Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR An Uncommon Presentation of Chronic Osteomyelitis of the Fibula in an 11-Year-Old Child: A Case Report Kashif Akhtar Ahmed, Tashi Galen Khonglah, Bhaskar Borgohain, Wanlam Khongwir, Dukhum Magu Chronic osteomyelitis of the long bones in children is one of the oldest diseases known. For orthopaedic surgeons in a developing country, it still remains a major challenge to treat such patients. The utmost priority remains to urgently diagnose and treat acute osteomyelitis as it can reduce the burden of this condition. We present a case report of an 11-year-old child with chronic osteomyelitis of the fibula and its subsequent management. The child hails from a low socio-economic background with limited access to healthcare facilities. Chronic osteomyelitis in children affects various long bones but involvement of the fibula has rarely been reported in literature. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=RD01-RD03&id=12891 https://doi.org/10.7860/JCDR/2019/41337.12891 Squamous Cell Carcinoma Involving Periocular Area Madhumita Rout, Zahiruddin Khan, Lipika Panda Squamous Cell Carcinoma (SCC) involving periocular area accounts for 5-10% of all malignant eyelid neoplasms. Although, periocular SCC is the second most common eyelid malignancy after basal cell carcinoma, but is more aggressive and invasive than basal cell carcinoma. It can metastasize and invade the orbital and intracranial structure, hence it has a considerable potential of mortality and morbidity. We report a case of 35-year-old male with SCC involving periocular area who presented with non-healing ulcer over the skin of upper eyelid, lower eyelid and outer canthus of left eye with Perineural Invasion (PNI) and Lymphovascular Invasion (LVI). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ND01-ND02&id=12893 https://doi.org/10.7860/JCDR/2019/41096.12893 Ankylosing Spondylitis Causing Obstructive Lung Disease and Tricuspid Insufficiency: A Case Report Amisha, Paras Malik, Monika Pathania, Vyas Kumar Rathaur Ankylosing Spondylitis (AS) is a chronic progressive inflammatory spondyloarthropathy typically involving the axial skeleton, especially the sacroiliac joints and spine. Genetic predisposition in AS leads to its common association with certain extra-articular diseases-anterior uveitis (25-30%), psoriasis (10%) and inflammatory bowel diseases (50%). Cardiorespiratory involvement in AS is rare and is usually present in long standing disease as restrictive lung disease, conduction abnormalities or aortic insufficiency. Here, we present a case of unusual AS in a 32-year-old non-smoker male with a major involvement of peripheral joints along with spine and chronic obstructive lung disease with apical fibro-bullous cavity and right sided heart failure over a short duration of disease course. His condition was acutely stabilised with diuretics, anti-hypertensive drugs, anti-pyretics, antibiotics and oxygen inhalation followed by maintenance on Non-steroidal anti-inflammatory agents. Hence, in a patient of AS, a strong index of suspicion should be there for both usual and unusual extra-articular manifestations and a complete work-up would help in early diagnosis and treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=OD01-OD03&id=12894 https://doi.org/10.7860/JCDR/2019/41550.12894 Emergency Caesarean Section in a Patient with Undiagnosed Eisenmenger’s Syndrome with Severe Pulmonary Hypertension Vandana Talwar, Neha Baduni, Neelam Verma Pregnancy is associated with major physiologic changes in various organ systems of the body, especially the cardiovascular system. This is especially dangerous in the presence of pre-existing Pulmonary Artery Hypertension (PAH) and maternal mortality is unacceptably high (30-50%) in such patients. We report the successful perioperative management of a parturient with severe PAH due to an undiagnosed Eisenmenger’s syndrome, posted for emergency caesarean section. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=UD01-UD02&id=12901 https://doi.org/10.7860/JCDR/2019/38407.12901 Aesthetic and Functional Rehabilitation of Anterior Teeth Using the In-Ceram Zirconia System: A Case Report Ana Caroline Pereira Norbert, Ana Paula Farina, Maria Salete Sandini Linden, Paulo Roberto Grafitti Colussi, Luiz Renato Paranhos, João Paulo De Carli Considering the need to improve dentogingival aesthetics, the scientific community has been improving surgical techniques and dental restorative materials, providing aesthetics, self-esteem, and quality of life to the patients. The present paper aimed to describe a clinical case of oral rehabilitation of anterior teeth using the In-Ceram Zirconia system. The patient was a 47-year-old, Caucasian female who sought dental care because she was not satisfied with her facial appearance and improper functioning. The treatment started with correction of the dentogingival asymmetry. Later, temporary crowns were cemented and finally, definitive porcelain metal-free crowns (In-Ceram zirconia system) were fixed. After the multidisciplinary execution of the procedures, positive results were noticed in the aesthetic, functional and psychosocial conditions of the patient. It may be noted that the integration between periodontal and prosthetic treatment is essential in clinical cases. It is also concluded that, when used properly, the In-Ceram Zirconia system allows achieving satisfactory results. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZD04-ZD06&id=12915 https://doi.org/10.7860/JCDR/2019/41248.12915 The Risk of Facial Fillings Aesthetic Procedures: A Case Report Tiago Novaes Pinheiro, Eliandro de Souza Freitas, Renata Gualberto da Cunha, Daniel Frota de Souza, Larissa Luzia da Silva Araujo Facial cosmetic procedures are on increasing demand, for plastic surgeons and dental professionals now-a-days. New techniques applied for the renewal offacial contours have become the first treatment option before surgical corrections. This case report highlights some of the risks related to such procedures, reporting a case of a painful fluctuating nodule in the midline of the vestibular sulcus, extending towards the upper lip. The patient mentioned a 2-year history of progression of the lesion. The nodule was 0.8 cm wide, well defined, with normal colour. The excisional biopsy was proposed with initial suspect of pleomorphic adenoma, or other soft tissue tumour. Microscopic evaluation of the excised lesion revealed a foreign body granuloma caused by multiple spherules of transparent synthetic material of uniform diameter, identified as Polymethylmetacrylate (PMMA). The patient then recalled that he underwent an aesthetic procedure of rhinoplasty with facial filling that he did not correlate with the symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZD01-ZD03&id=12911 https://doi.org/10.7860/JCDR/2019/39637.12911 Imaging in a Case of Extensive Paediatric Mediastinal Lymphoma Presenting as Haemothorax Manali Arora, Vishal Thakker, Kirti Rathod, Sanket Rana, Rajan Patel Lymphomas are the third most common paediatric malignancies and the most common paediatric mediastinal masses. On imaging they present as large, lobulated, homogenous, predominantly anterior mediastinal masses with possible extension into other mediastinal compartments and vascular encasements. Effusions, lung involvement and extensive disease are more common in paediatric patients; however haemothorax is an uncommon occurrence. In our case, multi-compartmental involvement, vascular encasement and haemothorax were the striking features. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=TD01-TD03&id=12907 https://doi.org/10.7860/JCDR/2019/41571.12907 An Interesting and Rare Case of Urachal Adenocarcinoma Enteric Type with Review of Literature P Manjusha Mullappali, Sandhya Sundaram, Lawrence D Cruze, S Rajendiran, T Chandru The urachus is a tubular structure that connects the bladder and allantois in the embryonic development, which involutes after third trimester. Urachal tumours are extremely rare and accounts of about 0.3-0.7% of all the bladder malignancies. We report here a case of 65-year-old male who was a known case of type II Diabetes, presented with complaints of haematuria for one and a half month. On abdominal ultrasonography and computed tomography, showed a pedunculated mass measuring 3×2 cm in the bladder wall protruding into the bladder. Cystoscopy was done, a papillary growth was noted in the dome of the bladder. Cystoscopically guided biopsy was done which showed enteric type adenocarcinoma. The surgical specimen showed urachus adenocarcinoma of enteric type Stage IIIA in the Sheldon System. This case has six months of follow-up without any recurrence or metastasis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ED03-ED05&id=12931 https://doi.org/10.7860/JCDR/2019/39963.12931 Significance of Cytological Diagnosis in Benign Salivary Gland Lesion Asif Baliyan, Ruchi Nagpal, Harshi Dhingra, Arnav KR Roychoudhury A diffuse, chronic, non-inflammatory, non-neoplastic usually bilateral, enlargement of major salivary glands is termed as Sialadenosis or sialosis. It is an uncommon cause for enlargement of the parotid gland. We here by describe two patients with history of unilateral painless swelling of parotid glands. Fine-Needle Aspiration (FNA) specimens showed highly cellular smears comprising of clusters of enlarged acini and numerous naked nuclei. A diagnosis consistent with sialadenosis was made. It is important to recognise this underestimated entity cytologically in the work-up of salivary gland swellings to avoid the unnecessarily surgical intervention. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ED10-ED11&id=12936 https://doi.org/10.7860/JCDR/2019/41405.12936 Masson’s Tumour: Two Case Reports with a Brief Review of Literature Neelam Sood, Navmeet Soin Masson’s tumour, also known as Intravascular Papillary Endothelial Hyperplasia (IPEH) is an uncommon vascular lesion. Although benign, the lesion can mimic malignant tumours like angiosarcomas. Hence correct diagnosis is essential for treatment, which involves complete excision of the lesion. Here, we present two cases- one case of primary Masson’s tumour (swelling on left index finger) and other case of secondary Masson’s tumour with angiomatosis (left foot swelling). Histopathological features of both the cases are discussed along with immunohistochemistry, differential diagnosis and brief review of literature. These cases are presented for their rarity and potential diagnostic dilemma with other vascular lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ED06-ED09&id=12933 https://doi.org/10.7860/JCDR/2019/40361.12933 Multiple Myeloma in a Patient with Sarcoidosis and Heavy Proteinuria: A Case Report Behzad Asanjrani, Esmat Abdollahpour, Samira Alesaeidi, Hamed Zainaldain The present case is of 44-year-old woman who was a known case of sarcoidosis revealed granulomatous inflammation without caseafication. She also reported to suffer from proteinuria about 2 g/day, which was reported as Focal Segmental Glomerulosclerosis (FSGS) secondary to sarcoidosis after renal biopsy and thorough evaluation. Skeletal survey showed multiple lytic lesions in her skull, ribs, vertebra and iliac bone. The patient fully met diagnostic criteria for symptomatic Multiple Myeloma (MM) and chemotherapy was started with Velcade, Cyclophosphamide and Dexamethasone. Having completed chemotherapy, bone marrow plasma cells reached 8% and there were no peak of the serum or urine protein. Our patient is the first report of correlation of three diseases of Sarcoidosis and MM together and FSGS. Immune system impairment may be the main predisposing factor. The relationship between sarcoidosis and MM is unclear. Since in sarcoidosis, impaired immune system is involved, it predisposes developing malignancies in sarcoidosis. It is suggested that two important factors i.e. aneuploidy in the granuloma and peripheral blood lymphocytes can cause haematologic malignancy via developing genetic instability. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=OD04-OD06&id=12943 https://doi.org/10.7860/JCDR/2019/40740.12943 <i>Exophiala jeanselmei</i> and <i>Rhizopus oryzae</i> Co-infection Post Renal Transplant Suneeta Meena, Gagandeep Singh, Mragnayani Pandey, Immaculata Xess Invasive fungal infections are associated with morbidity and mortality in immunocompromised patients. Dematiaceous fungi are being increasingly recognised as human pathogens, particularly in transplant recipients. However, most cases of dematiaceous fungal infections after organ transplantation have been reported as sole aetiological agents. We report a case of fatal, disseminated phaeohyphomycosis with rhinocerebral mucormycosis in post renal transplant patient. Quick diagnosis is challenging and inspite of aggressive management with a combination of surgical and medical therapies, the outcome is poor. Amphotericin B remains the cornerstone in the medical management of mucormycosis and itraconazole in phaeohyphomycosis, still we are short of drugs to fight against such catastrophic organisms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=DD01-DD03&id=12948 https://doi.org/10.7860/JCDR/2019/40304.12948 Hypoplastic Dysplasia of Kidney with Hydroureter: Two Cases Sarojini Raman, Sukant Kumar Padhy, Jayasree Rath, Urmila Senapati Various congenital anomalies of the kidney and urinary tract cause significant morbidity and mortality in children. Renal agenesis, hypoplasia and dysplasia belong to this group of abnormalities. The exact aetiology is still unknown. Imaging modalities like Ultrasonography (USG), Dimercaptosuccinic Acid (DMSA) Radionuclide Scan, Diethylene Triamine Pentaacetic Acid (DTPA) scan and Mercaptoacetyletriglycine (MAG3) scan are useful for assessing the relative functional status, degree of blood flow and any possible obstruction to the kidneys particularly in very young children and in patients with poor kidney function. Management is determined by the severity of cases. We report two cases of hypoplastic dysplasia of kidney, in which one case remained undetected till adulthood. Grossly the affected kidneys were small in size with dilated ureters. Histopathological study showed primitive ducts surrounded by immature mesenchymal tissue representing dysplasia. Radiological and histopathological examination remains the mainstay in diagnosis of such cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ED12-ED15&id=12954 https://doi.org/10.7860/JCDR/2019/41419.12954 <i>Pichia anomala</i>, A Rare Cause of Nosocomial Fungal Sepsis in Newborn. Is Empirical Use of Third Generation Cephalosporin to Blame? Poonam Marwah, Sunil Kumar, Ashish Marwah Traditionally, <i>Candida albicans</i> is known to be the major cause of nosocomial fungal sepsis in neonates. However, there has been increased detection of various other emerging pathogenic yeasts like <i>Pichia anomala</i> (also referred as <i>Wikerhamomyces anomalus/Hansenula anomala</i> in the literature). Here, authors report a case of a full-term male neonate born with severe birth asphyxia and respiratory distress empirically treated with third generation cephalosporins, who later developed fungemia and meningitis due to yeast (<i>Pichia anomala</i>) has been documented. The possible risk factors could be severe birth asphyxia and empirical use of third generation cephalosporin (cefotaxime) initially. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=SD01-SD02&id=12956 https://doi.org/10.7860/JCDR/2019/39543.12956 Uterine Gangrene and Mechanical Intestinal Obstruction in a Teenager Following Unsafe Abortion Anthony Jude Edeh, Chukwuemeka Chijoke Nwangwu, Willis Unebike Ene, Wilfred Okwudili Okenwa, Chinedu Chijioke Anekpo Unsafe abortion often leads to complications since it is carried out by untrained persons in an unsafe environment. The most common complications are anaemia, bowel injury, bladder injury, uterine perforation, and sepsis. Here, authors present a very unfortunate case of 18-year-old single nulliparous secondary school student who had self-induced abortion at 24 weeks gestational age with unusual complication of complete uterine gangrene and mechanical intestinal obstruction. Her recovery was prolonged but was managed successfully. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=QD01-QD03&id=12961 https://doi.org/10.7860/JCDR/2019/41567.12961 Intestinal Lipoma Causing an Ileo-ileal Intussusception Wafa Ghariani, Esma Leila Gouta, Hichem Jerraya, Mehdi Khalfallah, Chadli Dziri Adult intussusception is a rare condition and can be secondary to an intestinal lipoma. In this case report, a 41-year-old woman presented with an acute abdominal pain and a tender central abdominal mass. Abdominal computed tomography scan showed an ileo-ileal intussusception with a fat-density mass at the leading point. Laparotomy with reduction of the intussusception, bowel resection and anastomosis was performed. Histological examination revealed a benign submucosal lipoma. Early laparotomy with resection and without deintussusception is usually recommended. In this case, a careful reduction allowed to preserve the non necrotic intestinal segment involved in the intussusception. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=PD01-PD03&id=12963 https://doi.org/10.7860/JCDR/2019/36472.12963 Vulvar Smooth Muscle Tumours: Case Series and Review of Literature Banashree Nath, Harsha S Gaikwad, Nandini Rajamani, Minakshi Chouhan, Manjula Sharma, Sonam Topden Smooth muscle tumours are rare in vulva. Here we discuss three cases all presenting with vulvar mass but with different clinical features. The first patient was 26-year-old primigravida at 18 weeks gestation with vulvar mass in the region of bartholin gland. The second patient was 31-year-old presenting at term pregnancy in labour and with vulvar mass. The third patient was 38-year-old para 3 woman with complaints of pain, ulceration of a gradually growing mass in vulva for the last eight months. Local excision was done in first and second patient and wide local excision in third patient with good postoperative recovery and no recurrence till date. The aim of reporting these cases is to emphasise the need of having high clinical suspicion of vulvar smooth muscle tumours in any woman presenting with vulvar mass to avoid missing out on malignant ones and provide the best prognosis to patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=QR01-QR04&id=12958 https://doi.org/10.7860/JCDR/2019/41461.12958 Abnormal Laboratory Reports: Check Before Releasing It Divendu Bhushan, Rahul Shukla, Mala Mahto https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=OH01-&id=12928 https://doi.org/10.7860/JCDR/2019/41446.12928 Dengue Vaccines: Current Status and Future Prospects Kaushik Bharati, Hemant Jain https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=AB01-AB03&id=12962 https://doi.org/10.7860/JCDR/2019/20714.12962 Immediate Extraction or Delayed Extraction: A Common Factor for Parents and Dentists to Consider in the Dental Management of Shark Teeth Sashi Deepth Reddy Janapala, Ramasamy Chidambaram https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZL01-&id=12940 https://doi.org/10.7860/JCDR/2019/41465.12940 A Prospective Study on Assessment of Rationality in Prescribing Antimicrobial Agents at a Tertiary Care Hospital KLK Sneha, Malladhi Sai Gayatri, K Vinay, A Rajendra Prasad, Yuva Sri Sai <b>Introduction:</b> Antimicrobial Agents (AMAs) rationality has become the most prevalent issue world wide as the irrational prescribing is leading to antimicrobial resistance. So, reporting interventions and identification of drug related problems, may help in avoidance or control or prevention the antimicrobial resistance. <b>Aim:</b> To assess rationality in usage of AMAs in both infectious and non infectious conditions at a tertiary care hospital using ICMR guidelines, National Treatment Guidelines for Antimicrobial Use in Infectious Diseases, PCNE guidelines. <b>Materials and Methods:</b> A prospective observational study was carried out at inpatient department in a tertiary care hospital. The data of 260 cases were collected and recorded during regular ward rounds and were thoroughly analysed to evaluate inappropriateness in drug usage by ICMR guidelines, WHO-INRUD drug core indicators, Pharmaceutical Care Network Europe (PCNE) guidelines and Essential Drug List (EDL). Data analysed also included the results on patient’s demographics (age, gender, type of AMAs etc.,). Errors obtained were reported to physician. Data analysis was performed using descriptive analysis. <b>Results:</b> The findings of the study reveals that the average age of high incidence with AMAs was found to be 55.5 years, where male population were majority with 52% and female with 48% of AMAs prescriptions. Non infectious conditions (56.5%) were more than the infectious conditions (43.4%). Among 487 drugs prescribed in 260 prescriptions majority of them were antibiotic drugs (480), followed by antifungal drugs (6) and antiviral drug (1). The most commonly prescribed category of antibiotic was cephalosporins with 100 drugs (22.5%), along with fixed dose combinations of 162 drugs (33.2%). More number of prescriptions were found with two antibiotics (104). Among all prescriptions 46 were found to be irrational and 214 prescriptions were rational, the irrationality was found mostly due to drug interactions. At the end of the study six types of drug related problems were identified in 46 prescriptions such as wrong drug (2), wrong dose (14), wrong frequency (5), drug interactions (28), therapeutic duplication (5), wrong indication (7). According to WHO INRUD guidelines average number of antibiotics per prescription was 1.87, percentage of antibiotics prescribed by generic name was 36.34%, percentage of encounters with an antibiotic prescribed was 100%, percentage of encounters with an injection prescribed was 73.26%, percentage antibiotics prescribed from EDL was 30.7%. Length of stay of 52% patients having AMAs in their prescription was more than five days, where as 19% of patients were admitted for less than five days. The average cost of antibiotics per prescription was found to be Rs 3800, whereas the equivalent antibiotics with different brands the cost was Rs.1282.04. <b>Conclusion:</b> At the end of the study six types of drug related problems were identified in 46 prescriptions such as wrong drug, wrong dose, wrong frequency, therapeutic duplication, wrong indication, drug interactions, which lead to irrational prescriptions. Hence, there is a necessity of clinical pharmacist in hospital for minimising errors, thereby preventing the development of resistance towards antibiotics and reducing the prescription cost. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=FC11-FC14&id=12941 https://doi.org/10.7860/JCDR/2019/36921.12941 Correlation between Postnatal Weight Gain and Development of Retinopathy of Prematurity: An Experience in Rural Tertiary Care Centre K Madhava Kamath, MN Asha, Vadlamudy Vinay <b>Introduction:</b> Retinopathy Of Prematurity (ROP) is one of the leading causes of preventable blindness in our country. The minor risk factors responsible for development of such at Neonatal Intensive Care Unit (NICU) is still under discovery. It needs multiple trials to conclude or have guidelines on when to screen an infant. In order to make an attempt to fill the above knowledge gap, this study was conducted at our rural tertiary centre. <b>Aim:</b> To determine the need for early screening for ROP before discharge. Also, to study the relation between postnatal weight gain and risk of developing ROP and to determine the usefulness of CHOP-ROP (Children’s Hospital of Philadelphia-ROP) model in Indian population in order to use it as a predictor model for ROP screening purpose. <b>Materials and Methods:</b> This was a retrospective two year study of infants admitted in NICU between June 2016-May 2018 at Adichunchanagiri Institute of Medical Sciences, a rural tertiary care centre. ROP screening was carried out as per National guidelines and objective of the study. A cohort of 75, was eligible for the study; in these infants ROP screening was done before discharge, looked for postnatal weight gain and its relation to development of ROP. Also the CHOP – ROP algorithm was used to classify those who needed and not needed the early screening. <b>Results:</b> Of 75 infants studied all infants were screened for ROP before discharge, out of which 60 (80%) were not found to have ROP and 15 (20%) were found to have ROP, no screened out infant developed ROP successively. Among the 15 (20%) infants who developed ROP, 11 (73.3%) infants were having an average weight gain less than 10 gm/day and we found a positive correlation with development of ROP (p=0.101), Fischer-Exact test. By using CHOP-ROP algorithm it was found that, two infants were classified eligible for screening out of 75 infants and both infants had ROP; remaining 73 (97.3%) were classified as not eligible for screening and 13 (86.7%) of these developed ROP (p=0.003, Fischer-Exact test). <b>Conclusion:</b> Early screening of infants for ROP has been as effective as the national guidelines and in fact has helped in early identification of cases. Also, we found that poor postnatal weight gain has significant correlation with development of ROP. CHOP-ROP model although is statistically significant but has failed to classify large number of cases as risk group for ROP. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=SC01-SC04&id=12942 https://doi.org/10.7860/JCDR/2019/40728.12942 Factors that Affect the Career and Speciality Preferences of Dentistry Students in Turkey Ömer Hatipoglu <b>Introduction:</b> Many factors may be effective in the career and speciality plans of dentistry students. Graduated students have to make a choice between immediately starting their professional life or choosing a speciality. The increased number of dentists in recent years may have affected the career plans of Turkish dentistry students. <b>Aim:</b> To investigate the factors that affect the speciality and career choices of dentistry students in Turkey. <b>Materials and Methods:</b> A questionnaire was distributed to 436 dentistry students via the internet including students in their 4<sup>th</sup> and 5<sup>th</sup> years of study. They were asked how much their career decisions were affected by the factors of income, comfort, job guarantee, patient type and place of living. Additionally, they were asked how much their speciality decisions were affected by the factors of income, comfort, enjoyment, talent, patient type and prestige. The data were analysed by using binary logistic regression analysis with descriptive statistics. <b>Results:</b> The income factor was significantly more essential for male participants than the female participants in terms of their career preferences (p<0.001). Moreover, the comfort factor was more important for the fifth-year students in terms of their career choice (p=0.013). In their choice of speciality, the patient type factor was more important for the female participants (p=0.002). <b>Conclusion:</b> The factors of income and prestige are the main essential factors in the career and speciality decisions of Turkish dentistry students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=JC06-JC11&id=12934 https://doi.org/10.7860/JCDR/2019/41282.12934 Effect of Cuban Sugarcane Wax Acids and Policosanol on Serum Lipid Profile and Apolipoprotein A-I Expression in Hyperlipidemic Zebrafish Kyung-Hyun Cho, Cheol-Hee Kim, Myung-Ae Bae, Jae-Ryong Kim <b>Introduction: </b>Sugarcane Wax Acids (SCWAs) and Policosanol (PCO) are mixtures of higher aliphatic acids and alcohols purified from sugarcane wax. Octacosanoic acid and octacosanol are the chief components of PCO and SCWA, respectively. The role of PCO in the improvement of dyslipidemia is well documented, however, the lipid-lowering effects of SCWA remains debatable. <b>Aim:</b> To compare the atheroprotective effects of SCWA and PCO on the expression level of apolipoprotein A-I (apoA-I) in the treatment of dyslipidemia. <b>Materials and Methods: </b>Hyperlipidemic zebrafish were supplemented with either SCWA (40 mg/kg and 80 mg/kg) or PCO (40 mg/kg and 80 mg/kg) for 10 weeks. After the supplementation, lipid-lowering effects and apoA-I expressions were measured by plasma and histologic analysis, cholesteryl ester transfer and Ferric Reducing Ability (FRA) assay and immunoblotting. Data were evaluated using one-way ANOVA and differences between the mean were assessed using Duncan’s multiple range test. p-value <0.05 was considered statistically significant. <b>Results:</b> The supplementation significantly improved serum lipid profile, especially lowering Total Cholesterol (TC), Triglyceride (TG) and raising HDL-C in a dose-dependent manner. SCWA (80 mg/kg of body weight) supplemented High Cholesterol Diet (HCD) group showed are remarkable decrease in body weight and the significant reduction in TC and TG, up to 65% (p<0.01) and 45% (p<0.05) respectively, than HCD control. PCO (80 mg/kg of body weight) group showed the highest HDL-C level and apoA-I expression with the lowest serum Cholesteryl Ester Transfer Protein (CETP) activity. Both PCO and SCWA groups showed amelioration of fatty liver change with inhibition of Reactive Oxygen Species (ROS) production and enhancement of antioxidant ability in hepatic tissue despite of high cholesterol diet consumption. <b>Conclusion:</b> The supplementation of SCWA or PCO resulted in enhancement of survivability and hepatic function with the improvement of dyslipidemia and elevation of apoA-I and HDL-C via CETP inhibition. These results suggest that SCWA like PCO is an effective lipid-lowering agent. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=BC16-BC20&id=12935 https://doi.org/10.7860/JCDR/2019/41177.12935 Antimicrobial Efficacy of Lipopeptide Antibiotic, Lantibiotic and Cationic Bisbiguanide against <i>Enterococcus faecalis</i> Biofilm: An In-vitro Study Goliya Sneha, Uday Kumar Chowdary Birapu, Ravindar Puppala, Balaji Kethineni, Praveenkanth Reddy, Ravigna Peddi <b>Introduction:</b> Cyclic lipopeptides, lantibiotics are newer antimicrobials showing promising efficacy against various gram-positive micro-organisms. Daptomycin is a cyclic lipopeptide antibiotic with potent bactericidal activity against most gram-positive organisms. Nisin is a naturally occurring antimicrobial peptide produced by strains of Lactococcus lactis. <b>Aim:</b> To compare the antimicrobial efficacy of cyclic lipopeptide antibiotics with beta-lactamase inhibitors (Daptomycin-Ceftaroline) at 40 µg and 80 µg, lantibiotics (Nisin) at 25 mg and 50 mg, bisbiguanide (2% Chlorhexidine) and 3% Sodium hypochlorite against <i>E. faecalis</i> biofilm when used as irrigating solutions. <b>Materials and Methods:</b> Forty-five primary teeth were decoronated, sectioned along the midsagittal plane and each half was used as a sample. <i>E. faecalis</i>, biofilm which was grown on the tooth surface for three weeks, was removed by vortexing and an emulsion was prepared by adding 1.5 mL of saline. The samples were distributed into six groups (n=15, each group), Group I: D1-Daptomycin mixed with ceftaroline at 80 µg, Group II: D2-Daptomycin mixed with ceftaroline at 40 µg, Group III: N1-Nisin at 25 mg, Group IV: N2-Nisin at 50 mg, Group V: CHX- 2% Chlorhexidine, Group VI: NaOCl -3% Sodium hypochlorite. The disks of medicaments were prepared and placed in the petri dishes and zone of inhibition was assessed. Data obtained were analysed by One-way Analysis of Variance test and Post-Hoc multiple comparisons test and paired t-test. <b>Results:</b> Intragroup comparison showed no statistical significance when the mean zone of inhibition was observed after two days and seven days in all the groups except for NaOCl group (p-value=0.023.) When intergroup comparison was done, D2 showed highest inhibition of bacteria followed by D1>N2>CHX>N1>NaOCl at 2<sup>nd</sup> day. At 7<sup>th</sup> day D2 had highest zone of inhibition followed by CHX>D1>N2>N1>NaOCl. <b>Conclusion:</b> Daptomycin mixed with ceftaroline at 80 µg showed better antibacterial effect than all the tested groups but the cost and availability make them difficult to use as an intracanal irrigant. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZC32-ZC35&id=12944 https://doi.org/10.7860/JCDR/2019/41350.12944 Correlation between Total Plasma Homocysteine Levels and Oxidative DNA Damage in Healthy Indian Adults Jyothirmayi Kanukurti, B Sheshu Kumar, Bhavya Sirivelu, KSS Sai Baba, O Sai Satish, A Radha Rama Devi, Shaik Mohammad Naushad, Iyyapu Krishna Mohan <b>Introduction:</b> Association of serum folate, Vitamin B<sub>6</sub> and B<sub>12</sub> deficiencies with hyperhomocysteinemia are well-documented. Several studies on Indian population, address the association of hyperhomocysteinemia with numerous diseases, but population-specific baseline levels of homocysteine in healthy population have not been elucidated till date. <b>Aim:</b> To establish Indian-population specific reference ranges for total plasma homocysteine in healthy adults in accordance to variation in dietary factors, serum B12 and folate status. The study also aimed to assess the contribution of cofactors in modulating homocysteine levels, and evaluate the impact of higher homocysteine levels on the oxidative DNA damage. <b>Materials and Methods:</b> In this retrospective study, 151 apparently healthy non-diabetic, non-hypertensive individuals with normal thyroid, renal and cardiac function were recruited. Vitamin B<sub>12</sub>, Folate, and Homocysteine assays were performed on ADVIA Centaur® XP Immunoassay system. Plasma 8-oxo-2deoxyguanosine levels were estimated by using commercially available ELISA kit. Student’s t-test, ANOVA, Spearman rank correlation was used to establish the associations between variables. The p<0.05 was considered statistically significant. <b>Results:</b> The data was stratified according to age (Group 1: =45 yr, n=58 and Group 2: >45 yr, n=93) and gender. In both the age groups, homocysteine and 8-oxo-2deoxyguanosine levels were found to be elevated in men (p=0.003) while no gender-specific differences were observed in the levels of folate and B<sub>12</sub>. Post-menopausal women had higher oxidative DNA damage as compared to the pre-menopausal women. Positive correlation was observed between total plasma homocysteine and plasma 8-oxo-2deoxyguanosine (r=0.35, p=0.03). An inverse correlation was observed between plasma B<sub>12</sub> levels and total plasma homocysteine in men (r=-0.24, p=0.02) while no such correlation was observed in women (r=0.22, p=0.10). No significant correlation was observed between plasma folate levels and total plasma homocysteine in both genders (male: r=-0.10, p=0.33; female: r=-0.23, p=0.09). Non-vegetarians had higher plasma B12 levels (p<0.05) and lower homocysteine levels (p=0.03) than vegetarians. <b>Conclusion:</b> Healthy Indian adults have higher homocysteine levels than their counterparts due to vegetarian diet resulting in B<sub>12</sub> deficiency. A positive correlation was observed between total plasma homocysteine and oxidative DNA damage. Higher oxidative DNA damage was observed in post-menopausal women than pre-menopausal women, which might predispose them to many multifactorial disorders. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=BC21-BC24&id=12945 https://doi.org/10.7860/JCDR/2019/41399.12945 Patients’ Complications in ST Segment Elevation Myocardial Infarction Managed with Primary Percutaneous Coronary Intervention with and without Thromboaspiration Nima Naghshtabrizi, Leila Moradi Aramian, Jalal Poorolajal, Behshad Naghshtabrizi <b>Introduction:</b> One of the biggest challenges for interventional cardiologist is subsequent distal embolization and disturbance in microvascular perfusion after a Percutaneous Coronary Intervention (PCI). Theoretically, manual thromboaspiration might be a useful way to prevent this complication. According to recent studies, the use of thromboaspiration does not have a significant effect. <b>Aim:</b> To compare the clinical outcomes of patients managed with Primary PCI (PPCI) with and without thromboaspiration, based on coronary arteries flow and thrombus burden before the procedure. <b>Materials and Methods:</b> A total of 249 patients who were admitted with ST Segment Elevation Myocardial Infarction (STEMI) to Farshchian Heart Center, Hamadan, Iran, during 2015-2017 were enrolled in our study. Patients were managed with PPCI with and without thromboaspiration and were classified as case and control groups, respectively. In the follow-up course of 30 days, complications including mortality, Major Adverse Cardiovascular Events (MACE) and stroke were evaluated. After collecting data, analysis was done with statistical software SPSS 18. Chi-square test and independent t-test were used for analysis. All statistical analyses were carried out at 95% confidence level. <b>Results:</b> A total of 58 and 191 patients were managed with PPCI with and without thromboaspiration (case and control groups respectively). There was no significant difference in the occurrence of primary outcomes including mortality (1.72% vs. 2.62%, p-value=0.697), MACE (0 vs. 0.52%, p-value=0.581) and stroke (1.72% vs. 0.52%, p-value=0.370) in case and control groups respectively. Thrombolysis in Myocardial Infarction (TIMI) grade flow before the procedure was significantly higher in case group (p-value=00.1), but postprocedural TIMI grade flow was the same (p-value=0.450). <b>Conclusion:</b> One-month clinical complications including mortality, MACE and stroke were similar in both the groups. Despite the lower TIMI grade flow before the procedure in the case group compared to the control group, a similar TIMI grade flow after the procedure was achieved, which indicate the usefulness of thromboaspiration in the patients with lower TIMI grade flow at presentation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=OC13-OC17&id=12946 https://doi.org/10.7860/JCDR/2019/41624.12946 Autonomic Dysfunction in Patients with Guillain-Barré Syndrome in Sub-Acute Phase Nidhi Rawat, Meeka Khanna, MR Rukmani, Partha Haldar <b>Introduction:</b> Autonomic involvement is seen in two-thirds of Guillain-Barré Syndrome (GBS) patients. <b>Aim:</b> To evaluate the pattern and extent of autonomic dysfunction in GBS patients in sub-acute phase and its association with severity in GBS patients. <b>Materials and Methods:</b> A cross-sectional study was conducted in 29 GBS patients in Department of Neurological Rehabilitation at a tertiary care institute. All consecutive patients diagnosed with GBS fulfilling the inclusion criteria were subjected to laboratory cardiac autonomic tests. To assess the fatigue Fatigue Severity Scale (FSS) was used, disability status was assessed by Hughes Disability Scale (HDS), and muscle weakness was assessed by Medical Research Council (MRC) sum scores. Statistical analysis was done by Stata 11. The significance of p-value was considered at 0.05. <b>Results:</b> Twenty-nine patients were included with 17 (59%) men and mean age of 31 years. On Heart Rate Variability (HRV) test 26 (90%) patients had reduced power, 15 (52%) patients had sympathovagal balance and 14 (48%) had sympathovagal imbalance with sympathetic dominance. On conventional cardiac testing 16 (55%) patients had cardiac involvement. On tilt table 5 (17%) patients had Postural Orthostatic Tachycardia Syndrome (POTS) and 3 (10%) patients had orthostatic hypotension. Significant association was found on HRV and conventional cardiac autonomic tests with duration between disease onset and testing (p=0.04) and (p=0.01) respectively. Significant association of reduced power was found with presence of antecedent events (p=0.01) and duration between disease onset and testing (p=0.01). Sympatho vagal imbalance showed significant association with presence of respiratory distress and need for ventilator (p=0.04). <b>Conclusion:</b> Laboratory cardiac autonomic tests are noninvasive and easily applicable to quantitatively evaluate autonomic dysfunction even in severely disabled GBS patients. Autonomic dysfunction is common in patients with pulmonary involvement. However, it has no relation with the severity of motor disability. This study suggests that autonomic dysfunction in GBS should be studied even during the sub-acute phase. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=LC16-LC20&id=12947 https://doi.org/10.7860/JCDR/2019/41693.12947 Histomorphological Lung Changes and Cause of Death Correlation: An Autopsy Based Study in a Tertiary Care Centre Thej Mothakapalli Jagadish, Thomas Alex Kodiatte, Harendra Kumar Malligere-Lingaiah, Kiran Jayaramaiah <b>Introduction:</b> Organ-specific pathological changes that are seen during autopsy give a clearer picture of the cause of death and help to correlate with the clinical scenario. <b>Aim:</b> To study the histomorphological lung changes seen at autopsy and to correlate them with the clinical cause of death. <b>Materials and Methods:</b> Lung specimens were collected from 120 autopsies conducted at a tertiary care hospital in coordination with the Department of Forensic Medicine during a two-year period. Grossly, both lungs were carefully examined for any morphological changes. Histological studies were performed on the representative bits taken. The sections were examined for congestion, oedema, haemorrhage, hyaline membranes, inflammation, alveolar collapse/thinning, alveolar wall disturbances, capillary dilatation and micro-organisms. <b>Results: </b>Majority of patients belonged to the third decade of life. The most common cause of death was Road Traffic Accidents (RTAs). Majority RTA victims were males and all burns victims were females. The commonly seen morphological features were pulmonary congestion, pulmonary oedema and alveolar haemorrhage. Diffuse Alveolar Damage (DAD) was only seen in 13.5% of cases. <b>Conclusion:</b> The histological findings seen in the RTA cases were associated with circulatory failure manifesting in the lungs as alveolar haemorrhage, congestion and oedema, microvascular damage and eventually multi-organ injury. DAD was more commonly observed in cases of poison and burns than in RTAs. The most frequent manner of deaths was accidents (RTA), followed by suicides (poisoning and burns) and sudden death. Autopsy including histology plays an important role in the evaluation of the cause of death. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=EC10-EC15&id=12929 https://doi.org/10.7860/JCDR/2019/41472.12929 The Bivariate Correlation of Health Literacy and Cell Phone Addiction amongst Iranian Healthcare Students Elyas Soltani, Masoud Rezaei, Morteza Nasiri, Salman Barasteh, Fatemeh Rahmati-Najarkolaei, Maryam Amidi Mazaheri <b>Introduction:</b> Health Literacy (HL) is negatively associated with substance addiction. However, no study has examined the bivariate correlation of HL with cell phone addiction. <b>Aim:</b> To investigate the correlation between HL and cell phone addiction amongst Iranian healthcare students. <b>Materials and Methods:</b> This descriptive study was carried out on 287 male students (nursing, health, medicine and dentistry) in two medical universities in the northern and central part of Tehran, Iran, during February to May 2016. Data were collected via the Persian version of Mobile Phone Addiction Scale (PMPAS) and the Test Of Functional Health Literacy in Adults (TOFHLA). <b>Results:</b> The total score of TOFHLA showed a significant and positive correlation with the total score of PMPAS in nursing students (r=0.063, p=0.040), whereas this relationship was negatively significant for non-nursing students (r=-0.219, p=0.023). The total score of TOFHLA significantly and positively correlated with the psychological improvement subscale of PMPAS in total and also nursing students. The same correlation was found between the total score of TOFHLA and self-control inability subscale in total (r=0.142, p=0.016), and also non-nursing students (r=0.286, p=0.003). However, a significant and negative correlation was observed between the total score of TOFHLA and anxiety and sense of loss subscale in total (r=-0.137, p=0.020) as well as non-nursing students (r=-0.260, p=0.007). <b>Conclusion:</b> HL is significantly correlated with cell phone addiction in some dimensions. Based on findings, it is recommended that authorities should pay attention to HL and cell phone addiction, especially among nursing students. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=IC01-IC05&id=12932 https://doi.org/10.7860/JCDR/2019/40306.12932 RPR (Red Cell Distribution Width to Platelet Ratio): As a Prognostic Marker in Acute Pancreatitis Jitendra Kumar Barad, Debasis Debata, Vivek G Nath, Abhinash Sahoo, Prasanna Kumar Debata, Preetam Kumar Kar, Jyoti Ranjan Dash, Bedaprakash Dash <b>Introduction: </b>Acute pancreatitis is an inflammatory disease of the pancreas with grade of severity ranging from very mild indolent course to severely fatal necrotising pancreatitis. Early detection of the disease severity and early intervention is crucial for favourable outcome. Several prognostic markers and severity scores have been developed and studied to predict the disease severity in acute pancreatitis; but not a single one is ideal. <b>Aim:</b> To study Red-Cell Distribution Width (RDW) to Total Platelet Count (TPC) ratio, shortly RPR (Red Cell Distribution Width to Platelet Ratio); as a prognostic indicator in acute pancreatitis. <b>Materials and Methods: </b>A total of 60 patients with a diagnosis of acute pancreatitis were included in this prospective study. Patients were divided into two groups; mild acute pancreatitis group (MILD AP) and severe acute pancreatitis group (SEVERE AP) according to the revised Atlanta classification 2012 (the severe group includes both moderate and severe acute pancreatitis patients). Patients were followed up till the final outcome that means either death or discharge from the hospital. RPR (RDW/TPC) value was calculated from the complete blood count report for all patients. Various prognostic scores including RANSON’s score, SOFA score, BISAP score, APACHE II, modified Glasgow score were calculated for all patients. RPR and other score values were compared between the discharged and dead patients as well as between the MILD AP group and Severe AP group. Statistical analysis was done using SPSS 21 software and p-value was calculated using the unpaired t-test. <b>Results:</b> The RPR (RDW/TPC) value was found to be significantly higher in patients with severe acute pancreatitis as well as in patients in whom the final outcome was death (p-value <0.001). Using the ROC curve analysis, it was found that at a cut-off value of 0.045 (RDW-CV in % and TPC in x1000/µL) the RPR has a sensitivity of around 90% and a specificity of around 73% in predicting the severity of the disease and with a cut-off value of 0.071, RPR has a sensitivity of around 82% and a specificity of around 96%, in predicting mortality in acute pancreatitis patients. <b>Conclusion:</b> From this study we conclude that RPR is a useful marker of disease severity in acute pancreatitis, especially in early stage. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=PC05-PC08&id=12937 https://doi.org/10.7860/JCDR/2019/29344.12937 Spectrum of Complications of Chronic Liver Disease in Gauhati Medical College and Hospital: A Hospital Based Study Tanushree Maitra, Sumi Prabha Das, Pranjan Barman, Jyotismita Deka <b>Introduction:</b> Cirrhosis of liver is defined anatomically as a diffuse process with nodule formation and fibrosis. Cirrhosis can remain as a silent disease until decompensation occurs. The clinical features are the result of the pathological changes and they mirror the severity of the liver disease and they are the same irrespective of the cause. Decompensated disease can result in complications such as as cites, spontaneous bacterial peritonitis, hepatic encephalopathy and variceal bleeding from portal hypertension. Data regarding the aetiology and the spectrum of clinical manifestations and complications of cirrhosis of liver is lacking from the North-East, India. Against this background, this present study was conducted. <b>Aim:</b> To determine the clinical spectrum of patients with chronic liver disease with reference to its aetiology, clinical manifestations, complications and causes of death in Gauhati Medical College and Hospital. <b>Materials and Methods: </b>The cross-sectional study was carried out with 200 enrolled chronic liver disease patients. A detailed history, clinical examination and a structured questionnaire were used to collect the data. Haematological, biochemical, radiological as well as endoscopic investigations were performed to evaluate various complications and manifestations. Data was analysed and expressed as percentage. <b>Results:</b> Alcohol was the most common aetiological factor for cirrhosis in 62.5% patients followed by Hepatitis B in 11%, Non Alcoholic Steato Hepatitis (NASH) in 9% and Hepatitis C in 3.5%. After performing the necessary investigations, the various complications of cirrhosis were coagulopathy in 83%, gastroesophagealvarix/ portal hypertensive gastropathy in 81%, ascites in 64%, hepatic encephalopathy in 51%, hypersplenism in 24%, hyponatremia in 17.18%, spontaneous bacterial peritonitis in 12.5%, hepatorenal syndrome in 4% and hepatocellular carcinoma in 2.5%. Ascitic fluid culture was positive in 9.3% patients with ascites, the most common organism grown in culture was E. Coli. 52.5% of the patients had Child Pugh C cirrhosis and 13% died during hospital stay. The most common cause of death was worsening hepatic encephalopathy in 50% followed by UGI bleed and sepsis. <b>Conclusion:</b> Chronic liver disease proves to be fatal if allowed to decompensate. Therefore, the best option is to prevent it or to control it at the earliest. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=OC07-OC12&id=12938 https://doi.org/10.7860/JCDR/2019/36606.12938 Comparative Evaluation of Serum Malondialdehyde (MDA) Level in Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma Havisha Arya, Sindhu M Ganvir, Deovrat N Begde, Arti Dolas Passi <b>Introduction:</b> Lipid peroxidation, which is induced by reactive oxygen species, is involved in the pathogenesis of malignancy. This lipid peroxidation levels are indicated by Malondialdehyde (MDA), which is the most frequently, used biomarker for the detection of oxidative changes. <b>Aim:</b> Comparative evaluation of serum MDA level in Oral Submucous Fibrosis (OSMF) and Oral Squamous Cell Carcinoma (OSCC) patients and comparison of their serum MDA levels with healthy controls. <b>Materials and Methods:</b> The study included 150 patients comprising 50 apparently healthy controls without any tobacco chewing habits, 50 clinically diagnosed patients with OSMF which were also subgrouped according to Interincisal Opening (IIO) and 50 clinically diagnosed patients with OSCC, they were also subgrouped according to site, size and histopathological differentiation. Blood samples were obtained; serum was separated and evaluated for MDA levels, by using principle of spectrophotometry at 532 nm absorbance. Statistical analysis were conducted using independent t-test and one-wayanova test. Statistical package for social science (SPSS 16) was used for the analysis. <b>Results:</b> The mean serum malondialdehyde level in the control group was found to be 10.50 nmol/mL, whereas it was 25.87 nmol/mL and 57.00 nmol/mL in OSMF and OSCC, respectively. Different grades of OSMF patients according to IIO showed p<0.05, which was statistically significant. Among the subgroups of OSCC patients with respect to site and histopathological differentiation the results were not significant whereas there was statistically significant increase in MDA levels with increase in primary tumour size. <b>Conclusion:</b> The increased level of MDA reflects the extent of lipid peroxidation and is considered to be mutagenic as well as carcinogenic and can also modulate the expression of genes related to tumour promotion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZC27-ZC31&id=12939 https://doi.org/10.7860/JCDR/2019/40262.12939 Relationship of Respiratory Muscle Strength and Walking Distance with Pulmonary Function, Quality of Life and Nitric Oxide in Chronic Obstructive Pulmonary Disease Patients Jirakrit Leelarungrayub, Rungthip Puntumetakul, Thanyaluck Sriboonreung, Yothin Pothasak, Jakkrit Klaphajone <b>Introduction:</b> Respiratory muscle strength and walking distance have been associated with the severity of disease and is used in prescribing rehabilitation programs for persons with Chronic Obstructive Pulmonary Disease (COPD). <b>Aim: </b>To evaluate the correlation between respiratory muscle strength and walking distance with pulmonary function, plasma Nitric Oxide (NO) levels and Quality of Life (QoL) score in persons with stable COPD. <b>Materials and Methods:</b> The present cross-sectional study was conducted in 35 participants with moderate severity, stable COPD. Physical outcomes such as respiratory muscle strength (PImax), walking distance {6-minute walking distance (6MWD)} and pulmonary function {Forced Vital Capacity (FVC), Forced Expiratory Volume at one second (FEV1), and FEV1/FVC ratio} were evaluated. In addition, a total Clinical COPD Questionnaire (CCQ) and plasma NO levels were determined. The Pearson’s correlation test was analysed statistically. <b>Results:</b> The present results revealed that the participants had a significantly positive correlation on PImax with FVC (r=0.624, p<0.001), FEV1 (r=0.539, p<0.001), and NO (r=0.510, p<0.001), whereas, the 6MWD correlated positively to FVC (r=0.390, p=0.018), FEV1 (r=0.548, p<0.001), FEV1/FVC ratio (r=0.55, p<0.001) and NO (p=0.416, p=0.013), but negatively to the total QoL score (r=-0.579, p<0.001). <b>Conclusion:</b> This preliminary study demonstrates that respiratory muscle strength and walking performance possibly relate to pulmonary function and plasma NO among persons having COPD with moderate severity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=YC05-YC09&id=12959 https://doi.org/10.7860/JCDR/2019/39998.12959 Overview of Contraceptive Use in Usmanu Danfodiyo University Teaching Hospital Sokoto North Western Nigeria Karima Abubakar Tunau, Swati Singh, Abubakar Panti, Emmanuel Nwobodo, Mairo Hassan, Saratu Bello, Aisha Ibrahim <b>Introduction:</b> Family planning is a proven and cost-effective health intervention. Use of contraception has been reported to be low in developing countries. <b>Aim: </b>To determine the trend of acceptance of contraception and the preferred methods of modern contraception in the new fertility research unit of Usmanu Danfodiyo university teaching hospital Sokoto, Nigeria. <b>Materials and Methods:</b> This was a 10-year retrospective study involving all acceptors of modern contraceptive methods from the January 2008 to the December 2017. All case notes and theatre records were accessed. The data extracted were analysed using IBM SPSS version 23.0. Data were analysed using frequencies and percentages. Chi-square test was used for associations and level of significance was set at p<0.05. <b>Results: </b>There were 11,577 acceptors of family planning during the study period. Of these 5762 were new acceptors. There were 30,721 deliveries. The contraceptive prevalence rate and annual acceptor rate were 18.8% and 576.2 per annum respectively. There was a steady rise in the number of acceptors over the years of study. All the clients were female and married. The housewives constituted 78.4% (4487) of the clients and (59.7%) of them had completed secondary level of education. The Implanon® was the preferred contraceptive method of choice in 2698 (46.%) of the new clients Jadelle® was next with 942 (16%) clients using it. <b>Conclusion:</b> There was a rise in trend in the use of modern contraception followed by a plateau in the last two years of study. Most clients were young, educated and of low parity. Implants were the most preferred methods.. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=QC01-QC05&id=12960 https://doi.org/10.7860/JCDR/2019/41547.12960 Tuberculoma Versus Neurocysticercosis: Can Magnetic Resonance Spectroscopy and Diffusion Weighted Imaging Solve the Diagnostic Conundrum? Ravishankar Pillenahalli Maheshwarappa, Chandan Agrawal, Juhi Bansal <b>Introduction:</b> Tuberculoma and Neurocysticercosis (NCC) are the two most common infectious causes of intracranial ring enhancing lesions seen on CT and MRI in developing countries. They share common clinical and neuroimaging findings most of the times resulting in diagnostic conundrum. It is very important to differentiate these two conditions to avoid improper treatment. Magnetic Resonance Spectroscopy (MRS) and Diffusion Weighted Imaging (DWI) as additional imaging tools help to differentiate the two conditions when faced with diagnostic dilemma. <b>Aim:</b> To evaluate the utility of MRS and DWI as an adjuvant in differentiating tuberculoma and NCC. <b>Materials and Methods:</b> This was a retrospective study where the MRI of 30 subjects with clinical diagnosis of either tuberculoma or NCC were analysed. Imaging sequences included T1W, T2W, FLAIR, DWI, MRS images and post contrast T1W FS images. The data on MRS and DWI findings of both the conditions were collected. The correlation between the MRS and DWI findings with the lesions was studied. Finally, the data were pooled and analysed. Radiological diagnosis of the findings was confirmed by reasons to clinical trials (albendazole 15 mg/kg for one week for NCC and appropriate ATT for tuberculoma) in terms of remission of clinical symptoms and follow-up imaging for decrease in the size of the lesion and perilesionaloedema. <b>Results:</b> NCC cases showed no lipid peak whereas tuberculoma lesions except one showed predominant lipid peaks. Both lesions showed reduced N-acetylaspartate (NAA) levels. NCC lesions showed acetate/succinate or both peaks whereas these metabolites were normal in tuberculoma lesions. Cho/creatinine ratio was normal in all cases of NCC. Seven out of 17 tuberculoma lesions showed increased Cho/creatinine ratio (greater than 1) and almost all the lesions showed elevated normalised Cho/Cr ratio reflecting increased membrane damage and cellularity tuberculoma. All tuberculoma lesions except three showed restricted diffusion whereas none of the NCC lesions showed restricted diffusion. <b>Conclusion:</b> MRS and DWI are very useful imaging tools which when used along with conventional MRI imaging helps to differentiate tuberculoma from NCC and vice versa. These MR sequences when employed together will obviate the need for unnecessary biopsy thus helps in immediate clinical management and also follow-up. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=TC01-TC06&id=12957 https://doi.org/10.7860/JCDR/2019/41334.12957 Evaluation of Risk Management Knowledge among Nurses in Medical Training Hospital of Ilam Hamid Taghinejad, Zainab Suhrabi, Hamed Tavan <b>Introduction:</b> Risk management is one of the most important concepts of clinical administration in health care system. It includes different interventions planned and performed to improve and provide safety of services for the clients. <b>Aim:</b> To evaluate the status of risk management in the three state hospitals of medical education in Ilam (western Iran). <b>Materials and Methods:</b> In the present descriptive analytic study, 112 registered nurses were randomly selected. The necessary data was gained through the risk management questionnaire as follows: nurses knowledge about risk management (8 items) organising how to manage risks (8 items), policies and procedures (6 items), risk management training (8 items), organisational status of risk management (6 items), monitoring, analysis, evaluation and control of risk (9 items). The questionnaire of 45 items was provided in 5-choice format in accordance to the Likert Scale. The least score was 45, while the most was 225, divided into 4 levels of weak, average descending, average ascending and good sections. The data analysis was done using SPSS V.19. <b>Results:</b> The results showed that 56 people (50%) of the staff were male and 56 (50%) were female. Totally, the average score of risk management was 115.53, while the staff&#8217;s knowledge about of risk management was 22.62&#177;5.32 (the highest score), policies and procedures on risk management was 20.48&#177;5.7 (the lowest score). <b>Conclusion:</b> A total of 57.14% of the investigated cases showed an average descending score of 90-134. A finding that necessitates an educational program on risk management dimensions as an essential measure. Accordingly, determination of educational programs on risk management dimensions, application of appropriate executive procedures and approaches besides establishment of supervising programs at hospitals are suggested. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=LC21-LC23&id=12955 https://doi.org/10.7860/JCDR/2019/29353.12955 Syphilis Screening in Pre-procedural Patients at a Tertiary Cardiac Care Centre in India J Naveena, KR Nishanth, MP Nandini, CN Manjunath <b>Introduction:</b> Routine pre-procedural screening for blood-borne infections is a common practice despite lack of standard guidelines. The incidence of syphilis has shown an upward trend in recent years. <b>Aim:</b> To determine the prevalence and clinical significance of routine screening for syphilis in pre-procedural patients in tertiary care cardiac centre. <b>Materials and Methods:</b> This prospective study included consecutive patients undergoing surgical and percutaneous invasive procedures at a tertiary cardiac care centre from March 2017 to August 2017. All patients were screened for syphilis using ELISA for detection of <i>Treponema pallidum</i> IgG antibodies. All patients who were positive for ELISA were confirmed with <i>Treponema pallidum</i> Haemagglutination Assay (TPHA). <b>Results:</b> A total of 13,865 patients were screened and the seropositive rate was 0.45%. Most patients were in the age group of 51-70 years (71.4%) and were male (76.2%). Three patients had manifestation of cardiovascular syphilis and two patients were positive for HIV also. There was no reported incidence of needlestick injury or mucus membrane exposure to blood products during the procedures. <b>Conclusion:</b> Routine pre-procedural screening for syphilis is not beneficial due to low seroprevalence. Screening must be limited to at risk individuals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=DC09-DC11&id=12949 https://doi.org/10.7860/JCDR/2019/41891.12949 Soil Transmitted Helminth Infections and its Association with Haemoglobin Levels in India: A Meta-analysis Nasir Salam, Mohammad Fareed <b>Introduction:</b> Soil Transmitted Helminth (STH) infections affect some of the poorest countries in the world. India is one of the most severely affected countries by these parasitic infections. They primarily affect children by impairing nutritional status, cognitive ability and overall development. Lower haemoglobin levels are a very common symptom associated with Helminth infections. <b>Aim:</b> The present study was conducted to analyse the effect of STH infections on haemoglobin levels in India. <b>Materials and Methods:</b> A systematic search of PubMed and Web of Science was carried out. We systematically reviewed the literature to identify studies reporting data on STH infection associated anaemia without any bar on language or date of publication. Full text studies reporting data on STH infection associated anaemia in humans were considered for final analysis. <b>Results:</b> Careful screening resulted in 16 publications that met the eligibility criteria out of which six were case reports and ten were cross-sectional studies that reported data on helminth infections and haemoglobin levels. Odds ratio analysis of five cross-sectional reports indicated that Helminth infections are three times (OR-2.8, CI-95%, 2.4-3.4) more likely to be associated with lower haemoglobin levels as compared to uninfected population. An analysis of case reports indicated severe to moderate anaemia in all patients. <b>Conclusion:</b> Helminth infections are often associated with lower haemoglobin levels resulting in lower cognitive development. We have found evidence that helminth infections are associated with lower haemoglobin levels in Indian population. <b>Implications of Key Findings:</b> This study can provide a guideline to clinicians and healthcare professional in identifying a baseline for haemoglobin level associated with STH infection associated anaemia and might lead to more comprehensive analysis of reasons for anaemia, growth stunting and cognitive impairment in at risk Indian population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=DC12-DC16&id=12950 https://doi.org/10.7860/JCDR/2019/40681.12950 Investigation of ABO Blood Groups in Periodontal Status and its Effect on Level of Response to Nonsurgical Periodontal Treatment Mhd Ammar Kouki, Ali Abou Sulaiman, Mohammad Tawfik Kouki, Mohammed Monzer Alsabbagh <b>Introduction:</b> ABO blood groups have been associated with several systemic diseases. Various studies have investigated the relationship between ABO blood groups and periodontal diseases. <b>Aim:</b> The purposes of this study were to assess the possible association between ABO blood groups and Rh factor with periodontal status, and to determine whether the level of response to scaling and root planing would vary based on the patient’s blood phenotype. <b>Materials and Methods:</b> A total of 1009 subjects participated in this cross-sectional study and were allocated into three groups, healthy participants, with gingivitis and with periodontitis. Furthermore, sixty patients from the periodontitis group with generalised chronic periodontitis were further divided into four groups according to their blood phenotypes to participate in the second stage of the study. Blood sample were collected using the finger prick technique and the direct agglutination method was used to determine the blood group. Chi-square test was used to investigate the association between ABO blood groups and Rh factor with periodontal status, and One-Way ANOVA was chosen to assess the level of response to scaling and root planing based on the participant’s blood group. <b>Results:</b> A higher incidence of gingivitis was found in patients with blood group A whereas a higher incidence of periodontitis was found in patients with blood group O. In addition, a higher incidence of periodontitis followed by gingivitis was found in Rh positive patients. Regarding the effect of ABO blood groups on nonsurgical periodontal therapy, there was no significant difference between the four groups. <b>Conclusion:</b> A and O blood groups and Rh positive are possible risk factors for periodontal disease, and the level of response to scaling and root planing does not differ according the blood group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZC36-ZC40&id=12951 https://doi.org/10.7860/JCDR/2019/41518.12951 Tumour Necrosis Factor α Gene Polymorphism in Rheumatoid Arthritis and its Association with Oxidative Stress and Dyslipidemia Puja Kumari Jha, Mohd Jahid, Rajnish Avasthi, Rafat Sultana Ahmed, Basu Dev Banerjee <b>Introduction:</b> Rheumatoid Arthritis (RA) is a chronic inflammatory disease that affects joints. Increased oxidative stress and inflammation due to elevated levels of Tumour Necrosis Factor-a (TNF-a) leads to pathogenesis of RA. Single Nucleotide Polymorphisms (SNPs) in the promoter region of the TNF gene affects the expression of this pro-inflammatory cytokine TNF-a and TNF-a often leads to development of dyslipidaemia in RA cases. <b>Aim:</b> To investigate the association of SNP, TNFa-308G/A with disease development, plasma TNF-a levels, disease biomarkers, oxidative stress and dyslipidaemia parameters in RA cases. <b>Materials and Methods:</b> In this analytical case-control study, hundred cases of RA diagnosed according to American College of Rheumatology (ACR) Criteria 2010, were recruited from Outpatient Department at Guru Teg Bahadur Hospital, Delhi. Age and sex-matched, 100 apparently healthy individuals were recruited as controls. TNF-a-308G/A polymorphism in cases and controls were screened by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). Plasma TNF-a, anti-Cyclic Citrullinated Peptide antibody (anti-CCP), Rheumatoid Factor (RF), and C-Reactive Protein (CRP) were quantified by Enzyme-Linked Immuno Sorbet Assay (ELISA). Biochemical and oxidative stress parameters were measured by standard reference methods. Simple binary logistic regression analysis was done to determine the genetic association of disease with TNF-a-308G/A polymorphism. ANOVA was used for comparative analysis and Pearson’s correlation was applied for correlation of oxidative stress and lipid parameters. The p-value less than 0.05 was considered statistically significant. <b>Results:</b> The present study revealed that TNF-a 308G/A polymorphism was associated with RA (OR=1.9, p=0.02). Significant dyslipidemia, higher MDA and GST levels with decreased GSH and FRAP was observed in RA cases. RA cases with AA genotype presented with significantly higher levels of TNF-a, anti-CCP, CRP, MDA and GST. Plasma levels of TNF-a exhibited a positive correlation with ESR levels (r=0.22, p<0.05) and anti-CCP levels (r=0.21, p<0.05) whereas, MDA was positively correlated with Low-Density Lipoprotein (LDL-C) (r=0.32, p<0.05). <b>Conclusion:</b> The present study establishes that TNF a-308G?A polymorphism was positively associated with rheumatoid arthritis and played a crucial role in its development and progression. Screening for genetic polymorphisms can help in identification of the susceptible population, development of personalised treatment and prevention of the occurrence of severe RA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=BC25-BC29&id=12952 https://doi.org/10.7860/JCDR/2019/41526.12952 Clarification of Quantitative Intraoral Circumstances with the Community Periodontal Index of Treatment Needs Data using Covariance Structure Analysis Toshio Kobayashi, Tomonari Suda, Koji Mizutani, Norio Aoyama, Tatsuro Koyanagi, Sae Hayakumo, Yuichi Ikeda, Yuichi Izumi <b>Introduction:</b> Although the severity of periodontal disease is evaluated by various indices, the susceptibility is different among tooth types in the same dentition. Community Periodontal Index of Treatment Needs (CPITN) is a frequently used periodontal index and hierarchically assessed in each six-divided positions. Numerous factors related to periodontal disease determine this deviation of severity among tooth sites but is difficult to be identified precisely. While Covariance Structure Analysis (CSA) defines these unmeasurable factors as latent variables and is able to examine the association about a theoretical model between latent variables and measurable variables. <b>Aim:</b> To assess the difference in susceptibility to periodontal disease and tooth loss among tooth positions evaluated by CPITN score using CSA. <b>Materials and Methods:</b> In this cross-sectional study, the values of CPITN and the number of remaining teeth of 891 Japanese patients were used as measured variables. The factor related to periodontal disease progression was defined as a latent variable “Intraoral Circumstances”. Then, a simple one-way flow is described and the quantitative associations were estimated by CSA between the Intraoral Circumstances and the values of sextants evaluated by CPITN and between the CPITN values of sextants and the number of remaining teeth. <b>Results:</b> Values showing the quantitative, individual and detailed relationship of risk factor among sextants in the oral cavity are obtained. The molar teeth are susceptible to periodontal disease and the periodontal progression into upper anterior region is related to a small number of remaining teeth. The indicators used to evaluate the goodness of fit of the estimation exhibit that the applied model is acceptable. <b>Conclusion:</b> The precise differences among six positions are quantitatively estimated finally. The obtained results are statistically and epidemiologically able to determine the difference of the susceptibility and the effect on the number of remaining teeth among six positions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZC41-ZC44&id=12953 https://doi.org/10.7860/JCDR/2019/40092.12953 Comparative Evaluation of Colony Forming Units of Candida After Using Plain and Probiotic Added Denture Adhesive in Completely Edentulous Patients: A Randomised Crossover Trial Tamanna Chhabra, Vandana Shah, Rajesh Sethuraman <b>Introduction: </b>Completely edentulous patients who wear dentures are more prone to candidiasis, under certain special conditions like compromised immunity. Besides that, if denture adhesives are also being used and hygiene maintenance is not carried out properly, because of decreased ability of senile patients, the risk factor surmounts. Such situations can be controlled with use of adhesives with anticandidal activity. Therefore, the present study was carried out to develop and evaluate a new combination of denture adhesives with Probiotics. <b>Aim:</b> To evaluate the Colony Forming Units (CFU) of candida after using plain and probiotic added denture adhesive in completely edentulous patients. <b>Materials and Methods:</b> At first, the stability testing for the new product which is a combination of probiotics and denture adhesives was done . The CFU/mL of candida was counted at the baseline and the participants were divided into two groups based on application of plain (group A) and probiotics added adhesives (Group B). The CFU was counted before and after crossover of patients to either group. The statistical tests used were descriptive statistics, repeated measures ANOVA and Bonferroni test for pair-wise comparison of CFU/mL. <b>Results: </b>The stability test showed that the novel combination was stable for three months. The results revealed a statistically significant decrease in CFU/mL of candida from baseline to post intervention group B (p=0.001), and after crossover of participants from Group A to Group B. (p=0.01). <b>Conclusion:</b> Therefore, it can be concluded that probiotics can play a significant role in decreasing the amount of candida in edentulous patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZC07-ZC12&id=12908 https://doi.org/10.7860/JCDR/2019/40070.12908 Clinicomorphological Study of Leiomyoma Associated Endometrial Changes in Correlation with LMP: In a Tertiary Care Hospital in Rural Tamil Nadu Anusha Babu Rajendran <b>Introduction:</b> Leiomyomas are benign smooth muscle tumors. They are the single most common cause for hysterectomy in the reproductive and peri-menopausal age group associated with abnormal uterine bleeding. There are certain endometrial changes with leiomoyomas due to hormonal and mechanical influences of the leiomyomas. <b>Aim: </b>To study the incidence of leiomyomas of uterus in a rural area of Tamil Nadu and the endometrial changes associated with it correlating it to the LMP, in hysterectomy specimens. <b>Materials and Methods:</b> This is a retrospective study of three hundred thirty one patients who underwent hysterectomy for uterine leiomyoma between 2013 and 2015, histopathological analysis of the cases for endometrial changes was done. <b>Results:</b> A total of 331 hysterectomy specimens done for leiomyomas were studied. The most common age group was observed as 41-50 years (56.50%). Multiparous women (94.86%) are more commonly affected. Menorrhagia was the most common symptom seen in 46.53%. Majority of the cases had a single leiomyoma (59.82%). The most common location was intramural (49.85%). The most common degenerative change associated with a leiomyoma was hyaline change (23.87%). The most common type of endometrium was proliferative endometrium observed in 44.41%. The percentage of mailignacy associated with a leiomyoma was 0.60%. <b>Conclusion:</b> Leiomyomas are the most common causes for hysterectomy. The associated endometrial change is proliferative in nature suggesting the role of harmones such as oestrogen and progesterone on the leiomyoma and simultaneously on the corresponding endometrium. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=EC01-EC04&id=12909 https://doi.org/10.7860/JCDR/2019/41034.12909 Assessment of Clinical Competence of Interns using Work Place Based Assessment in Ophthalmology Rotational Posting Tania Moudgil, Yashi Bansal, Rajiv Arora, Seema Dutt Bandhu <b>Introduction:</b> Acquisition of clinical skills is the main aim of the compulsory clinical rotations during internship. It is left to chance that students acquire clinical skills as there is no formal assessment to ensure that skill learning has actually taken place. The best method for assessing clinical competence is Work Place Based Assessment (WPBA). Mini-clinical Evaluation Exercise (mini-CEX) and Directly Observed Procedural Skills (DOPS) are among some of the tools used for assessment of clinical competence. These tools can also be used to incorporate feedback to the students and at the same time it can be used as an excellent teaching-learning opportunity. <b>Aim:</b>To assess the feasibility and use of Mini-clinical evaluation exercise and directly observed procedural skills as assessment tools for assessing clinical competence of interns. <b>Materials and Methods: </b>This Prospective interventional study was conducted in Department of Ophthalmology of Punjab Institute of Medical Sciences, Jalandhar, Punjab, India from June 2016-June 2017. The clinical competence of interns was assessed using mini-CEX and DOPS. One Hundred interns undertook four Mini-clinical evaluation exercises each by different assessors and at least one DOPS for refraction was conducted per intern. If result was unsatisfactory, then further DOPS was undertaken till performance was satisfactory. The grading was done on the checklist (key points required) and evaluation done in points as pre-decided by assessors on a scale of 1-9 (1-3 unsatisfactory, 4-6 satisfactory and 7 to 9 superior). Satisfaction with the process of assessment by mini-CEX was also graded on a 9 point scale. Overall performance of interns for the procedure of refraction was graded on a 9 point scale in DOPS. A feedback questionnaire about the conduct and acceptability of assessment tools was taken from the interns and assessors at the end of their posting using a pre-validated questionnaire. All the results were computed using SPSS software (version 22.0). Average scores of all the interns in each subcompetency of mini-CEX and DOPS were recorded. The progression of the scores was observed from first mini-CEX and the fourth mini-CEX. Comparison of scores was done between mini-CEX 1 vs. mini-CEX 4 using ANOVA Post-hoc Tukey’s Test. <b>Results:</b> A total of 100 interns undertook 400 Mini-clinical evaluation exercise (four Mini-clinical evaluation exercise each intern) and 160 DOPS (at least one DOPS each). For Mini-clinical evaluation exercise (total including 1, 2, 3 and 4) the grading was satisfactory in 76.25% (305) and unsatisfactory in 23.75 % (95). For DOPS (total=160), 62.5% (100) were graded as satisfactory and 37.5% (60) of the DOPS were graded unsatisfactory. A mean score of 8.0 was given by interns and 7.7 by faculty for their satisfaction with assessment by mini-CEX. Overall performance in DOPS was graded as 6.2. <b>Conclusion:</b> Mini-clinical evaluation exercise and directly observed procedural skills are useful assessment tools for assessing competence in interns and further improving clinical skills. It is feasible to use these assessment methods in ophthalmology clinical setting. These assessment methods act as an effective tool for giving feedback. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=NC01-NC08&id=12926 https://doi.org/10.7860/JCDR/2019/40981.12926 Evaluation of the Diagnostic Utility of Second Generation Anti-cyclic Citrullinated Antibodies and Rheumatoid Factor IgM Isotype in Clinically Suspected Rheumatoid Arthritis Patients Saranya Arumugam, Vigneshwaran Jeyasekaran, Jayanthi Sivasubramaniam, Priyadarshini Shanmugam <b>Introduction:</b> Rheumatoid Arthritis (RA) is one of the most common autoimmune diseases that require early diagnosis and treatment. There are various methods by which these tests are done. The present study was carried out to compare Anti-Cyclic Citrullinated Peptide (Anti-CCP) ELISA, Rheumatoid Factor (RF) IgM ELISA and RF latex agglutination tests and their combined sensitivity and specificity in the diagnosis of RA. Usually, Anti-CCP Antibodies (Ab) appear early before RF in patients with RA. The values of these tests are given in titres. The higher the titre, the higher the chance for it to represent RA (specificity increases). Lower titres can be positive in some normal elderly patients, in other autoimmune disorders, post viral syndromes, and in some cancers. <b>Aim:</b> To comparatively evaluate second generation Anti-CCP Ab with RF isotype in diagnosis of RA. <b>Materials and Methods: </b>This cross-sectional descriptive study was conducted in Department of Microbiology, in a tertiary care hospital, from November 2016 to May 2018. After obtaining informed consent, blood samples were collected from 60 RA patients diagnosed using the American College of Rheumatology-European League Against Rheumatism (ACR/ EULAR) classification criteria for RA. Serum was separated and three tests were performed: RF by latex agglutination test, RF by IgM ELISA and Anti-CCP by ELISA test. The sensitivity and specificity of Anti-CCP, RF factor, RF IgM ELISA were calculated using Non-parametric tests (McNemar test) keeping the clinical diagnostic criteria as the gold standard. <b>Results:</b> Among the 60 study participants, female were 51 (85%), Male/female ratio was 1:5.6. Out of 60, 39 (65%) were positive for RF by latex agglutination test. Around 41 (68.3%) were positive for RF IgM by ELISA and 42 (70%) were positive for Anti-CCP done by ELISA. Both RF ELISA and Anti-CCP had a higher sensitivity of 47.5% and 50% when compared to RF latex. Also, the specificity of Anti-CCP and RF ELISA were higher, that is 82.4% and 80.4% when compared to RF latex which had a specificity of 76.5%. <b>Conclusion: </b>This study concludes and suggests that both RF IgM ELISA and Anti-CCP test should be included in the investigation panel for undifferentiated arthritis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=DC05-DC08&id=12927 https://doi.org/10.7860/JCDR/2019/41269.12927 A Study on the Knowledge, Attitude and Practices Regarding Menstrual Hygiene among Adolescent Girls in Schools in a Rural Area of Goa Sheena Manoj Patel, Shefalee Pai Vernekar, Archana Milind Desai <b>Introduction:</b> Menstruation is a natural physiological process surrounded by myths and taboos which often lead to misconceptions and faulty knowledge and practices in menstruation. Along with social and cultural barriers, lack of adequate facilities such as water supply and sanitation have posed a problem for maintaining menstrual hygiene especially in adolescent school girls. <b>Aim:</b> To study the knowledge, attitudes and practices towards menstruation among adolescent school girls. <b>Materials and Methods:</b> A cross-sectional study was conducted from August 2018 to September 2018 among 273 adolescent girls in the age group of 11-16 years studying in the five schools under field practice area of Rural Health and Training Centre, Mandur, using a semi structured, pretested questionnaire containing questions regarding their knowledge of origin, cause and source of menstrual bleeding as well as the various restriction imposed and various practices followed related to menstrual hygiene. Data were analysed using Statistical Package for the Social Sciences (SPSS) Version 22. <b>Results:</b> The results showed that 83.9% were aware of menses before they attained menarche. Majority received their knowledge of menstruation from their mother. Only 54.9% of the participants were aware that menstrual blood arises from the uterus while 35.9% girls were aware that the cause of menstruation is physiological. Different restrictions were compared against different religions and it was found that there was a significant difference in the restrictions imposed between the Hindu, the Catholic and the Muslim religions with respect to entering prayer room, entering kitchen, visiting people’s homes and attending family functions. Only 28.6% girls faced no restriction during menstruation. Around 73.6% girls used sanitary pads. <b>Conclusion:</b> The study highlights that there are many aspects regarding the attitude and practices of menstruation that need to be addressed. Promoting health seeking behaviour and educating the people who play a role in being sources of information of menstruation will help to improve menstrual hygiene among rural adolescent girls. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=LC07-LC10&id=12912 https://doi.org/10.7860/JCDR/2019/41251.12912 Clinical and Investigative Study of Hirsutism Vaishali Hainath Wankhade, Vrutika Hasmukh Shah, Suyash Singh Tomar, Rajesh Pratap Singh <b>Introduction:</b> Hirsutism is the presence of excessive terminal hair in androgen-dependent areas in a female with varied aetiology. The most common endocrine disorder leading to hirsutism is Polycystic Ovary Syndrome (PCOS). Hirsutism can be androgen induced or non-androgen induced. Hyperandrogenism with hirsutism can be associated with various signs and symptoms such as Acanthosis Nigricans (AN), obesity, acne, virilisation, Female Pattern Hair Loss (FPHL) and pelvic mass. <b>Aim:</b> To assess the aetiology of hirsutism and to study the clinical, biochemical characteristics of these patients along with other associations like AN, hypothyroidism, PCOS, FPHL, acne, deepening of voice and clitoromegaly. <b>Materials and Methods:</b> A retrospective cross-sectional study in which medical records of patients having hirsutism from pre-filled proformas attending the outpatient department during June 2016 to May 2018 were analysed. Fifty patients with modified Ferriman-Gallwey (mF-G) score of eight or more were reviewed with respect to age, sex, history of symptoms including the menstrual history, height, weight, Waist Circumference (WC) and Body Mass Index (BMI). Hormonal profile {Serum Free and total testosterone, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, Luteinizing Hormone (LH), Follicle Stimulating Hormone (FSH), prolactin, free tri-iodothyronine, free tetra-iodothyronine, Thyroid Stimulating Hormone (TSH), fasting blood sugar, fasting insulin and fasting lipid profile} and transabdominal ultrasonography reports were assessed. Statistical analysis was done using STATA version 14.0 software. Chi-square test was used for comparison between categorical variables (viz., acne and menstrual history). One-way ANOVA (Analysis of variance) was used for comparison of means of WC, BMI, mF-G score and hormone profile in different aetiologies of hirsutism for normalised data and Kruskal-Wallis ANOVA test was used for non-normalised data. Multiple comparisons were performed by Bonferroni t-test to compare any type of significant difference of study parameters between two aetiologies. The p-value of <0.05 was considered significant. The p-value of <0.001 was considered as highly significant. <b>Results:</b> The mean age of the patients was 29.42&#177;10.83 years. The causes of hirsutism were Idiopathic Hirsutism (IH) (40%), PCOS (32%), Hyperandrogenic Insulin Resistant Acanthosis Nigricans Syndrome (HAIR-AN) (16%), Hypothyroidism (8%) and late Onset Congenital Adrenal Hyperplasia (CAH) (4%). Associated signs of hyperandrogenism included acne (40%), FPHL (26%), AN (20%), deepening of voice (4%) and clitoromegaly (4%). Serum LH and LH:FSH ratio was significantly raised in PCOS and CAH. Serum 17-OH progesterone was significantly raised in CAH. WC and serum fasting insulin were statistically significant in HAIR-AN group as compared to other groups. Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was significantly raised in HAIR-AN group as compared to CAH but there was no statistically significant difference between other groups (PCOS, IH and hypothyroidism). <b>Conclusion:</b> Hirsutism though a benign condition should be thoroughly evaluated. Idiopathic hirsutism was most common cause in this study. WC, serum fasting insulin and HOMA-IR were statistically significant in HAIR-AN patients which signify the importance of ruling out insulin resistance in patients presenting with hirsutism and AN as they require additional management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=WC01-WC06&id=12913 https://doi.org/10.7860/JCDR/2019/40439.12913 Evaluation of Dynamic Hip Screw Blade in Extracapsular Fracture Neck of Femur in the Elderly Tejasvi Bhatia, Anil Juyal, Rajesh Maheshwari, Atul Agrawal, Digvijay Agarwal <b>Introduction:</b> Intertrochanteric fractures account for 50% of all fractures of the proximal femur, the average age of incidence being 66 to 77 years. Dynamic Hip Screw (DHS) fixation is considered to be one of the standard treatments of trochanteric fractures. The most common mode of failure with the DHS is cut-out of the screw which significantly relates to the bone mineral density of proximal femur. DHS blade was developed in an attempt to enhance anchorage of the implant in the osteoporotic bone. <b>Aim:</b> To assess the radiological and functional outcome of extracapsular fracture neck femur in osteoporotic patients treated with DHS blade. <b>Materials and Methods:</b> In this descriptive observational study, DHS blade fixation was done in 30 osteoporotic patients with intertrochanteric fracture of the femur. Osteoporosis was graded as per Singh&#8217;s Index. The patients were followed up for a minimum of six months with radiological and clinical evaluations. Descriptive statistics were used to analyse data. <b>Results:</b> The male to female ratio was 1:2.75. The mean age of patients was 73.4&#177;8.64 years (range 60-97 years). Thirty patients were operated with DHS blade and followed up for a minimum of six months. Pre-operatively, the patients were categorised as per Singh&#8217;s Index; 66.7% (20 cases) were in Grade 3 while 33.3% (10 cases) fell in Grade 2. Postoperatively, the average Tip Apex Distance (TAD) was 21.66 mm (range 18-28 mm), 25 cases (83.3%) had TAD <25 mm. Neck-shaft angle of the contralateral hip was measured for comparison. No change in neck-shaft angle was observed in 21 cases (70%) however varus collapse more than 4&#176; was seen in 2 cases (6.6%). In 2 cases (6.66%), we encountered screw penetration leading to varus collapse, shortening of the limb and medialization of the distal fragment. <b>Conclusion:</b> It was seen that DHS blade is reliable and safe fixation devise for intertrochanteric fractures in elderly patients with similar cut-out rates as for DHS. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=RC01-RC03&id=12914 https://doi.org/10.7860/JCDR/2019/26357.12914 Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound Guided Paediatric Caudal Epidural Block: A Randomised Controlled Study B Sarvesh, Prashanth G Raj, MS Soumya, Vasantha Kumar, Kanchan Sharma, Amit Agarwal <b>Introduction:</b> Caudal epidural block is a reliable technique to provide perioperative analgesia for infra-umbilical surgeries in paediatric population. Several adjuvants are used along with local anaesthetics to prolong the postoperative anaesthesia. <b>Aim:</b> To evaluate the efficacy of Dexmedetomidine as an adjuvant to ropivacaine in prolonging the duration of postoperative analgesia and reduction of pain scores in paediatric patients undergoing infra-umbilical surgeries. <b>Materials and Methods:</b> This was a double-blinded randomised study, conducted at a tertiary care institution. Sixty patients (2-12 years) of ASA physical status classes 1 and 2 were randomly allocated into two groups. After general anaesthesia, each patient received an ultrasound-guided caudal block. Group R (n=30) received 0.25% ropivacaine (1 mL/kg) +0.5 mL saline and Group RD (n=30) received 0.25% ropivacaine 1 mL/kg +1 µg/kg dexmedetomidine (in 0.5 mL volume). Duration of postoperative analgesia, FLACC pain scores, consumption of rescue analgesics, sedation and adverse-effects were assessed during the 24-hours. The present authors used Student&#8217;s t-test and chi-square test for statistical analysis. <b>Results:</b> The duration of postoperative analgesia was significantly prolonged in Group RD, 790.77&#177;7.70 minutes as compared to Group R, 377.97&#177;12.20 minutes (p-value <0.001). Group RD achieved lower FLACC pain scores compared to group R. There were no significant differences in the incidence of adverse-effects. <b>Conclusion:</b> Dexmedetomidine (1 µg/kg) as an adjuvant to ropivacaine 0.25% (1 mL/kg) in an ultrasound-guided caudal block significantly prolongs the duration of postoperative analgesia and reduces FLACC pain score in paediatric patients undergoing infra-umbilical surgeries without any significant adverse-effects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=UC10-UC13&id=12916 https://doi.org/10.7860/JCDR/2019/41703.12916 Measurement of Perioral Pressures at Rest and its Correlation with Dental Parameters in Orthodontic Patients with Different Occlusions Ekta Gupta, Maninder Singh Sidhu, Seema Grover, Ashish Dabas, Vikas Malik, Namrata Dogra <b>Introduction:</b> Forces exerted by lips, cheeks and tongue in resting state is believed to be more important in affecting the position of teeth and malocclusion than during any activity. Muscles play the primary morphogenetic role to final size and shape of skeletal components. Hence there may be a probable relationship between the muscular pressure and structural configuration in Class I, Class II and Class III malocclusions. <b>Aim:</b> To evaluate perioral pressure in various malocclusions and their correlation with incisor inclination and arch width. <b>Materials and Methods:</b> This descriptive cross-sectional study was conducted in Department of Orthodontics, Faculty of Dental Sciences, SGT University, Budhera, Haryana with the aim of establishing a correlation between developing malocclusion and encompassing musculature which consisted of evaluation of lip and cheek pressure in different malocclusions for six months duration from April 2016 to September 2016. Out of 86 subjects who reported for orthodontic consultation in three months duration in department’s OPD; 50 subjects (32 females and 18 males) with age group range from 12 to 20 years; were advised for fixed orthodontic therapy. Before starting the treatment, they were selected for the present study and were divided into three groups based on their occlusal status; Group I (20 subjects) as Angle’s Class I; Group II (20 subjects) as Angle’s Class II division 1 (Class II/1) malocclusion and Group III (10 subjects) as Angle’s Class II division 2 (Class II/2) malocclusion. A force-sensing resistor device with a transducer thickness of less than 1 mm was used for measurements. The sensor was positioned intraorally at different sites with a thin layer of soft wax for stabilisation. Labial and buccal pressure measurements were made with lips and cheek at rest. Pressure values, cephalometric parameters, gender and arch width of all subjects were recorded. Intergroup comparison of pressure values was done using independent t-tests; where p-value <0.05 were considered as statistically significant. Correlations between upper and lower lip pressure, buccal pressure, arch width, upper and lower incisor angulation were carried out using Pearson’s correlation test. <b>Results:</b> Lower lip pressure was greater than upper lip pressure in all the subjects. Buccal pressure showed inverse relationship with maxillary arch width however the relationship was not significant. Maximum upper and lower lip pressure was observed in subjects with Angle’s Class II division 2 malocclusion. <b>Conclusion:</b> Lower lip and buccal pressure showed significant difference and hence are two chief causative factors associated with different malocclusions with minimal role of upper lip pressure. There was a moderately significant positive correlation between the upper lip pressure and the lower incisor angulation in Group III. There was no significant correlation between upper lip pressure and upper incisor angulation, lower lip pressure and upper and lower incisor angulation and buccal pressure and maxillary arch width. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZC13-ZC18&id=12917 https://doi.org/10.7860/JCDR/2019/41542.12917 A Prevalence Study of Odontomas in a Brazilian Population Leonardo Santos Leal, Daniel Sousa Pardini, Samuel Mendes Teixeira, Leonardo Oliveira Buzatti, Amaro Ilídio Vespasiano, Flávio Ricardo Manzi <b>Introduction:</b> Odontomas are one of the most common odontogenic tumours and are classified as benign odontogenic tumours. According to radiographic, microscopic and clinical features there are two main types of odontomas: compound and complex. <b>Aim:</b> To analyse the prevalence of benign odontogenic tumours compatible with odontomas in digital panoramic radiographs in a Brazilian population. <b>Materials and Methods:</b> This retrospective study was conducted from January 2015 to December 2015 and analysed 2,167 digital panoramic radiographs from the database of a Specialised Dental Radiological Clinic in Belo Horizonte, Brazil. <b>Results:</b> Seven images presented lesions compatible with odontomas, resulting in a prevalence rate of 0.32%. Three images (42.9%) were compatible with compound odontomas and 4 (57.1%) with complex odontomas. Regarding gender, the majority of odontomas were found in female patients (71.4%). The age of the patients diagnosed with odontomas ranged from 7 to 37 years and the main clinical manifestation observed was their association with non-erupted teeth. Regarding the location of the lesions, compound odontomas were mainly observed in the incisor region (66.6%), whereas complex odontomas were found in the posterior region of the molars (50.0%). <b>Conclusion:</b> Data presented in this study reinforce the importance of panoramic digital radiographic images during dental practice for incidental diagnoses of odontogenic tumours, such as odontomas, since these lesions are in most cases, asymptomatic. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZC19-ZC22&id=12918 https://doi.org/10.7860/JCDR/2019/40296.12918 Colour Change and Surface Gloss of Unpolished Infiltrated Bovine Enamel Submitted to Toothbrushing, pH Cycling and Artificial Ageing Ana Carolina Souza Barboza, André Luiz Fraga Briso, Mariana Dias Moda, Marjorie de Oliveira Gallinari, Eduardo Bresciani, Paulo Henrique dos Santos, Ticiane Cestari Fagundes <b>Introduction:</b> The first clinical sign of a caries lesion which represents mineral loss from the enamel subsurface is white spot lesion. Thus, the use of a resin infiltrant has been cited as a promising treatment, once the resin infiltrant promotes an obstructive effect, hindering the progression of lesions by preventing the diffusion pathways for cariogenic acids. <b>Aim:</b> To evaluate the colour change and surface gloss of white spot lesions after application of unpolished resin infiltrant submitted to toothbrushing, pH cycling and artificial ageing. <b>Materials and Methods:</b> The present in-vitro study was conducted from June 2014 to September 2014. This study was related to the Araçatuba School of Dentistry, São Paulo State University (UNESP), Araçatuba, São Paulo, Brazil. Fifty Bovine enamel discs were divided into five groups (n=10) white spot lesion (W-control), infiltrated white spot lesion (IW), infiltrated white spot lesion submitted to toothbrushing (IWb), infiltrated white spot lesion submitted to pH cycling (IWc), and infiltrated white spot lesion submitted to artificial ageing (IWa). After the challenges, the specimens were evaluated for colour change using L*a*b*system (CIELAB), and surface gloss analysis was performed using a gloss meter. The data were submitted to one-way ANOVA and Tukey’s test for multiple comparisons (p<0.05). Kruskal-Wallis and Dunn’s tests were used for the final surface gloss and ?a. <b>Results:</b> When considering the ?E, all groups were similar (p>0.05). All groups receiving resin infiltrant (IW, IWb, IWc, IWa) presented lower surface gloss when compared to W group (p<0.05). <b>Conclusion:</b> No colour change was observed when the samples were subjected to different challenges. Unpolished resin infiltrant appeared to reduce the surface gloss of enamel independently if it is challenged. The differences in the mean colour and gloss changes were similar for all challenges. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZC23-ZC26&id=12919 https://doi.org/10.7860/JCDR/2019/40510.12919 Study to Find Out Predisposing Factors, Causality, Severity and Avoidability of Adverse Drug Reactions among Patients Treated under DOTS Centre of Northern India Sachin Tutu, Garima Adhaulia, Suchi Jain, Surya Kant, Ajay Verma, Amod Kumar Sachan, Rakesh Kumar Dixit <b>Introduction:</b> Tuberculosis (TB) is among the top 10 leading causes of death globally. Association of Adverse Drug Reactions (ADRs) with Anti Tubercular Therapy (ATT) drugs has been encountered more commonly which causes significant morbidity and even mortality. <b>Aim:</b> To find out the predisposing factors and to assess the causality, severity and avoidability of the ADRs in proven TB patients treated under Directly Observed Treatment Shortcourse (DOTS) regimen. <b>Materials and Methods:</b> This study was conducted at the Department of Respiratory Medicine, King George’s Medical University, Lucknow. TB patients who were kept on DOTS regimen under Revised National Tuberculosis Control Programme (RNTCP), satisfying the inclusion and exclusion criteria with written informed consent, were recruited and monitored from May 2016 to April 2017. A total of 115 patients were enrolled for the study. TB diagnosis was confirmed by sputum smear. The treatment was initiated as per Category I-newly diagnosed patients of TB and Category II-previously treated patients pending drug sensitivity testing result (According to Treatment of TB: Guidelines, 4<sup>th</sup> edition, 2010, WHO, Geneva). The patients were followed up and monitored for suspected ADRs. For causality assessment Naranjo’s algorithm and WHO-UMC classification scales, for severity assessment Modified Hartwig and Siegel Scale according to severity levels, for avoidability assessment Halla’s scale were used. Categorical variables were presented in number and percentage (%). Chi-Square test/Fisher’s-exact test was used for the comparison of qualitative variables. The p-value of <0.05 was considered statistically significant. <b>Results:</b> Out of 115 patients enrolled, 87 ADRs were observed in 67 cases. Incidence of ADRs were more in patients of TB with Diabetes Mellitus (DM) (79.16%) and with HIV (70.59%) than in patients of TB without diabetes (52.75%) and without HIV (56.12%). Naranjo’s causality assessment accounted 47.12% of the ADRs as “probable”, 51.72% as “possible”, 1.15% as “doubtful”. WHO-UMC causality assessment scale accounted 43.68% as “probable”, 44.82% as “possible”, 8.05% as “unlikely”, and 3.44% as “unclassified”. Modified Hartwig and Siegel Scale for assessment of severity of ADRs showed 70.11% as mild, 27.58% as moderate and 2.29% as severe. Halla’s avoidability assessment scale showed 44.83% ADRs as ‘not avoidable’, 48.28% as ‘possibly avoidable’, 4.59% as ‘not evaluable’, and 2.29% as ‘definitely avoidable’. <b>Conclusion:</b> Regular and vigilant drug monitoring of various ADRs can improve the clinical outcome, quality of life as well as patient adherence towards treatment. Results of this study can help to promote safer drug use and increase awareness regarding these ADRs. Data obtained can be used as a guide to make future decisions regarding therapy and risk benefit assessment of drugs in therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=FC06-FC10&id=12920 https://doi.org/10.7860/JCDR/2019/40634.12920 Impact of Planning Target Volume Reduction on Toxicity and Outcome in Prostate Carcinoma Treated with Image Guided-Intensity Modulated Radiotherapy Madhup Rastogi, Sambit Swarup Nanda, Ajeet Kumar Gandhi, Divakar Dalela, Rohini Khurana, Surendra Prasad Mishra, Satyajeet Rath, Madan Lal Brahma Bhatt <b>Introduction:</b> Image Guided Intensity-Modulated Radiotherapy (IG-IMRT) with marker based prostate localisation could potentially reduce the Planning Target Volume (PTV), thus reducing radiation toxicity. <b>Aim:</b> We retrospectively evaluated the influence of PTV reduction on radiation induced toxicity and biochemical control. <b>Materials and Methods:</b> This study was a single institution retrospective evaluation. Patients with histopathologically proven adenocarcinoma of prostate, age 18-80 years, Karnofsky performance status =70, T1c-T3bN0M0 and treated with definitive Radiotherapy (RT) were considered in the study. Patients were treated with two different approaches. The HRPTV in the PTV_7 arm was obtained by giving a 7 mm uniform PTV expansion of High-risk Clinical Target Volume (HR-CTV), except posterior margin (6 mm). While the HRPTV in the PTV_5 arm was formed by a 5 mm isotropic expansion. IG-IMRT was delivered in 2 phases with a total dose of 78 Gray in 39 fractions. Acute toxicities were graded weekly as per common terminology criteria for adverse events and late toxicities by the radiation therapy oncology group late morbidity criteria. Biochemical failure was defined by phoenix guideline. <b>Results:</b> Fifty patients (25 each arm) were evaluated with a median age of 68 years. At a median follow-up of 37 months (range 11-76), Grade 1, 2 and 3 overall late (3-year) Genitourinary (GU) toxicities were 68%, 24% and 8%, Gastrointestinal (GI) toxicities were 72%, 18% and 10%, respectively. The PTV_7 group had significantly higher Grade =3 chronic GI toxicities (10% vs. 0%, p=0.05), compared to PTV_5 group. However, there was non-significant difference in Grade =3 chronic GU toxicities (6% vs. 2%, p=0.6). Acute proctitis was significantly higher (48% vs. 16%, p=0.03) in the PTV_7 arm. The 3-year biochemical progression free survival rates were similar in both arms {89.5% (PTV_5) vs. 85.9% (PTV_7), p=0.47}. <b>Conclusion:</b> PTV reduction can be safely used with dose escalated radiotherapy while using marker based IG-IMRT. This may result in the reduction of chronic GI toxicity without compromising biochemical control. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=XC01-XC06&id=12921 https://doi.org/10.7860/JCDR/2019/41197.12921 Cytomorphic Study of Lymphocytic Thyroiditis: A Correlation between Cytological Grade and Biochemical Parameters Iha, Aparna Bhardwaj, Rajnish Kumar, Seema Acharya <b>Introduction:</b> Lymphocytic thyroiditis is an autoimmune disorder characterised by lymphocytic infiltration of the thyroid gland leading to follicular destruction in addition to immunological alterations attributed to the antibodies circulating in the serum against thyroid peroxidase, thyroglobulin, and thyroid stimulating hormone receptor antigens. <b>Aim:</b> To study the cytomorphic spectrum of lymphocytic thyroiditis, and correlate the cytological grades with the levels of TSH, FT3, FT4 and Anti-TPO antibodies. <b>Materials and Methods:</b> This study was carried out over a period of 24 months in Pathology department of SGRRIM & HS, Dehradun. Out of 58 cases diagnosed as lymphocytic thyroiditis on cytology and graded using Bhatia et al. grading system, the levels of TSH, FT3, FT4 and Thyroid Peroxidase Antibody were known in 31 cases. The cytological grades of lymphocytic thyroiditis were correlated with these parameters and statistical analysis was done using one way ANOVA. <b>Results:</b> Out of 31 cases, majority of patients (30 cases, 96.7%) were females presenting in third decade of life. Cytologically, in 21 cases (67.7%) the patients had grade 2 thyroiditis, followed by grade 3 thyroiditis in 7 cases (22.6%). Anti-TPO was elevated in 26 cases (83.8%) and elevated level of TSH was seen in 17 cases (54.8%). On correlating the cytological grades with these parameters, p-value was found to be 1.00 which is statistically insignificant. <b>Conclusion:</b> While Lymphocytic infiltration of thyroid follicles is pathognomonic and positivity for antithyroid antibodies is strongly associated with lymphocytic thyroiditis, no correlation was observed between the grades of thyroiditis and the levels of Anti-TPO, FT3, FT4 and TSH. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=EC05-EC09&id=12922 https://doi.org/10.7860/JCDR/2019/41202.12922 Assessment of Serum Cystatin C and Creatinine in Monitoring Pre-eclampsia P Vijayalakshmi, SMR Usha <b>Introduction:</b> Pre-eclampsia is one of the common pregnancy related hypertensive disorders often accompanied with proteinuria with or without oedema. It is associated with risk of preterm labour, Intrauterine Growth Restriction (IUGR), perinatal and maternal mortality. The development of pre-eclampsia is believed to be multifactorial; however the exact aetiopathogenesis of pre-eclampsia remains debatable. The development of early predictive markers for timely prediction/detection, orderly management and prevention of the disorder can improve overall outcome. <b>Aim: </b>To determine the diagnostic efficacy of serum cystatin C as a biomarker of renal health in pre-eclampsia and to compare it with conventional renal parameter creatinine. <b>Materials and Methods:</b> This case-control study was conducted in the Department of Biochemistry, Raja Rajeswari Medical College and Hospital, Bengaluru, Karnataka, India. The study group included 50 pre-eclamptic women aged 18-35 years and 50 age-matched healthy pregnant women. Serum cystatin C was estimated by immunoturbidimetry method and serum creatinine by Isotope Dilution Mass Spectrometry (IDMS) traceable Jaffe’s kinetic method. The data were analysed using unpaired Student’s t-test, p<0.05 was considered statistically significant. Analysis of variance (ANOVA) was used to compare Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), cystatin C and creatinine between groups. Pearson’s correlation coefficient analysis was used to determine the correlation between study parameters. Receiver Operating Characteristic (ROC) curve was used to assess the diagnostic efficacy of study parameters. <b>Results:</b> In the present study, a significant increase in serum cystatin C levels in pre-eclampsia (p<0.001), compared to creatinine (p=0.126) was observed. ANOVA analysis in mild, severe pre-eclampsia cases and controls showed a significant difference in the level of cystatin C between the groups (p<0.001), whereas no statistically significant difference was observed in the level of creatinine (p=0.06). A positive correlation was observed between SBP (r-value 0.47; p<0.001) and DBP (r-value 0.42; p<0.01) with cystatin C. Creatinine showed a weak positive correlation with SBP (r-value 0.17; p=0.23) and DBP (r-value 0.10; p=0.48). ROC curve analysis revealed that in pre-eclampsia cases, cystatin C exhibited better diagnostic efficacy than creatinine. <b>Conclusion:</b> In the present study, the diagnostic role of cystatin C in pre-eclampsia was evaluated. The study findings indicate that cystatin C has a better predictive value than currently used creatinine for diagnosing renal damage, even in its early stages. Therefore, cystatin C holds potential for identification of pregnant women at risk of developing renal complications of pre-eclampsia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=BC12-BC15&id=12923 https://doi.org/10.7860/JCDR/2019/41385.12923 Musculoskeletal Disorders and Quality of Life of Sugarcane Farmers in the Northeast of Thailand: A Cross-sectional Analytical Study Narupawan Prommawai, Wongsa Laohasiriwong, Kessarawan Nilvarangkul <b>Introduction:</b> Musculoskeletal Disorders (MSDs) were directly associated with Quality of Life (QOL). It could cause various adverse consequences to daily life function, psychological health, work capacity and income. <b>Aim:</b> To identify the prevalence of MSDs and its association with QOL among sugarcane farmers. <b>Materials and Methods:</b> This cross-sectional analytical study was conducted among 529 samples selected through multistage random sampling from 3 provinces of the Northeast (NE) of Thailand to respond to the WHO-QOLBREF questionnaire. Multiple logistic regression was administered to determine the association between MSDs and QOL when other covariates were controlled. <b>Results:</b> It was found that as high as 74.29% (95% CI: 70.83-77.84) of sugarcane farmers had MSDs and 36.29% (95% CI: 32.29-40.49) had poor QOL. MSDs were significantly associated with poor QOL (Adjusted OR=3.01; 95% CI: 1.84-4.94; p<0.001). Other significant covariates were psychological factors including: depression (Adjusted OR=2.09; 95% CI:1.41-3.10; p<0.001), high and severe levels of stress (Adjusted OR=2.11; 95% CI: 1.43-3.13; p<0.001), worked >8 hours per day (Adjusted OR=2.45; 95% CI: 1.57-3.81; p<0.001), and had monthly income =13,000 Baht (Adjusted OR=1.69; 95% CI:1.14-2.52; p=0.008). <b>Conclusion:</b> MSDs and other covariates including psychological factors, depression, severe levels of stress, long working hours and low income were associated with poor QOL. Therefore, ergonomic behaviour modification including body preparation before work, proper working postures, and rehabilitation were needed to improve the QOL among the sugarcane workers in Northeast Thailand. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=LC11-LC15&id=12924 https://doi.org/10.7860/JCDR/2019/41844.12924 Effect of Intracuff Inflation with Alkalinised Lignocaine, Saline and Air on Early Postoperative Airway Morbidity-A Randomised Control Trial Suvajit Podder, Gayathri Bhat <b>Introduction:</b> Endotracheal intubation is the gold standard of airway management, and usage of the cuffed Endotracheal Tube (ETT) is routine clinical practice. The ETT provides adequate ventilation and reduces aspiration risk. N<sub>2</sub>O, when used along with oxygen for maintenance, diffuses inside the cuff and increases the cuff pressure leading to laryngotracheal morbidity postoperatively. When alkalinised lignocaine and saline are instilled in the cuff, it prevents the increase of cuff pressure. Alkalinised lignocaine is more permeable and has additional anaesthetic property. We formulated this study to find out whether alkalinised lignocaine, saline or air is better for intubated patients. <b>Aim:</b> To assess and compare the incidence and severity of post extubation airway morbidity when alkalinised lignocaine, saline and air is used for cuff inflation. <b>Materials and Methods:</b> Ninety patients were randomly allocated, between 18-70 years of age who were posted for surgery under general anaesthesia with endotracheal intubation into three groups of 30 each. The cuff of the ETT was inflated with air in Group A, saline in Group B, alkalinised lignocaine in Group C. The three groups were compared regarding sore throat, hoarseness of voice and cough at intervals of two, four and six hours along with haemodynamic stability and smoothness of extubation. Statistical analysis was done using one-way ANOVA or Kruskal-Wallis test for continuous data and Chi-Square test for categorical data. Post-Hoc Bonferroni or Mann-Whitney test were used for intergroup comparison. <b>Results:</b> The demographic data along with the duration of surgery and the volume of injectate in the cuff was comparable between the three groups. The incidence of sore throat, hoarseness of voice and cough was significantly less in Group C compared to Group A and B. The haemodynamic variations during extubation were also significantly less in Group C compared to the other two groups. <b>Conclusion:</b> Alkalinised lignocaine instilled into the cuff of intubated patients undergoing general anaesthesia decreases the extubation response and the immediate postoperative airway morbidity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=UC05-UC09&id=12902 https://doi.org/10.7860/JCDR/2019/41354.12902 Quality of Life and Nutritional Status of People Living with HIV/AIDS (PLHA’s) in Western Maharashtra-A Prospective Cohort Study Ravishekar N Hiremath, Shailaja S Patil, Arun K Yadav, DB Kadam <b>Introduction:</b> Decades ago HIV/AIDS epidemic was considered as unprecedented human catastrophe. With Anti-Retroviral Therapy (ART) services easily available and accessible to everyone, HIV/AIDS has become a chronically manageable illness wherein Nutritional status and Quality of Life (QOL) play a key role in long-term impact of ART on People Living with HIV/AIDs (PLHA’s). Therefore, a study is needed to better understand the factors affecting them. <b>Aim:</b> To assess the psychological component of QOL of PLHAs and their association with nutritional status, health satisfaction and socioeconomic factors at the end of one year and to recommend measures to improve the QOL based upon the findings of the study. <b>Materials and Methods:</b> A prospective cohort study was carried out across two ART centres in western Maharashtra and data were collected by means of pre-validated, pre-tested questionnaire with relevant investigations and anthropometric measurements. PLHAs who were freshly placed on ART and consented to participate were included in the study and followed up for one year. A total of 10 PLHAs were lost to follow-up and finally 249 were included in the analysis. <b>Results:</b> With respect to nutritional status, 107 (43%) were having under-nutrition at the baseline and 84 (33.7%) at the end of one year in spite of free ART. Anaemia was found among 179 (71.9%) participants at baseline and 159 (63.9%) at the end of one year. Low albumin was seen among 39 (15.7%) participants at the baseline and similar number of them were at the end of one year. Dietary intake was inadequate among 178 (71.5%) participants. Forty (16.1%) participants had excellent QOL, 82 (32.9%) still had poor QOL in spite of free ART being given for one year. There was no significant difference in the health status before and after one year of ART among 180 (72.3%) participants. Female sex deteriorated income status, deteriorated BMI status, deteriorated anaemic status, deteriorated CD4 count, after health status less than five, diet inadequacy were significantly associated with poor QOL. On multiple logistic regression model, female sex was 2.4 times (p=0.014) and deteriorated BMI/undernutrition was 3.6 times (p<0.001) more associated with poor QOL and were statistically significant. <b>Conclusion:</b> Immediate measures need to be directed to improve nutritional status in PLHA’s by giving nutritional support (food security), job security, income security along with free ART in order to have excellent QOL as compared to providing free ART alone. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=LC01-LC06&id=12903 https://doi.org/10.7860/JCDR/2019/37487.12903 Prevalence of Cryptococcaemia in HIV Seropositive Patients in an Indian Setting Swati Vijay, Nayana Ingole, Shashir Wanjare, Preeti Mehta <b>Introduction:</b> Cryptococcal infection is the most common opportunistic fungal infection was seen in HIV patients. Despite specific treatment, mortality due to cryptococcaemia still remains high primarily because of late diagnosis. Therefore, studies have recommended that routine screening is cost-effective in patients with CD4 count =100 cells/mm<sup>3</sup> in areas with cryptococcal antigenemia >0.6%. Prevalence of cryptococcaemia in India is reported to be variable and therefore, whether routine screening for cryptococcal infection is cost-effective or not, cannot be ascertained. <b>Aim:</b> To find out the prevalence of cryptococcaemia in HIV infected patients with CD4 counts of =100 cells/mm<sup>3</sup>. <b>Materials and Methods:</b> This was a cross-sectional study, conducted at KEM hospital, Mumbai, India which is a tertiary care hospital, all HIV infected patients with CD4 count =100 cells/mm<sup>3</sup> coming to the hospital between January 2015 and December 2015 were enrolled. Blood samples drawn were processed for wet mount, negative staining with India ink, gram staining, fungal culture and Cryptococcal Antigen (CrAg) Lateral Flow Assay (LFA) using IMMY LFA Kit. Statistical calculation was done using SPSS software Version 20.0 (SPSS Inc. Chicago, IL, USA) and chi-square and Fisher-exact test was used to compare categorical variables. <b>Results:</b> Out of 150 patients enrolled, 23 (15.3%) had CD4 count below 50, while 127 (84.7%) had between 51-100. 108 patients (72%) were Anti-Retroviral Therapy (ART) experienced and 42 (28%) were ART naïve. An amount of 53.3% of patients had no opportunistic infections, 27.3% had pulmonary tuberculosis, 11.3% had candidiasis and 8% had extra-pulmonary tuberculosis. Four samples tested positive for LFA giving a prevalence of 2.67%, while none of the cultures were positive for <i>Cryptococcus species</i>. No significant association was seen between age and gender to positive serum cryptococcal antigenemia. However, low CD4 count was found to be strongly co-related to positive serum cryptococcal antigenemia. <b>Conclusion:</b> This study reveals that cryptococcal antigenemia is a health problem and Cryptococcal antigen screen and treat policy recommended by World Health Organisation should be made routine for HIV patients registering at ART centre in the present setting especially those who are ART naive and have CD4 counts =100 cells/mm<sup>3</sup>. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=DC01-DC04&id=12904 https://doi.org/10.7860/JCDR/2019/40763.12904 The Association between Birth Order and Academic Performance of Undergraduate Dental College Students in Riyadh, Saudi Arabia Abdullah Albarkheel, Emad Masuadi, Hicham Riba, Azzam Al-Jundi, Salah Sakka <b>Introduction:</b> Children in the same family are different from each other in their academic achievement and birth order plays an important role in defining a child&#8217;s character and personality. Grade Point Average (GPA) refers to the grading processes used to measure educational achievement. <b>Aim:</b> To investigate the association between birth order (sibling rank) and academic performance in connection with other variables such as sibling size, gender, age, parent&#8217;s education, parent&#8217;s job and family monthly income. <b>Materials and Methods:</b> The study design was a cross-sectional survey where data were collected by a self-administered questionnaire to gather information about students&#8217; Cumulative Grade Point Average CGPA, birth order, age, socioeconomic status of the parents, family size and gender. Various methods were used for assessment such as written and oral exams, Objective Structured Clinical Examination (OSCE), Objective Structured Practical Examination (OSPE) and oral case presentation. A total of 308 questionnaires were distributed to the participants (174 male and 134 female) out of which 269 (148 male and 121 female) were returned. Excel sheet was used before reverting to statistical software SPSS version 20.0 for analysis. The F-test (ANOVA) compared the mean CGPA by the birth order. General linear model was used as a multivariable analysis to accommodate for other baseline characteristics. Chi-square test assessed the relationship between the birth order and CGPA categories. p-value <0.05 considered significant. <b>Results:</b> Comparing the mean CGPA between genders, females had higher mean than males with significant difference (p<0.001). While there was no significant difference in mean CGPA across the birth order groups (p=0.06). The results showed that the mean of the middle-born male participants had a CGPA of 4.31&#177;0.32 compared to the last born with a CGPA of 4.17&#177;0.43 and first or only child with a CGPA of 4.06&#177;0.38, whereas the participants who were not the first born but the first gender or only gender had a CGPA of 4.01&#177;0.45. <b>Conclusion:</b> This study found that middle-born males in Riyadh dental college had shown the highest tendency to have better academic performance compared to other birth order groups. Females did not show the same tendency and are eager to achieve high level in academic education regardless of their birth order or family size. The controversy of birth order effect on academic performance may continue to vary among countries, family sizes and different cultures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=JC01-JC05&id=12905 https://doi.org/10.7860/JCDR/2019/39728.12905 Variation in Serum Total Testosterone Levels in Men with Type 2 Diabetes Mellitus Jyoti Trivedi, Sangeeta Kapoor, Rahul Arora <b>Introduction:</b> Testosterone is a steroidal hormone that plays an important role in the regulation of carbohydrate, protein, lipid metabolism, thereby control insulin sensitivity. An inverse relationship between serum testosterone, insulin resistance and hyperglycaemia has been well documented. Decreased serum testosterone in Type-2-Diabetes Mellitus (T2DM) promotes accumulation of visceral fat, which increases insulin resistance and in turn, leads to progression of Diabetes Mellitus (DM). <b>Aim: </b>To determine variation in serum total testosterone levels in men with T2DM. <b>Materials and Methods:</b> In the present case-control study, 30 T2DM men (aged 35-55 years) were selected from the OPD of Teerthanker Mahaveer College and Research Centre, Moradabad and 30 healthy age matched individuals, were recruited as controls. Fasting Plasma Glucose (FPG) was estimated by Glucose Oxidase Peroxidase (GOD-POD), end point method. HbA1c was measured by particle enhanced immunoturbidimetric test method and serum testosterone by Enzyme Linked Fluorescent Assay (ELFA) using fully automated VIDAS analyser. Various parameters were analysed using Student’s t-test (independent and unpaired) and the coefficient of correlation was calculated using Pearson’s correlation coefficient. p-value <0.05 were considered as statistically significant, and p-value <0.001 as highly significant. <b>Results:</b> In T2DM patients, serum total testosterone was found to be negatively correlated with FPG (r value=-0.496, p=0.005) and HbA1c (r=-0.548, p=0.002). Out of 30 diabetic patients, 13 (43%) patients had lower level of serum total testosterone when compared to the reference range (<3 ng/mL). The serum total testosterone levels were found to be elevated in diabetic patients with FPG&#8804;200 mg/dL or HbA1c&#8804;6.5 in comparison to patients with FPG>200 or HbA1c>6.5 mg/dL, however the differences were not statistically significant. Relatively comparable serum total testosterone levels were found in diabetic patients with duration of DM&#8804;2 years and DM>2 years, thus suggesting that serum total testosterone concentration might be independent of the duration of DM. <b>Conclusion:</b> Testosterone not only plays a prime role in men’s sexual health but also have an influence on glycaemic status of diabetic patients. Assessment of lower serum total testosterone levels can serve as a useful tool for evaluation of prognosis of T2DM. Therefore, all T2DM patients should be screened for androgen levels and testosterone replacement therapy should be considered to improve overall health of diabetic men. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=BC09-BC11&id=12906 https://doi.org/10.7860/JCDR/2019/40309.12906 Association of Serum Free Haemoglobin in Normoglycemic and Hyperglycemic Individuals Jiut Ram Keshari, Manish Mandal, Montosh Chakraborty, Debajit Bagchi, Praveen Sablania <b>Introduction:</b> Besides glycation induced injury, hyperglycemia in both type 1 and 2 diabetes can also increase oxidative stress leading to alterations in erythrocytic structural-functional organisation, shortening of life span and eryptosis. Free Haemoglobin (fHb) is released in circulation that could cause deleterious clinical effects. No study has associated fHb with hyperglycemia till now, thus it is pertinent to examine this aspect. <b>Aim:</b> The present study has associated serum fHB with hyperglycemia by simple, rapid, inexpensive spectrophotometric assay using Allen correction. <b>Materials and Methods:</b> The present case control study consisted of a total of 74 participants grouped into normoglycemic controls (n=37) and hyperglycemic subjects (n=37). Serum sample were analysed for haemoglobin (Hb) concentration by direct spectrophotometry using Allen correction. Concentration of Hb was calculated by Harboe&#8217;s Allen correction as Hb (mg/L)=1.68.A415-0.84.A380-0.84.A450 (absorbance in milliabsorbance). Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version V21.0 and Microsoft excel software employing independent unpaired student&#8217;s-t-test and pearson&#8217;s correlation coefficient and ?2 test for trend while Odds Ratio (OR) and corresponding 95% CI was calculated using binary logistic regression. <b>Results:</b> Mean serum fHb levels were significantly elevated in hyperglycemia (101.74&#177;61.73 mg/L; p=0.001) as compared to controls (58.44&#177;39.69 mg/L). A dose dependent relationship was evident between increased serum fHb with hyperglycemia (p<0.001) and OR was statistically significant in hyperglycemia [OR (95% CI)=2.95 (1.05&#8211;8.31); p=0.04]. Serum fHb concentration was positively and significantly correlated with fasting plasma glucose (FPG) (r=0.34, p=0.003). <b>Conclusion:</b> Hyperglycemia causes glycation of tissue and circulating proteins as well as oxidative stress to erythrocyte membrane leading to alterations in erythrocytic membrane fluidity and shortening of life span. Serum fHb is widely used as marker of intravascular haemolysis and fHb is estimated by immunoassay that is expensive and cyanide based spectrophotometry that is toxic. The current study has associated fHb with hyperglycemia with direct spectrophotometry using Allen correction that uses minimal reagents and is non-toxic besides being inexpensive. We found that levels of fHb were significantly increased in hyperglycemia than controls (p<0.05) and fHb was positively and significantly correlated with FPG (p=0.003). The findings of our study suggests that erythrocytes are susceptible to hyperglycemic injury and fHb could be estimated inexpensively as marker of haemolysis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=BC01-BC04&id=12897 https://doi.org/10.7860/JCDR/2019/41427.12897 Role of Gamma Glutamyl Transferase in the Diagnosis of Metabolic Syndrome in Patients with Hypothyroidism ME Sumathi, K Prabhavathi, S Harish Kumar, KN Shashidhar, V Mahesh <b>Introduction:</b> Hypothyroidism is the most prevalent thyroid disorder in India that affects one in ten adults. Gamma Glutamyl Transferase (GGT) is an ectopic enzyme associated with oxidative stress in various diseased conditions. Prior research suggests that increased levels of GGT are associated with Metabolic Syndrome (MetS) in hypothyroidism. <b>Aim:</b> To study the prevalence of MetS in patients with hypothyroidism and to correlate serum GGT levels with the components of MetS. <b>Materials and Methods:</b> The case-control study was conducted on 62 clinically diagnosed hypothyroidism patients (cases) and 63 clinically proven healthy subjects (controls). All these subjects were screened for metabolic syndrome based on the NCEP ATP ??? (National Cholesterol Education Programme Adult Treatment Panel III) guidelines. Waist circumference, blood pressure, serum Fasting Blood Sugar (FBS), Urea, Creatinine, T3, T4, Thyroid Stimulating Hormone (TSH), Total Cholesterol (TC), Triglycerides (TG), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein Cholesterol (LDL-C) and GGT were measured. Data was expressed as mean&#177;SD and analysed using Independent Student t-test. The p-value <0.05 was considered as statistically significant. <b>Results:</b> Waist circumference, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), FBS, TC, Triglycerides TG, LDL-C, GGT and TSH were significantly increased in hypothyroid cases when compared to the controls. HDL-C was significantly decreased in hypothyroid cases. Significant positive correlation was observed between GGT and TSH (r=0.57, p=0.004) in hypothyroid cases with MetS. Significant inverse correlation was observed between GGT and HDL-C (r=-0.25, p=0.04) in hypothyroid cases. <b>Conclusion:</b> In this study, 38% of hypothyroid patients had MetS. Serum GGT is found to be elevated in hypothyroid cases and associated with components of MetS. Hence GGT can be used as an additional diagnostic marker to assess the MetS in hypothyroidism. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=BC05-BC08&id=12898 https://doi.org/10.7860/JCDR/2019/37795.12898 An Examination of Bacterial Colonisation on Nickel-Titanium Arch-wires with Different Surface Properties Selcan Hasipek, Neslihan Ebru Senisik, Emel Sesli Çetin <b>Introduction:<b> Microbial dental plaque accumulation during fixed orthodontic treatment, leads to iatrogenic decalcification of the enamel and to development of the white spot lesions. The surface charcteristics of orthodontic wires can affect this situation. <b>Aim:<b> To comparatively assess the uncoated nickel-titanium archwires (A-NiTi) and epoxy resin-coated nickel-titanium archwires (A-NiTi/ER) in vivo, regarding the periodontal status, Streptococcus mutans (SM) and Lactobacillus (LB) colony numbers on wires and in saliva samples. <b>Materials and Methods:<b> In this cross-sectional study, 31 individuals (20 females, 11 males) with a mean age of 15.5&#177;1.84 years were included. A-NiTi and A-NiTi/ER were applied randomly and in sequential order. Saliva and archwire samples were obtained, to assess the amount of SM and LB colony numbers before archwire application, and after archwire applications (A-NiTi and A-NiTi/ER). Periodontal parameter that was assessed was gingival bleeding index. Factorial design repeated measures ANOVA and Bonferroni methods were used for statistical analysis. <b>Results:<b> The SM count in saliva before archwire application was statistically lower than A-NiTi and A-NiTi/ER application (p<0.001) statistically significant differences were found between A-NiTi and A-NiTi/ER archwires for LB colony numbers (p<0.001). The LB counts between saliva and archwires for A-NiTiand A-NiTi/ER, were in a moderate positive relationship with each other. No significant difference in the GBI percentage was observed (p>0.05). <b>Conclusion:<b> Increased LB colony numbers were obtained on A-NiTi/ER compared to A-NiTi. The increase in LB colony numbers between saliva and archwires for A-NiTi, and similarly for A-NiTi/ER were correlated with each other. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZC01-ZC06&id=12899 https://doi.org/10.7860/JCDR/2019/40377.12899 RCT on the Effect of Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound Guided Fascia Iliaca Block for Postoperative Analgesia Following Hemi-Arthroplasty Sandeep Kundra, Barinderpal Singh, Mirley Rupinder Singh, Dinesh Sood, Rajat Roy, Tania Singh <b>Introduction:</b> Fascia Iliaca Compartment Block (FICB) has been employed for post-operative pain relief after hip surgeries. Dexmedetomidine has been found to prolong effect of peripheral nerve blocks but its effect has not been adequately evaluated for FICB. <b>Aim:</b> To study the effect of addition of dexmedetomidine for FICB. <b>Materials and Methods:</b> The study was conducted at a tertiary level hospital in a randomised double blinded manner. Sixty adult American Society of Anaesthesiologists (ASA) Physical Class I-III patients of either sex scheduled for elective hemi-arthroplasty under spinal anaesthesia, were included in the study after ethics committee approval and written informed consent. Patients were administered ultrasound guided FICB in operation theatre at the end of surgery. Group A patients were administered FICB by injecting 3 mg/kg of ropivacaine whereas, Group B patients received FICB using 3 mg/kg of ropivacaine along with 1 µg/kg dexmedetomidine as an adjuvant, making injectate volume of 40 mL in each group by the addition of normal saline. Post-operative pain scores using Visual Analogue Scale (VAS) and total rescue analgesic consumption were recorded in both the groups. Observation data obtained was tabulated and analysed statistically using Student&#8217;s t-test and Chi-square test. All statistical calculations were done using SPSS (Statistical Package for the Social Science) 21 version statistical program for Microsoft Windows and p-value less than 0.05 was considered to be significant. <b>Results:</b> Both groups were similar in their demographical profile and baseline haemodynamic parameters. Mean time of administration of first rescue analgesic was significantly earlier in group A at 275.29&#177;226.31 minutes as compared to 465.8&#177;325.56 minutes in group B. Similarly, group A patients needed rescue analgesic more frequently and mean total tramadol consumption was significantly higher in group A at 207.24&#177;45.17 mg as compared to 145.56&#177;48.31 mg in group B. There was no difference in the incidence of adverse effects between the two groups (p=0.072). <b>Conclusion:</b> The addition of dexmedetomidine to ropivacaine significantly prolongs the duration of analgesic effect of FICB without any adverse effects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=UC01-UC04&id=12900 https://doi.org/10.7860/JCDR/2019/41237.12900 Can Clipless Division of Cystic Duct be Performed Safely Using Harmonic Scalpel? Kumar Nishant, Phuchungla Bhutia, Varun K Singh, Choksi Prdyuman Yogeshbhai <b>Introduction:</b> The increasing frequency of cholecystectomy implies that there is a potential for increasing incidence of rare complications like migration of clips applied for occlusion of cystic duct into the common bile duct and causing biliary obstruction, many times several years after the initial surgery. Though use of Harmonic Scalpel (HS) alone for occlusion and division has been described, most surgeons are reluctant to use it. <b>Aim:</b> To assess the feasibility of cystic duct closure by using HS in laparoscopic cholecystectomy, done by comparing the burst pressures of excised gallbladders where cystic duct was closed using either conventional clip method or by HS. <b>Materials and Methods:</b> One hundred intact excised gallbladders from patients undergoing elective laparoscopic cholecystectomy for uncomplicated gall-stone disease were used for this study. Ex-vivo the cystic ducts of these gallbladders were randomly occluded by clip or HS (50 in each group). Then the gallbladder was immersed in isothermic saline and connected to a pressure transducer using 20-gauge cannula inserted through the body of the gallbladder. The gallbladder was slowly instilled with normal saline (1 mL/sec) until the gallbladder burst, while pressure recordings were continuously made. The burst pressure and site of burst was noted. The data on burst-pressure was subjected to Student&#8217;s t-test. <b>Results:</b> The overall mean burst pressure of extracted gallbladders was 164.12 mmHg, being 162.26&#177;19.25 mmHg and 165.98&#177;21.34 mmHg in the clip and HS group respectively (p-value=0.362). Analysis of subgroups based on sex, age, BMI, gallbladder wall thickness, cystic duct diameter, site of burst or eventual histopathological report also showed no significant difference between the burst pressures in the two groups. The minimum pressure at which burst occurred was 102 mmHg. <b>Conclusion:</b> HS provides equivalent safety (on comparison of burst pressure) for occlusion of cystic duct compared to metallic clip. Thus, HS alone can be used for cystic duct occlusion safely without any clip application. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=PC01-PC04&id=12892 https://doi.org/10.7860/JCDR/2019/41597.12892 Evaluation of Pattern of Oral Hypoglycaemic Agents Usage and their Cost among Type-2 Diabetic Patients in a Tertiary Care Teaching Hospital Selvalaxmi Gnanasegaran, Srija Gopal, Sakthibalan Murugesan, Gerard Marshall Raj, Mangaiarkkarasi Adhimoolam <b>Introduction:</b> Diabetes mellitus is a chronic disorder requiring life-long treatment to maintain the blood glucose levels. The total economic cost of diabetes was $245 billion in 2012. In India, one spends approximately 20% of their income for the treatment of diabetes per year which affects the patients’ compliance and there is also a huge discrepancy in the cost of drugs. <b>Aim: </b>To study the pattern of oral hypoglycaemic agents’ usage among Type-2 diabetic patients and also compare their cost-analyses, to determine the percentage cost variation and to arrive at the economical oral hypoglycaemic drugs. <b>Materials and Methods:</b> This observational cross-sectional study was conducted among Type-2 diabetic patients attending the diabetology department over a period of three months in a tertiary care teaching hospital. Three hundred prescriptions (both old and new cases) were used to extract information like number of oral hypoglycaemic agents prescribed, their strength, duration, price, generic or branded and manufacturer’s details. The percentage cost variation was calculated using the cost difference between the highest and lowest priced brand. Data were analysed using chi-square test (to elicit the association between duration of treatment and mono/combination therapy) using SPSS Software 20.0 version. <b>Results:</b> Majority of the patients (59.3%) were above 50 years of age with female preponderance (54%). Branded drugs were prescribed to 87.7% of patients. 85.3% received combination therapy (Metformin, Glimepiride, Gliptins) and 14.7% received monotherapy (Metformin, Teneligliptin). Commonly used monotherapy was metformin with cost of about 2.75 INR/day and the combination therapy was teneligliptin and metformin with a minimum cost of 13.31 INR/day. The most economical combination therapy was found to be of glimepiride and metformin with cost of 8.25 INR/day. Percentage cost variation of different brands ranged from 5.88% to 177.57%. There was a significant association between combination therapy and disease duration greater than five years (p<0.01). <b>Conclusion:</b> It was observed from this study that there is a wide variation in cost of different drugs. Hence, it is necessary for regulatory authorities to regulate the wide variation that exists among the drug cost. This study will be useful to the clinicians to choose most economic drugs without change in quality of treatment in diabetic patients. Metformin is the most commonly used economic monotherapy and combination therapy was Glimepiride+Metformin. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=FC01-FC05&id=12886 https://doi.org/10.7860/JCDR/2019/40807.12886 Validity and Responsiveness of Balance Measures using Pedalo<sup>®</sup>-Sensomove Balance Device in Patients with Diabetic Peripheral Neuropathy Irshad Ahmad, Majumi M Noohu, Shalini Verma, Muhammad Azharuddin, M Ejaz Hussain <b>Introduction:</b> It is important to assess the integrity of the balance system in order to estimate individual balance capabilities. Various static, dynamic and functional balance tests have been developed to evaluate performance. <b>Aim:</b> To assess the validity and responsiveness of Centre Of Pressure (COP) range and COP sway taken from Pedalo®-Sensomove balance device with clinical balance tests in diabetic Peripheral Neuropathy (DPN) patients. <b>Materials and Methods:</b> Twenty subjects (age: 60.45±8.79) with DPN were recruited to participate in an outpatient balance training program. Validity was assessed by correlating COP range and COP sway measured using Pedalo<sup>®</sup>-Sensomove balance system with Functional Reach Test (FRT), One Leg Stance (OLS) and Time Up and Go test (TUG). Responsiveness was assessed by comparing the COP range and COP sway, before and after the completion of balance training. Data analysis was done using SPSS version 21. The construct validity was established by evaluating the relationship of COP range and COP sway with FRT distance (using pearson correlation coeffecient) and OLS (using spearman correlation coefficient). The concurrent validity was examined by assessing the correlation of COP range and COP sway with TUG scores (using pearson correlation coefficent). Effect Size (ES) and Standardised Response Mean (SRM) were used to assess responsiveness. <b>Results:</b> There was a significant correlation between COP range front (p=0.001) and COP sway (Antero-Posterior (AP): p=0.022; Medio-Lateral (ML): p=0.047). OLS eyes open was also associated with COP range (front: p=0.029; right: p=0.025) and COP sway (AP: p=0.001; ML: p=0.001). OLS eyes closed and COP sway (AP: p=0.02; ML: p=0.038) were found to be negatively correlated. TUG score showed positive correlation with COP ranges (p=0.039), and negatively correlated with COP sway (p=0.023) in all directions. Following balance training, the change in the COP range and COP sway showed moderate to high ES (0.73 to 0.93) and SRM (0.827 to 1.38). <b>Conclusion:</b> The COP range and COP sway measured by Pedalo<sup>®</sup>-Sensomove balance device are valid measures of balance assessment in patients with DPN. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=YC01-YC04&id=12889 https://doi.org/10.7860/JCDR/2019/40372.12889 Subclinical Risk Markers for Cardiovascular Disease (CVD) in Metabolically Healthy Obese (MHO) Subjects Sourya Acharya, Samarth Shukla, Anil Wanjari <b>Introduction:</b> Metabolically Healthy Obesity/Metabolic Healthy Obesity (MHO) is an enigma in scientific medical literature. Debate is still on regarding the safety status of MHO phenotype. The general consensus states that it is a condition with obesity but lacking metabolic abnormalities such as dyslipidemia, impaired glucose tolerance, or Metabolic Syndrome (MS). MHO population has less visceral adipose tissue, and a decreased inflammatory profile as compared to MS. <b>Aim:</b> To assess subclinical cardiovascular risk markers like Carotid Intima-Media Thickness (CIMT), Non Alcoholic Fatty Liver Disease (NAFLD) and high sensitivity C-reactive Protein (hs-CRP) level in MHO subjects. <b>Materials and Methods:</b> This cross-sectional study was done in a tertiary care hospital conducted for a period of three years from January 2016 to January 2019. After obtaining institutional ethical clearance, this cross-sectional study was conducted on 222 MHO subjects, 65 MS and 81 Metabolic Healthy Non Obese (MHNO) subjects. Anthropometric data was obtained. Metabolic parameters like hs-CRP, CIMT and NAFLD status were estimated and compared with MS and MHNO group. The data was analysed using appropriate statistical significance tests. <b>Results:</b> In one way Analysis of Variance (ANOVA), anthropometric determinants and metabolic variables differed significantly across the groups (p<0.0001). The mean hs-CRP in MHO was; 4.01&#177;1.68 versus control group; 2.16&#177;0.56 (p<0.0001). Using Pearson&#8217;s correlation coefficient, significant positive correlation was found between the sub clinical CVD risk markers with other anthropometric and metabolic parameters. In multiple regression analysis body mass index Waist Circumference (WC), NAFLD and abnormal CIMT were significantly associated with elevated hs-CRP. The mean CIMT in MHO was; 0.74&#177;0.17 versus control group; 0.65&#177;0.14 (p<0.0001). In multiple regression analysis NAFLD and hs-CRP were significantly associated with CIMT values. Prevalence of NAFLD in MHO was 59.01%. In multiple regression analysis WC, CIMT and hsCRP were significantly associated with NAFLD. Adjusted Odd&#8217;s Ratio (AOR) for high hs-CRP, NAFLD, and abnormal CIMT in MHO as compared to MHNO was 1.98, 1.81, 1.61 respectively. <b>Conclusion:</b> MHO phenotype is associated with higher prevalence of fatty liver, increased hs-CRP levels and abnormal CIMT as compared to MHNO phenotype. This indicates that obesity even if associated with a healthy metabolic profile, still harbour subclinical inflammation. So subjects with MHO should be targeted for appropriate preventive strategies in form of health education, life style modifications to avoid future cardiovascular morbidities. MHO phenotype with evidence of subclinical inflammation should not be considered a benign condition. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=OC01-OC06&id=12890 https://doi.org/10.7860/JCDR/2019/41317.12890 Apelin and its Receptor: An Overview Rajeev Gandham, ME Sumathi, CD Dayanand, SR Sheela, P Kiranmayee Apelin protein is an endogenous ligand of Apelin Receptor (APJ). APJ is a member of G-protein coupled receptor family. Both apelin and its receptor express extensively in the human body. Apelin receptor activation occurs by its cognate peptide ligand, apelin and many physiological effects, including vasodilation, vasoconstriction, angiogenesis, fluid homeostasis, neuroendocrine response to stress and energy metabolism. Apelin derived from its precursor might yield a number of bioactive peptides. Apelin is synthesised as an immature single peptide (preproapelin) which consists of 77 amino acids. In the endoplasmic reticulum, preproapelin is cleaved by endopeptidases to a 55 amino acid proapelin and subsequently, to various biologically active apelin-36, apelin-17 and apelin-13 isoforms. Post-translation, the apelin containing the pyroglutamate group at N-terminus of the peptide is modified to pyroglutamate apelin 13. In adipocytes, proprotein convertase subtilisin/kexin 3 directly cleaves the proapelin to apelin 13 and does not produce any longer isoforms. In contrast, Angiotensin Converting Enzyme 2- (ACE-2) cleaves at proline-phenylalanine site at C-terminus and renders apelin 13 and apelin 36 inactive. To date, ACE-2 is the only known enzyme for apelin degradation. The C-terminal region is responsible for receptor binding and subsequent activation. Prior research suggests the role of apelin and its receptor in pathogenesis of various conditions including preeclampsia, hypertension, cardiovascular diseases, diabetes mellitus, obesity and cancer. Despite its established importance and link to therapeutic target, the precise role of this apelin/APJ remain obscure. In this attempt, we summarised the structure, chemistry, biosynthesis, expression and gene regulation, distribution, receptor binding mechanism, biological functions and therapeutic applications along with the associated recent advances. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=BE01-BE06&id=12930 https://doi.org/10.7860/JCDR/2019/41074.12930 Extra Uterine Leiomyoma with “Amianthoid-like” Fibers Santosh Govind Rathod, Bharat R Sonwane, Shubhada N Pore, Rajan S Bindu Uterine leiomyoma is a benign smooth muscle neoplasm, typically arising in uterus and deep soft tissue. In the present case, tumour size of 7×4×3 cm identified on subserosal aspect of uterus. Grossly, tumour was well circumscribed, whitish nodule and on cut surface whitish whirls were seen. Microscopic examination showed a cellular spindle cell population with numerous eosinophilic amianthoid-like fibers. Immunohistochemically, the tumour showed positivity for H-caldesmon, desmin, alpha smooth-muscle actin, and negativity for CD10. The finding of amianthoid-like fibers in leiomyoma is very rare. Amianthoid fibers are hyalinized collagen mats. It extends the histomorphological spectrum of leiomyomas. Amianthoid fibers are very characteristics of “intra nodal palisaded myofibroblastoma”. Presence of “Amianthoid-like fibers” creates histomorphologically similar picture between leiomyoma and “intra nodal palisaded myofibroblastoma”. Pathologist should be aware of such variant of leiomyoma that contains “Amianthoid-like fibers” to avoid confusion with other tumours. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ED01-ED02&id=12925 https://doi.org/10.7860/JCDR/2019/28590.12925 RETRACTED Article <b>Garima M Anandani, Swati B Parikh</b>, Effect of Pre-Analytic Variables on Prothrombin Time and Activated Partial Thromboplastin Time (Published in Journal of Cilinical and Diagnostic Research. 2018 July: 12(7):). EC01–EC05 Investigating on the complaint received, the journal could not ascertain the authenticity of the study even after consultation with the head of the institution and other authors of the study, hence article has been retracted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2019&month=June&volume=13&issue=6&page=ZZ01-&id=12895 https://doi.org/10.7860/JCDR/2019/.12895 RETRACTED Article <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=June&volume=13&issue=6&page=ZZ02-&id=12896 https://doi.org/10.7860/JCDR/2019/.12896