2 was divided into G2a, G2b, and G2c. Serum CTN levels were estimated using enzyme linked immunosorbant assay (ELISA) kit. Chi-square test, unpaired t-test, ANOVA and regression analysis were used for statistical analysis. <b>Results:</b> The mean serum CTN levels in groups G1, G2a, G2b, G2c, G3 and G4 were found to be 117.45 ng/mL, 138.09 ng/mL, 72.35 ng/mL, 100.34 ng/mL, 145.21 ng/mL and 5.28 ng/mL respectively. When the mean values were compared between the groups the values were found to be statistically highly significant. The finding suggests significantly higher CTN levels in tobacco users compared with tobacco non-users, also in tobacco chewers compared with tobacco smokers, as well as for dual tobacco smokers and smokeless tobacco users compared with smokers. <b>Conclusion:</b> Dual tobacco smokers and smokeless tobacco users tend to have relatively high level of serum CTN, which suggests tobacco dependence. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=BC05-BC09&id=12580 https://doi.org/10.7860/JCDR/2019/40145.12580 Effect of Cyclic Loading on Abutment Screw Loosening in Angled Implant Abutments- An In-vitro Study Syed Ershad Ahmed, Chitra Shankar Krishnan, Jayashree Mohan, Parithimar Kalaignan <b>Introduction:</b> Axis of loading can impact the effect of abutment fit to implant, thereby affecting the implant-abutment screw joint preload leading to screw loosening. <b>Aim:</b> The aim of the in-vitro study was to comparatively evaluate the effect of cyclic loading on abutment screw loosening of 25° angled premachined titanium abutments with that of 25° angled custom cast cobalt chromium (Co-Cr) abutments. <b>Materials and Methods:</b> Premachined titanium abutments (Group I) and custom cast cobalt-chromium abutments (Co-Cr) (Group II), 10 each of 25° angulation were connected to their respective titanium implants mounted in stainless steel blocks. Cement-cum-screw retained nickel-chromium cast crowns were fabricated. Abutment screws were torqued to 35 Ncm. Reverse torque values were measured using digital torque meter before and after cyclic loading simulating six months of function. The results were statistically analysed using Paired t-test and Independent t-test. <b>Results:</b> Mean pre-cyclic loading reverse torque values were 28.96 Ncm (Group I) and 26.01 Ncm (Group II) and mean post-cyclic loading reverse torque values were 25.84 Ncm (Group I) and 23.82 Ncm (Group II) respectively. Cyclic loading resulted in significantly lesser reverse torque values within both test groups (p<0.01). There was significantly greater loss of preload for Group II samples both prior to and after cyclic loading compared to Group I samples (p<0.01). <b>Conclusion:</b> Cyclic loading resulted in significant screw loosening within both test groups. Screw loosening was found to be significantly less for angled premachined titanium abutments than for angled custom cast Co-Cr abutments both before and after cyclic loading. The study is clinically significant regarding the importance of screw joint-abutment connection acting in a maxillary anterior implant region under load and the consequences of poor connection. The study is important in the aspect of clinical implications of angled implant abutments and the effect of loading on them. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZC01-ZC06&id=12585 https://doi.org/10.7860/JCDR/2019/37807.12585 Association Between Health Behaviours during Menstruation and Endometriosis Sanaz Mollazadeh, Mahin Kamalifard, Behnaz Sadeghzadeh Oskouei, Mojgan Mirghafourvand, Nayyereh Aminisani, Mehri Jafari Shobeiri <b>Introduction:</b> Endometriosis is characterised by implantation of endometrium outside the uterine cavity. There are numerous risk factors for this disease. <b>Aim:</b> To study the association between health behaviours during menstruation and endometriosis as one of the various risk factors for this disease. <b>Materials and Methods:</b> This case-control study recruited 555 women visiting a hospital in North West of Iran. The case group comprised 185 women of reproductive age with confirmed diagnosis of endometriosis through laparoscopy or laparotomy. The control group comprised 370 women without endometriosis visiting the hospital for other health problems. Data were collected using a researcher-made questionnaire; included socio-demographic and health behaviours characteristics based on previous studies. Univariate analysis was performed using the chi-squared test, and multivariate analysis was done using conditional logistic regression. <b>Results:</b> Based on multivariate logistic regression, the health behaviours of the two groups during menstruation were significantly different. Taking hot baths {OR (95% CI)=4.78 (2.22 to 10.30); p>0.001} and performing vaginal washing {OR (95% CI)=7.20 (1.32 to 39.22); p=0.022}, during menstruation increased the risk of endometriosis approximately five and seven times in those women who stated they took hot baths and performed vaginal washing during menstruation compared to those who stated they did not. Moreover, the chance of developing endometriosis was about two times higher in women who used cloth menstrual pad during menstruation than those who did not {OR (95% CI)=1.97 (1.12 to 3.44); p=0.017}. There was a significant difference between the two groups in terms of the average number of days in which they used cloth menstrual pad and the average number of cloth menstrual pad used per day. <b>Conclusion:</b> Based on the results, there is a relationship between taking hot baths and performing vaginal washing during menstruation as well as using cloth menstrual pad during menstruation and endometriosis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=LC16-LC20&id=12583 https://doi.org/10.7860/JCDR/2019/37416.12583 Glypican 3 Expression in Urothelial Carcinoma: A Histopathological and Immunohistochemical Study Solafa Amin Abd Al Aziz, Samia Mohamad Gabal, Wael Moustafa Mohamad, Sara Mohamad Abou Fandoud Mohamad <b>Introduction:</b> Glypican 3 (GPC3) is an oncofetal protein, playing a role in cell regulation during fetal development, via Wingless/Integration (Wnt) signaling pathway. GPC3 immunohistochemical expression was detected in several tumours, most obvious in hepatocellular carcinoma. The GPC3 antibody is under clinical trials for the therapeutic approach of hepatocellular carcinoma. <b>Aim:</b> Correlation of glypican 3 expression in urothelial carcinoma with clinicopathological features, to detect its possible role in stimulating Wnt signaling which is supposed to be responsible for urothelial carcinogenesis, where GPC3 can be used as a future therapeutic target. <b>Materials and Methods:</b> This retrospective study included a total of 125 archived, formalin fixed, paraffin embedded tissue blocks of 125 cases of UC, including 90 cases of radical cystectomies with high-grade UC and 35 cases of Transurethral Resection of Bladder Tumour (TURT) with low-grade UC. The samples were immunohistochemically analysed for GPC3 expression. <b>Results:</b> A statistically significant correlation was detected between GPC3 expression and tumour (T) stage (p-value=0.047). <b>Conclusion:</b> GPC3 has a partial role in urothelial carcinogenesis. Further studies are needed to investigate the possible role of GPC3 in differentiation between low and high-grade UC. Also, GPC3 may differentiate between neoplastic and non-neoplastic urothelial tissue. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=EC06-EC11&id=12593 https://doi.org/10.7860/JCDR/2019/39883.12593 Introduction and Comparison of Direct Observation of Procedural Skills (DOPS) with Conventional Method of Skill Assessment in Dental Students Daisy Happy, Amita Aditya, Parag Hadge, Nihal Devkar, Akshay Vibhute <b>Introduction:</b> Procedural competence and professional behaviour are integral components of clinical skills in Dentistry. However till date, most of the clinical procedures performed by undergraduate dental students are only assessed at the end of the procedure. Because of this, there could be a lack of assessment of their actual procedural and patient handling skills. Also, because of lack of a standard format, there could be a lot of ambiguity in assessment scores given by different examiners for same performance. <b>Aim:</b> The aim of this study was to introduce and compare Direct Observation of Procedural Skills (DOPS) with conventional method of case presentation for skill assessment of dental undergraduate students. <b>Materials and Methods:</b> DOPS, as a skill assessment tool was analysed on the basis of its feasibility, acceptability, validity and reliability. Checklist for DOPS assessment of Scaling and Root Planing (SRP) procedure was generated and process of internal validation was completed. Forty final year Bachelor of Dental Surgery (BDS) students participated in this study during their clinical posting in the Department of Periodontology. One of the most routinely performed procedure by the students in the clinical posting; i.e., SRP was selected for skill assessment. Each student performed SRP on patients and was assessed by two assessors using conventional method (CA1 and CA2) and two assessors using DOPS method (DA1 and DA2). Three such assessments were carried out for each student i.e. on day 1, day 2 and after feedback i.e., at the end of their clinical posting of 14 days. Descriptive analysis, ANOVA, Tukey’s Post-Hoc and Spearman-Brown formula were used for statistical analysis concerned with reliability as compared to the conventional method. Feedback from students and assessors was used to analyse the feasibility and acceptability of DOPS. <b>Results:</b> Correlation between DOPS examiners (74%, 71%) was significantly higher as compared to correlation between conventional examiners (23%, 55%). According to Spearman-Brown formula, reliability was found to be 80-90% in case of DOPS, and 50-70% in case of conventional method. Based on feedback collected from students and faculty regarding the feasibility and acceptability of DOPS, 97% students and all faculty members chose DOPS over conventional method. <b>Conclusion:</b> According to this study, DOPS seems to be a reliable, valid, acceptable and feasible method of skill assessment in dental students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZC13-ZC17&id=12594 https://doi.org/10.7860/JCDR/2019/37913.12594 Educational Intervention to Increase Hepatitis B Vaccination among Housekeeping Staff Aruna Arumugam, R Deepashree, Prasanna Bhat, R Akshatha, Rahul Dhodapkar, Apurba Sastry <b>Introduction:</b> Hepatitis B Virus (HBV) causes acute and chronic liver disease which can progress to cirrhosis and hepatocellular carcinoma. The seroprevalence in India is about 2% to 8%. When compared to general population, seroprevalence in HCWs is 2-4 times higher. A 40%-65% of HBV in Health Care Workers (HCWs) is due to occupational exposures. Housekeeping staff are also exposed to risk, as they are involved in handling of inappropriately discarded bio medical waste, low vaccination coverage due to low educational and socio-economic status. This is the first study conducted in India, to do Knowledge Attitude Practice (KAP) assessment using Turning point technology, an innovative method using clickers. <b>Aim:</b> To evaluate the role of educational intervention, to increase hepatitis B vaccination among housekeeping staffs of our hospital. <b>Materials and Methods:</b> This study was conducted for six months, between April-September 2017 in a tertiary care hospital in southern India. The sample size for the given study was 656. Knowledge was assessed in two phases, at baseline and one month after education intervention. <b>Results:</b> The results at baseline showed that average correct response to knowledge on HBV disease, transmission, prevention and post exposure prophylaxis was 22%, 45%, 36% and 26% respectively which improved to 76%, 82%, 90% and 70% respectively post intervention. Attitude and practice towards preventing HBV was analysed at baseline and 60% opined that they were not vaccinated against HBV because of lack of awareness. <b>Conclusion: </b>In the present study percentage of HCWs protected from HBV increased from 26% to 39%. We consider that all cadre of HCWs have right to be protected against hepatitis B in view of their increased risk from occupational exposure. Having institutional protocol, availability of vaccine and test for anti HBs titre will largely influence the vaccination compliance. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=DC01-DC06&id=12595 https://doi.org/10.7860/JCDR/2019/39882.12595 Comparison of Magnesium Sulphate Protocols by Weight-Adjusted Versus Two Grams Per Hour for Preventing Convulsion in Preeclampsia: A Randomised Controlled Trial Saowanee Tangmanowutthikul, Rawisara Champawong, Srisuda Songthamwat, Metha Songthamwat <b>Introduction:</b> Magnesium Sulphate (MgSO4) is the most effective drug used for seizure prevention in preeclampsia; however, the dosage of MgSO4 is still in controversy. Maternal weight is an important factor for the serum MgSO4 level; however, there has not been any weight-adjusted regimen of MgSO4 reported. <b>Aim:</b> To compare the effectiveness of weight-adjusted versus standard two grams per hour (g/hr) protocols of intravenous MgSO4 for preventing convulsion in preeclampsia. <b>Materials and Methods:</b> A randomised controlled trial was conducted with 86 preeclamptic women from January 2018 to September 2018. The study group (43 cases) received MgSO4 4 g loading followed by a weight-adjusted protocol starting with 1.2-1.5 g/hr depending on maternal weight. The control group (43 cases) received MgSO4 4 g loading followed by 2 g/hr. The serum Mg level was monitored at two and four hours after MgSO4 injection, The MgSO4 dosage was adjusted and continued until 24 hours after delivery. The percentages of those who achieved a therapeutic level of MgSO4 (4.8-8.4 mg/dL) in the first four hours were compared between the two groups. Clinical signs of Mg toxicity were monitored. Maternal and neonatal outcomes were evaluated. <b>Results:</b> At four hours after treatment, the proportion of participants who achieved a therapeutic level were 11.6% in the study group and 41.9% in the control group (RR 0.28, 95% CI 0.11 to 0.68, p-value <0.01). The 2 g/hr protocol for those participants whose maternal weight was <80 kg had a higher proportion who achieved a therapeutic level (p-values >0.001). However, both protocols had similar low proportions who achieved a therapeutic level for those whose maternal weight was >80 kg (8% in maternal weight 80-99.9 kg, 0% in maternal weight >100 kg). No clinical MgSO4 toxicity was observed. Maternal and neonatal outcome were not statistically significant. <b>Conclusion: </b>Maternal bodyweight is important for MgSO4 dosage adjustment. In those patients whose maternal bodyweight is <80 kg, a 2 g/hr maintenance dose is more effective than a lower dose; however, in patients whose maternal bodyweight is >80 kg, higher dose is required for achieving therapeutic level. A low dose is not sufficient for any weight range. At least 2 g/hr is minimum required for preventing convulsion in preeclampsia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=QC01-QC04&id=12596 https://doi.org/10.7860/JCDR/2019/39642.12596 The Short Cervix Management as a Prevention Method of Preterm Birth Aizada Marat, Talshyn Ukybassova, Zarema Gabdilashimova <b>Introduction:</b> Preterm birth is considered to be the most common cause of antenatal mortality and further newborns’ morbidity in the world. The majority of children, who are born before physiologically normal term, suffer from long-term unfavourable consequences of the preterm births. Therefore, there is a strong demand on effective medically tested and proved mechanisms of decreasing the preterm birth coefficient. In the following survey, the short cervix has been identified as a significant predictor of preterm birth. Thus, its management helps find relevant solution in reducing the level of preterm birth. <b>Aim:</b> To assess the effectiveness of: 1) the Arabin obstetric pessary; 2) cerclage (surgical management of the cervix by Lyubimova and Mammadaliyeva); 3) intravaginal micronised progesterone 200 mg affecting to the short cervix with purpose of the preterm birth prevention; to confirm the achieved results by the method of transvaginal cervicometry. <b>Materials and Methods:</b> A total of 125 women were included in the study. Obstetric pessary was used in 62 women Group I, cerclage was done in 31 women Group II and vaginal progesterone was used in 32 women Group III to treat the short cervix. The results of short cervix management methods were assessed according to the comparison of pregnancy outcomes between groups. <b>Results:</b> Comparison of pregnancy outcomes between group I and group II did not reveal notable statistical differences in the rates of urgent labour if taken into account the premature births over 34 weeks and interruptions of pregnancy with less than 22 weeks. Nevertheless, there were significantly more frequent cases of premature births on the term of less than 34 weeks (CI (95%) 13.7-18.4) in group II (p<0.05). Indicatively, more often premature births within the term of less than 34 weeks occurred in groups II and III, comparing with the group I. Comparison of the outcomes of pregnancy in groups II and III did not demonstrat significant statistical differences between them. <b>Conclusion:</b> Application of the Arabin obstetric pessary, the cerclage and progesterone has an equal effectiveness for women with the short cervix, singleton pregnancy and with the history of preterm birth. There were no registered cases of extremely early preterm births. In order to determine the effective methods of the short cervix correction, further randomised control trials with broad number of participants should be conducted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=QC05-QC09&id=12597 https://doi.org/10.7860/JCDR/2019/36398.12597 Effectiveness of Shade and Thickness of Resin Cement on the Final Colour of the Porcelain Laminate Veneer: A Scoping Review Arun Ravi, Rajan Saranya Raj, Anna Serene Babu, Arun Keepanasseril, Anil Mathew <b>Introduction:</b> Porcelain laminate veneer has evolved as a dependable treatment option due to their superior optical properties similar to natural tooth and exceptional aesthetic outcome. Among the factors which influence the final shade of laminate veneers, shade and thickness of resin cement used for luting contributes to the ultimate result. <b>Aim: </b>To analyse whether the shade and thickness of resin cement affects the final colour of the veneer restoration. <b>Materials and Methods:</b> Electronic databases Cochrane, MEDLINE and PubMed were searched for articles published in English between 1990 and 2017 based on set inclusion criteria. Data screening and extraction was performed in covidence systematic review software. Pre-clinical studies which assessed the effects of resin cement shade and thickness on the final shade of porcelain laminate veneers were included in the study. The initial search of literature included 22 studies, of which five articles were excluded, a total of 17 articles for full text reading were included after which 14 articles which did not meet the inclusion criteria were eliminated and remaining three articles were accepted as eligible for the review. <b>Results:</b> The search resulted in three studies reporting the effect of resin cement shade on porcelain. The mean colour difference was assessed in terms of clinical acceptability and perceptibility threshold. Various resin cement systems with similar shade showed different colour parameters and changes in final translucency. None of the studies compared the thickness parameter of resin cement on the final colour of restoration. <b>Conclusion:</b> The aesthetic outcome of veneer restorations are reflected by the shade of resin luting cements, considering the mean colour difference within various cement systems. There is a definite need for further research to evaluate the effect of cement thickness on final colour of veneers and a standardised resin cement shade classification. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=ZE01-ZE05&id=12576 https://doi.org/10.7860/JCDR/2019/38481.12576 Standardisation and Automation of Netra Seka Technique in Ayurvedic Drug Delivery System K Sivabalaji, BN Ashwini, AS Anoop, P Kanakasabapathy Netra Pariseka/Seka (procedure for closed eye irrigation) is an ayurvedic treatment method of pouring a very fine stream of medicated liquid over the closed eyes from a height for a specified time period. This procedure is done to cure eye-related diseases through ayurvedic medicines. Presently this Seka procedure is done manually where there are chances for human errors. To override this, an automation system is introduced that includes flow control heat control and speed control. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=KE01-KE03&id=12577 https://doi.org/10.7860/JCDR/2019/38479.12577 An Overview on the Protocols used in the Management of Infertility Kundan V Ingale, Anoop Laxminarayan Hajare, Swati Uday Naik Infertility is currently a huge burden in India. Artificial Reproductive Techniques (ART) are helpful for the couples in various cases of infertility. Various drugs are available today which includes ovulation inducing agents like clomiphene or letrozole, gonadotropins like Follicle Stimulating Hormone (FSH) and menotropins (Human Menopausal Gonadotropin; HMG) for follicular growth. Also, certain drugs are available, used for controlling the ovarian stimulation or causing hyperstimulation which includes Gonadotropin Releasing Hormone (GnRH) analogues. GnRH analogues especially the antagonists (e.g., Cetrorelix, Ganirelix) are the commonly used drugs for down regulating the gonadotropin production from the pituitary which eventually helps in avoiding the premature Luteinizing Hormone (LH) surges. These hormonal preparations like FSH, HMG are available as urinary (uFSH), Highly Purified (HP-FSH) and/or recombinant (rFSH) preparations. Even with the availability of so many drugs today, infertility management is a challenge to the doctors. Choosing a right protocol is still a widely debated topic and requires years of clinical experience. Currently there are no guidelines recommending the use of drugs which are available today. This overview helps in understanding the commonly used protocols in the management of infertility. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=QE01-QE03&id=12588 https://doi.org/10.7860/JCDR/2019/39855.12588 Communicable Diseases Pattern in Religious Mass Gatherings: A Systematic Review Arezou Karampourian, Davoud Khorasani-Zavareh, Zohreh Ghomian <b>Introduction:</b> Religious mass gatherings annually attract many pilgrims from around the world. Communicable diseases are one of the challenges of religious mass gatherings. <b>Aim:</b> To develop an understanding of the communicable diseases pattern in religious mass gatherings. <b>Materials and Methods:</b> A general literature search was done according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklists in the main electronic databases such as PubMed, Web of Science, Scopus, and Cochrane. The focus of the articles found was on topics such as mass gathering, crowding, communicable disease, infectious disease, Hajj, Kumbh Mela, Arbaeen. The initial search was conducted on 8 July 2017 and the most recent search was done on 1 March 2018. <b>Results:</b> Out of 927 articles, 21 articles were included in the qualitative synthesis of the systematic review. Of 21 articles, 19 articles were about respiratory infection, one article was about gastrointestinal infection, and one article was about meningococcal meningitis. In total, in 10 of these articles vaccination was also studied. <b>Conclusion:</b> Prevention and control programs along with other preventive measures such as screening vulnerable people, vaccination, personal hygiene, health education, and improving the living conditions of pilgrims may help to reduce transmission and prevent the spread of communicable diseases in pilgrims returning to their country. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=LE01-LE06&id=12539 https://doi.org/10.7860/JCDR/2019/37916.12539 Comparison of Filter Paper and Gelfoam as Templates for Orientation of Endoscopic Duodenal Biopsies Priyavadhana Balasubramanian, Bhawana Ashok Badhe, Rajesh Nachiappa Ganesh, Lakshmi C Panicker, Pazhanivel Mohan <b>Introduction:</b> Proper orientation of endoscopic mucosal biopsies is crucial for accurate histomorphologic assessment. <b>Aim:</b> To compare the morphology on two different templates, filter paper and gelfoam for orientation of biopsies. <b>Materials and Methods:</b> In this study a total of 21 duodenal biopsies were studied which were taken from the same site, fixed and oriented on wet filter paper and gelfoam in formalin, from patients who presented with malabsorptive symptoms. Histomorphological parameters studied were villous architecture, crypt architecture, intraepithelial lymphocyte (IEL) count per 100 enterocytes, villous tip IEL count per 20 enterocytes, inflammatory cells in lamina propria. Statistical analysis was done using IBM- SPSS software version 21. p-value <0.05 was considered as statistically significant. <b>Results:</b> Twenty-one biopsies were taken in both the templates. Authors had 18 biopsies for analysis as three sections on gelfoam were lost during processing. All the histomorphological parameters were studied and it was similar on both the templates. The level of agreement by kappa statistics was significant with kappa value of 0.727 for villous architecture, 0.852 for lamina propria inflammatory infiltrate, 1 for IEL and eosinophils in lamina propria with p-value of <0.001. <b>Conclusion:</b> Authors concluded, gelfoam or filter paper serves as a good template for proper orientation of tiny mucosal biopsies. However, further studies are needed on larger sample size to validate this finding. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=EM01-EM03&id=12603 https://doi.org/10.7860/JCDR/2019/37550.12603 Some Objectivity to the Ethical Aspects in Conduct of Clinical Research in Vulnerable Population Atul Juneja, Tulsi Adhikari, M Vishnu Vardhana Rao Vulnerable population is one of the important parts of our population which also need to be benefited from the results of clinical research. In view of their limited autonomy it may not be easy to conduct clinical research such as clinical trials in them because of ethical issues. When it is must to conduct clinical trial in this population, along with ethical considerations, some statistical and clinical research issues may also be addressed to give the objectivity to the decision of conducting trials in this population, which is not in a position to convey their acceptance of participating in the trial independently. The paper discusses the issues in vulnerable population through the concepts in clinical research and some objective ethical considerations before arriving at the decision of conducting a clinical trial. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=February&volume=13&issue=2&page=YM01-YM02&id=12629 https://doi.org/10.7860/JCDR/2019/38396.12629