Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Anecdote from Editors Desk Anecdote 4- Data Falsification: Student-guide Collaboration and a Subsequent Fall Out Hemant Jain, Aarti Garg, Sunanda Das https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=AB01-AB02&id=13670 https://doi.org/10.7860/JCDR/2020/13036.13670 Gitelman Syndrome: A Cause for Recurrent Hypokalaemia with Tetany Lakshmi Narayanan Balasubramani, Sujay Iyer An important genetic cause of recurrent hypokalaemia is defect in the distal tubules. This case report is about a 35-year-old male patient that presented to the casualty with acute onset of flaccid weakness of all the four limbs with muscle pain, cramps and tetanic spasm. Patient also had similar weakness in the past, 2 years back. On examination, he was normotensive with hypotonia noted in all four limbs with retained reflex. Evaluation showed hypokalaemia (1.4 mEq/L), hypomagnesaemia (1.1 mg/dL), metabolic alkalosis (pH 7.535, bicarbonate 33 mEq/L), increased urinary sodium (80 mEq/L) and potassium (60 mEq/L) and reduced urinary calcium excretion (0.73 mmols/L). Renal functions were normal and renal ultrasound showed normal size kidneys. Based on this clinical and biochemical background, a diagnosis of Gitelman syndrome was made patient was managed with intravenous and oral potassium chloride, injectable magnesium sulphate and normal saline. The aim this report was to emphasise that Gitelman syndrome though rare, is an important differential diagnosis for recurrent hypokalaemia presenting with tetany. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=OD04-OD05&id=13654 https://doi.org/10.7860/JCDR/2020/43817.13654 Knee Effusion with Peripheral Eosinophilia: A Need to Rule out Idiopathic Eosinophilic Synovitis Suneel Kumar, Gaurav Kumar Upadhyaya, Amit Kumar Synovial Fluid Eosinophilia (SFE) is a rare finding. Minor SFE is defined as <10% eosinophils of the total leucocyte count in Synovial Fluid (SF), and major SFE as >10% eosinophils of the total leucocyte count in SF. The aetiology and pathophysiology of eosinophilic synovitis is unclear. Most commonly affected joints are Knees; however ankle, elbow and metatarso-phalangeal joint involvement is also being reported. A 10-year-old girl reported with history of pain, swelling and difficulty in bending left knee since five days. On the basis of investigations such as blood investigations including complete blood count, Rheumatoid factor, filarial card test etc., radiographs of knee and arthrocentesis of knee, she was diagnosed as Eosinophilic Synovitis of Knee with peripheral eosinophilia without any known cause. She was treated with Ibuprofen 200 mg BD for 10 days and was relieved of her complaints. After one and half year of follow-up, there were no episodes of recurrent pain or swelling and patient was doing well. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=RD01-RD04&id=13655 https://doi.org/10.7860/JCDR/2020/44142.13655 Splenic Haemangioendothelioma in an Infant Amit Kumar, Sambedna, Rashi, Amit Kumar Sinha, Bindey Kumar Primary Haemangioendothelioma (HE) of spleen is a rare vascular tumour. These tumours have intermediate biologic behaviour between haemangioma and angiosarcoma. So far, few cases have been reported in literature and most of them are in adults or adolescents. Here the present authors report a 6-month-old infant who presented with mass per abdomen. Contrast Enhanced Computerised Tomography (CECT) abdomen revealed a splenic mass which was treated by partial splenectomy. Histopathology confirmed it to be haemangioendothelioma of spleen. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=PD01-PD02&id=13610 https://doi.org/10.7860/JCDR/2020/43257.13610 Histochemical Analysis of Anterior Lens Capsule in Chalcosis Bulbi Shweta Dhiman, Paromita Dutta, Vikas Kumar Jha Retained Intraocular Foreign Bodies (RIOFB) can cause significant visual morbidity due to the primary trauma or subsequent secondary complications. Copper Intraocular Foreign Body (IOFB)s can cause ocular changes involving cornea, lens, retina, and vitreous depending on its concentration. This report highlights the histochemical analysis of anterior lens capsule in a case of presumed chalcosis bulbi. A 27-year-old female presented with gradual decrease of vision in Left Eye (LE) since four months. Best Corrected Visual Acuity (BCVA) in LE was Perception of Light (PL) with inaccurate Projection of Rays (PR). Slit lamp examination showed Kayser-Fleischer ring and sunflower cataract. Posterior segment evaluation revealed diffuse vitreous strands along with vitreous haze. Computerised Tomography (CT) scan orbit was obtained presuming ocular chalcosis which revealed IOFB. Removal of IOFB was not an option due to poor visual prognosis. However, the final diagnosis was cinched by using a copper detecting stain (Orcein) on the anterior lens capsule obtained during cataract surgery. Orcein staining may be used as a surrogate marker for confirmation of copper induced cataract in suspected cases of chalcosis bulbi and is a less expensive alternative to electron microscopy or spectroscopy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ND01-ND02&id=13616 https://doi.org/10.7860/JCDR/2020/43764.13616 Congenital Lymphatic and Venous Abnormality of Leg Dwijesh Kumar Panda Primary lymphoedema arises from congenital disorders of Veins and Lymphatic Vessels. The diagnosis of congenital oedema leg is confirmed by the absence of Venous and Lymphatic Vessels and by Vascular Doppler and Lymphoscintigraphy. Congenital lymphoedema of leg is defined as lymphoedema that is present at birth. It may be due to defect of the venous and lymphatic systems which results in excessive fluid load at the tissue level. The important evaluations that aid in the diagnosis of lymphoedema are detection of circulating adult filarial antigen, lymphoscintigraphy to identify patient lymphatic vessels and duplex ultrasound of leg to detect patency and competency of venous system. Physiotherapy and compression stocking can control swelling and prevent development of irreversible skin changes. Surgical intervention may help by creating alternate pathways. In this case report, a 35-year-old man reported for treatment of his bilateral oedema leg which was present since childhood. The patient consulted the surgeons and physicians of different super-specialist hospitals of the state. He was treated with antibiotics and analgesics for the last five years without any effect. After that, patient was presented to the author, where the diagnosis of patient was made as Congenital Lymphoedema based on Vascular Doppler and Lymphoscintigraphy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=DD01-DD03&id=13617 https://doi.org/10.7860/JCDR/2020/43793.13617 Co-Existence of Pulmonary Tuberculosis and Interstitial Lung Disease in a Patient of Connective Tissue Disorder: A Case Report Huma Firdaus, Nafees Ahmad Khan, Ummul Baneen, Mohammad Shameem, Rakesh Bhargava Pulmonary involvement is common in patients with systemic sclerosis. The most common underlying histology is NSIP. Disrupted immunity from the disease or associated medication may render such patients prone to develop tuberculosis infection. A 55-year-old female patient presented with chief complaints of shortness of breath for 5 years which was gradually progressive, cough initially dry later with minimal expectoration for last 2 months, low grade fever for last 2 months. She also gave history of bluish discolouration of fingers tips on exposure to cold water. On examination there was restrictive mouth opening, thickened skin over hands, forearm, face, neck and trunk on pinching. Sclerodactyly was present with clubbing grade 2. On auscultation bilateral fine crepts were present. Serum ANA was highly raised and Scl 70 was positive. PFT was suggestive of restrictive ventilatory abnormality. Sputum smear for AFB was found to be positive. HRCT thorax was suggestive of NSIP. Patient was put on antituberculer treatment under DOTS category 1; nifedipine, pentoxyphylline and nitroglycerine gel was started for raynauds phenomenon. Chemotherapy for systemic sclerosis was given with cyclophosphamide infusion in 6 cycles every 4 weeks. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=LD01-LD03&id=13623 https://doi.org/10.7860/JCDR/2020/43556.13623 Ocular Adnexal Lymphoma Misdiagnosed as Myelodysplastic Syndrome Sonali Vinay Kumar Systemic lymphoma can have a varied presentation which can mislead physician resulting in wrong diagnosis. Lymphoma, when involves bone marrow, results in deranged blood picture as production of blood cells is affected. A 55-year-old patient presented with occipital headache since two and a half years and protrusion of both eyes, since two years. Patient was initially diagnosed of Myelodysplastic syndrome as he was found to have deranged blood picture and was advised observation. Ophthalmic consultation was sought and he was subjected to conjunctival incision biopsy. Histopathology showed features suggestive of extranodal marginal zone lymphoma. Tissue biopsy played a crucial role for definitive diagnosis and patient was started on treatment. Patient responded to treatment and has recovered. So, lymphoma should be considered as a differential diagnosis whenever patient presents with altered blood picture associated with a lesion in eye. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ND03-ND05&id=13624 https://doi.org/10.7860/JCDR/2020/43617.13624 Endodontic Management of Mandibular Second Premolar with Type-III Vertucci: A Rare Case Neelam Mittal, Tarun Kumar, Vijay Parashar This case report describes endodontic management of mandibular second premolar with type-III Vertucci root canal configuration, in a 42-year-old female patient. She reported to the department for root canal treatment intended for prosthetic purpose. Vertucci type-III configuration (one common canal in coronal part, two distinct canals in the middle third of root which ended with a common apex) has been reported less worldwide; in range of 1.5%-6.66% only. Clinical examination revealed access opening which was restored with Zinc Oxide Eugenol (ZnOE). Radiographs showed minimal periapical changes, no widening of periodontal ligament space and lamina dura was intact. Clinician should have thorough knowledge of the pulp canal system so that an effective treatment can be provided. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ZD05-ZD06&id=13625 https://doi.org/10.7860/JCDR/2020/42484.13625 Advanced-Platelet Rich Fibrin Assisted Papilla Reconstruction by Modified Beagle's Technique- A Novel Approach Rajaram Vijayalakshmi, Ravi Sathyapriya, Prakash Prashanthi, Chellathurai Burnice The loss of key papilla in an unaesthetic zone and the presence of a “black triangle” depicts the requirement for papillary reconstruction. The complete reconstruction of lost papilla is unpredictable; therefore, retention of papilla is very important for aesthetics. There are many causes for loss of papillae and the establishment of “black triangle” between teeth. However, the most common cause is loss of periodontal support due to plaque-associated lesions. However, abnormaility in tooth shape, improper contours of the prosthetic restorations and traumatic oral hygienic procedures may also impact the interdental papilla. The loss of interdental papilla soft tissue causes difficulties in phonetics, aesthetic appearance and lateral food impaction. This case report deals with a variant method of Beagle’s technique 37-year-old systemically healthy male patient with the chief complaint of black space between the upper front teeth region, causing displeasing smile and food entrapment. Intraoral examination done with periodontal probe revealed the loss of 2 mm of interdental papilla. Patient was treated surgically with Advanced Platelet Rich Fibrin (A-PRF) membrane for papilla reconstruction in the upper anterior aesthetic zone. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ZD07-ZD09&id=13626 https://doi.org/10.7860/JCDR/2020/43115.13626 Medullary Sponge Kidney in a Paediatric Patient: A Rare Case Report Sachin Dangi, Namita Gwasikoti, Kapil Bhalla, Poonam Dalal Medullary Sponge Kidney (MSK) is a rare disease which is characterised by dilatation of the collecting ducts in one or both kidneys. These patients are more prone to develop recurrent kidney stones, nephrocalcinosis, repeated Urinary Tract Infections (UTIs) and distal Renal Tubular Acidosis (dRTA). Presentation is very uncommon in children, it usually presents at 10-30 years of life. Here we report a case of five-year-old boy who presented to us with the complaints of inadequate weight gain and short stature. Patient was consistently having hypokalemia with normal anion gap metabolic acidosis and laboratory features were suggestive of dRTA. Computed tomography of abdomen revealed bilateral nephrocalcinosis with increased medullary echogenicity consistent with MSK. Patient was started on oral alkali therapy and showed significant improvement in growth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=SD01-SD03&id=13614 https://doi.org/10.7860/JCDR/2020/43354.13614 Malignant Transformation of Solitary Cylindroma Involving the Frontonasal Region- A Rarity Chinmay Ghavat, Nitin Bhola, Anendd Jadhav, Nupoor Deshpande, Chetan Gupta Cylindromas are adnexal tumours of either eccrine or apocrine origin. Two common variants- Solitary and Multiple are seen, of which the malignant transformation of a solitary lesion is rare. Solitary tumours occur sporadically in the head and neck and are without a familial history whereas the multiple tumours are inherited in an autosomal dominant pattern occurring in scalp and rarely on trunk. Malignant transformation is observed commonly in multiple tumours, although transformation of solitary lesions has also been reported. We report a rare case of malignant transformation of a solitary cylindroma involving the fronto-nasal region in a 72-year-old diabetic and hypertensive male reported to the Department of Oral and Maxillofacial Surgery, with a chief complaint of rapidly growing, painful growth over fronto-nasal region for 3-years and difficulty in breathing since 3-months. on examination; a single, large, well circumscribed, tender, firm and fixed multinodular growth with focal areas of ulcerations and reddish brown crustations of approx. 9.0×3.5 cm measuring in its greatest dimension was seen in naso-frontal region. A CECT Head showed a well defined, heterogeneously enhancing lobulated soft tissue mass, occupying the left nasal cavity, ethmoid sinus and extending into medial extraconal space of left orbit. The incisional biopsy report suggested low grade skin adnexal tumor of malignant cylindroma. Based on the finding in the biopsy, the CECT surgical excision of the lesion was planned. The patient was kept on follow-up of 3 years and no local recurrence or distant metastases was noted. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ZD01-ZD04&id=13620 https://doi.org/10.7860/JCDR/2020/43006.13620 Co-Existent Periampullary Adenocarcinoma with Serous Cystadenoma of the Pancreas: Case Report and Review of Literature JMV Amarjothi, J Jeyasudhahar, Villalan Ramasamy, OL Naganath Babu Serous Cystadenoma (SCA) are benign, cystic lesions of the pancreas. They are rarely known to occur in association with other pancreatic conditions which include malignancies like pancreatic neuroendocrine tumour and adenocarcinoma. Asymptomatic benign lesions of the pancreas like serous cystadenomas can be followed with surveillance. However, the problem arises when they are associated with other co-existent pancreatic lesions. We present a rare case of serous cystadenoma pancreas in association with a periampullary carcinoma for which Whipple Pancreaticoduodenectomy was done. This report emphasises thorough clinical, radiological investigations must be done in all cases of serous cystadenomas so that any co existent lesions can be picked up and treatment tailored appropriately. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=PD03-PD05&id=13635 https://doi.org/10.7860/JCDR/2020/43051.13635 Odontogenic Keratocyst with Ameloblastomatous Transformation: A Rare Case Report Metehan Keskin, Nilüfer Özkan, Nihat Akbulut, Mehmet Cihan Bereket Odontogenic Keratocysts (OKC) are a developmental odontogenic cysts arising from remnants of the dental lamina. They differ from other odontogenic cysts due to their aggressive growth behaviour and high recurrence rates. Malignant or benign transformation may develop from their epithelium. Ameloblastomatous transformation of OKC is an extremely rare case. Such lesions have been described as combined or hybrid odontogenic lesions. In this case report, a 22-year-old patient presented with an unusual lesion in the mandible showing histological features of both OKC and ameloblastoma, and review of the available literature regarding the combined lesions. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ZD10-ZD13&id=13636 https://doi.org/10.7860/JCDR/2020/43336.13636 A Customised Brachytherapy Radiation Carrier for Squamous Cell Carcinoma of Tongue: A Case Report Anoop Sharma, Sweekriti Mishra, BH Harshitha Gowda, Sanober Khan Squamous Cell Carcinoma (SCC) of the tongue is the most widely recognised malignant neoplasm, representing 25 to 50% of all oral malignancies. In recent years, brachytherapy has been used in management of neoplasms of the head and neck region. This clinical report illustrates a method of customised mould fabrication for a 48-year-old patient diagnosed with SCC of lateral border of tongue undergoing brachytherapy treatment and emphasises the responsibility of a maxillofacial prosthodontist in designing a non-invasive prosthesis which maintains the radiotherapy catheters in the required predetermined position as per the requirement of the radiologist. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ZD14-ZD16&id=13641 https://doi.org/10.7860/JCDR/2020/43603.13641 A Case Report of Staphylococcal Scalded Skin Syndrome with Toxic Shock Syndrome Vaishali Kathuria, Sanjay Pandit, Dharampal Bhadoria Toxins produced by bacteria can result into various systemic manifestations through the release of cytokines which leads to changes at the molecular level. This index case of an 18 years old adult immuno-competent male patient, presented with high grade ongoing fever for 3 days, had wound on left arm in deltoid region. there were diffuse maculo-papular rash predominantly in both palms feet and trunk, erythematous and blanchable on examination. Patient was treated with inj. Piperacillin- Tazobactam and Linezolid, i.v. fluids and nor-adrenaline infusion. Patient was diagnosed with concurrent Staphylococcal Scalded Skin Syndrome (SSSS) and Toxic Shock Syndrome (TSS). The two syndromes are caused by different toxins produced by different strains of Staphylococcus aureus. The source of infection was a pus discharging sinus on left arm. The findings were proven on skin biopsy and met the case definition criteria of TSS. He is currently asymptomatic after the treatment being given against Methicillin-resistant Staphylococcus aureus (MRSA) isolated from the pus. It is therefore possible for a single strain of bacteria being capable of producing different toxins, resulting in two different clinical syndromes having a concurrent presentation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=OD01-OD03&id=13649 https://doi.org/10.7860/JCDR/2020/43504.13649 Hyperhomocysteinemia in Acquired Non-traumatic Paralytic Strabismus: A Case Series Priyanka Sharma, Urvish Vashist Diabetes and hypertension are among the main causes of acquired non-traumatic paralytic strabismus in elderly. They cause ischemic changes in the cranial nerves resulting in paralysis. Recently, hyperhomocyteinemia has emerged as a risk factor in systemic ischemic diseases. Only a few studies have suggested role of homocysteine in acquired abducens palsy. This article describes six cases (2 males, 4 females) with hyperhomocysteinemia, out of 67 patients of acquired non-traumatic strabismus, seen over 10 years from January 2010 to December 2019. The mean age of patients was 45 years. Three patients had abducens palsy, while two patients had oculomotor palsy and one patient had trochlear nerve palsy. Two elderly females also had co-existing diabetes mellitus and dyslipidemia. It can be concluded that patients with acquired non-traumatic paralytic strabismus should be evaluated for serum homocysteine. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=BR01-BR03&id=13662 https://doi.org/10.7860/JCDR/2020/44060.13662 Thrombocytopenia to Reactive Thrombocytosis in Scrub Typhus- The Play of Platelets Sourya Acharya, Samarth Shukla, Swapnil Lahole, Preeti Mishra https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=OL01-OL02&id=13648 https://doi.org/10.7860/JCDR/2020/44102.13648 Effectiveness of Prophylactic Intranasal Phenylephrine in Prevention of Nasal Congestion and Hypotension after Spinal Anaesthesia in Obstetric Patients: A Randomised Double Blinded Study Sankar Roy, Arunava Biswas, Dipasri Bhattacharjee <b>Introduction:</b> Spinal anaesthesia is an accepted technique in obstetric surgery but often associated with hypotension and nasal congestion. Phenylephrine, a1 agonist has been tried earlier in managing such adverse situations by parenteral route. <b>Aim:</b> To compare the effect of prophylactic phenylephrine nasal drop versus normal saline as nasal drop in the prevention of hypotension and nasal congestion during spinal anaesthesia in emergency Lower Uterine Caesarean Section (LUCS). <b>Materials and Methods:</b> A prospective randomised double blinded study was conducted on 90 parturient over a period of five months. Patients were randomised into Group A (n=46) phenylephrine (3 &#956;g/kg) nasal drop (10%) and Group B (n=44) received normal saline nasal drop apart from all other standard pre-anaesthetic medications. Blood pressure was measured and nasal congestion recorded every two minutes in the first five minutes and then every five minutes until 30 minutes after spinal anaesthesia. Numerical variables were analysed using independent student&#8217;s t-test. <b>Results:</b> The incidence of hypotension was significantly prevented for those participants with prophylactic phenylephrine (p<0.001) compared to the normal saline group. Systolic and diastolic blood pressures parameters after administration of spinal anaesthesia were maintained well in the phenylephrine group as compared to the normal saline group at various time intervals. Moreover, there were no incidences of nasal congestion among the parturient in the phenylephrine arm. <b>Conclusion:</b> Prophylactic phenylephrine nasal drop remarkably reduced the incidence of spinal anaesthesia induced hypotension and nasal congestion compared to normal saline treated group. Such approach can be recommended in emergency LUCS provided more robust data are generated from large multicentric studies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=UC15-UC18&id=13663 https://doi.org/10.7860/JCDR/2020/43788.13663 Comparison of Pain Levels between Infraorbital Nerve Block with and without Greater Palatine Anaesthesia during Orthodontic Extraction: A Split-mouth, Prospective Study Jitender Kumar, Rahul Kashyap, Alok Bhatnagar, Namrata Dogra, Seema Grover, Vatsala Ranganathan <b>Introduction:</b> Pain free dentistry is the need of the hour, and when our dental procedure involves treatment specially in children then it is of prime concern. Even after introduction of latest pain control measures, greater palatine nerve block injection is still considered a painful experience in most of the patients due to firm adherence of palatal mucosa to the underlying bone. <b>Aim:</b> To evaluate the pain levels between Infraobital nerve block with and without Greater Palatine (GP) anaesthesia during orthodontic extraction of maxillary first premolar. <b>Materials and Methods:</b> This Split-Mouth, Prospective Study was conducted from November 2019 to January 2020 on 60 patients with age group range from 12-18 years requiring bilateral maxillary first premolar extractions for orthodontic purpose. Each patient received 1.8 mL of lignocaine HydroChloride (lignocaine HCl) for infraorbital nerve block on 1 side and on the other side received 0.5 mL lignocaine HCl for greater palatine nerve block in addition to 1.8 mL lignocaine HCl for infraorbital nerve block. The nerve block were given based on a computer-generated list. In each patient, difference in the pain levels was assessed on administration of infraorbital nerve block with and without greater palatine nerve block. <b>Results:</b> There was no statistically significant difference in pain levels between Orthodontic extraction of maxillary first premolar extraction with and without palatal injection (p>0.05). <b>Conclusion:</b> Orthodontic extraction of maxillary first premolar teeth can be done by giving only infraorbital nerve block with 2% lignocaine without greater palatine nerve block. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ZC14-ZC17&id=13664 https://doi.org/10.7860/JCDR/2020/43812.13664 Comparison of Transvaginal Colour Doppler Ultrasound and Progesterone Level Estimation in Outcome of Threatened Abortion in Early Pregnancy Priyanka Kumari, Sanjivani Wanjari <b>Introduction:</b> Threatened abortion is a clinical puzzle in obstetrics on which depends the fate of pregnancy. It is one of the most common complications in the 1st trimester and early 2nd trimester and these women are more prone to abort in comparison of healthy pregnancy. During luteo-placental shift, sometimes adequate progesterone is not produced by placenta and its falling level may start onset of vaginal bleeding and put a brake on successful continuation of pregnancy. Abnormal Colour Doppler findings can be used to anticipate satisfactory or poor outcomes in women with first trimester threatened abortion. <b>Aim:</b> This study was done to compare efficacy of transvaginal Colour Doppler ultrasound of uterine arteries with serum progesterone levels in outcome of threatened abortion in early pregnancy. <b>Materials and Methods:</b> This prospective study was conducted at the Department of Obstetrics and Gynaecology, Acharya VinobaBhave Rural Hospital, JNMC, Sawangi (Meghe) Wardha, Maharashtra. The duration of the study was two years (September 2017 to August 2019 and sample size for the study was 101 cases. Subjects included in this study were viable pregnancies with 6-12 weeks Gestational age presenting with pain in abdomen or with bleeding per vagina. All 101 subjects were admitted and underwent serum progesterone estimation and Transvaginal ultrasound Colour Doppler. Statistical analysis was done by using descriptive and inferential statistics using student’s unpaired t-test, sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), Receiver Operating Characteristic analysis (ROC). <b>Results:</b> In this study, it was found that serum progesterone and uterine artery blood flow studies by transvaginal colour doppler Ultrasonography (USG) both were useful for predicting the outcome of threatened abortion in early pregnancy. Serum progesterone, uterine artery Resistance Index, Pulsatility Index and Systolic/Diastolic ratio were compared with ROC curves and AUC (Area Under Curve) were measured. It was found that the resistance index of uterine arteries had a higher AUC than serum progesterone (0.855 vs 0.773). <b>Conclusion:</b> Doppler study of uterine artery in early pregnancy was found to be a better tool for evaluating women with threatened abortion. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=QC11-QC15&id=13665 https://doi.org/10.7860/JCDR/2020/43319.13665 A Study of Proportion of Pseudomyopia in Hypermetropia Niharika Krishna Shetty, MS Sushmitha <b>Introduction: </b>Pseudomyopia results from spasm of accommodation and accommodative excess. It manifests with spurious myopia, and patient may accept myopic correction in this state. Inability to detect the underlying hypermetropia can lead to asthenopia, eye pain and recurrent headaches. <b>Aim: </b>To find out the number of hyperopes presenting with pseudomyopia and to correlate the diopteric value of hyperopia manifesting with pseudomyopia. <b>Materials and Methods:</b> Patients attending ophthalmology department with low myopia were recruited in the study. Sixty two patients were evaluated on Autorefractometer (UNIQUERK 100) before and after cycloplegia with 2% Homatropine. Results were tabulated and paired t-test was applied to find out the p-value and t-value. <b>Results:</b> In the study, the mean precycloplegic myopia of -1.0484 Diopters changed to a mean postcycloplegic hyperopia of +0.6774 Diopters, contributing to a mean difference of -1.726 Diopters in both the eyes. The mean t-value for both eyes from precycloplegic to postcycloplegic state finding was -15.723, showing a significant test. The mean precycloplegic astigmatism was found to change from -0.3911 to -0.3447 postcycloplegia. The mean difference being -0.046 diopters; it contributed to a mean t-value of -1.689, which was non-significant. <b>Conclusion:</b> Low diopters of myopia can indicate pseudomyopia. Cycloplegic refraction is the only method to manifest the hyperopia underlying pseudomyopia. Significant proportion of pseudomyopia is associated with low diopters of hypermetropia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=NC09-NC14&id=13666 https://doi.org/10.7860/JCDR/2020/43613.13666 Tumour Characteristics Predicting Axillary Nodal Metastasis in Early Breast Cancers- A Study from Southern India Raghunandan Gorantlu Chowdappa, Suhaildeen Kajamohideen, Balasubramanian Venkitaraman <b>Introduction:</b> Breast cancer is the commonest cancer among women in India and the leading cause of cancer related deaths. In patients with invasive breast cancer, axillary nodal metastasis remains as the most important predictive factor for recurrence and survival, despite progression made in molecular and genetic characterisation of these cancers. <b>Aim:</b> To know the nodal positivity rate and pathologic predictive factors of nodal positivity in early breast cancer in Indian patients, which may help in predicting the axillary status preoperatively. <b>Materials and Methods:</b> This study was retrospective review of patients treated in Cancer Institute, Chennai, Tamil Nadu, India between January 2011 to October 2014 for invasive breast cancer which were clinical T1 and T2 and either N0 or N1. Pathologic characteristics of the primary tumour such as size, centricity, histological type, nuclear grade, and Lympho Vascular Invasion (LVSI), Estrogen receptor (ER) and Progesterone Receptor (PR) Status, Human Epidermal growth factor Rector 2 (HER-2)/neu and Ki-67 were analysed and correlated to nodal positivity using univariate and multivariate analysis. <b>Results:</b> In the univariate analysis using chi-square test, Pathological T stage, number of tumours, LVSI, ER and PR status emerged as significant variables. Variables like pT2 (p-0.032), multiple tumours (p-0.007), LVI (p<0.0001), ER positive (p-0.002) and PR positive (p-0.001) and HER2 -2+ (p-0.040) was found to have positive predictive value with statistical significance. On multivariate analysis, LVSI proved to be a highly significant predictor of positive nodes. <b>Conclusion:</b> Although variables such as pT2, multiple tumours, LVSI, ER positive, PR positive and HER2+ was found to have positive predictive value with statistical significance, only LVSI emerged as significant independent predictive factors of positive lymph node. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=XC07-XC11&id=13667 https://doi.org/10.7860/JCDR/2020/43361.13667 Immunoexpression of Nanog and Nestin in Egyptian Women Predicts Outcome in Breast Carcinoma Samar M Abdel Raouf, Doaa Abdelaziz Ibrahim, Lobna A Abdelaziz <b>Introduction:</b> Breast cancer is the commonest malignant tumour in females. Drug resistance and disease relapse are common problems occurring during treatment. Cancer Stem Cells (CSC) are implicated in tumourigenesis and resistance to therapy. Nanog is a transcription factor important for regulation of Embryonic Stem Cell (ESC) maintenance and survival. Whereas, Nestin, is a class VI intermediate filament protein that was primarily found during development in neural stem cells. They have been observed in CSC in several neoplasms. <b>Aim:</b>To evaluate the expression of Nanog and Nestin in breast carcinoma in Egyptian women and its relation to clinicopathologic parameters and prognosis. <b>Materials and Methods:</b> The current study was a prospective cohort study conducted in Zagazig University hospitals in Egypt in General surgery Department, Pathology Department and Clinical Oncology and Nuclear medicine Department during the period between September 2015 and September 2019. The study evaluated the immunohistochemical expression of Nanog and Nestin in 74 breast carcinoma cases. <b>Results:</b> The immunoexpression of Nanog and Nestin were related to high tumour grade, advanced TNM stage (TNM Classification of Malignant Tumors), nodal infiltration, lymphovascular invasion, ER negative status, PR negative status and high Ki67 expression. Nestin expression was significantly associated with 4-year Disease Free Survival (DFS), and 4-year Overall Survival (OS) (p<0.001). <b>Conclusion: </b>Nanog and Nestin were poor prognostic markers of breast carcinoma patients and Nestin is superior to Nanog in predicting patients’ outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=EC18-EC24&id=13668 https://doi.org/10.7860/JCDR/2020/43474.13668 Comparative Evaluation of Antimicrobial Efficacy of Commercially Available Herbal Dentifrices against Selected Putative Oral Microorganisms: An <i>In-vitro</i> Study Jayesh Palekar, Sameer Anil Zope, Girish Suragimath, Siddhartha A Varma, Apurva Kale <b>Introduction:</b> Dental plaque accumulation has been identified as the primary cause of dental caries, periodontal diseases, and halitosis. Worldwide, a wide range of commercially available nonherbal and herbal dentifrices are used along with tooth brush as mechanical aids in plaque control. Owing to some undesirable side effects associated with non-herbal toothpastes, there has been an increased popularity of herbal toothpaste among the general population. <b>Aim:</b> To assess and compare antimicrobial efficacy of three commercially available herbal toothpastes against selected putative cariogenic, periodontal and fungal microorganisms. <b>Materials and Methods:</b> An in vitro assessment of antimicrobial efficacy of Sudanta, Dant Kanti, Colgate Cibaca Vedshakti toothpastes was done during the months of February to March 2017 against pure culture standard strains of S. mutans, C albicans, P. gingivalis, A. actinomycetemcomitans and T.forsythia. All the selected microorganisms were sub-cultured on specific culture media. Antimicrobial efficacy of the toothpastes was then tested in triplicate at full strength using standard discdiffusion method. The antimicrobial efficacy was evaluated by measuring the zones of inhibition in millimetres surrounding disc containing the toothpastes. Means and standard deviations of the inhibitory zones were calculated for all herbal toothpastes and analysed using one-way ANOVA followed by Tukey’s posthoc tests for differences amongst the different groups. The p-value =0.05 was considered statistically significant. <b>Results:</b> Sudanta and Dant Kanti toothpastes demonstrated higher antimicrobial activity against majority of the test microorganisms as compared to Colgate Cibaca Vedshakti toothpaste. Intergroup comparisons among the three toothpastes demonstrated that Dant Kanti toothpaste was significantly better in inhibiting S. mutans and C. albicans than Sudanta and Colgate Cibaca Vedshakti (p=0.05) while Sudanta toothpaste was significantly more effective against A. actinomycetemcomitans and T. forsythia than Colgate Cibaca Vedshakti toothpaste and Dant kanti (p=0.05). A. actinomycetemcomitans and T. forsythia were resistant to Colgate Cibaca Vedshakti toothpaste. However, Colgate Cibaca Vedshakti exhibited substantial antimicrobial activity against P. gingivalis when compared against Sudanta (p=0.05) and Dant kanti (p>0.05). <b>Conclusion:</b> Results of the present study revealed that Sudanta demonstrated better antimicrobial activity against selected putative periodontal microorganisms: A. actinomycetemcomitans and T. forsythia. Dant kanti toothpaste demonstrated better antimicrobial activity against selected putative cariogenic and fungal microorganisms: S. mutans and C.albicans. Whereas Colgate Cibaca Vedshakti toothpaste exhibited highest antimicrobial activity against P.gingivalis https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ZC18-ZC21&id=13669 https://doi.org/10.7860/JCDR/2020/43888.13669 Occurrence and Motives Associated with Relapse after a De-addiction Treatment in Men with Alcohol Dependence Syndrome in a Tertiary Care Hospital- A Cross-sectional Study Alka Chandrakar, Suvarna Jyothi Kantipudi, K Sandhya, Sathianathan Ramanathan <b>Introduction:</b> Alcohol dependence is a chronic relapsing brain disorder. A combination of biological, psychological and social factors influences the outcome of de-addiction treatment. Understanding these factors help in formulation of effective relapse management strategies in alcohol dependence. <b>Aim:</b> To understand the occurrence and motives of drinking behaviour after de-addiction in males with past diagnosis of alcohol dependence syndrome. <b>Materials and Methods:</b> A cross-sectional design was employed for determining the prevalence of relapse after de-addiction treatment. A semi structured socio-demographic proforma, clinical data form and Drinking Motives Questionnaire-Revised (DMQR) were used to assess correlates of relapse and remission on men who underwent de-addiction for alcohol dependence (n=58) after obtaining informed consent. Comparisons were carried out on different variables between relapse and remission groups using Statistical Package for Social Sciences (SPSS) version 20 and were reported. <b>Results:</b> The occurrence of relapse after de-addiction treatment was 51.7%. Patients who had relapsed were significantly more likely to have less than a year of abstinence in the past and have received less than two de-addiction treatments in the past. More patients who had received less than two weeks of in-patient treatment for de-addiction maintained remission when compared to patients who had relapsed. Presence of high scores on social, coping and conformity motives was positively associated with relapse in this study. <b>Conclusion:</b> The occurrence of relapse after de-addiction treatment was found to be high. Multiple biological, psychosocial and treatment variables influence the outcomes of de-addiction treatment. This study added to the literature on treatment variables and individuals motive for drinking behaviour. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=VC11-VC14&id=13656 https://doi.org/10.7860/JCDR/2020/44240.13656 Dexmedetomidine versus Fentanyl in Attenuation of Haemodynamic Response during Laryngoscopy and Intubation- A Randomised Controlled Trial Sahil Garg, Manisha Aggarwal, Anusha Bhat, Achla Rani <b>Introduction:</b> Endotracheal intubation is a strong adrenergic stimulus leading to unpredictable increase in heart rate, systolic and diastolic blood pressure which can be detrimental. Various drugs like dexmedetomidine and fentanyl are used for the attenuation of these responses. <b>Aim:</b> To compare the effects of Dexmedetomidine (1 &#956;g/kg) and Fentanyl (2 &#956;g/kg) on haemodynamic response to endotracheal intubation and on anaesthetic requirements. <b>Materials and Methods:</b> This study included 100 patients, undergoing elective surgeries under general anaesthesia. Patients were randomised into Group D (Inj. Dexmedetomidine 1 &#956; &#956;g/kg iv in 100 mL normal saline) and Group F (Inj. Fentanyl 2 &#956; &#956;g/kg iv in 100 mL normal saline). Vital monitoring (HR, SBP, DBP, MAP, SpO<sub>2</sub>) was done. Continuous variables were analysed with unpaired t-test and Mann Whitney U test. Categorical variables were analysed with the Chi-square test. <b>Results:</b> The age range of the study participants were 20-60 years. It was found that magnitude of increase in heart rate at intubation and 1 min after intubation was statistically higher in Group F as compared to Group D. SBP and DBP during intubation and at 1 min after intubation were also significantly higher in group F as compared to Group D. <b>Conclusion:</b> Dexmedetomidine is more effective in attenuating the sympathetic response of laryngoscopy and intubation as compared to Fentanyl. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=PC01-PC04&id=13657 https://doi.org/10.7860/JCDR/2020/43022.13657 Relationship between Bispectral Index and Observer's Assessment of Awareness/Sedation Score during Onset of Sedation: Study with Midazolam, Propofol and Dexmedetomidine Usha Shukla, Mouparni Karan, Jay Brijesh Singh Yadav, Urvashi Yadav <b>Introduction:</b> Supplementation of sedation along with regional anaesthesia is a good practice to reduce anxiety and amnesia related to surgery. Monitoring the level of sedation is important to prevent excessive sedation. Propofol, midazolam and dexmedetomidine have been studied individually using either BIS index or OAA/S scale. <b>Aim:</b> To compare the time of onset of sedation for propofol, midazolam and dexmedetomidine using both Bispectral index monitor and simultaneous clinical assessment. <b>Materials and Methods:</b> Ninety patients of ASA Grade I and II, of either sex and aged 20-60 years scheduled for lower limb surgeries under spinal anaesthesia were randomly allocated into three groups (n=30). After subarachnoid block, when sensory block reached T-10 level, sedation was started using either propofol (Group P), midazolam (Group M) or dexmedetomidine (Group D) and level of sedation was assessed using BIS monitor and OAA/S scale. The dose of sedation was titrated to maintain BIS value between 60-75. Time to reach BIS value 70 and OAA/S score 3, intraoperative haemodynamic parameters, BIS value, OAA/s score and complications were recorded. <b>Results:</b> The Spearman&#8217;s correlation between time to reach BIS score 70 and OAA/S score 3 in Group P, Group M, Group D were 0.925, 0.211 and 0.512, respectively with p-values of 0.022, 0.133 and 0.163, respectively. The time to reach BIS score 70 was significantly less in Group P as compared to Group D and Group M (6.00&#177;1.87 minutes v/s 7.97&#177;1.62 minutes and 12.23&#177;1.92 minutes). The time to reach OAA/S score 3 was significantly less in Group P as compared to Group M and Group D (6.27&#177;1.92 minutes v/s 12.77&#177;3.19 minutes and 15.20&#177;2.69 minutes). <b>Conclusion:</b> A poor correlation was found between clinical observation and EEG based monitor while assessing sedation using dexmedetomidine and midazolam. On the other hand, a better correlation was observed when propofol was used. Onset of sedation was earlier with propofol compared to dexmedetomidine and midazolam. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=UC10-UC14&id=13658 https://doi.org/10.7860/JCDR/2020/44227.13658 Clinical and Biochemical Parameters Correlation with Complications and Mortality in Community Acquired Pneumonia in A Tertiary Care Hospital Kamal Singh, Neha Sharma <b>Introduction:</b> Pneumonia continues to remain a serious health risk despite ongoing efforts. Community Acquired Pneumonia (CAP) is a common respiratory disease often requiring hospitalisation and is a major cause of morbidity and mortality in the population. <b>Aim:</b> To study clinical and biochemical profile of patient admitted with the diagnosis of community acquired pneumonia and to see the association with various complications and outcomes. <b>Materials and Methods:</b> In this prospective study, 130 patients of CAP admitted in the institution were enrolled. Data relating to their age, gender, clinical profile, severity score, microbiological details, complications and outcome were recorded. All the laboratory parameters of the patients were compared among the survival and mortality groups using student&#8217;s t-test and Chi-square test. The analysis was performed using Statistical Packages for the Social Sciences (SPSS Inc, Chicago, IL, version 22.0 for windows). p-value <0.05 was significant. <b>Results:</b> Out of 130 patients of CAP 109 (83.8%) survived and 21 (16.2%) died. Seventy were male (53.8%) and 60 female (46.1%). Increase mean pulse rate, respiratory rate, lactate and low blood pressure, low oxygen saturation, low GCS scale and acidosis were associated with increased mortality. Sputum cultures were positive in 33 (25.38%), common organism isolated was <i>E. coli</i> (8.5%), <i>pseudomonas</i> (6.9%) and methicillin sensitive <i>staphylococcus</i> (3.1%). The need for ICU admission, mechanical ventilation, inotropes were statistically significant and associated with high mortality (p<0.001). Mean quick Sequential Organ Failure Assessment (qSOFA) score and Systemic Inflammatory Response Syndrome (SIRS) score was higher in mortality group. <b>Conclusion:</b> Early diagnosis, prompt severity scoring, early sepsis management and monitoring can reduce mortality in CAP. Underlying co-morbid conditions like diabetes, Chronic Obstructive Pulmonary Disease (COPD), hypertension and others need to be managed precisely to prevent adverse outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=OC26-OC30&id=13659 https://doi.org/10.7860/JCDR/2020/44237.13659 Same Day Discharge after Emergency Appendicectomy: Is it Feasible? Alexander Achile Aikoye, Mohamed Toeima, Veera Allu, Sanjoy Basu <b>Introduction:</b> In the UK, approximately 70,000 appendicectomies (one of the most common surgical procedures) are performed yearly. There is a wide variation in length of stay following Laparoscopic Appendicectomy (LA). <b>Aim:</b> To review the feasibility of safe same day discharge following LA for patients with acute appendicitis. <b>Materials and Methods:</b> This was a retrospective review of 92 consecutive adults (=18 years) who underwent emergency appendicectomy in a District General Hospital (DGH), between April and July 2018. The patients were divided into two groups. Group A comprised all patients not discharged on day of operation while Group B comprised all patients discharged on same day of operation. Data collected and analysed included demographics, clinical diagnosis, WBC, CRP, operative details, complications and length of stay. Outcomes were compared using Fisher’s exact test. <b>Results:</b> Group A: Total 86 (93%), included male: female of 38:48, age 36 years (median), range (18-81) years, heart rate 78(median), range (51-162)/minute, temperature 36.8°C (median), range (35.7- 40.2)°C, WBC 13.5 (median), range (3.8-25.6), CRP 36 (median), range (2-498) and PO stay 1 (median), range (1-11) days. Group B: Total 6(7%), included male:female of 2: 4 with age of 27 years (median), range (18-49) years, temperature 36.8°C (median), range (36.5-39.2) °C, WBC 10.5 (median), range (7-15.6), CRP 5.5 (median), range (1-94) and PO stay of 0 day. Four had uncomplicated appendicitis, 1 had pus and 1 had appendicular mass with pus. Five out of six patients had LA and were operated before noon. Group B had no complications including no readmissions. <B>Conclusion:</b> Selective approach to same day discharge, for medically fit patients undergoing emergency laparoscopic appendicectomy, is safe. Complicated appendicitis is not an absolute contraindication to same day discharge. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=PC05-PC08&id=13660 https://doi.org/10.7860/JCDR/2020/43234.13660 Ultrasound-guided Compression Repair of Post Catheterisation Femoral Artery Pseudoaneurysm: A Retrospective Study from a Tertiary Cardiac Institute Milin N Garachh, Yashpal R Rana, Megha M Sheth, Dinesh L Patel, Samir G Patel, Shreya K Vora <b>Introduction:</b> Femoral Artery Pseudoaneurysm (FAP) is a rare complication after catheterisation however due to huge workload of interventional procedures in a nodal cardiac institute; they are seen with relatively increasing frequency. <b>Aim:</b> To share high volume cardiac institute&#8217;s experience of Ultrasound-Guided Compression Repair (UGCR) technique, results and probable predictive factors of failed compression. <b>Materials and Methods:</b> A retrospective study was conducted from 2012 to 2019 in which 310 patients diagnosed with FAP on ultrasound study were enrolled. All the patients who were diagnosed on same day of the procedure were given tight compression bandage and re-evaluated after 24 hours to look for presence or absence of spontaneous thrombosis. Those patients in whom pseudoaneurysm were still present 24 hours after the procedure were given compression. Manual compression was given with a 10 MHz linear probe until complete thrombosis was achieved or maximum four cycles were attempted before labelling patient as failure. In those patients where complete thrombosis was achieved, follow-up study was obtained at 24 hours and after one month to detect any recurrence. All statistical studies were carried out using IBM SPSS program version 20. Quantitative variables were expressed as mean&#177;standard deviation and qualitative variables were expressed as percentage (%). <b>Results:</b> Out of 310 pseudoaneurysms, 53 of them were of small size and thrombosed spontaneously on 24 hours follow-up and tight compression bandage and seven patients fell in exclusion criteria. Remaining 250 patients were attempted for UGCR. Successful thrombosis of the pseudoaneurysm was achieved in 235 (94%) patients. The mean largest dimension of the pseudoaneurysms sac was 3.5 cm (range 1-8 cm) and mean sac area was 9 cm<sup>2</sup> (range 1-36 cm<sup>2</sup>). The mean length of pseudoaneurysm neck was 11 mm (1-26 mm) while mean width of neck was 2.3 mm (range 0.5-6 mm). The mean compression time of the successful compressions was 26 minutes (range 6-110 min). Successful thrombosis of the pseudoaneurysm was achieved in <60&#176; angle (97.1%) compare to >60&#176; angle (27.3%). <b>Conclusion:</b> UGCR is a safe, reliable and cost-effective treatment for post catheterisation FAP. Width, and angle of the pseudoaneurysm neck were major predictive factor of technical success. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=TC05-TC09&id=13661 https://doi.org/10.7860/JCDR/2020/43325.13661 Spatio-Temporal Analysis of Dengue Fever Cases: A Retrospective Study M Siva Durga Prasad Nayak, KA Narayan <b>Introduction:</b> In India, during the last ten years, the dengue fever increased in incidence and in territorial extent. Several studies already described the dengue fever incidence in terms of time, place and person But in spatio-temporal analysis, space and time will be analysed together to identify the high priority areas and during which time period there is chance for occurrence of outbreaks in these high priority districts. <b>Aim:</b> To identify the districts with high log likelihood ratio for high dengue fever incidence. <b>Materials and Methods:</b> The current study design was a retrospective observational study conducted using the secondary data provided by Director of Public Health of Kerala state on a public domain. All the suspected dengue fever cases reported for a period of six months from 1<sup>st</sup> May 2017 to 4<sup>th</sup> November 2017 was used for the study. Weekly incidence rates of dengue fever cases and moving averages of dengue fever cases were calculated using MS Excel software. Retrospective spatio-temporal analysis was done with SaT Scan software using discrete poisson model. <b>Results:</b> Total number of dengue fever cases reported was 52371. The incidence of dengue fever rose from May 1-7 to June 26-July 02 and later showed declining trend. Moving averages graph of actual data shows peaks and troughs with an approximate 7 day pattern and the troughs coincided with public holidays. Spatio-temporal analysis revealed that, ten districts out of thirteen districts were identified having significantly (p<0.005) high relative risk and high likelihood ratio for dengue fever cases. <b>Conclusion:</b> Epidemic of dengue fever cases will start in the month of May, reaches peak in June and July, declines thereafter and reaches to normal by September. Time series analysis revealed the lacunae in surveillance system. Spatio-temporal analysis identified ten high priority districts out of which top four are in south Kerala. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=LC05-LC08&id=13650 https://doi.org/10.7860/JCDR/2020/43472.13650 Epidemiological, Clinical and Paraclinical Characteristics of Childhood Acute Lymphoblastic Leukaemia in Sana’a, Yemen Mohammed Ali Al-Shehab, Abdulrahman Mohammed Alhadi, Muna Abdo M Elnemr, Farouk Abdulrahman Al-Qadasi, Naseem Abdo Alabsi, Mohammed Abdo Aqlan <b>Introduction:</b> Acute leukaemia is one of the most common types of cancers among children. There is only restricted number of studies about childhood leukaemia in Yemen, hence the importance of performing this study. <b>Aim: </b>To assess the epidemiological, clinical and para-clinical characteristics of childhood acute lymphoblastic leukaemia in Sana’a, Yemen. <b>Materials and Methods:</b> This was a descriptive retrospective study. It included 177 children younger than 15 years with Acute Lymphoblastic Leukaemia (ALL), who were diagnosed in the period from May to September 2011 to 2017 in the Childhood Leukemia Management Center (CLMC) in Sana’a, Yemen. The diagnosis was based on clinical characteristics, bone marrow morphology and immunophenotyping. The data was analysed using SPSS program. Chi-square test with Yate correction and Fisher tests were used to identify the significance of associations. <b>Results:</b> Majority of patients 129 (72.8%) were between 1-9 years and male to female ratio was 1.53 to 1. The most common presenting features were fever (89.3%), pallor (89.3%) and bone pain (71.3%). Immunophenotyping was done for 126 patients; 99 (78.6%) had precursor B-cell and 27 (21.4%) had T-cell ALL. Ninety two (52.6%) of patients were classified as standard risk and 83 (47.4%) were high risk; most of them were T-cell ALL. Response to chemotherapy in induction phase was excellent with complete remission rate of 94.2%. Relapse was 16.5%; 62.9% of them were medullary relapses. Mortality during induction was 15.6%. Infection was the most common cause of death (37.8%), followed by haemorrhage (11.1%). <b>Conclusion:</b> ALL is considered a significant health problem in Yemen. It needs high awareness and more attention from the governorate regarding improving the capacities of health facilities on health information, diagnosis and treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=SC07-SC10&id=13651 https://doi.org/10.7860/JCDR/2020/43517.13651 Correlation of Fasting Serum Magnesium with Glycaemic and Nephropathy Status in Type 2 Diabetes Mellitus Aditya Dhanawat, Lalatendu Mohanty, Pravakar Khatua, Sudhansu Sekhar Panda, Guncha Maheshwari <b>Introduction:</b> The estimated prevalence of Hypomagnesemia in Type 2 Diabetes Mellitus (T2DM) ranges between 14% to 48% in various studies. Hypomagnesemia has been found to be associated with increased insulin resistance in patients of T2DM. <b>Aim:</b> The aim was to estimate fasting serum magnesium levels in the patients of T2DM and to correlate serum magnesium with glycaemic status and nephropathy status. <b>Materials and Methods:</b> It was a cross-sectional study conducted at KIMS, Bhubaneswar between October 2017 to September 2019 which included a total of 187 T2DM patients. The glycaemic status was assessed by HbA1c and subdivided into good (HbA1c <7%), intermediate (HbA1c 7-9%) and poor control (HbA1c >9%). The nephropathy status was assessed by urine Albumin-Creatinine Ratio (ACR) and subdivided into macroalbuminuria (Urine ACR >300 mg/g), microalbuminuria (Urine ACR 30-299 mg/g) and non-nephropathy (Urine ACR <30 mg/g) groups. Student t-test and One-way ANOVA test were used to find the significance of mean pattern of serum magnesium in different groups and Pearson correlation coefficient test was used to correlate serum magnesium with glycaemic and nephropathy status. <b>Results:</b> Out of 187 patients, 49 (26.2%) patients were found to have hypomagnesemia. In the poor glycaemic status group, 30% of patients had hypomagnesemia as compared to 26% in the intermediate and 19% in the good glycaemic status group. In the macroalbuminuria group, 41.3% patients had hypomagnesemia as compared to 17.6% in the microalbuminuria group and 4.5% in the non-nephropathy group. <b>Conclusion:</b> There was a weak negative correlation (r=-0.04) between serum magnesium and glycaemic status which was not statistically significant (p=0.62). There was a negative correlation (r=-0.17) between serum magnesium and nephropathy status which was found to be statistically significant (p=0.02). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=OC21-OC25&id=13652 https://doi.org/10.7860/JCDR/2020/43632.13652 Acceptability and Outcome of Cervical Cytology in Postnatal Women and Other Nonpregnant Women in Enugu, Nigeria: A Cross-Sectional Study Kingsley Chukwu Obioha, Cyril Chukwudi Dim, Emmanuel Onyebuchi Ugwu, Chibuike Ogwuegbu Chigbu, Joseph Tochukwu Enebe, Benjamin Chukwuma Ozumba <b>Introduction:</b> Cervical cancer is a leading cause of cancer-related mortality in Sub-Saharan Africa. Although the disease is largely preventable via routine cervical cancer screening, the uptake is ridiculously poor in the sub-region. In Nigeria, current efforts are directed at counselling and screening of eligible women in health care facilities. Therefore, the routine post-natal clinic visit at six weeks postpartum provides a good opportunity to offer cervical cancer screening services. <b>Aim:</b> To compare the acceptability of Pap-test and prevalence of abnormal cervical cytology between post-natal clinic attendees and other non-pregnant women at the University of Nigeria Teaching Hospital Enugu, Nigeria. <b>Materials and Methods:</b> A cross-sectional analytical study was conducted in which acceptability and Pap-test results of 172 women attending the post-natal clinic were compared with an equal number of non-pregnant women from gynaecology and family planning clinics of the hospital. Both groups were selected by systematic sampling method. Outcome measures for each group included the prevalence of abnormal Pap-test and the proportion of women that accepted the Pap-test after appropriate cervical cancer education. Statistical analyses were both descriptive and inferential at 95% confidence level. <b>Results:</b> Prior to the study, 44.2% (76/172) of participants in postpartum group, and 47.7% (82/172) in control group were aware of Pap-test (p=0.473); while 9.3% (16/172) and 10.5% (18/172) had used Pap-test in the two groups respectively (p=0.718). All participants in each group accepted the Pap-test after cervical cancer education. Prevalence of cervical Squamous Intraepithelial Lesion (SIL) in the postpartum group was similar to that of the control group (OR: 1.8; 95%CI: 0.75-4.10; p=0.21). The most common SIL in both groups was low-grade squamous intraepithelial lesion. There was no statistically significant difference in the distribution of SIL categories (p>0.05). <b>Conclusion:</b> Acceptability and outcome of Pap-test are similar in post-natal and non-pregnant women in Enugu, Nigeria. Post-natal clinic visit provides an effective opportunity for routine cervical cancer information and screening in Nigeria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=QC07-QC10&id=13653 https://doi.org/10.7860/JCDR/2020/43641.13653 Primary Percutaneous Coronary Intervention in Elderly Patients with Acute Myocardial Infarction: A Single Centre Experience from Southern India Manjappa Mahadevappa, Nagaraj Desai, S Sunil Kumar, Prashanth Kulkarni <b>Introduction:</b> Due to increasing life expectancy, the elderly population is constantly rising globally and the number of older patients presenting with Acute Coronary Syndrome (ACS) and Acute Myocardial Infarction (AMI) is also on the rise. The treatment of choice for patients suffering from acute ST Elevation Myocardial Infarction (STEMI) is Primary Percutaneous Coronary Intervention (Primary PCI). However, Primary PCI in elderly patients is thought to carry higher mortality and morbidity when compared to general population due to multiple co-morbidities and other factors. <b>Aim: </b>To evaluate the clinical outcomes of Primary Angioplasty in Myocardial Infarction (PAMI) in elderly south Indian patients, attending a single center. <b>Materials and Methods: </b>This was a retrospective, nonrandomised, single center observational study, conducted at a tertiary care centre in southern India, between January 2015 and December 2017. Consecutive elderly patients (aged =65 years) who underwent primary angioplasty for acute STEMI were studied. The clinical endpoint of cumulative incidence of Major Adverse Cardiac Events (MACE), which included composite of cardiac death, Myocardial Infarction (MI) and Target Vessel Revascularisation (TVR) were analysed. The MACE during one, six and twelve months follow-up after procedure was noted as documented in the hospital records. <b>Results:</b> The mean age of 103 patients was 79.23±3.61 years, and 67% (69) patients were males. Amongst those enrolled patients, 58.3% (60) were hypertensive and 50.5% (52) were diabetic. Single vessel disease was present in 57.3% (59) patients and 30.1% (31) patients had isolated Left Anterior Descending (LAD) artery lesion and 53.4% (55) had combined LAD and one other vessel lesions. At 12th month follow-up, the cumulative incidence of MACE was 8.73% (9) in the form of cardiac deaths 7.77% (8) and TVR 0.97% (1). There were 3.88% (4) patients who suffered stroke. <b>Conclusion: </b>The lower rate of MACE reported in the present study implies that, for the management of AMI in elderly patients, the primary angioplasty is advantageous and can be performed safely. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=OC16-OC20&id=13642 https://doi.org/10.7860/JCDR/2020/44116.13642 Role of Diffusion-Weighted Magnetic Resonance Imaging in Differentiating Benign From Malignant Thyroid Lesions: A Prospective Study Kanika Bhargava, Harneet Narula, Amit Mittal, Divya Sharma, Kritesh Goel, Divya Nijhawan <b>Introduction:</b> Accurate non-invasive imaging technique for characterising thyroid nodules has always been problematic. Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) is a functional MR imaging modality that quantifies the net diffusion of water molecules in any lesion. Thyroid carcinoma due to its increased cellularity shows diffusion restriction on DWI with low Apparent Diffusion Coefficient (ADC) values that can be used to differentiate benign and malignant thyroid nodules. <b>Aim:</b> To evaluate role of DW-MRI in differentiating benign from malignant thyroid disease and to calculate ADC values of thyroid lesion/nodule on DW-MRI and correlate with FNAC/ histopathology findings. <b>Materials and Methods:</b> A prospective study was conducted in department of Radiodiagnosis, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. Total of fifty patients with neck swelling diagnosed clinically and confirmed on ultrasound were included. The patients underwent routine as well diffusion weighted MRI using b-values of 0,400 and 800 mm2 /sec. Their ADC values were calculated and were finally correlated with histopathological findings. Statistical analysis was done using SPSS v.21 and a p-value of <0.05 was considered as significant. <b>Results:</b> The mean age of the patients was 41.8±13.9 years with maximum number of patients in the age group of 31 to 40 years. The mean ADC value of benign thyroid nodules (1.721×10-3mm2 /sec) was significantly higher than that of malignant thyroid nodules (1.075×10-3mm2 /sec) (p=0.01). The best cut-off value for distinguishing benign and malignant nodules was 1.371×10-3mm2 /sec with sensitivity, specificity, PPV an NPV of 93.75%, 91.17%, 83.33% and 96.87%, respectively. The accuracy of the study in differentiating benign from malignant thyroid lesions was 92%. <b>Conclusion:</b> DW-MRI due to its ability to probe the microstructure of the tumour, its short acquisition time, its high repeatability and safety is a new promising non-invasive imaging modality that can reliably differentiate between benign and malignant thyroid nodules and can help avoid unnecessary biopsies and consequently its hazards. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=TC01-TC04&id=13643 https://doi.org/10.7860/JCDR/2020/43405.13643 Chemopreventive Potential of Myrtenal in 7,12-Dimethylbenz(a) Anthracene Induced Experimental Oral Carcinogenesis in Golden Syrian Hamsters Rajamanickam Buddhan, Shanmugam Manoharan, Radhakrishnan Murali Naidu, Mohan Karthik, Mani Neelakandan <b>Introduction:</b> Oxidative stress has been associated with the pathogenesis of several diseases including cancer. Myrtenal, a monoterpene, has been shown to possess various therapeutic potentials including anti-inflammatory, hypolipidemic, antidiabetic and antioxidant properties. <b>Aim:</b> The present study utilises the status of oxidative stress and detoxification cascade markers to explore the chemopreventive potential of myrtenal in experimental oral carcinogenesis induced in Golden Syrian hamsters. <b>Materials and Methods:</b> Oral neoplasms were developed using 0.5% 7,12-dimethylbenz(a) anthracene (DMBA), three times a week for 14 weeks in the buccal pouch of Golden Syrian hamsters. the developed lesions were confirmed histopathologically as well differentiated squamous cell carcinoma. The status of oxidative stress markers {Thiobarbituric Acid Reactive Substances (TBARS)}, antioxidants {Superoxide Dismutase (SOD), Catalase (CAT), vitamin E, vitamin C, reduced glutathione (GSH), Glutathione Peroxidase (GPx)} and detoxification agents {cytochrome p450, cytochrome b5, Glutathione-S-Transferase (GST), Glutathione Reductase (GR), oxidised glutathione (GSSG), DT diaphorase} were determined using suitable colorimetric assays. The statistical comparison between the experimental groups was done by one-way analysis of variance followed by Duncan’s multiple range test. <b>Results:</b> Topical application of DMBA not only resulted in tumour formation but also caused severe biochemical abnormalities in both plasma and buccal mucosa of Golden Syrian hamsters. Myrtenal administration (230 mg/kg bw p.o) to the hamsters painted with DMBA, suppressed or inhibited the formation of tumours and restored the status of oxidative stress markers and detoxification agents as well. <b>Conclusion:</b> The present study thus concludes that the chemopreventive efficacy of myrtenal is either due to its antilipid peroxidative efficacy or due to its modulating effect on the detoxification agents towards the inhibition of oral carcinogenesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=XC01-XC06&id=13644 https://doi.org/10.7860/JCDR/2020/43399.13644 Minimum Inhibitory Concentration of Vancomycin against Methicillin Resistant <i>Staphylococcus aureus</i> Strains Isolated from a Tertiary Care Hospital Subi Das, Prithi Nair Kannambra <b>Introduction:</b> Methicillin Resistant <i>Staphylococcus aureus</i> (MRSA) is one major healthcare associated infection. Prevalence of MRSA and its antibiotic susceptibility changes from time to time. Disc diffusion method remains the most widely used antibiotic susceptibility method in routine clinical laboratories but MIC detection is essential for checking susceptibility to Vancomycin. <b>Aim:</b> To detect MRSA isolates both by disc diffusion method and Minimum Inhibitory Concentration (MIC) method using E-test, their susceptibility to common antibiotics. <b>Materials and Methods:</b> A cross-sectional study was conducted on different samples for culture and sensitivity in the microbiology laboratory of a tertiary care centre for six months. Antibiotic susceptibility testing was done in <i>Staphylococcus aureus</i> isolates by disc diffusion method in Mueller Hinton agar. Cefoxitin and Vancomycin MICs of different isolates were detected. Frequencies of MRSA isolates from different clinical samples and their susceptibility to various common antimicrobial agents such as Penicillin (10 units), Cefoxitin (30 &#956;g), Erythromycin (15 &#956;g), Clindamycin (2 &#956;g), Cotrimoxazole (1.25/23.75 &#956;g) and Linezolid (30 &#956;g) were determined. Data were analysed using the IBM SPSS version 23. Descriptive statistics were used. <b>Results:</b> Total 353 <i>S.aureus</i> isolated over six months period, 100 were Methicillin Resistant (28.3%). A 66% were from males and 34% were from females. MIC50 of Cefoxitin was found to be 16 while the Vancomycin MIC50 was 0.38 and Vancomycin MIC90 was 0.25. <b>Conclusion:</b> Percentage of MRSA out of <i>S. aureus</i> isolates was 28.3%. Pus swabs were the major sample. All the MRSA isolates had a Vancomycin MIC &#8804;1.5 &#956;g/mL. E-test has the advantage of detecting even minor changes in MIC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=DC01-DC05&id=13645 https://doi.org/10.7860/JCDR/2020/43696.13645 Relationship between Vitamin D and Mental Health among Dental Students in Saudi Arabia: A Descriptive Cross-Sectional Study Abdulrahman A Al-Atram, Gunapriya Ragunath, S Karthiga Kannan <b>Introduction: </b>Vitamin D is a unique neuro-steroid hormone, which has significant effects on mood disorders such as depression and anxiety. <b>Aim:</b> To determine the prevalence of vitamin D deficiency, depression, and anxiety among University Dental students. <b>Materials and Methods:</b> A descriptive cross-sectional study was carried out during the academic year 2018 January to March using a simple, randomised sampling method. Hundred students at different academic levels and grades from College of Dentistry, Majmaah University in Saudi Arabia were a part of the study. Blood samples were collected to record 25- hydroxyvitamin D 25(OH)D levels. A validated Arabic Behaviour Rating Scales was used to measure depression and anxiety. The Grade Point Average (GPA) score of each student was also recorded. <b>Results:</b> Vitamin D deficiency was prevalent in 89% of the students, with a mean value of 10.24 ng/mL. Anxiety levels were observed in 62% of the students and the anxiety levels ranged between 29% (moderate) and 33% (severe). Vitamin D deficiency was found to be positively correlated with anxiety (r=0.459 with p=0.001) and GPA scores (r=0.282 with p-0.004) although no significant correlation between Vitamin D deficiency and depression was observed (r=0.173, p-0.07). <b>Conclusion:</b> Vitamin D deficiency showed significant correlation with anxiety and GPA scores, but no correlation with depression among the students of Majmaah University (dental faculty). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=VC07-VC10&id=13646 https://doi.org/10.7860/JCDR/2020/43248.13646 Clinical Characteristics, Laboratory Profile and Outcome of Children with <i>Vibrio Cholerae</i> Gastroenteritis (Both O1 and Non-O1/Non-O139) and <i>Vibrio Cholerae</i> (Non-O1/Non-O139) Bacteraemia- A Retrospective Single Centre Study Leenath Thomas, Shalini Anandan, Valsan Philip Verghese, Veeraraghavan Balaji, S Mahasampath Gowri, Anila Chacko, Anu Punnen, Winsley Rose <b>Introduction:</b> <i>Vibrio cholerae</i> (<i>V. cholerae</i>) infection (O1, O139, and non-O1/non-O139) in children can occur in the form of gastroenteritis and bacteraemia. <b>Aim:</b> To describe and compare the clinical characteristics, laboratory profile and outcome of children with gastroenteritis due to <i>V. cholerae</i> O1, O139 and <i>V. cholerae</i> non-O1/non-O139 and to present a case series describing the clinical and laboratory profile and outcome of children with <i>V. cholerae</i> non-O1/non-O139 bacteraemia. <b>Materials and Methods:</b> A retrospective study was conducted on the medical records of children under 15 years of age in whom <i>V. cholerae</i> was identified in stool culture or blood culture. The children who presented from January 2010 to November 2018 in Christian Medical College and Hospital, Vellore, India were included. The following details were noted: symptoms and signs (including vital signs and state of dehydration) at presentation, co-morbidities, anthropometry, complete blood counts, serum electrolytes, creatinine, reports of stool culture, blood culture and antibiotic susceptibility, details of treatment given (including hospital admission, IV fluids and antibiotics) and outcome. The group-wise comparison for continuous variables was done using Independent t-test. The categorical data among the groups were compared using the chi-square test. <b>Results:</b> Among the 8990 stool cultures and 1,23,005 blood cultures done in children during the study period for various reasons, <i>V. cholerae</i> had grown in stool culture of 105 children and blood culture of 6 children. Children with <i>V. cholerae</i> O1 were more tachypnoeic/acidotic (44.8% vs. 10.0%; p<0.001), had dehydration and shock (65.5% vs. 6.6%; p<0.001) at presentation and required hospital admission more often (87.3% vs. 18.1%, p<0.001) compared to <i>V. cholerae</i> non-O1/non-O139. Both isolates in stool culture were susceptible to cefotaxime, norfloxacin and tetracycline. All 6 children with <i>V. cholerae</i> non-O1/non-O139 bacteraemia had co-morbidities and 66% of them had chronic liver disease. About 50% of these children (n=3) succumbed to the illness in the first week of illness itself and 2 of them were infants. <b>Conclusion:</b> The gastroenteritis due to <i>V. cholerae</i> O1 was more severe than that with <i>V. cholerae</i> non-O1/non-O139. Children with chronic liver disease and immunodeficiency were particularly susceptible to non-O1/non-139 <i>V. cholerae</i> bacteraemia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=SC01-SC06&id=13647 https://doi.org/10.7860/JCDR/2020/43621.13647 Knowledge, Attitude and Practice of Green Dentistry among Dental Professionals of Bhopal City: A Cross-sectional Survey Shivangi Verma, Ankur Jain, Ruchi Thakur, Satish Maran, Anaya Kale, Krishna Sagar, Sapna Mishra <b>Introduction:</b> Eco-friendly dentistry is an environment friendly way of practicing dentistry. It reduces wastage, conserves energy and decreases pollution. <b>Aim:</b> The aim of this study is to assess the awareness and practices regarding eco-friendly dentistry among dental professionals of Bhopal city. <b>Materials and Methods:</b> A cross-sectional survey was conducted among 200 dental professionals of Bhopal city to assess their knowledge and practice regarding eco-friendly dentistry. A modified predesigned questionnaire was used to collect the information of eco-friendly dentistry which consisted of 20 questions. Data was analysed with Statistical Package for Social Sciences (SPSS) version 21, IBM Inc by using chi-square test and p<0.05 was fixed as the level of significance. <b>Results:</b> The study included 200 participants of which 65 were pursuing post graduation (PG Students), 40 were practicing postgraduates (MDS) and 95 were practicing graduates (BDS). The term green dentistry was heard before by 21 (52.5%) Postgraduates, 46 (48.4%) graduates and 53 (81.5%) PG Students. Lack of enough knowledge regarding green dentistry was the prime factor that influenced the adoption of green dentistry between study subjects. <b>Conclusion:</b> The current study revealed that knowledge, awareness and practice regarding green dentistry were not up to the mark. As dentistry is a profession that consumes a lot of resources and in a country like India where water and electricity are deficient in many parts thus conservation of resources is paramount. This goal can only be achieved when all dentists have adequate knowledge regarding eco-friendly dentistry. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ZC09-ZC13&id=13637 https://doi.org/10.7860/JCDR/2020/43406.13637 A Study of Agreement between Histopathological and Clinico-Radiological Diagnosis of Bone Tumours and Tumour-like Lesions Pallavi Patil, Sulata Kamath, DC Sundaresh <b>Introduction:</b> Bone lesions are diverse and can develop at any site in the bone. They can be non-neoplastic or benign or malignant neoplasms. These neoplasms are most commonly developed during the first few decades of life, but this is not the thumb rule. Bone lesions differ in their clinical and histopathological features, posing diagnostic challenges. <b>Aim: </b>To analyse the level of agreement between the initial clinicoradiological and the subsequent histopathological diagnosis of bone tumours and tumour-like lesions. <b>Materials and Methods:</b> This prospective study was carried out in the Department of Pathology at Ramaiah Medical College and Hospital, Bengaluru, Karnataka, from May 2009 to April 2011 over a period of two years, including analysis performed over a period of month. Data presentation was done in bivariate tables and to understand association between diagnostic entities kappa statistics was estimated and interpreted. <b>Results:</b> In this study, 64 cases consented to be included for the concurrence study. It was observed that among the total number of cases, males were more frequently affected than females, with a ratio of 2.2:1. The peak age of incidence for bone lesions was found to be the second and third decade of life, accounting for 32.3% (n=30) of all cases. Pain with swelling constituted the most common presenting feature (n=28, 43.8%). Osteogenic (n=17, 25%) and Giant cell (n=17, 25%) tumours were the commonest lesions. Kappa statistical coefficient of 0.749 was observed, showing substantial concurrence between the histopathological and radiological diagnosis. <b>Conclusion:</b> The present study revealed that there was a reliable agreement between clinico-radiological and histopathological diagnosis. Histopathological confirmation of radiological diagnosis should be performed before conclusive treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=EC12-EC17&id=13638 https://doi.org/10.7860/JCDR/2020/43408.13638 Clinical Profile of Acute on Chronic Liver Failure Patients in a Tertiary Care Centre Nishant Saxena, Anuj Singhal, Shankar Subramanian, Arun Kumar Yadav, Ashita Mathur <b>Introduction:</b> Human dental enamel is made of hydroxyapatite crystals and fluorapatite combined with traces of delta calcium metaphosphate. Topical fluoride interacts with saliva and forms Calcium Fluoride (CaF) compounds on enamel which acts as a barrier in demineralisation process of caries formation. <b>Aim:</b> To evaluate and compare the anti-microbial efficacy against S. mutans and enamel surface microhardness after application of two fluoride varnishes containing Casein PhosphopeptideAmorphous Calcium Phosphate (CPP-ACP) and xylitol coated calcium phosphate ions as active ingredients. <b>Materials and Methods:</b> This was an in-vitro study involving one parameter on agar discs and one parameter on human enamel samples from November 2019 to January 2020. The antimicrobial efficacy of MI Varnish (GC Dental) and Embrace Varnish (Pulpdent) was comparatively assessed. Ten wells of each varnish were assessed using disc diffusion method on Trypticase-Yeast Cysteine-Sucrose-Bacitracin (TYCSB) agar plate. Zone of inhibition around each sample was measured after 48 hours of agar plate anaerobic incubation and the value was recorded using digital Vernier calliper. The change in enamel surface microhardness with and without application of fluoride varnish was assessed using Vickers Microhardness method on 30 samples. The results were compiled and compared using ANOVA. <b>Results:</b> MI Varnish showed the higher antibacterial effects, compared to Pulpdent Embrace Varnish against S. mutans (p<0.05). The MI Varnish group showed significantly high value of enamel surface microhardness as compared to Pulpdent Embrace group and Control group (p<0.05). <b>Conclusion: </b>MI Varnish showed higher anti-bacterial efficacy as compared to Pulpdent Embrace Varnish against S. mutans by disc diffusion method on TYCSB agar. The surface microhardness of enamel group treated with MI Varnish was significantly greater than Pulpdent Embrace and control group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=OC12-OC15&id=13639 https://doi.org/10.7860/JCDR/2020/43449.13639 Time Course of Changes in Leptin Levels and their Relationships with Oxidant Status Biomarkers in Pregnant Women with Obesity Nassima Malti, Hafida Merzouk, Loubna Bouhmama, Meriem Saker, Mourad Elhabiri, Sabri Cherrak <b>Introduction:</b> Changes in leptin signaling during obesity are emerging as a potential risk factor leading to pregnancy complications. Increased oxidative stress may also contribute to the adverse outcomes associated with pregnancy in obese women. Although hyperleptinemia and oxidative stress are risk factors of pregnancy complications during obesity, their relationships have not yet been clarified. <b>Aim:</b> To explore the association between leptin and oxidative stress status in maternal obesity and to evaluate the prediction of oxidant biomarkers by maternal leptin in first trimester. <b>Materials and Methods:</b> This longitudinal study included 60 obese pregnant women and 80 controls who were followed during the three trimesters of pregnancy. Oxidative stress parameters such as nitric oxide (NO), superoxide anion (O<sub>2</sub>), peroxynitrite, Malondialdehyde (MDA), hydroperoxides, and Protein Carbonyl (PC) contents were measured spectrophotometrically. Serum leptin was measured by ELISA assay. Association between leptin and oxidative stress parameters was performed by multiple regression analysis. <b>Results:</b> Plasma leptin (more than 40%) and oxidant marker concentrations (more than 25%) were significantly higher in obese mothers compared to control subjects from the first to the last trimester. Two-way repeated measures ANOVA revealed a significant effect for obesity and time on leptin and oxidant levels (F-values 10.42 to 185.25 for obesity effect and 3.01 to 49.35 for time effect; p<0.01). Leptin concentration was correlated to all oxidant markers (p<0.0008) and explained in general 22 to 52% of their variation. Leptin level measured in the 1<sup>st</sup> trimester permitted estimation of 3<sup>rd</sup> trimester hydroperoxide, O<sub>2</sub>, NO, MDA, PC and peroxinitrite concentrations (p-value<0.0001) and accounted for 77.30 to 94.70% of their variation. <b>Conclusion:</b> Obesity during pregnancy is characterised by high concentrations of leptin and oxidant markers. The leptin levels could be used to predict oxidative stress in late gestation. An early identification of women with increased risk of oxidative stress may provide a window of opportunity to improve redox status by antioxidant supplementation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=CC01-CC05&id=13640 https://doi.org/10.7860/JCDR/2020/43475.13640 Clinical Prescribing Philosophies Survey for Hyperopia in Riyadh Farah Maqsood, Zainab A Alhawas <b>Introduction:</b> The prescribing philosophies of medical practitioners differ from group to group and place to place. To study the differences might be useful in developing standards of practice to improve outcomes. <b>Aim:</b> In this survey-basedstudy, Riyadh optometrists were surveyed to evaluate the prescribing philosophies for asymptomatic hyperopic children. <b>Materials and Methods:</b> The optometrists were selected from the reputed hospitals of ophthalmology/optometry clinics in Riyadh. They were given the survey of Lyons SA. Sixty surveys were given to the responsible authorities of eight hospitals for the distribution to their optometrists. The survey questionnaire included questions about the amount of hyperopia and anisometropia in asymptomatic children. The questions were included for three age groups; 6 months, 2 years, and 4 years. <b>Results:</b> A total of 26 surveys (43.3%) were returned and analysed. For six-month-old infants the majority of Riyadh optometrists reported that they prescribe for more than 3D (38.5%), and for more than 5D (27%) of hyperopia. As for two-year-old children 73% of Riyadh optometrists reported to prescribe for asymptomatic hyperopia more than 3D. Majority of Riyadh optometrists (73%) reported that they would consider prescribing for more than 3D of hyperopia for asymptomatic four-year-old children. <b>Conclusion:</b> A general understanding of the prescribing philosophies of optometrists in Riyadh found a lack of consensus on prescribing philosophies for hyperopic children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=NC01-NC04&id=13621 https://doi.org/10.7860/JCDR/2020/43162.13621 Correlation between Epicardial Fat Thickness and Severity of Coronary Artery Disease in Diabetic Patients- A Prospective Observational Study Vignesh Gopu, Tumbanatham Apikkatla <b>Introduction:</b> People with diabetes are at high risk of Coronary Artery Disease (CAD) duration of diabetes is directly proportional to macro vascular complications. Epicardial fat through its various mechanism and anatomical closeness to the myocardium it has the direct impact on the severity of CAD. <b>Aim:</b> To determine the correlation between EFT and severity of CAD in diabetic patients using syntax scoring system. <b>Materials and Methods:</b> This prospective observational study was done on 100 diabetics who were admitted and treated in study institution for CAD. Epicardial Fat Thickness (EFT) was measured with 2D-ECHO, severity of CAD calculated with syntax-2 scoring system. Pearson correlation test was carried out to find the correlation between EFT and CAD. <b>Results:</b> The mean age of the study population was 54.22 years. The mean EFT was 4.35 mm. The minimum thickness was 2.50 mm and the maximum thickness was 6.20 mm. Among the study population, based on SYNTAX-2 score, 53 cases had moderate CAD accounting for 53%; 30% of the cases had mild CAD and 16% of the cases had severe CAD. Among the 30 cases with mild CAD, the mean EFT was 4.09 mm, Among the 53 cases with moderate CAD, the mean EFT was 4.36 mm, Among the 16 cases with severe CAD, the mean EFT was 4.89 mm. The increased thickness of epicardial fat was found to have a direct correlation with the severity of CAD. <b>Conclusion:</b> It can be concluded that EFT has significant correlation with severity of coronary artery disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=OC09-OC11&id=13622 https://doi.org/10.7860/JCDR/2020/43382.13622 Outcomes of Arteriovenous Fistula and Arteriovenous Graft in Patients on Maintenance Haemodialysis in a Tertiary Care Centre Elayaperumal Indhumathi, Srivatsa Angraje, Jayakumar Macha <b>Introduction:</b> Arterio-Venous (AV) fistula is the preferred choice of vascular access in all haemodialysis patients but AV graft may be an alternate option in selective patients. <b>Aim:</b> To compare and evaluate the primary and cumulative patency of patients with AV Fistula (AVF) and AV Graft (AVG) undergoing maintenance haemodialysis. <b>Materials and Methods:</b> This was a retrospective study of the data of 32 patients with AVG and 63 patients with AVF between November 2013 and December 2018. Primary survival and cumulative patency between AVF and AVG were compared using Kaplan Meier survival curves and Log Rank tests. Sixty three patients with AVF (66.3%) and 32 with AVG (33.7%) were included for the study. <b>Results:</b> AVF group had more males (47.6%) compared to AVG group (37.5%) but the mean age in both the groups was almost similar with 57.1 and 57.2 years respectively. Primary survival was longer for AVF than AVG (34.1 vs 25.1 months; HR-3.85; 95% CI: 1.696-8.752; p=0.001). Thrombosis occurred more in AVG than AVF (59.4% vs 28.6%; p=0.007) and hence required more interventions (40.6% vs 12.7%; p=0.003). Interventions were more salvageable in AVG group compared to AVF (34.4% vs 11.1%; p=0.01). Infections were seen only in AVG (15.6% vs Nil; p=0.003). Total cumulative patency did not show significant difference between groups (38.5 months vs 33.3 months; HR-1.508; 95% CI 0.8-2.6; p=0.152). Mortality was high in patients with AVG compared to AVF (18.8% vs 4.8%; p=0.05). <b>Conclusion:</b> Based on the study findings it can be stated that AVF has better primary access survival compared to AVG and graft requires more interventions which are more salvageable than fistula. Total cumulative patency between fistula and graft do not differ significantly. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=OC05-OC08&id=13615 https://doi.org/10.7860/JCDR/2020/43695.13615 In-vitro Comparison of Anti-microbial Efficacy and Enamel Microhardness after Application of Two Types of Fluoride Varnishes Shreya Arun Bapat, ND Shashikiran, Sachin Gugawad, Namrata Gaonkar, Swapnil Taur, Savita Hadakar, Pradnya Chaudhari <b>Introduction:</b> Human dental enamel is made of hydroxyapatite crystals and fluorapatite combined with traces of delta calcium metaphosphate. Topical fluoride interacts with saliva and forms Calcium Fluoride (CaF) compounds on enamel which acts as a barrier in demineralisation process of caries formation. <b>Aim:</b> To evaluate and compare the anti-microbial efficacy against S. mutans and enamel surface microhardness after application of two fluoride varnishes containing Casein PhosphopeptideAmorphous Calcium Phosphate (CPP-ACP) and xylitol coated calcium phosphate ions as active ingredients. <b>Materials and Methods:</b> This was an in-vitro study involving one parameter on agar discs and one parameter on human enamel samples from November 2019 to January 2020. The antimicrobial efficacy of MI Varnish (GC Dental) and Embrace Varnish (Pulpdent) was comparatively assessed. Ten wells of each varnish were assessed using disc diffusion method on Trypticase-Yeast Cysteine-Sucrose-Bacitracin (TYCSB) agar plate. Zone of inhibition around each sample was measured after 48 hours of agar plate anaerobic incubation and the value was recorded using digital Vernier calliper. The change in enamel surface microhardness with and without application of fluoride varnish was assessed using Vickers Microhardness method on 30 samples. The results were compiled and compared using ANOVA. <b>Results:</b> MI Varnish showed the higher antibacterial effects, compared to Pulpdent Embrace Varnish against S. mutans (p<0.05). The MI Varnish group showed significantly high value of enamel surface microhardness as compared to Pulpdent Embrace group and Control group (p<0.05). <b>Conclusion: </b>MI Varnish showed higher anti-bacterial efficacy as compared to Pulpdent Embrace Varnish against S. mutans by disc diffusion method on TYCSB agar. The surface microhardness of enamel group treated with MI Varnish was significantly greater than Pulpdent Embrace and control group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ZC05-ZC08&id=13627 https://doi.org/10.7860/JCDR/2020/43917.13627 Clinicopathological Study of Hashimoto Thyroiditis Pooja Jain, Geetha Vasudevan, Kanthilata Pai <b>Introduction:</b> Thyroiditis comprises various group of disorders with some form of thyroid inflammation. Hashimoto thyroiditis is the most common and clinically significant type of thyroiditis seen commonly in middle age females and also one of the most common cause of goitre seen in iodine sufficient regions. Endemic goitre a major health problem, still prevalent in various regions of india even after implementation of widespread national salt iodisation programme by Government of India. This study performed in tertiary centre of western coastal area where seafood is the staple diet of large number of people and inspite of widespread use of iodised salt large number of patients dignosed with HT. The proposed study is intended to further establish the role of histopathological study along with its correlation with clinical, biological and radiological parameters in the diagnosis of Hashimoto thyroiditis. <b>Aim: </b>To record the morphological features along with its correlation with clinical, biochemical and ultrasonographic picture of this disease in western coastal endemic area for goitre and document morphological variation, if any and also to identify any thyroid neoplasm that may develop in the background of HT. <b>Materials and Methods:</b> In this retrospective study records of patients with histological diagnosis of Hashimoto thyroiditis was conducted with respect to their clinical presentation, thyroid profile, antibody titre and ultrasonographic features. <b>Results:</b> A total 55 patients with histopathological diagnosis of HT were included in the study. The histological slides were reviewed and reclassified into two groups based on hurthle cell change. Thus, 35 cases were diagnosed as HT while remaining were categorised as chronic lymphocytic thyroiditis. Ninety seven percent of patients were females and majority of them presented within 5 years of onset of symptoms. An amount of 68% patients had diffuse goitre, 33% were clinically euthyroid and 60.6% were biochemically hypothyroid. Antibody titre were elevated in 78% patients. In most of the cases USG picture showed hypoechogenecity with increased vascularity. Histopathological features were diagnostic and characteristic. <b>Conclusion:</b> In the present study majority of patients were females in the middle age group with clinical presentation of diffuse goitre and inspite, of widespread use of iodised salt in this studied population large number of patients diagnosed with Hashimoto thyroiditis. Therefore, author conclude that all females of middle age group in an endemic area for goitre should be screened and also histologically confirmed by biopsy for this thyroiditis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=EC01-EC05&id=13628 https://doi.org/10.7860/JCDR/2020/41227.13628 Evaluation of High Risk Pathological Features with Regards to HPV Status in Squamous Cell Carcinoma of Head and Neck Monica Gupta, Nirav Asarawala, Meera Khoont, Hetal J Joshi <b>Introduction:</b> Positivity for Human Papilloma Virus (HPV) is an important prognostic factor and is associated with a favourable outcome in Head and Neck Squamous Cell Carcinoma (HNSCC). Patients with HPV positive tumours have a better response rate after chemo-radiotherapy. These patients have improved overall survival rates, a low risk of progression and death from any cause as in comparision to those with HPV negative tumours. There are few Indian studies related to HPV status in head and neck cancer patients, and none of them have been reported from Gujarat. <b>Aim:</b> To study the incidence of HPV and to evaluate its histopathological features in HNSCC patients who have been treated with an intention to cure at Manibhai Shivabhai Patel Cancer Centre, Shree Krishna Hospital, Karamsad, Gujarat, India. <b>Materials and Methods:</b> This was a retrospective study of 100 cases who underwent treatment for HNSCC at our cancer centre from January 2014 to January 2016. Details of clinical history and histopathological findings were recorded. Representative sections block from the tumour were sent to Gene Lab, Surat for HPV DNA PCR study. Results were analysed statistically by using STATA 14 software for Windows 7 and Microsoft Excel 2007. <b>Results:</b> Out of 100 cases 11 cases (11%) were positive for HPV. Of these 6 patients (54.54%) were in age group 30-49 years, 10 patients (90.90%) were male, 10 patients (90.90%) had a habit of tobacco chewing. Out of 11 tumours, 7 (63.63%) were ulceroproliferative on gross appearance, 3 (27.27%) involved the tongue and 3 (27.27%) involved the buccal mucosa, 6 (54.54%) were well differentiated tumours, 4 (39.08%) showed lymph node metastasis, 4 (36.36%) were stage IV disease. <b>Conclusion:</b> HPV is an aetiological agent in development of HNSCC. HPV positive HNSCC occur in middle aged men with a habit of tobacco chewing, early T category and N category as compared to HPV negative HNSCC. HPV positive SCC were predominately keratinising SCC and have marginally better prognosis, survival and response to treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=EC06-EC11&id=13629 https://doi.org/10.7860/JCDR/2020/42660.13629 A Cross-sectional Study on Patterns of Social Media Chat Usage and its Association with Psychiatric Morbidity among Nursing Students Hemavathi Hamsa, Savinder Singh, Rajdeep Kaur <b>Introduction:</b> The nursing students are a particularly vulnerable group based on amount of the time they spend on the internet especially with social media. There are numerous social media chatting system available and the most commonly used in our region is whatsapp therefore the present study has been carried out on WhatsApp usage. <b>Aim:</b> To study the patterns of WhatsApp usage and its association with Psychiatric morbidity among the nursing students. <b>Materials and Methods:</b> A cross-sectional study was conducted on 500 nursing students who met the inclusion criteria was recruited. Levels of usage of Social Media and associated psychiatric morbidity were assessed for WhatsApp usage which was measured using Bergen&#8217;s Facebook Addiction Scale modified for WhatsApp usage. Life-satisfaction was assessed using Satisfaction with Life Scale and Self-Esteem was assessed using Rosenberg Self-Esteem Scale. Negative emotional states like Depression, Anxiety and Stress was assessed using Depression Anxiety Stress Scales (DASSs). Loneliness was assessed using Differential Loneliness Scale. The results obtained were tabulated and statistically analysed using Pearson&#8217;s association Chi Square test and Spearman&#8217;s correlation test. <b>Results:</b> The nursing students belonging to middle socio-economic status, from nuclear families were less lonely, having high satisfaction with life and self esteem, were more addicted to WhatsApp usage. Almost 2/3rd of the students having average academic performance interested in more creative hobbies than physical activity suffered from depression, anxiety and stress due to WhatsApp addiction. <b>Conclusion:</b> WhatsApp dependence was most commonly seen among nursing students and had highly significant correlation with the associated psychiatric morbidity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=VC01-VC06&id=13630 https://doi.org/10.7860/JCDR/2020/43023.13630 A Comparative Study of the Feasibility of External Jugular Vein Cannulations versus Internal Jugular Vein Cannulations in Patients Undergoing Elective Surgical Procedures Zulfiqar Ali, Abdul Waheed Mir, Shahid Ahmad Mir, Nelofar Hassan, Abrar Ahad Wani <b>Introduction:</b> The Internal Jugular Vein (IJV) and subclavian vein cannulations are mainly performed in daily clinical practice. Although success rates for IJV and subclavian veins are high, still the complications are not infrequent. The External Jugular Vein (EJV) approach to the subclavian vein is less taught and less practiced. The fear of frequent failures has discouraged the practitioners from using this approach. <b>Aim:</b> To compare the success rate, number of attempts, and complications associated with IJV and EJV catheterisations. <b>Materials and Methods:</b> A total of 160 patients, requiring central venous catheterisation for various surgical procedures were randomly divided into two groups. Patients in group I (n=80) underwent right IJV catheterisation and patients in group E (n=80) underwent right EJV catheterisation. The number of attempts for cannulation, success or failure of catheterisation and any complications associated with the procedure or in the post-operative period were noted in each group. The data was compared between the two groups by using Chi-square test and Student’s Independent samples t-test. <b>Results:</b> The right IJV was successfully cannulated in 90% while as the right EJV was successfully cannulated in 70% of the patients (p=0.05). All cannulations were done by the same anaesthesiologist. Malpositioning of catheter was noted in eight patients in Group E while five patients had malpositions in Group I. Pneumothorax was encountered in two patients, and carotid artery puncture in three patients from group I. <b>Conclusion:</b> The rate of success for IJV was better than the EJV. The complication rate of pneumothorax and carotid artery injury was more with IJV than EJV. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=UC06-UC09&id=13631 https://doi.org/10.7860/JCDR/2020/44085.13631 Lipid Profile and C-Reactive Protein Levels in Healthy, Overweight and Obese Adults: A Hospital-based Observational Study Vaneet Kaur, Himanshu Madaan, Meenakshi Puri, Pawan Kumar Kare <b>Introduction:</b> Numerous biomarkers involved in inflammation have been associated with cardiovascular events, out of which high sensitivity-C-Reactive Protein (hs-CRP), an acute-phase protein, appears to be the most promising. The association between dyslipidaemia and obesity is well established in literature and has been found to be risk factor for Cardiovascular Disease (CVD). <b>Aim:</b> To study the levels of lipid profile and hs-CRP and also find out the relationship between hs-CRP and Body Mass Index (BMI) in obesity. <b>Materials and Methods:</b> The present observational study was carried out from June 2018 to August 2018 in Kalpana Chawla Government Medical College, Haryana, India. A total of 100 apparently healthy volunteers, aged 21-60 years were enrolled for this study. The participants were divided on the basis of BMI into three groups; Healthy (normal): 18.5-22.9 kg/m<sup>2</sup>, overweight: 23-24.9 kg/m<sup>2</sup>, and obese &#8805;25 kg/m<sup>2</sup>. Anthropometric measurements and biochemical investigations were conceded in all the study participants. Lipid profile and hs-CRP levels were estimated on fully automated clinical chemistry analyser. Statistical analysis was conducted using IBM SPSS statistics (version 22.0). A p<0.05 was considered as significant level. <b>Results:</b> The median levels of HDL were the lowest in the obese group and a statistically significant difference was observed in HDL levels between healthy and obese group (z=3.190, p=0.001) and between overweight and obese group (z=2.760, p=0.006). The median hs-CRP levels were highest in the obese group and statistically significant difference was observed between healthy and overweight group (z=2.009, p=0.044) and between healthy and obese group (z=2.849, p=0.004). A significant positive correlation was observed between BMI and hs-CRP levels (r=0.302, p<0.002). It was further observed that 17 subjects of obese group had hs-CRP levels greater than 3 mg/L as compared to eight of healthy group and nine of overweight group. <b>Conclusion:</b> The subjects of the obese group are at the highest risk of CVD. Hence, they need to be considered for future development. However, abnormalities of lipid metabolism were not observed in the obese study subjects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=BC01-BC04&id=13632 https://doi.org/10.7860/JCDR/2020/43462.13632 Traumatic Optic Neuropathy: Early Detection and Intervention in a Tertiary Care Centre Arino John, Andrews CV Kakkanatt, Monsy Thomas Mathai, Babu Urumeese Palatty, NI Kurian, Aiswarya Sasidharan <b>Introduction:</b> Acute injury to the optic nerve resulting in vision loss is known as Traumatic Optic Neuropathy (TON). Optical Coherence Tomography (OCT) documents the progression of damage of axons over time. <b>Aim:</b> To assess visual outcome of patients diagnosed with TON after management with intravenous (IV) steroids and to study Retinal Nerve Fiber Layer (RNFL) using OCT in patients with TON. <b>Materials and Methods:</b> An observational prospective study was conducted in a tertiary care centre, including 29 TON patients. IV steroids, methylprednisolone was administered in indirect TON patients. RNFL was assessed using OCT on the day of discharge. Follow-up for one week and one month after discharge. Paired t-test/Wilcoxon sign rank test was applied to test the mean differences of the study. <b>Results:</b> Patients treated with IV, steroids showed significant improvement over time. Patients with just Perception of Light (PL) or Hand Movements (HM+) did not show much improvement. Another factor for visual recovery was timing of steroid administration. The time limit was within 24 hours after the injury before full-fledged inflammation sets in. RNFL study using OCT showed reductions in circumpapillary RNFL thickness and Retinal Ganglion Cell (RGC) complex began to decrease at two weeks after trauma and plateaued at 20 weeks in all cases. <b>Conclusion:</b> IV steroids can be considered as a treatment of TON rather than wait for spontaneous recovery. But baseline visual acuity played a crucial role in recovery. OCT is a useful follow-up tool to analyse axonal loss. But a standard protocol is still lacking. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=NC05-NC08&id=13633 https://doi.org/10.7860/JCDR/2020/43600.13633 Study of Maternal Near Miss and Maternal Mortality in a Tertiary Care Hospital Sanju Kumari, Garima Kapoor, Manjula Sharma, Bindu Bajaj, Rupali Dewan, Banashree Nath <b>Introduction:</b> There are several advantages of using Severe Acute Maternal Morbidity (SAMM) as a tool compared to maternal mortality as an indicator of obstetric care. The health personnel are more forthcoming in giving detailed treatment information as there is no threat of punitive liability. Hence, over the last decade, there is a gaining momentum to use Maternal Near Miss as an indicator of obstetric care. However, unlike maternal deaths, it often becomes difficult to define maternal near miss cases. Ministry of Health and Family Welfare, India, have recently laid down Operational guidelines to define and report MNM cases in the country. Being a relatively new guideline, there is paucity of well designed, prospective studies using Near miss definition as per it. <b>Aim:</b> To determine the incidence and cause of MNM cases and Maternal deaths in a tertiary care hospital and identify gaps in the existing Health system in India and determine an approach to resolve them. <b>Materials and Methods: </b>An Audit of Maternal Death and MNM cases was undertaken in a Safdarjang hospital in Delhi, India from October 2015 to December 2016. During this study period, all the women who met the criteria according to MNM Operational Guidelines were identified and enrolled in the study; specially the potentially life-threatening conditions were selected. The MNM indices were calculated. In data analysis, for qualitative data, proportions were calculated. Mean score was calculated for quantitative data. Test of significance of differences between proportions and mean were calculated. Qualitative data was analysed by Chisquare test and t-test was applied for quantitative data. <b>Results:</b> There were 31,925 deliveries at the Institute. The MNM IR (Maternal Near Miss Incidence Ratio) in this study was 8/1000 live births and the MMR was 421/100,000 live births. The MNM: MM ratio was 1.9:1. Overall Mortality Index (MI) was 34%. Severe Maternal Outcome Ratio (SMOR) was 12.2/1000 live births. Most common causes of MNM were haemorrhage (53.8%), hypertensive disorders of pregnancy (21.7%), medical disorders (13.3%) and obstetric sepsis (8.8%). Majority of Maternal deaths were due to direct obstetric causes (71.8%). The most common direct causes for maternal deaths were hypertensive disorders of pregnancy (31.2%). More number of women in the maternal death group (34.3% versus 27.7%) presented to the hospital with postpartum complications, however, the difference was not statistically significant. Illiteracy (p<0.01) and lower socio-economic status (p<0.0001) were associated with higher probability of maternal deaths. <b>Conclusion:</b> The most common cause of MNM was haemorrhage, mostly, post-partum haemorrhage. Mothers will benefit by up-gradation of the infrastructure of the peripheral health centres (like ensuring availability of blood banks, round the clock operation theatre facility, magnesium sulphate for seizure prophylaxis etc.,) along with a network of referral linkage to ensure speedy and appropriate referrals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=QC01-QC06&id=13634 https://doi.org/10.7860/JCDR/2020/42710.13634 Incidence and Risk Factors of Diaper Dermatitis in Hospitalised Children Aged 0-24 Months: An Epidemiological Descriptive Study in Iran Hajar Esmaeilzadeh, Arina Qolizadeh, Saeideh Hosseini, Kobra Norouzi, Maryam Mafi, Hossein Rafi <b>Introduction: </b>Diaper dermatitis can cause unpleasant complications for the child and the family. However very limited studies are reported on the topic. <b>Aim:</b> To investigate the incidence of diaper dermatitis and its risk factors in hospitalised children. <b>Materials and Methods:</b> A descriptive epidemiological study was conducted at Qazvin, Iran, total of 228 hospitalised children were studied. A structured questionnaire and face to face interviews regarding risk factors of diaper dermatitis were used for data collection at admission to the hospital. Skin examination was performed using the diaper dermatitis severity scale per 48 hour. Descriptive and inferential statistics were used for data analysis and the significant level was set as p<0.05. <b>Results:</b> The incidence rate of diaper dermatitis in children admitted to the hospital was 50.9%. The mean age of children was 6.43 months. 127 (55.7%) were male out of 228 participants. The type of ward, gender, history of dermatitis, type of nutrition, stool consistency, diaper changes for more than 5 times per day, increase in the frequency of defecation and the use of protective creams significantly affected the incidence of dermatitis. The multivariate logistic regression analysis showed that one of the most important risk factors were hospitalisation in the neonatal ward or neonatal intensive care unit, a previous history of diaper dermatitis, female gender and breast feeding. These factors predicted a total of 31%-42% of the incidence of diaper dermatitis. <b>Conclusion:</b> More than half of the children suffered from diaper dermatitis during hospital stay. The members of health care and treatment team should pay more attention to prevent this common skin problem in children. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=LC01-LC04&id=13618 https://doi.org/10.7860/JCDR/2020/41175.13618 Post-operative Sensitivity of Selective-etch and Total-etch Techniques in Composite Resin Restorations: An In-vivo Study Tony Francis, Nasil Sakkir, Htoo Htoo Kyaw Soe, Teh Yeong Yeow, Hoo Zhi Hwe, Adrienne Loh Ming Tze <b>Introduction:</b> Composite restorations placed using selectiveetch technique has been claimed to induce significantly lower postoperative sensitivity than a three-step etch and rinse technique. Selective-etch technique overcomes the main drawback of self-etch technique, which is suboptimal etching of mineralised enamel, by acid etching only the enamel prior to using the adhesive. The newer universal bonding agent can be used in a self-etch, selective-etch, or etch and rinse mode. <b>Aim:</b> To evaluate the influence of selective-etch versus totaletch techniques of using Scotchbond universal adhesive on the postoperative sensitivity in composite restorations placed by undergraduate students. <b>Materials and Methods:</b> Sixty patients with ICDAS code 4 or 5 cavities for composite restorations by undergraduate students were randomly allocated into two groups. Restorations were done using Filtek Z350 XT and Scotchbond™ Universal Adhesive. In total-etch group, the entire preparation was acid etched for 20 seconds, and rinsed with water spray for 15 seconds. In selective-etch group, only the enamel was acid etched for 20 seconds, and rinsed. The postoperative sensitivity of the restorations was evaluated preoperatively, immediately after treatment, 24 hours and 2 weeks after treatment. Sensitivity scores were generated from the patient’s response to a Visual Analogue Scale (VAS) having scores from 0 to 10. The results were statistically analysed using Mann Whitney U-test and Friedman test. The level of significance was set at p-value less than 0.05. <b>Results:</b> There was no significant difference in the sensitivity between total-etch and selective-etch groups pre-treatment and during three postoperative follow-up periods (p-value >0.05). However, there was statistically significant decrease in the sensitivity at 24 hours and 2 weeks after treatment when compared with baseline scores in both total-etch and selectiveetch groups (p-value <0.001). <b>Conclusion:</b> Both total-etch and selective-etch techniques of bonding using universal adhesive systems can be safely practiced by dental undergraduate students without the fear of developing postoperative sensitivity in patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=ZC01-ZC04&id=13619 https://doi.org/10.7860/JCDR/2020/42997.13619 Nutritional Status of School Age Children in Urban Slum Area in Vijayawada and Guntur Vaishnaw Twinkle, MC Das, V Prem Kumar <b>Introduction:</b> Nutritional deficiency may result in adverse health consequences. Socio-cultural practices, financial condition, awareness of parents and local factors influence the nutritional status. Malnutrition is one of the leading health issues in India. Aim: To assess the nutritional status of school age children and the influence of socioeconomic status on nutrition. <b>Materials and Methods:</b> A community based cross-sectional study was conducted among 208 numbers of school children (4-14 years) in Guntur and Vijayawada slum areas during July and August 2018. Semi-structured questionnaire was used to collect anthropometric and general data. Anthropometric measurements such as weight in Kg and height in cm were recorded. Chi-square test, unpaired t-test and Multivariate analysis were used to assess nutritional status at 5% level of significance. <b>Results: </b>The prevalence of stunted children (low height for age), Wasted children (low BMI for age) were 46.63% and 48.08%, respectively. The percentage of children with underweight (low weight for age), overweight (high BMI for age) were 68.27% and 4.80%, respectively. 53.85% underweight children belonged to lower socioeconomic status. No difference in prevalence was observed among boys and girls for stunting and underweight (p>0.05). The mean heights of normal and stunted children were significantly different (p<0.01). The mean weights of normal and underweight were significantly different (p<0.01). The mean BMIs of normal and wasted children were significantly different (p<0.01). <b>Conclusion:</b> Both boys and girls had equal prevalence of malnutrition. Prevalence of stunting, underweight and wasting were more than that of national prevalence. Underweight are significantly high in low socio-economic status and nuclear family. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=OC01-OC04&id=13611 https://doi.org/10.7860/JCDR/2020/43114.13611 Evaluating the Clinical Performance and Upper Airway Morbidity of I-Gel and its Comparison with Proseal Laryngeal Mask Airway- A Randomised Controlled Trial HL Asha, MC Nagaraj <b>Introduction:</b> Studies comparing the efficiency of i-gel against Proseal Laryngeal Mask Airway (PLMA) have reported that both devices can maintain adequate airway sealing pressure, thus facilitating controlled ventilation. However, studies on postoperative events in the Indian context are quite rare. <b>Aim:</b> To evaluate i-gel against PLMA in terms of insertion characteristics, haemodynamic response, airway seal pressure, Minimum Minute Ventilation (MMV) and upper airway morbidity. <b>Materials and Methods:</b> Sixty-six patients were randomised to receive PLMA (Group P=33) or i-gel (Group I=33) for airway management. Demographic and operative data were recorded. Patient vitals including heart rate, systolic/diastolic blood pressures, peripheral capillary oxygen saturation and end-tidal carbon dioxide were measured. Airway sealing pressure and MMV were noted after device insertion. Postoperative upper airway morbidities observed (cough, sore throat, hoarseness of voice, dysphagia, odynophagia, and dysphonia) were noted (%). ANOVA, Mann-Whitney and chi-square tests were employed to analyse the data. <b>Results:</b> Demographic data including clinical characteristics were comparable in both groups. Airway seal pressures (p=0.05) and MMV (p&#8805;0.05) were also similar in either group. Haemodynamic responses also showed no significant differences. Postoperative airway morbidities were similar in both groups (p>0.05 except odynophagia with p<0.05) and although a higher incidence was observed in the PLMA group compared to the i-gel group, the difference was statistically insignificant. <b>Conclusion:</b> PLMA and i-gel were both found to be efficient supraglottic airway devices for intraoperative airway maintenance, while the incidence of postoperative airway morbidities was lesser in the i-gel group. Significantly low incidence of blood on device and high airway seal pressure in the i-gel group indicates that i-gel may be an ideal alternative to PLMA among patients undergoing elective surgeries under controlled ventilation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=UC01-UC05&id=13612 https://doi.org/10.7860/JCDR/2020/43456.13612 Measurement of Pain, Delayed Onset of Muscle Soreness and Muscle Strengths after Performing Various Eccentric Exercise Protocols with Partial Range of Motion Chakravarthy Marx Sadacharan <b>Introduction:</b> Physical activity and unaccustomed exercise induces muscle pain, muscle soreness that can decrease the muscle strength at joints initially. <b>Aim:</b> To understand the level of muscle strength, Delayed Onset of Muscle Soreness (DOMS), pain and functional limitations after completing various intensities of Eccentric Exercise (ECC) through Partial Range of Motion (PROM). <b>Materials and Methods:</b> Eighteen participants (men and women) aged between 18 and 30 years were recruited from the students of the University of New England assigned into 3 groups. Participants performed ECC protocol through 60&#176; of total Range of Motion (ROM) using dynamic adjustable ROM controlled elbow and knee joint splints (on elbow flexors, elbow extensors, knee flexors and/or knee extensors; one muscle group/limb). Before and after ECC protocols, the Maximal Voluntary Isometric Contraction (MVIC) was calculated for all the muscles. Group-1 performed ECC exercise only; group-2 performed yoga poses prior to ECC exercise; and group-3 performed ECC exercise prior to yoga poses. Participants performed ECC exercise (5&#215;10 repetitions) on all four limbs at 60&#176; of total ROM using their 15%/25%/35% of MVICs on day 1 and subjective {health Activities of Daily Living (ADL) difficulty scale, Visual Analogue Scale (VAS)} and objective assessments {Pain Pressure Threshold (PPT), arm and thigh circumference, and ROM} from day 2-6 of weeks 2, 3 and 4. <b>Results:</b> The post-ECC MVIC was higher than pre-ECC MVIC values in all tested muscles and showed statistically significant differences (p<0.05) within each group. ADLs, VAS, and PPT for the elbow extensors and knee flexors showed a minimal pain (0-2) and didn&#8217;t show a statistically significant difference (p>0.05) between groups. The elbow flexors and knee extensors didn&#8217;t show pain within and between the groups. There was no significant difference in the ROM and, arm and thigh circumference between the groups. <b>Conclusion:</b> Four weeks of ECC exercise protocol with and without yoga improved the muscle strength, reduced muscle soreness and pain in elbow and knee for ADLs in the younger individuals. Current research protocol can be applied to the older adults&#8217; who are in chronic conditions with co-morbidities to improve their muscle strength, and ROM to fulfill their ADL and healthy independent life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=April&volume=14&issue=4&page=YC01-YC06&id=13613 https://doi.org/10.7860/JCDR/2020/43860.13613