Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Neonatal Pemphigus in a Neonate of a Mother Suffering from Pemphigus Vulgaris- A Case Presentation Sandeep Kulkarni, Pooja Jaideep Sahu, Aishwarya Patil, Bhushan Madke, Vikrant Saoji Neonatal pemphigus is a transient, self-limiting entity featuring appearance of evanescent blisters in a neonate born to mother diagnosed with immuno-bullous blistering disorders. A case report of neonatal pemphigus born to a 30-year-old female with Pemphigus Vulgaris is being reported. Higher maternal antibody titre causing clinically evident blistering in neonate is not commonly reported. This report, thus, emphasises the need for diagnostic considerations and vigilant surveillance of neonatal pemphigus in neonates born to mothers with immunobullous disorders. Since the cases reported in the literature and the references assessed revealed that neonatal pemphigus is infrequent, but the understanding about the disease permits for an early diagnosis to be made. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=WD01-WD03&id=13397 https://doi.org/10.7860/JCDR/2020/42833.13397 Thrombocytopenia Associated Multi-Organ Failure: A Fatal Complication of Diabetes Ketoacidosis Meenakshi Dadwal, Bablu Kumar Gaur, Parveen Kumar Antil, Baljeet Maini Thrombocytopenia Associated Multiple Organ Failure (TAMOF) is an extremely rare fatal thrombotic microangiopathic disorder in children that can occur in association with Diabetes Ketoacidosis (DKA). An 11-year-old adolescent boy presented with severe DKA and later on he developed severe thrombocytopenia, intrinsic renal failure and pulmonary haemorrhage. The clinical picture was most consistent with TAMOF. The clinical condition, renal function test and platelet counts were gradually improved after multiple transfusion of fresh frozen plasma. A high index of suspicion of TAMOF is required in children with DKA who present with severe TAMOF. Plasma transfusion is suggested to be a life-saving intervention in a child with TAMOF secondary to DKA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=SD01-SD02&id=13398 https://doi.org/10.7860/JCDR/2020/42881.13398 Effect of Levodopa Treatment on Respiratory Muscle Power in a Patient with Newly Diagnosed Parkinson's Disease Askin Gülsen, Berat Uslu Parkinson’s Disease (PD) is a common neurodegenerative, progressive motor disease. The condition is often accompanied by tremor, stiffness, bradykinesia, postural imbalance, and subsequent respiratory problems. In many patients with PD, the aspiration and respiratory problems that develop after difficulty in swallowing and loss of mouth and throat muscle control are the main causes of morbidity and mortality. A 62-year-old non-smoker male was admitted because of progressive dyspnea, unconsciousness, slowing of movement, and respiratory failure. The patient was diagnosed with Parkinson’s disease after neurological consultation. After two weeks of levodopa treatment, the patient showed a significant improvement in pulmonary function and respiratory muscle strength parameters. This case demonstrates the effect of levodopa treatment on respiratory muscle strength and emphasises the importance of respiratory muscle strength parameters in special pulmonary function test. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=OD01-OD02&id=13399 https://doi.org/10.7860/JCDR/2020/42984.13399 Hyperleukocytosis (Re)Visited- Is it always Leukaemia: A Report of Two Cases and Review of Literature Ashutosh Rath, Richa Gupta Hyperleukocytosis is defined as total leukocyte count of more than 100&#x2715;10<sup>9</sup>/L. Commonly seen in leukaemic conditions, nonleukaemic causes are usually not encountered and thought of. We report two such non-malignant cases of hyperleukocytosis. A six-year old girl presented with fever, cough and respiratory distress with a leukocyte count of 125.97&#x2715;10<sup>9</sup> /L. Another case is of a two-month old female infant, who presented with fever and respiratory distress and a leukocyte count of 112.27&#x2715;10<sup>9</sup> /L. The present case thrives to highlight various possible causes of hyperleukocytosis with an emphasis on non-malignant causes. Also, important complications and management of hyperleukocytosis are discussed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ED01-ED03&id=13409 https://doi.org/10.7860/JCDR/2020/40556.13409 First Case of Chronic Myeloid Leukaemia Associated Microfilariasis at the Brazzaville University Hospital Lethso Thibaut Ocko Gokaba, Olivia Firmine Atipo Galiba, Géril Sekangue Obili, Lydie Ocini Ngolet, Alexis Elira Dokekias The association between Chronic Myeloid Leukaemia (CML)-Filariasis is rare. Moreover, finding microfilariae in the bone marrow is uncommon. We reported the case of 47-year-old patient living in a rural area who was admitted in the haematology ward in order to further examine a splenomegaly he had which was associated with a leucocytosis. Physical examination revealed oedematous lower limbs and peripheral blood film comment showed the presence of myelocytosis and eosinophilia. The myelogram showed hyperplasia of immature granulocytes and presence of <i>Loa loa, Wuchereria bancrofti</i> and <i>Mansonella perstans</i> microfilariae. The diagnosis of CML was then confirmed by the presence of the gene translocation t (9; 22) and the MBCR-ABL transcription type b3a2 on cytogenetic examination. This case represents a semiotic interest because oedema of both upper and lower limbs associated with a leucocytosis in filarial endemic zone must first of all indicate a haematological malignancy associated with filariasis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=XD01-XD02&id=13410 https://doi.org/10.7860/JCDR/2020/42441.13410 An Orthodontic- Prosthetic Approach for a Missing Maxillary Lateral Incisor Orlando Motohiro Tanaka, Lara Karolina Guimarães, Susiane Queiroz Bastos, Caio Seiti Miyoshi, Marcio Furtado Niwa Restoring patients smile with congenitally missing maxillary lateral incisor often needs a challenging interdisciplinary treatment, which can be done either by canine substitution, single implants, or tooth-supported restorations. This case report describes the orthodontic treatment of an Angle Class I malocclusion, slightly convex lower third profile, absence of right maxillary lateral incisor, microdontia of the left lateral incisor, and prolonged retention of the right deciduous canine. The treatment was completed with good dental and functional occlusion with a third premolar implant-borne crown. After one-year of follow-up there was maintenance of good aesthetics, with gingival and periodontal health with stability. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZD03-ZD06&id=13411 https://doi.org/10.7860/JCDR/2020/42655.13411 Cystic Hygroma of Bilateral Parotid Glands and Neck Sanjay M Khaladkar, Suhani Jain, Amit Arun Choure, Radhika K Jaipuria Lymphangiomas are congenital malformations of lymphatic system. Most of the lymphangiomas appear before the age of 2 years. Microscopically lymphangiomas are capillary, cavernous and cystic. Cystic hygromas usually show extensive infiltration in surrounding tissues. Cystic hygromas of the parotid gland are rare. It is more common for cystic hygromas of neck to secondarily involve the parotid gland. Increase in the size of the mass is associated with haemorrhage into the cyst and upper respiratory tract infection. Recurrence is common if incompletely excised. Here, authors report a case of 16-month-old child (female) presented with swelling in bilateral parotid regions for 15 days. USG, CT and MRI showed bilaterally enlarged parotid glands showing multilocular cystic lesions of variable sizes with extension in bilateral masticator spaces, parapharyngeal and carotid spaces, posterior triangle and bilateral tonsillar fossa. Small cystic hygroma was also seen in superior mediastinum in prevascular space. Bilateral parotid gland involvement is the peculiar finding of the present case. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=TD01-TD04&id=13407 https://doi.org/10.7860/JCDR/2020/42930.13407 Regeneration Potential of Pulp: A Case Report Rohith Shinde, Pranitha Shinde, Sanganand Gavle, Madhuri Reddy, T Sai Pravallika Regenerative endodontics is a boon to dentistry as it restores the non-vital tooth with a less invasive procedure. Revascularization helps in restoration of teeth with medicaments having antimicrobial properties. There is a substantial literature supporting revascularization using this technique. Hence the present case report was documented with the objective of presenting the regeneration potential of pulp. A 15-year-old male patient presented with complaints of pain in upper right back tooth region since last one month. The pain aggravated on biting and during night. The patient had a history of previous visit to satellite clinic followed by emergency access opening. The tooth was tender on percussion. Pulp vitality tests gave a negative response. The tooth was diagnosed as apical periodontitis with immature apex. Under strict aseptic environment after administration of Local anaesthesia (LA), access cavity was opened. The canal was then dried and temporarily restored with Triple Antibiotic Paste (TAP) and sealed with 4 mm of Intermediate Restorative Material (IRM). It was found that there was narrowing of the apical area after 3 months follow-up and after 5 months follow-up, there was complete apical closure. Hence, tooth with immature apex with viable radicular pulp should not be treated with aggressive procedures, as root canal treatment. So, in such cases application of TAP (Triple Antibiotic Paste) followed by revascularization should be done and follow-up of the case must be done till the apex has been completely closed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZD07-ZD09&id=13422 https://doi.org/10.7860/JCDR/2020/43101.13422 Lymphangioleiomyomatosis in a Young Male Vishwanath Pujari, Sanchit Mohan, Priti Meshram, Rohit Hegde Lymphangioleiomyomatosis (LAM) is a rare multisystem disorder, predominantly affecting females in the reproductive age group, characterised by multiple cysts in lungs. A 15-year-old male was admitted in our institute for right sided renal mass for which he underwent right nephrectomy and was referred to our department for bilateral spontaneous pneumothoraces. CT thorax was done which showed bilateral pneumothoraces with multiple thin walled cysts and subtle ground glass opacities in both lung fields suggestive of changes of LAM. LAM is rarely seen in males, however if present ER/PR status can help in modifying the management. This is the youngest case of LAM reported in a male worldwide. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=OD03-OD05&id=13424 https://doi.org/10.7860/JCDR/2020/43159.13424 Neonatal Varicella Revanth Reddy, Gauri Chauhan, Anand Kumar Bhardwaj, Aradhna Gupta Neonatal Varicella is an uncommon disease in the Indian population, due to the presence of antibodies in the mother formed on the exposure to illness in their teenage in majority of population. The acquired varicella in newborn period, born to a non-immune mother shows a disseminated disease pattern with poor prognosis and high risk of mortality due to pneumonia, hepatitis, coagulopathy and secondary severe sepsis. The definite diagnosis is made by virus isolation or amplification of viral DNA from the skin lesions by PCR, but the clinical diagnosis from the pattern of rash hints the diagnosis well and appropriate. The drug of choice is intravenous acyclovir and Varicella Zoster Immune Globulin (VZIG), although the use of VZIG still remains debatable in symptomatic individuals. Here, we present a case of a 15-day-old newborn with confluent maculo-papular rash preceded by rash in the mother at 10th day post-delivery. The newborn was managed in NICU with standard protocols, but the prognosis became poor due to complications that were pneumonia, hepatitis and secondary sepsis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=SD03-SD04&id=13425 https://doi.org/10.7860/JCDR/2020/43240.13425 Steroid Induced Spinal Epidural Lipomatosis-An Imaging Diagnosis Shibani Mehra, Harshita Tripathi, Umesh Garga Spinal epidural lipomatosis is a rare condition that occurs due to pathological overgrowth of normal spinal extradural fat with subsequent canal narrowing and cord impingement. The condition may be idiopathic or iatrogenic. A strong aetiological association with prolonged exogenous steroid administration has been described. On the other hand, obesity is known to be a cause of idiopathic spinal epidural lipomatosis. We present the radiological picture that led to the diagnosis of iatrogenic epidural lipomatosis induced by exogenous steroid administration in young child post-meningitis. Present case is unusual because exogenous steroid administration that led to abnormal fat proliferation was one time for a short duration of less than a week, unlike other cases reported in literature where epidural lipomatosis has developed in patients on long term steroid therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=TD05-TD07&id=13426 https://doi.org/10.7860/JCDR/2020/42604.13426 Marine-Lenhart Syndrome- A Curious Case of Thyrotoxicosis Swayamsidha Mangaraj, Vaibhav Pathak, Rukma Narkar, Arun Kumar Choudhury, Anoj Kumar Baliarsinha Hyperthyroidism is one of the common prevalent endocrine problems. The common causes of hyperthyroidism include Graves’ disease, toxic nodular goiter and toxic adenoma. The diagnosis is usually straightforward but can be challenging at times. Marine-Lenhart syndrome refers to the rare co-existence of hyperfunctioning nodule in presence of Graves’ disease. The disease can easily be misdiagnosed if clinical vigil is not high. The disease differs from classical Graves’ disease in terms of clinical course, management modality and outcome. Here we present a case of 52 years old female with complaints of weight loss, excessive sweating, tremors and palpitation for last six months and swelling in antrior aspect of neck for last four months. Technetium 99 m thyroid scintigraphy showed presence of diffuse increased tracer uptake 15% with suppression of background activity. Based on these findings, a diagnosis of Marine-Lenhart syndrome was made. Early and corrected identification of this rare variant is essential for proper therapeutic management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=OD09-OD11&id=13435 https://doi.org/10.7860/JCDR/2020/42751.13435 Uterine Artery Embolization: A Boon for a Near Miss Case of Pseudoaneurysm Anam Khan, Neema Acharya, Mahima Koshatwar, Janhvi Sabnis, Akshayata Sorte One of the unusual causes of secondary postpartum haemorrhage is Uterine Artery Pseudoaneurysm (UAP) and is associated with high mortality rate. Authors report a case of 26-year-old female who had secondary postpartum haemorrhage due to left UAP after caesarean section. Transcatheter arterial embolization is safe and beneficial for managing postpartum haemorrhage resulting from pseudoaneurysm. Angiographic embolization was done for the pseudoaneurysm in this patient successfully. Hence, reporting this case to highlight the availability of transcatheter arterial embolization as a treatment option in UAP before going for surgery in favourable cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=QD01-QD03&id=13428 https://doi.org/10.7860/JCDR/2020/42951.13428 Hyponatremia-Associated Troublesome Hiccups: A Report of Rare Manifestation: A Review Kuan Yee Lim, Khairul Najmi Muhammad Nawawi Hiccup is an intermittent spasmodic contraction of the diaphragm, which is usually a benign and self-limiting condition. However, persistent hiccups may indicate a more sinister underlying pathology. Hiccups have been reported in the literature as an unusual manifestation in hyponatremia. Some literature had linked the severity of hiccups to the level of serum sodium. Present case report is of persistent hiccups, seen in a 60-year-old male patient who presented with serum sodium of 100 mmol/L. Apart from the troublesome hiccups, he had associated dizziness, unsteady gait and poor oral intake. His hiccups resolved after correction of serum sodium above 124 mmol/L. The dose-response relationship between hyponatremia and hiccups vary in different individuals. A fluoroscopic examination can be considered in cases of hiccups or hyponatremia to conclude the association between both. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=OD06-OD08&id=13430 https://doi.org/10.7860/JCDR/2020/43203.13430 Cavernous Haemangioma of the Maxillary Sinus Mimicking Antrochoanal Polyp Saranya Thangavel, Manu Coimbatore Balakrishnan, Rajesh Nachiappa Ganesh, Arun Alexander Cavernous haemangioma of the maxillary sinus often presents with recurrent epistaxis and nasal obstruction. Clinical features usually mimics sinonasal mass or antrochoanal polyp. We report this case of a 13 years old female patient with unilateral maxillary sinus cavernous haemangioma which was managed successfully by both endoscopic and Caldwell Luc approach. The patient presented with features of antrochoanal polyp. Radiologically, it was suspected to be an Angiomatous Antrochoanal polyp and histologically proved to be a cavernous haemangioma. Postoperative period was uneventful. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=MD01-MD03&id=13431 https://doi.org/10.7860/JCDR/2020/39714.13431 Bilateral Endogenous Cryptococcal Endophthalmitis in an Immunocompetent Host Treated with Two Different Tailored Approaches Luigi Sborgia, Alfredo Niro, Giancarlo Sborgia, Alessandra Sborgia, Giovanni Alessio Endogenous fungal endophthalmitis is one of the most severe and rare ocular pathologies. Rarely, it occurs in healthy and immunocompetent people and is observed in both eyes. This case report describes diagnosis and treatment of a rare case of bilateral endogenous fungal endophthalmitis with different degree of severity. Smear and culture of vitreous samples were not helpful in confirming the aetiology but blood samples revealed Cryptococcus neoformans antigen. Systemic therapy was set up with voriconazole. Vitrectomy with intravitreal injection of voriconazole was performed in left eye as it was clincally worst, while only intravitreal injection of antifungal drug was performed in right eye. After 3 months of follow-up, a relevant functional and morphologic improvement was reported in both eyes. Cryptococcal endogenous endophthalmitis is a challenge for ophthalmologists. Prompt aggressive treatments tailored to the known aetiology and clinical conditions are imperative to achieve good morpho-functional recovery in case of bilateral involvement with different degree of severity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ND01-ND02&id=13444 https://doi.org/10.7860/JCDR/2020/42713.13444 Onychomycosis Due to <i>Fusarium oxysporum</i> in Sulumaniyah City, Iraq Sazan Jamal Gharib, Samir Khalaf Abdullah Onychomycosis is a fungal infection of the nail plate of fingernails or toenails that is caused by dermatophytes, non-dermatophyte filamentous fungi or yeasts. An opportunistic pathogenic fungus was isolated from toenail of a 38-year-old female with newly diagnosed Acute Myeloid Leukaemia (AML) which appeared to belong to the genus <i>Fusarium</i>. Identification of aetiologic agent was performed by morphological and cultural characteristics and was confirmed by sequencing of the Internal Transcribed Spacer (ITS) region of rDNA. The isolated <i>Fusarium oxysporum</i> in this paper is the first case of its kind to be sequenced and reported by molecular method in Iraq. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=DD01-DD03&id=13446 https://doi.org/10.7860/JCDR/2020/42846.13446 Hydatid Cyst of the Thyroid Gland: A Case Report Reema Abdul Rahman Al Gunaid, Wael Abdu Thabet Hydatid disease is a zoonotic infestation caused by the genus <i>Echinococcus</i>. It is still widespread in agricultural communities. It is common in temperate and sheep raising countries of the world where it causes a significant public health problem. It is a chronic disease and cyst can be presented in different organs. In humans, hydatid cyst develops most often in the liver (65%) and lungs (25%). Other organs affected occasionally include the brain, muscle, kidney, heart, pancreas, adrenal, and thyroid gland. Involvement of the thyroid gland by hydatid cyst is rare. It is most often asymptomatic or presenting with anterior neck swelling or rarely dysphagia or dyspnea. This case report explains our experience with a patient suffering from hydatid cyst in the thyroid. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ED04-ED05&id=13448 https://doi.org/10.7860/JCDR/2020/42977.13448 Pleural Mesothelioma Diagnosed on Inguinal Lymph Node Biopsy: A Rare Entity Divya Singh, Rekha Bhandari, Surender Bana, Deepak Sundriyal, Arvind Kumar Gupta Mesothelioma is a locally aggressive tumour arising from mesothelial lining of serous cavities, commonest site being the pleura. Distant metastasis to extra thoracic lymph node is rare. We herewith report a case of pleural mesothelioma with extensive peritoneal involvement which was diagnosed after inguinal node biopsy. This case highlights the aggressive nature of mesothelioma along with unusual site of metastasis. Though rare, a differential diagnosis of malignant mesothelioma should be kept while dealing with patients presenting with ascites and inguinal lymphadenopathy. A high index of suspicion along with immunohistochemical confirmation can prevent disease progression and prolong patient survival. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ED06-ED07&id=13454 https://doi.org/10.7860/JCDR/2020/43143.13454 Epidermolysis Bullosa in Newborn: A Rare Case with Management Dilemmas Ekta Kale, Sumita Mehta, Tarun Kumar Epidermolysis Bullosa (EB) is a rare genetic and connective tissue disorder affecting 1 in every 50000 live birth that causes skin to be very fragile and blister easily. Epidermolysis Bullosa Simplex (EBS) is the most common of all EB and it presents at birth or during the neonatal period. Diagnosis of EB is mainly clinical and can be confirmed by genetic analysis of the parents and the patient. There is presently no definite cure for EB and treatment is only conservative to alleviate symptoms and provide supportive care. We present a case report of a neonate born with reddish discolouration and peeling of skin of fingers of both hands which progressively developed into fluid filled vesicles over the abdomen and buttocks. The biopsy of the lesions was deferred due to financial constraints and a clinical diagnosis of EBS was made. The newborn was started on injectable antibiotics and given supportive therapy in the form of daily wound care and protective bandaging with which she improved and was discharged on 10<sup>th</sup> postnatal day in stable condition. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=QD04-QD05&id=13457 https://doi.org/10.7860/JCDR/2020/42983.13457 Bilateral Fusion of Primary Mandibular Lateral Incisors and Canines: A Case Report Sahar Fahad Alotaibi, Raya Almufleh, Hamed Alshamrani, Fouad Salama Fusion is known as a developmental anomaly described by the union of two neighbouring teeth. The worldwide prevalence of bilaterally fused teeth in the primary dentition is about 0.02% which is considered very rare. Only few cases of bilateral fusion have been reported in Indian population. This paper presents a rare case of three-year-old boy with bilateral fusion of primary mandibular lateral incisors and canine teeth. Treatment consisted of pit and fissure sealants and topical fluoride application. To conclude, fused primary teeth are considered as harmless asymptomatic abnormality. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZD10-ZD12&id=13460 https://doi.org/10.7860/JCDR/2020/42926.13460 Klinefelter Syndrome Complicated with Diabetes Mellitus, Hypothyroidism and Cryptorchidism: Case Report and Literature Review Wei Zhu, Shiliang Wang, Shaogang Ma, Liuxue Yang, Yali Qiu Klinefelter Syndrome (KS) remains underdiagnosed due to its complex clinical presentation. Here, the authors present the case of a 48-year-old of KS complicated with Type 2 Diabetes Mellitus (DM), hypothyroidism and cryptorchidism as well as perform a literature review. The patient first visited the hospital for diabetes. Male sexual characteristics were missing, complicated with cryptorchidism. Laboratory and chromosome tests were performed to confirm the diagnosis. The patient demonstrated low testosterone and high gonadotropin levels, with the karyotype of 47, XXY. Thus, for diabetes patients who lack male sexual characteristics, gonadal function and chromosome-related examinations should be performed for analysis and differential diagnosis. Based on existing data, there is a pressing need to generate better evidence for KS early diagnosis and comprehensive treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=OD12-OD13&id=13465 https://doi.org/10.7860/JCDR/2020/43167.13465 Decompressive Craniectomy for Traumatic Acute Extradural Haematoma: Decision Making and Outcomes Paresh Anil Korde, Sandeep W Iratwar, Akshay Patil, Vijay M Mundhe, Chetan Tukaram Rathod Extradural Haematoma (EDH) in neurosurgery needs no introduction. It is the most commonly encountered and dealt traumatic pathology in neurosurgery. Operative indications for the same has been in the literature and followed unchecked. Evacuating haematoma and repositioning the bone flap back has been a usual protocol. But decision for Decompressive Craniectomy (DC) in EDH and their outcomes have less vividly thought of. In the present case series the authors shared their experience of 10 patients, of traumatic EDH, who presented with Glasgow Coma Scale (GCS) of <5 and underwent DC with haematoma evacuation in first sitting itself. Based on the experience it is proposed that DC in traumatic EDH patients bring about better outcome in these patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=PR01-PR03&id=13462 https://doi.org/10.7860/JCDR/2020/43142.13462 Anecdote from Editors Desk Anecdote 1- Image Tampering Hemant Jain, Aarti Garg, Sunanda Das https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=AB01-&id=13459 https://doi.org/10.7860/JCDR/2020/12620.13459 Effects of Thymoquinone and Busulfan on Reproductive Parameters in Male Rats: An Experimental Study Cyrus Jalili, Amir Abdolmaleki, Azita Faramarzi, Mohammad Reza Salahshoor <b>Introduction:</b> Busulfan (BUS) is a drug for the treatment of certain cancers and capable to produces free radicals and induces disturbance on some of male reproductive parameters. Thymoquinone (THYM) applies the therapeutic effects by its antioxidant property. <b>Aim:</b> To evaluate the effects of THYM against damage to the male rats’ reproductive parameters induced by BUS. <b>Materials and Methods:</b> In this experimental study, 64 male Wistar rats were categorised into 8 groups (8 mice in each): normal control (saline) and BUS control (10 mg/kg) groups; THYM groups (4.5, 9, 18 mg/kg) and BUS+THYM group (10 mg/kg BUS+4.5, 9 and 18 mg/kg of THYM). Treatments were applied daily for 5 weeks by intraperitoneal (i.p.) injection. The sperm parameters, testicular Malondialdehyde (MDA), Total Antioxidant Capacity (TAC), testosterone level and germinal layer height were evaluated and analysed using one-way ANOVA. <b>Results:</b> All parameters reduced significantly in the BUS control group compared to the normal control group (p<0.01) except MDA level (increased). At all doses of THYM and THYM+BUS groups, all parameters significantly increased except MDA level (decreased) in comparison with the BUS control group (p<0.01). No significant alteration was observed in all THYM groups compared to the normal control group (p>0.05). <b>Conclusion:</b> THYM attenuates the toxic effects of BUS on some of the male reproductive parameters and it is suggested that THYM may have beneficial effect on reproductive parameters in patients with BUS administration. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=AF01-AF04&id=13404 https://doi.org/10.7860/JCDR/2020/42917.13404 Microbial Flora and Antimicrobial Susceptibility of Microorganisms from Asymptomatic Contraceptive Users and Non-Users of Reproductive Age Adesumbo Idowu Odaranle, Olufunmiso Olusola Olajuyigbe, Morenike Olutumbi Adeoye-Isijola, Otunola Adedayo, Roger Murugas Coopoosamy <b>Introduction:</b> The use of contraceptives is important in preventing unplanned pregnancy and sexually transmitted diseases. However, the use of various contraceptive methods could expose women to microbial infections. <b>Aim:</b> To investigate the antimicrobial susceptibility of microbial flora from vaginal swab of asymptomatic women using different contraceptive methods. <b>Materials and Methods:</b> In this study, high vaginal swab samples were collected from sexually active 406 women between 20 and 45 years of age. Women who were non-specific user of methods were considered as control group. All participating women had no history of antibiotic use since last 2 weeks from the study period as well as abstained from the same during the study period from June to December 2017. The use of contraceptives among different age groups was determined. The microbial flora of asymptomatic individuals were assessed by direct smear, microscopy examination, bacteriological and biochemical identification of the isolated microorganisms and their susceptibility were carried out on the samples collected. All information collected was compiled and data were analysed using SPSS Software programme. <b>Results:</b> In this study, 39.4% of the population (n=406) were combined hormonal users. While the percentage of the Intrauterine Device (IUD) users was 27.1% and those of the condom users was 21.2%, the non-specific users were 12.3% of the sampled population. Of the women using different contraceptives, 8.1% (29) women using combined hormonal contraceptives, and 2.53% (9) barrier users, 1.97% IUDs users and only 10% of the 50 women in the control groups had bacterial infection. On the other hand, the distribution of fungal strains isolated from contraceptive users showed that 16.01% (57) IUDs users, 5.7% (23) combined hormonal users, 5.06% (18) barrier users and only 16.0% (8) of the women (n=50) in the control group had fungal infection. The antimicrobial assay showed that more than 90% of P. mirabilis, K. oxytoca, E. coli, Group B beta-haemolytic streptococci and S. aureus were susceptible to ciprofloxacin, ofloxacin, P. mirabilis (50%), K. oxytoca (95%), E. coli (96%), H. streptococci (80%) and S. aureus (94%) were susceptible to nitrofurantoin. However, these isolates were highly resistant to ceftazidime, gentamycin, kanamycin, tetracycline, cloxacillin, augmentin, ampicillin and amoxicillin. On the other hand, 80% of the fungal isolates were susceptible to ketoconazole, nystatin (75%), clotrimazole (65%) and fluconazole (60%) but were all resistant to griseofulvin. <b>Conclusion:</b> This study shows that more strains of bacteria and fungi were isolated from women in ages 31-35 years of women sampled and indicated that the most predominant isolates in asymptomatic individuals using contraceptives were highly resistant to most of the antibiotics used except ciprofloxacin, ofloxacin and nitrofurantoin to which they were highly susceptible. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=DC01-DC07&id=13405 https://doi.org/10.7860/JCDR/2020/40759.13405 Seroprevalence and Trend of Hepatitis B and C Viral Infections in Patients at a Tertiary Care Hospital in Southern India- A Retrospective Study Padmalatha Anjaneyulu Mahalakshmi, Racherla Rishi Gowtham, Nagaraja Mudhigeti, Madhavi Latha Pamireddy, Kante Meenaskhi, Umapathi Nallapireddy, Usha Kalawat <b>Introduction:</b> Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) are serious public health problems worldwide with estimated 350 million chronically infected people. Transmission of infection occurs through blood transfusion, needles, body fluids and sexual intercourse. To know the magnitude of transmission of any disease in a community and for its control and prevention; trend and study of its prevalence is most important. <b>Aim:</b> To analyse the overall trend of HBV and HCV infection and to estimate the seroprevalence in a tertiary care hospital of Southern India. <b>Materials and Methods: </b>This was a retrospective study conducted at the Department of Microbiology, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India. The data of 77,158 and 58,024 samples for the test of Hepatitis B surface antigen (HBsAg) and test for anti-hepatitis C antibody respectively, for a period of three years four months (from September 2013 to December 2016) was retrieved from Departmental registers and Hospital Information System. Statistical software IBM SPSS, Version 20.0 (IBM SPSS Statistic, Somers NY, USA) was used for statistical analysis. <b>Results:</b> A total of 77,158 samples were tested for HBsAg whereas, 58,024 were tested for the presence of anti-HCV antibody. Seroprevalence of HBV was 2.27% and for HCV, it was 0.73%. <b>Conclusion:</b> HBV infection is showing a decreasing trend and the HCV infection, a fluctuating trend. Attempt should be made to reduce the incidence of HBV and HCV by simple preventive measures like public education, screening of blood and blood products, increasing public awareness about importance of vaccination. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=DC08-DC12&id=13406 https://doi.org/10.7860/JCDR/2020/42717.13406 Nutritional Anaemia among Medical Students and its Correlation with Body Mass Index Varsha Gajbhiye, Yeshwant Lamture, Shivangi Ghidiyal <b>Introduction:</b> Medical students may suffer from anaemia probably because of hectic study schedule leading to irregular diet. The association between Anaemia and Body Mass Index (BMI); has been controversial. Screening for the detection of anaemia is important in order to identify the at-risk population. There is paucity of data correlating haemoglobin with BMI. Very few studies have been conducted on medical students, who are an integral part of society. <b>Aim:</b> To estimate nutritional anaemia among medical students and its correlation with BMI. <b>Materials and Methods:</b> This was an observational study. Total 250 students were enrolled, aged between 18 to 21 years from April 2018 to October 2018. BMI and haemoglobin (Sahli&#8217;s haemoglobinometer) were measured. Data analysis was being carried out by using Statistical Package for Social Science i.e., SPSS. Correlation between BMI and haemoglobin was determined by Pearson&#8217;s correlation analysis. <b>Results:</b> Out of the total 250 students participating in the study, 4.8% (12) were boys and 95.2% (238) were girls. Anaemia was found in 13.6% (34) students, among which 5.88% (2) were boys and 94.11% (32) were girls. The mean haemoglobin value in boys was 12.38 gm/dL (&#177;1.70) and 11.75 gm/dL (&#177;1.15) in girls. Among 250 students, 13.2% (33) were underweight, 78.4% (196) were within normal BMI and 8.4% (21) were overweight. The value of Pearson&#8217;s correlation coefficient (r) was 0.7956. This suggests undernutrition was associated with anaemia. <b>Conclusion:</b> Majority of the anaemic girls were found to be underweight. A positive correlation was also found between anaemia and BMI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=PC01-PC02&id=13401 https://doi.org/10.7860/JCDR/2020/42858.13401 Influence of Socio-demographic Variables on the Acceptance Rate of Laparoscopic Tubal Ligation: A Retrospective Study Paresh Shyam, Mili Ronghangpi, Ram Chandra Rongphar <b>Introduction:</b> Female sterilisation accounts for 36% of the population using various methods of contraception in India. Laparoscopic tubal ligation is a commonly used method for female sterilisation. Acceptance of sterilisation is influenced by socio-demographic factors. Better appreciation of socio-demographic factors influences the acceptance rate of laparoscopic tubal ligation and therefore it is important to be assessed. <b>Aim:</b> To assess the socio-demographic factors among the acceptor of laparoscopic tubal ligation. <b>Materials and Methods:</b> It was a retrospective study carried out at Silchar Medical College, Silchar, Assam. The socio-demographic data of woman undergone laparoscopic tubal ligation during one year period was collected. The women included in the study were Post Medical Termination of Pregnancy (Post-MTP) ligation, interval ligation and post-partum ligation. Women undergoing tubectomy during caesarean section were excluded from the study. Data were presented as percentage and proportion and subsequently, analysis was done. <b>Results:</b> The mean age of the woman was 29.76&#177;4.19. The number of woman with parity three was highest (45.45%). The interval from last childbirth to laparoscopic tubal ligation was more than 3 years in 34.55% woman. Majority (70%) of the women had post-MTP ligation. <b>Conclusion:</b> There is long interval from last childbirth to tubal ligation. This gap must be filled up so that couples adopt permanent method of contraception at the earliest occasion after completion of family. Most of the woman had undergone medical termination of pregnancy at the time of sterilisation. Family welfare programme must be strengthened to prevent these unwanted pregnancies and its consequences. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=QC01-QC03&id=13402 https://doi.org/10.7860/JCDR/2020/43110.13402 Cervical Cytological Changes Associated with Prolonged Sexual Exposure due to Early Marriage in Rural India Jata Shanker Misra, Anand Narain Srivastava, Zeeshan Haider Zaidi <b>Introduction:</b> There is likelihood of development of premalignant changes in the cervix in the teenagers due to early sexual activity. This assumes importance under rural conditions in India where majority of marriage of girls are performed at young age below 20 years. <b>Aim:</b> The present cytological study was carried out in the three cohorts of rural girls- adolescents (16-20 years), young adult girls (21-25 years) and adult women (26-30 years) to see the effect of early increasing sexual exposure. <b>Materials and Methods:</b> The study cases were derived from the cervical cancer screening which is in progress in the rural population of Lucknow, Uttar Pradesh, India. Of the 1185 study cases, 97 were adolescents, 338 young adult girls and remaining 750 were adult women. <b>Results:</b> The Atypical Squamous Cell Changes of Unknown Significance (ASCUS) were found higher in the adolescents than in young adult girls and adult women while Squamous Intraepithelial Lesions of cervix (SIL) rate was almost equal in the three cohorts. Follow-up revealed progression of ASCUS to Low grade SIL (LSIL) almost equal in the three groups while the persistence of SIL was higher in the young adult girls and adult women. The gynaecological symptoms especially vaginal discharge was more common in the last two groups than in adolescents but the SIL rate was higher with all symptoms in the adolescents. The cervical lesions were more common in the young girls and adult women and SIL rate was higher with different cervical lesions. The majority of adolescents were nulliparous with high SIL rate while in the young adult girls and adult women, the SIL incidence showed rising trend with increasing parity. <b>Conclusion:</b> The study highlights the importance of cytological screening of all the rural young girls and adult women specially who reveal cervical lesions or are symptomatic. This will yield large number of pre-cancerous cases, timely treatment of which will check the progression of SIL to malignancy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=EC06-EC10&id=13412 https://doi.org/10.7860/JCDR/2020/42757.13412 Methotrexate Usage Trends in Psoriasis in a Tertiary Care Hospital: A Retrospective Study S Harshatha, S Murugan, S Adikrishnan, M Krishnakanth, R Sudha, V Mahalakshmi <b>Introduction:</b> Methotrexate has been successfully used for treating Psoriasis over the past six decades. There is a range of methotrexate dosing regimens for psoriasis and the clinical data illustrating its efficacy and safety are inadequate. <b>Aim:</b> To evaluate the utilisation of methotrexate prescription trends, the time taken for the lesions to resolve, evaluate the safety, efficacy and its rational use in patients with psoriasis. <b>Materials and Methods:</b> It was a hospital based retrospective study in which medical records of the patients having psoriasis from pre-filled proformas attending the outpatient department during January 2015 to December 2017 were analysed. Patients of both genders with age ranging between 18 years to 60 years were included. Methotrexate was initiated in a dose of 5-10 mg/week (maximum upto 20 mg), depending on the Psoriasis Area and Severity Index (PASI) score and the dose was increased or decreased based on the treatment efficacy. The mean baseline PASI scores were calculated and mean PASI scores following the Methotrexate treatment were evaluated. The drug safety was evaluated by patient&#8217;s clinical symptoms and relevant lab investigations. <b>Results:</b> In this study, 86 patients with psoriasis were included with mean age being 40.73&#177;5.353 years, male:female ratio was 2:1. The mean baseline PASI scores showed clear and comparable improvement of the psoriatic plaque lesions from (mean&#177;SD) a PASI score of 18.12&#177;10.07 to 5.50&#177;1.97. Out of 86 patients, 13 patients achieved a score of < PASI 50; 58 between PASI 50-75; 15 patients > PASI 75 indicating a clinically meaningful endpoint. The mean clearance time for the lesions was 16 weeks. Adverse effect being dose dependent, the most common was gastrointestinal disorders, myelosuppresion and long term adverse effect was hepatotoxitiy. <b>Conclusion:</b> The present study provides an overview for methotrexate dosing for future consenses and guidance in daily practice. Methotrexate still remains a near to gold standard treatment for psoriasis, inducing quick remission and delays relapse. PASI reduction was observed during each month of therapy. If given with proper monitoring will have significantly low adverse effects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=WC01-WC04&id=13413 https://doi.org/10.7860/JCDR/2020/43052.13413 Sleep Quality and Cognitive Dysfunction among Acute Stroke Patients from Coastal Areas of North Sulawesi, Indonesia Sekplin AS Sekeon, Finny Warouw, Eva Mantjoro <b>Introduction:</b> Poor sleep quality is one of the non conventional risk factors for stroke. Cognitive dysfunction is prevalent among stroke survivors. There is limited data on the association between sleep quality and cognitive dysfunction among stroke patients from coastal areas of Indonesia. <b>Aim:</b> The objective of this study was to analyse the association between sleep quality and cognitive dysfunction among acute stroke patients from coastal areas in North Sulawesi province. <b>Materials and Methods:</b> This was a hospital-based cross-sectional study. Samples of 78 acute stroke patients from coastal areas were consecutively selected. The dependent variable was cognitive dysfunction measured by Mini Mental Status Examination (MMSE). The independent variable was pre stroke sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI). Stroke was diagnosed from history taking, physical examination, and/or neuroimaging study. The data were analysed by Chi-square test and Odds Ratio. <b>Results:</b> More than half of 78 (52.6%) patients were female, with the mean age 59.71 (SD=13.78), and majority in 51-60 years age group (30.8%). Patients mostly graduated from high school (48.7%), lived in urban area (60.3%) and suffered ischemic stroke (62.8%). Poor sleep quality was found in 79.5% patients and cognitive dysfunction was detected in 53.9% patients. Stroke patients with poor sleep quality were almost two times more likely to experience cognitive dysfunction than counterparts with good quality of sleep (OR=1.89; 95%CI=0.54 to 6.55; p=0.467). The association between sleep quality and cognitive dysfunction among acute stroke patient from coastal areas of North Sulawesi province of Indonesia was not statistically significant. <b>Conclusion:</b> Although poor sleep quality had a likely higher risk to develop cognitive disorders among acute stroke, but we could not establish significant association between sleep quality prior to stroke attack with impairment of cognitive function. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=OC06-OC09&id=13414 https://doi.org/10.7860/JCDR/2020/41322.13414 Efficacy of Mini-perc in Patients with less than 2 cm Renal CalculiA Prospective Observational Study Abid Raval, Kshitij Raghuvanshi, DK Jain, Rajesh Dhake, Hrishikesh Deshmukh, Shams Iqbal <b>Introduction:</b> Miniaturisation of the instruments in Percutaneous Nephrolithotomy (PCNL) is advantageous over standard PCNL procedure in patients with renal stone <2 cm in size. <b>Aim:</b> To assess efficacy and safety of miniaturised (mini-Perc) and standard PCNL in patients with renal calculi &#x2265;2 cm in size. <b>Materials and Methods:</b> This prospective observational study included patients with age >18 years and renal stones &#x2265;2 cm in size. Patients were equally randomised to standard PCNL and mini-Perc group. The primary outcomes included operative time, stone clearance, postoperative analgesic requirement, and associated complications. Association between qualitative variables were evaluated using Chi-square test and Fisher-exact test; while, comparison of quantitative data was performed using unpaired t-test or Mann-Whitney U test. <b>Results:</b> A total of 100 patients (standard PCNL, n=50; mini-Perc, n=50) were enrolled. The mean age (years) of patients in standard PCNL and mini-Perc were 40.78 and 39.79, respectively. The complete stone clearance rate was comparable between miniPerc and standard PCNL (92% vs 94%). The mean operative time (minutes) was significantly more with mini-Perc than standard PCNL (78.86 vs 73.72; p<0.05). Four patients from standard PCNL group had bleeding and none from mini-perc reported bleeding. Other complications observed were fever and pelvic perforation. Duration of hospitalisation (days) was significantly shorter in mini-Perc group as compared to standard PCNL (3.16 versus 4.12; p<0.01) group. Drop in haemoglobin and drop in Packed Cell Volume (PCV) were significantly reduced in mini-Perc group than standard PCNL (p<0.01). <b>Conclusion:</b> Both the mini-Perc and standard PCNL techniques were effective and well-tolerated in patients with renal calculi &#x2265;2 cm in size. However, shorter duration of hospitalisation and longer operative time were associated with mini-Perc treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=PC03-PC07&id=13415 https://doi.org/10.7860/JCDR/2020/42008.13415 Evaluating Efficacy of P-6 vs. CV-24 Acupressure Points in Controlling Severity of Gag Reflex Rohit Ashok Mistry, Sweta Kale Pisulkar, Anjali Bhoyar Borle, Surekha R Godbole <b>Introduction:</b> Gagging compromises treatment, affects patient compliance and vexes the operator. Acupressure is one of the non-pharmacological modes which have been cited in literature as an effective method in controlling the severity of gag reflex. <b>Aim:</b> The study aims at evaluation and comparison of the efficacy of using acupressure points CV-24 and P-6 in controlling the severity of gag reflex. <b>Materials and Methods:</b> Thirty students who qualified inclusion criteria and scored 7 or above on the &#x2019;Predictive Gagging scale&#x2019; which categorised them as severe gaggers were included in the study from October 2017 to March 2018. Customised bands were fabricated for application of acupressure. The gag reflex was triggered; pre and post application of acupressure and the scores were noted on the Dickinson and Fiske&#x2019;s Gag-Index. One point was tested in one subject during one phase. The study was carried out in 3 phases to avoid the overlapping effect of acupressure at any point. A sham point was included in the study to maintain objectivity and eliminate subject and operator bias. The points to be evaluated and compared were Point A (P-6), Point B (CV-24), Point C (placebo). <b>Results:</b> It was observed that as (p<0.05) is the level of significance, CV-24 is more effective than P6 in controlling the gag reflex in adults within the set age group of 18-28 years of age. <b>Conclusion:</b> Acupressure is an effective modality in controlling gag reflex and can be helpful adjuvant in addressing unfavourable gag incidences during routine dental practise. Acupressure at Point CV-24 is better in controlling the severity of gag-reflex. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZC01-ZC03&id=13416 https://doi.org/10.7860/JCDR/2020/42672.13416 Comparative Evaluation of Postoperative Pain after Root Canal Treatment using Three Different Sealers, Viz., Tubli-Seal EWT, Apexit Plus, AH Plus: An In-Vivo Study Bhavna Gudlavalleti, Avinash A Patil <b>Introduction:</b> Pain after treatment is an undesired yet frequently occurring sensation of primary concern for both patients and endodontists. Although pain does not cardinally suggest endodontic failure, alleviation of this discomfort is of utmost importance for the patient. Further, the ability to prevent or control this pain is an essential pre-requisite for a dentist&#x2019;s professional success. <b>Aim:</b> To evaluate the prevalence of postoperative pain experienced by patients after root canal treatment using three different sealers, viz., Tubli-Seal EWT, Apexit Plus, AH Plus. <b>Materials and Methods:</b> Ninety nine patients who fulfilled specific inclusion and exclusion criteria were randomly assigned to three groups: A (Tubli-Seal EWT), B (Apexit Plus), and C (AH Plus) according to the root canal sealer used. A single visit root canal treatment was carried out and the severity of postoperative pain was assessed by Visual Analogue Scale (VAS) score after 8, 24 and 48 hours. Statistical analysis was done using SPSS software version 20.0. <b>Results:</b> There was statistically significant difference seen in all three groups (p=0.0001) at all the time points (8 hrs, 24 hrs and 48 hrs). When compared with the preoperative, the mean pain scores were statistically significant at the end of 8 hrs and 48 hrs with relatively lower pain score in group C than other groups. <b>Conclusion:</b> Within the limitations of this study, it can be concluded that when different sealers were used, postoperatively, the pain gradually reduced with time. However, the pain after using AH plus as root canal sealer was relatively much lesser compared to the preoperative status. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZC04-ZC09&id=13417 https://doi.org/10.7860/JCDR/2020/42767.13417 Role of Ganglionic Cell Complex, Retinal Nerve Fibre Layer in Glaucoma Evaluation Atul Kumar Singh, Hari Kumar Sreerangam, Dattakiran Joshi, Ashish Pandey <b>Introduction:</b> Glaucoma is a multifactorial disease characterised by damage to Retinal Ganglion Cells (RGCs) that inturn results in damage of nerve fibers resulting in functional visual impairment. <b>Aim:</b> To evaluate the sensitivity and specificity of Ganglion Cell Complex (GCC) parameters and Retinal Nerve Fibre Layer (RNFL) thickness obtained with Spectral Domain-Optical Coherence Tomography (SD-OCT) and to determine their role in the diagnosis of primary open-angle glaucoma patients. <b>Materials and Methods:</b> A case control observational study was conducted on 55 patients of Primary Open Angle Glaucoma (POAG) cases and 50 normal (control) patients presenting to the Eye OPD at tertiary eye hospital over a period from August 2015 to November 2017. Institutional ethical clearance was taken and tenants of a declaration of Helsinki were adhered to. Apart from complete ophthalmic examination, all patients underwent reliable standard automated perimetry (30-2) testing and SD-OCT imaging for RNFL thickness, Optic Nerve Head (ONH) analysis and GCC. Receiver Operating Characteristic Curves (ROC) were studied for all parameters. <b>Results:</b> The diagnostic ability for distinguishing between normal and glaucoma patients were same when we consider average RNFL thickness and avgerage GCC thickness. Diagnostic accuracy increases when we consider both RNFL and GCC thickness. There was a significant difference in both RNFL and GCC thickness between normal and glaucoma patients (p<0.001). The Mean Deviation (MD) showed a significant correlation with all the parameters in eyes with glaucoma (<0.001). <b>Conclusion:</b> GCC thickness seems to have higher sensitivity and specificity for the detection of early glaucoma. Diagnostic accuracy increases when we include other parameters like RNFL and visual fields. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=NC01-NC04&id=13418 https://doi.org/10.7860/JCDR/2020/42498.13418 Endotoxemia among Postpartum Mothers with Periodontitis Delivering Low Birth Weight Babies: A Case Control Study in Rural Indian Population Sonia Nath, Jayant Prakash, Virendra Kumar Prajapati, Shaju Jacob Pulikkotil <b>Introduction:</b> The presence of circulating maternal endotoxin can arise from pathogenic periodontal bacteria resulting in preterm labour and delivery of Low Birth Weight (LBW) infant. <b>Aim:</b> The aim of this study was to find if periodontitis induced maternal endotoxemia could be a risk factor for delivery of LBW infant. <b>Materials and Methods:</b> A total of 60 primiparous mothers between the age group of 18-35 years delivering LBW infants (weight &#x2264;2500 gm) were selected for this case control study. Cases were 30 postpartum mothers with periodontitis whereas controls were 30 postpartum mothers without periodontitis. Periodontitis was defined according to WHO criteria, as pocket probing depth of &#x2265;4 mm in atleast one site. Endotoxin level was assessed by a quantitative end point chromogenic limulus amebeocyte lysate (Lonza QCL 1000®). Odds Ratio (OR) was calculated to see if periodontitis was a risk factor. <b>Results:</b> Periodontitis increased the risk for occurrence of endotoxemia by more than three times among mothers delivering LBW infants with an OR of 3.21. <b>Conclusion:</b> Maternal endotoxemia due to periodontal infection can form a possible biological explanation for periodontitis as a risk factor for delivery of LBW babies. Future research is needed to study the effect of endotoxins in periodontal pathogenesis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZC10-ZC13&id=13419 https://doi.org/10.7860/JCDR/2020/42851.13419 Evaluation of Salivary Lipid Profile in Tobacco Chewers: A Pilot Study Manjushri Waingade, Pooja Rathod, Asawari Shidhore, Daya K Jangam <b>Introduction:</b> Traditionally, blood has always been used to diagnose most of the diseases and conditions due to limitations in technology. Salivary diagnostics has been preferred lately as the salivary constituents become effectively altered in response to certain disease states. Lipids form one of the important components that maintain cell integrity. Most of the authors have proposed that changes in lipid profiles are associated with malignancies. Till date, most of the studies have been conducted on the serum lipid profile in smokers, tobacco chewers, in patients with oral premalignant disorders and malignant lesions. So, in the present study, saliva was used to evaluate the alterations in salivary lipid profile in tobacco chewers. Thus, saliva may provide a cost effective approach for the screening of large populations. <b>Aim:</b> To assess and compare the salivary lipid profile in the tobaco chewers and the controls. <b>Materials and Methods:</b> A cross-sectional study was conducted on 15 tobacco chewers and 15 controls from May to July 2019. The parameters assessed include salivary analysis of Total Cholesterol (TC), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Very Low Density Lipoprotein (VLDL) and Triglycerides (TG). Student&#39;s unpaired t-test was used for comparing difference between means for salivary lipid levels in tobacco chewers and controls. <b>Results:</b> The mean±standard deviation in tobacco chewers for salivary TC, TG, HDL, VLDL, and LDL were 15.37±4.82, 5.2±2.66, 3.35±1.43, 1.04±0.53, 10.97±4.28 (mg/dL), respectively. Salivary lipid profile was higher in tobacco chewers groups when compared to healthy subjects and the difference was statistically significant (p<0.05). <b>Conclusion:</b> Thus, saliva can be used as a simple and cost-effective diagnostic tool for asssesing changes in lipid profile in tobacco chewers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZC14-ZC17&id=13420 https://doi.org/10.7860/JCDR/2020/42877.13420 Pain Management Practices and Perceived Barriers among the Health Professionals in Different Hospitals of Nepal Bigen Man Shakya, Sujata Shakya, Ninadini Shrestha <b>Introduction:</b> Despite the availability of resources and protocol, and advances in pain management, improvement in pain management practice is still lacking especially in developing countries like Nepal. Certain barriers act as obstacle to adequate pain management. The barriers can be classified into three categories: barrier related to patient, health care professionals and health care system. There are very few literature that focuses on pain as public health problem in Nepal. So there is need for such multicentre study in the country. <b>Aim:</b> To assess the pain management practices of the health professionals in different hospitals of Nepal and to identify different types of perceived barriers which prevent adequate pain management of the patients. <b>Materials and Methods:</b> A cross-sectional multi-centre study was conducted among 292 health professionals of five different hospitals of Nepal. Simple random sampling technique was used to select the participants from each hospital. Data collection was done by using structured self administered questionnaire. Descriptive and bi-variate analysis was done. <b>Results:</b> Out of 292 participants (182 doctors, 102 nurses and 10 health assistants), only 56 (19.2%) had participated in pain management training. Only 39.7% always used pain scale for assessment of pain. The documentation of pain was also poor with only 22.3% always doing documentation. The documentation of pain assessment was better among nurses when compared with doctors (p<0.005). The pain scale was always used for reassessment by 33.2%. The main barriers to pain management as perceived by the participants were opioids being strictly regulated (75.7%), insufficient staff in the hospital (73.4%), lack of knowledge among patients about pain management (66.8%) and least priority for pain management by hospital (60.1%). <b>Conclusion:</b> The barriers that prevent pain management exist at all three levels - patient barrier, health professional’s related barrier and health system barrier and to overcome all these should be given equal importance. The use of multidimensional approach would help to break the barriers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=UC01-UC05&id=13421 https://doi.org/10.7860/JCDR/2020/42904.13421 Multidrug Resistance Pattern of Bacteria Isolated from Fish Samples Sold in Retail Market Abdullah Al-Ghanayem, Babu Joseph, Mohammed Bin Mahdi, Bibin Scaria, Abdulmoneim Mohammad Saadabi <b>Introduction:</b> The uncontrolled use of antibiotics increases the emergence of resistant bacteria and makes it difficult to treat the infections. Antibiotics are widely used as growth promoters in animal breeding to control bacterial infections and also as preservatives to increase shelf-life. Development of antibiotic resistance in environmental bacteria has become a serious threat and growing problem for the entire population worldwide. <b>Aim:</b> To evaluate the Multi Drug Resistance (MDR) pattern of bacterial isolates collected from different fish samples sold in Shaqra retail market. <b>Materials and Methods:</b> The isolates (80) were identified based on morphological and biochemical characteristics. Further the isolates were subjected to antibiotic sensitivity test by using disc diffusion method and the MDR pattern was studied. SPSS version 23 was used for analysing the results. <b>Results:</b> Among the 80 isolates 28 (35%) bacterial isolates were Gram positive and 52 (65%) were Gram negative bacteria. The isolates were presumptively identified by morphological and biochemical characteristics as Aeromonas species, Escherichia coli, Enterobacter species, Proteus species, Enterococcus species, and Streptococcus species. Some of these isolates showed resistance to more than one antibiotic used in the present study. The MDR index ranged from 0.33 for Streptococcus species and 0.44 for E.coli strains which is considered as high risk contamination. <b>Conclusion:</b> Transfer of antibiotic resistant gene from these bacteria to pathogenic bacteria would become a serious threat for the human population in the coming future. The usage of high dose of preservatives and antibacterial agents in the fishes during storage can be avoided. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=DC13-DC16&id=13436 https://doi.org/10.7860/JCDR/2020/42847.13436 Exploring Barriers for Early Initiation of Breastfeeding among Mothers in the Post-natal Ward: A Cross-sectional Study Arunava Pariya, Adwitiya Das <b>Introduction:</b> Early Initiation of Breast Feeding (EIBF), referred to as “provision of mother’s breast milk to infants within 1 hour of birth”, is the cornerstone of infant survival and health. In spite of an increase in proportion of mothers practising EIBF over the past decade, the number is still less than satisfactory. <b>Aim: </b>To find out the proportion of mothers who practised EIBF, and the factors influencing the same. <b>Materials and Methods:</b> Ninety-seven post-natal mothers were interviewed from June 2017 to August 2017 using a pre-designed, pre-tested semi-structured questionnaire. Other relevant information collected from in-patient records. Logistic regression analysis was done. <b>Results:</b> Out of 97 mothers, EIBF was practised by 59 (60.82%). Main reason for not initiating EIBF according to the mothers was “baby not roomed/bedded-in” soon after birth, followed by exhaustion from delivery. Knowledge regarding benefits of EIBF was inadequate. Colostrum feeding was done by 83.51% of mothers. On logistic regression analysis, it was observed that in the multivariate model, education of mother, higher age at marriage, vaginal/vaginal assisted delivery and term/post-term baby were significant factors promoting EIBF. <b>Conclusion:</b> EIBF was practised by less than two-thirds of study subjects. Knowledge regarding EIBF was unsatisfactory. This study revealed education of mother, higher age at marriage, vaginal/vaginal assisted delivery and term/post-term baby were significant factors promoting EIBF. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=LC06-LC10&id=13437 https://doi.org/10.7860/JCDR/2020/43041.13437 A Time-and-Motion Approach to Micro-Costing of a School-Based Fluoride Mouth Rinsing Programme Archana Krishna Murthy, Nusrath Fareed </b>Introduction: </b>Fluoride mouthrinsing has been established as an effective method to prevent dental caries among school children. Time-and-motion studies help to identify the efficiency of different processes and give a comprehensive cost estimate. Economic cost of utilising teachers for fluoride mouthrinsing in schools has not been explored. <b>Aim:</b> To determine the economic costs of fortnightly school-based Fluoride Mouthrinsing (FMR) program using the micro-costing technique for a period of three years. <b>Materials and Methods:</b> The cost analysis study (community trial) was conducted in three government primary schools among 110 school children who were six to seven years old with high caries risk as assessed by the American Academy of Paediatric Dentistry guidelines. The school teachers were trained to carry out the FMR program by the investigator. Data on costs of resources was collected by micro-costing method using time-and-motion technique. Costs were classified as capital and recurrent costs and the total cost of the program along with unit cost were estimated. <b>Results:</b> In the three years, 58 sessions of mouthrinsing were conducted with dentist being the provider for the first three sessions and the rest were provided by the teachers. The total economic cost of all inputs amounted to Indian Rupees 2,00,592.6 (US $ 3,283.0) with 95.4% from recurrent costs and only 4.6% from capital costs. The capital costs with teachers as program providers were higher than that with the dentist as program provider whereas the recurrent costs with teachers was lower than the dentist as a program provider. <b>Conclusion:</b> Since the recurrent costs that make up 95% of the total costs was lower with teachers as providers than dentists, school-based FMR program using teachers can be used to provide dental services for underserved children with unmet preventive care needs. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZC23-ZC26&id=13438 https://doi.org/10.7860/JCDR/2020/42609.13438 Association of Cadmium, Chromium, Manganese and Lead with Hyperprolactinemia: A Pilot Study Amanpreet Kaur Kalsi, Ashutosh Halder, Manish Jain, Amita Srivastava <b>Introduction:</b> Hyperprolactinemia is one of the most common hypothalamic-pituitary dysfunctions where serum prolactin levels increase beyond normal range. Studies have suggested association of heavy metals with prolactin levels. <b>Aim:</b> To investigate the association of serum levels of heavy metals with prolactin levels in hyperprolactinemia patients. <b>Materials and Methods:</b> A total of 102 hyperprolactinemia patients (>100 ng/mL serum prolactin levels) and 25 controls were included in the study. Hyperprolactinemia patients were classified into macroprolactinemia (n=22) and true hyperprolactinemia (n=80) based on post Poly Ethylene Glycol (PEG) recovery of prolactin of <25%. Serum Cadmium (Cd), Chromium (Cr), Manganese (Mn) and Lead (Pb) levels were analysed using Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES) method. Statistical analysis was done using SPSS version 21.0 and Stata version 14.2. Student&#39;s t-test and Pearson correlation were used. The p<0.05 was considered statistically significant. <b>Results:</b> There was no significant correlation between serum levels of prolactin and heavy metals Cd (r=0.067, p=0.457), Cr (r=-0.065, p=0.465), Mn (r=-0.076, p=0.393) and Pb (r=-0.148, p=0.097). No significant difference was found in serum levels of heavy metals between macroprolactinemia and true hyperprolactinemia patients (p=0.521, 0.690, 0.564 and 0.488 for Cd, Cr, Mn and Pb, respectively). ROC analysis also did not reveal any significance in any of the four heavy metals studied. <b>Conclusion:</b> The results suggest that probably there is no association of serum prolactin levels, macroprolactinemia or hyperprolactinemia with heavy metals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=QC04-QC07&id=13439 https://doi.org/10.7860/JCDR/2020/42690.13439 Assessment of Knowledge and Practices of Mothers about Infant Feeding: A Hospital Based Study Varsha Mishra, Jagannath Mohapatra, Pradeep Kumar Debata <b>Introduction:</b> Exclusive Breast Feeding (EBF) is one of the most efficacious and cost effective intervention for reduction of child morbidity and mortality. Institutional delivery with maternal counselling and training is accepted as an effective modality to implement EBF. However, EBF rates have remained unacceptable despite high proportion of institutional deliveries in India. <b>Aim:</b> To estimate EBF rate amongst institutional deliveries, and the factors affecting breastfeeding practices among these mothers. <b>Materials and Methods:</b> This was a cross-sectional hospital based study. Institutionally, delivered infants attending Paediatrics Out-Patient Department (OPD) and immunisation clinic, who had received complete vaccination till 14 weeks, were included. All mother-baby pairs satisfying inclusion criteria were recruited after written informed consent. Institutional ethics committee approved the study. Infant and Young Child Feeding (IYCF) guidelines and Integrated Management of Neonate and Child Illness (IMNCI) Feeding Assessment Questionnaire based proforma was used to access breastfeeding knowledge and practices amongst recruited subjects. Chi-square test was used to assess the relationship between background characteristics of subjects and feeding practices. Further these associations were tested using multiple logistic regression models with each associated factor. <b>Results:</b> A total of 500 mother and baby dyad were recruited. Only 64 (12.8%) mothers initiated breastfeeding within 1 hour of birth; 12.6% babies never received breastfeeding. A 17.6% discarded colostrum considering it bad or indigestible for their babies. Prelacteal feeding in first six months of birth was practiced by 47.6% mothers. Scheduled and on-demand breastfeeding was higher amongst mothers living in nuclear families as compared to those in joint families (90.4% vs. 80.7%; p=0.003). <b>Conclusion:</b> Inspite of institutional delivery and multiple contacts with health personnel, EBF rate is still low. Many faulty practices, like withholding colostrum and prelacteal feeding are still prevailing in the society. Effective and repeated counselling is required in each contact with care givers for successful EBF. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=SC01-SC05&id=13440 https://doi.org/10.7860/JCDR/2020/42176.13440 Visual Impairment among Older Adults in Selangor State of Malaysia: The Grand Challenge Project Mohd Harimi Abd Rahman, Kee Qiu Ting, Zainora Mohammed, Norliza Mohamad Fadzil, Suzana Sahar, Mahadir Ahmad <b>Introduction:</b> The increased prevalence of Visual Impairment (VI) in the elderly is in tandem with the increase of its populations in Malaysia. <b>Aim:</b> This study was aimed to determine the prevalence and risk factors of VI among older adults in Selangor, Malaysia as it is one of the highly populated states in the country. <b>Materials and Methods:</b> A total of 230 adults aged 60 years and above from the longitudinal study on neuroprotective model for healthy longevity (TUA) took part in this study from August 2018 to May 2019. Information on socio-demographic, smoking status and health condition were obtained through interview. Habitual distance Visual Acuity (VA) was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart. Refractive error was determined using retinoscopy technique followed by subjective refraction. Subjects&#8217; height and weight were measured for their Body Mass Index (BMI). Descriptive statistics were used to determine the prevalence of VI and status of refractive error. Pearson correlation was used to determine correlation between household income and VI whereas Kendall&#8217;s Tau-b was used to determine correlation between age, educational level and smoking status with VI. Multivariate logistic regression was carried out to determine the risk factors of VI. <b>Results:</b> Analysis was performed on 201 subjects (29 were excluded due to incomplete data) and the mean&#177;SD VA for better eye was 0.23&#177;0.20 logMAR. Overall, emmetropia has the highest percentage (37.3%), followed by hyperopia (34.3%) and myopia (28.4%). This study found that the prevalence of VI among older adults in Selangor was 27.3%. Pearson correlation showed significant correlation between monthly household income with VI. Kendall Tau-b showed a significant correlation between age, educational level and smoking status with VI. Multivariate logistic regression shows significant association between age older than 80-year-old with VI. <b>Conclusion:</b> The prevalence of VI among the elderly in Selangor was notably high (27.3%) and greater age is associated with VI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=NC05-NC09&id=13441 https://doi.org/10.7860/JCDR/2020/42998.13441 Iron Profile in Multiple Myeloma and Chronic Kidney Disease NS Madhura, R Kowsalya <b>Introduction:</b> In normal individuals serum ferritin levels would indicate the body iron stores. Ferritin levels are known to be increased despite the low body iron stores in conditions like chronic inflammation and malignancies. However, the increased levels of ferritin and its correlation with the other iron profile parameters need to be validated in Chronic Kidney Disease (CKD) and Multiple Myeloma (MM). <b>Aim:</b> To compare the abnormalities of iron profile markers in CKD and MM with age and sex matched controls and to find out whether Serum Ferritin (SF) levels correlate with body iron stores in these clinical states. <b>Materials and Methods:</b> This was a hospital-based retrospective study done in tertiary care Nephrourology Centre, Bangalore, Karnataka, India from April 2017 to April 2018. Patients attending routine nephrology OPD were included in the study. There were three study groups, group I (n=50) included non-dialysed CKD patients, group II (n=50) included newly diagnosed cases of MM using International Myeloma Working Group (IMWG) criteria and group III (n=50) consisted of controls included age and sex matched normal subjects who had been referred to the laboratory centre for routine check-up. Iron profile which includes Serum Iron (SI), Total Iron Binding Capacity (TIBC), Transferrin Saturation (TS), and SF, was done in all the subjects enrolled in the study. Data analysis was done by Statistical Package for Social Science (SPSS) version 17. The significance level, or p-value, was calculated using the unpaired t-test. <b>Results:</b> In the CKD group (n=50), only seven patients had normal iron profile. Forty-three patients had deranged iron profile. Among these 43 cases, the mean SI was 34&#177;10 ug/dL, mean TIBC was 206&#177;39 ug/dL, mean TS was 17&#177;9 ug/dL. SF levels were >100 ng/dL in 20 CKD patients and <100 ng/dL in 30 CKD patients. In MM patients (n=50), five had normal iron profile. Forty five patients had abnormal iron profile with mean SI levels 29&#177;9 ug/dL, low TIBC 163&#177;10 ug/dL, low TS 13&#177;4 ug/dL, and SF was 793&#177;20 ng/dL. On comparison of CKD and MM patients with controls; the mean values of SI, TIBC and TS were significantly lower than controls (p<0.05). Also, the mean SF values of CKD and MM group patients were significantly higher than the controls (p<0.05). Also, the values of all these parameters (SI, TIBC, TS, SF) were much more deranged in MM group compared with the CKD group and this was statistically significant (p-value <0.05). <b>Conclusion:</b> High ferritin values in these patient groups should not be mistaken for iron overload; rather a prompt correction of iron deficiency must be sought based on total iron profile assessment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=BC01-BC05&id=13427 https://doi.org/10.7860/JCDR/2020/42794.13427 Awareness of Coronary Artery Disease among Section Population of Al-Qassim, Saudi Arabia: A Community-Based Study Fatin Ahmad, Rami M Abazid, Abdulaziz Suliman Allihimy, Dawood -Abdurhman Aldrewesh, Sarah ¬Abdulrahman Alkuraydis, Shaima Abdullah Alharb, Marghoob Hasan , ¬Abdelmarouf ¬Hassan Mohieldein <b>Introduction:</b> Recognition of Coronary Artery Disease (CAD) symptoms affects the time-sensitive benefits of reperfusion therapy in case of acute myocardial infarction. <b>Aim:</b> To evaluate awareness of CAD symptoms and risk factors in population of Al-Qassim Region, Saudi Arabia. <b>Materials and Methods:</b> A cross-sectional, hospital and community-based descriptive study was conducted from May to October 2018. Total of 3235 Saudi citizens, comprising of 3085 healthy participants (without documented CAD) and 150 patients (with documented CAD) participated in the study. A pre-piloted well-structured questionnaire was used. The questionnaire included questions about participants&#8217; demographic characteristics, CAD risk factors and symptoms. Data were analysed by using SPSS. Descriptive statistics (mean, standard deviation, percentage, Student&#8217;s t-test, chi-square test) was applied. <b>Results:</b> Participants&#8217; baseline data revealed 54.4% of healthy participants and 13.3% of patients had an education at a university or higher level (p<0.001). Out of overall score 22 points, mean&#177;SD for CAD knowledge was 12.62&#177;5.1 and 13.59&#177;4.8 (p=0.015) for healthy participants and patients, respectively. For all study participants, total score for knowledge of CAD risk factors was 6.73&#177;2.4 (out of 10), while total score for knowledge of CAD symptoms was 5.07&#177;3.1 (out of 10). One remarkable finding was that only 37.8% of healthy participants and 16% of patients knew cardiopulmonary resuscitation. <b>Conclusion:</b> This research revealed that general population in Al-Qassim Region showed a serious lack of knowledge about CAD symptoms when compared to CAD patients. Authorities should implement great efforts to improve public perception about CAD and its symptoms. This could support in diminishing the morbidity and mortality of the disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=OC10-OC14&id=13423 https://doi.org/10.7860/JCDR/2020/43124.13423 Presenting Features and Clinical Profile of Scrub Typhus Fever Cases in Adult Patients Admitted in a Tertiary Care Hospital in Puducherry, India A Tumbanatham, K Jayasingh, S Lokesh, Selvaraj Stephen <b>Introduction:</b> The infection of scrub typhus is caused by the bite of infected chiggers and the clinical manifestation of scrub typhus is characterised by the presence of fever, headache and body pain and rarely can causes rashes. There is paucity of information regarding the clinical presentation and the pathophysiological manifestation of scrub typhus infection, especially in tropical regions in Southern India. <b>Aim:</b> To determine the clinical profile and manifestation of scrub typhus infection among adults in Puducherry, India. <b>Materials and Methods:</b> This retrospective study was conducted on data of 79 IgM Immunochromatography (ICT) positive for scrub typhus patients, who were admitted and treated in 2015 in the study institution. Particulars regarding the clinical presentation, laboratory parameters and course in the hospital were documented from the medical records. Chi-square test was carried out to look for statistical significance between clinical and demographic parameters. <b>Results:</b> Fever was the predominant symptom (49.4%) followed by headache (38%) and cough (19%). Eschar was present in 16.4% of the participants, and it was predominantly located in hypochondrium, anterior abdominal wall and sacral region (15.4%). About 17.7% of the participants had abnormal respiratory signs, of which bilateral crackles with ronchi was the most common sign (64.4%). While most common complication was gastrointestinal (18.1%); multi-organ involvement was present in 11.4% of the participants. Participants >40 years of age increasingly presented with symptoms of Central Nervous System compared to younger age group (p<0.05). <b>Conclusion:</b> The features of febrile illness with low total count and thrombocytopenia with high index of suspicion for scrub typhus may prevent mortality due to multiorgan failure by early institution of treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=OC01-OC05&id=13408 https://doi.org/10.7860/JCDR/2020/43000.13408 Clinicopathological and Prognostic Value of Immunohistochemical Expression of CD44 (Stem Cell Marker) and Ki67 in Serous Ovarian Cancer Taiseer R Ibrahim, Samar M Abdel Raouf, Mohamed Abdelgawad, Amira Elwan <b>Introduction:</b> Failure of effective treatment of epithelial carcinoma of the ovary necessitates searching factors that lead to resistance to chemotherapy and recurrence. Cancer stem cell theory hypothesis provides an explanation of how small group of cells inside the tumour remain resistant to treatment. CD44 has been considered as cancer stem cell marker in multiple malignancies but its role in Ovarian Serous Carcinoma (OSC) is still controversial. <b>Aim:</b> To investigate the expression of stem cell marker CD44 and proliferative activity using Ki67 immunostaining in serous ovarian carcinoma and their relation to clinical and pathological variables and outcome of the patients. <b>Materials and Methods:</b> The present study was a prospective study done on 45 patients with serous ovarian tumours, the ovarian sections obtained from the patients were immunostained by CD44 and Ki67 immunohistochemical markers. The Overall Survival (OS), Disease Free Survival (DFS) and response to treatment were investigated and analysed. <b>Results:</b> Both CD44 and Ki67 were positive in patients with increased grade and advanced stage and the difference was highly statistically significant (p=0.001 and p<0.001, respectively). CD44 and Ki67 expression were higher in bilateral cancer with presence of lymph node and distant metastasis than in unilateral tumours without lymph node and distant metastasis. The present study found positive relation between CD44 and Ki67 expression (p=0.006). CD44 and Ki67 positive expression level in OSC had a significantly shorter 3-year DFS than the patient group with negative expression of CD44 and Ki67 (p=0.020 and p=0.002, respectively). <b>Conclusion:</b> This study demonstrated that CD44 and Ki67 expression were significantly associated with high grade and late stage serous ovarian carcinoma, and their high expression was associated with poor prognosis and resistance to chemotherapy, so proper quantification may play a vital promising function in choosing targeting therapy and predicting more better result outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=XC01-XC07&id=13453 https://doi.org/10.7860/JCDR/2020/43003.13453 Evaluation of Tear Film Functions Preoperatively and Postoperatively in Cases with Pterygium: A Case Control Study Prarthana Patkar, Pradeep Sune <b>Introduction:</b> The presence of pterygium and dry eye symptoms often co-exist. Pterygium disturbs the tear film. The extent to which the excision of pterygium will affect the tear film needs to be evaluated. Tear-film Break Up Time (TBUT) and Schirmer&#8217;s I and II test are some of the common tests used for evaluation of the tear film. <b>Aim:</b> To study the effect of pterygium and pterygium excision surgery with conjunctival autograft technique on tear film. <b>Materials and Methods:</b> A hospital based case control study was conducted on 200 eyes of 100 patients from September 2017 to August 2019. The eye affected with pterygium was the case eye and the other normal eye of the same patient was taken as the control. TBUT, Schirmer&#8217;s I and II test were done preoperatively and postoperatively on day 10, 30 and 60. Statistical analysis was done using descriptive and inferential statistics using Student&#8217;s unpaired t-test and software used in the analysis was SPSS 22.0 version and GraphPad Prism 7.0 version and p<0.05 was considered as level of significance. <b>Results:</b> The mean TBUT preoperatively in the case eye was 9.71&#177;1.35 seconds and in the control eye was 10.64&#177;1.32 seconds. Their difference was statistically significant (p-value <0.0001). TBUT increased significantly postoperatively (p-value <0.0001). The mean Schirmer&#8217;s I preoperatively in the case eye was 13&#177;2.47 mm and in the control eye was 14.54&#177;2.45 mm. Their difference was statistically significant (p-value<0.0001). Postoperatively it increased significantly (p-value<0.0001). The Schirmer&#8217;s II test value preoperatively in the case eye was 9.85&#177;2.33 mm and in the control eye was 10.44&#177;2.54 mm. There was no significant difference between the two (p-value=0.08). No change was seen postoperatively. <b>Conclusion:</b> There was an increase in the TBUT and Schirmer&#8217;s I test in the case eye after pterygium excision. Preoperatively there was a significant difference between the case and control eye but after pterygium excision, no significant difference was seen between the two. This showed that ultimately, post pterygium excision, the case eye showed an increased stability of tear film which was comparable to the control eye. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=NC10-NC13&id=13461 https://doi.org/10.7860/JCDR/2020/43113.13461 Factors Related to Job Satisfaction amongst Endodontists in Saudi Arabia: A Cross-sectional Study Nawaf Labban, Nouf Al -shibani, Hanan Al -Otaibi, Reem Al -kattan, Sara Al fadda, Emad Al Shwaimi, Sahar Faisal Albarakati <b>Introduction:</b> High incidence of job dissatisfaction among practising endodontist raises serious concerns on the health care system. <b>Aim:</b> To evaluate overall job satisfaction among endodontist highlighting the significance of intrinsic and extrinsic factors and their satisfaction level with patients, facilities and workplace when working in Kingdom of Saudi Arabia (KSA). <b>Materials and Methods:</b> A questionnaire was sent to endodontist using survey monkey instrument consisting of total 38 questions in seven domains. Socio-demographic characteristics, academic, professional qualifications, motivation behind choice of endodontist as a speciality, satisfaction as an endodontist, satisfaction with the workplace, environment facilities and staff and their satisfaction with their relationship with patients were assessed. The responses were measured using a five-point Likert’s Scale coded as: 1 strongly disagree; 2 disagree; 3 fair; 4 agree; 5 strongly agree. A descriptive analysis of all responses was done using Statistical Package for the Social Sciences. Standard Deviation (SD), percentages and means were calculated. <b>Results:</b> Demographic factors exhibited that 93.6% (103) were Saudi national. Gender analysis indicated 25 respondents (22.7%) were male, whereas 85 (77.3%) were females. Regarding qualification, 58 (52.7%) of the dentists had their qualification from Saudi commission of health sciences, by completing the Endodontic Saudi board specialist training and examination. Majority of the respondents, 78 (69.6%), reported “challenging profession” as the main reason for choosing endodontics. Regarding satisfaction at job 77.2% of the respondents stated that their responsibilities were well defined. An 80.9% of the endodontist was of the view that they have good relations with their patients. The results of 110 respondents revealed highly significant differences among responses to different questions (p<0.05). <b>Conclusion: </b>Job satisfaction of endodontist working in KSA was satisfying. More studies should be performed to validate the results of present study. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZC27-ZC31&id=13458 https://doi.org/10.7860/JCDR/2020/42762.13458 Evaluation of Hypomagnesemia in Acute Myocardial Infarction Patients R Vedamanickam, Palanychamy Anandan, Giridharan Bupesh <b>Introduction:</b> Magnesium inhibits potassium efflux and calcium influx, the two events which are harmful to cardiac muscle survival during ischaemia. Magnesium prevents mitochondrial calcium overloading and maintains Adenosine Triphosphate (ATP) synthesis, which could result in smaller infarct size. <b>Aim:</b> To compare the levels of serum magnesium in patients with Acute Myocardial Infarction (AMI) presenting within the first 24 hours. <b>Materials and Methods:</b> This case-control study was conducted in Department of Medicine at a Tertiary Care Hospital, for 6 months from June 2018 to December 2018. A total of 60 participants were taken into the study and were divided into two groups. Group-1 was control subjects and Group-2 was patients with AMI. Serum magnesium level was assessed in both the groups and the results were compared. Student&#8217;s t-test was performed using SPSS version 21.0. <b>Results:</b> A total of 73% of patients with AMI were more than 41 years, 53% of patients presented with anterior wall MI, 40% of patients presented with inferior wall Myocardial Infarction (MI) and 7% of patients with anterolateral MI. The mean serum magnesium level in AMI patients was found to be 1.23&#177;0.98 mg/dL and was 2.12&#177;0.68 mg/dL in control group, which was statistically significant. <b>Conclusion:</b> Low serum magnesium was significantly found in AMI patients and their comorbidities. Therefore supplementation of Magnesium might improve the patients&#8217; outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=OC15-OC16&id=13455 https://doi.org/10.7860/JCDR/2020/42568.13455 Expression and Clinical Significance of Large Tumour Suppressor Kinase 2 (LATS2) Gene in Acute Myeloid Leukaemia: An Egyptian Study Shereen Mohamed El-Hoseiny, Raafat Mohamed Abd El Fattah, Rehab Muhammad Abdelkareem, Doaa Sayed Saleh Sayed, Thoraya Aly, Heba Hamdy El Demellawy, Rasha Abd El Razek Khattab <b>Introduction:</b> Large Tumour Suppressor (LATS) family proteins were discovered for the first time in Drosophila in 1995. Since that date, LATS proteins have been considered tumour suppressors. The family includes two members, LATS1 and LATS2, which have a chief function in the control of tumour growth and cell cycles through several mechanisms and signalling pathways, including those of p53, Hippo, and Wnt. LATS2 gene was involved in many types of haematological malignancies as it plays a role in the leukaemogenesis of AML and also in the clinical outcome of the disease. <b>Aim:</b> The current study was an attempt to clarify the relation of LATS2 gene expression and clinical manifestations of Acute Myeloid Leukaemia (AML). <b>Materials and Methods:</b> The present case-control study included 60 adult denovo AML patients and 60 age and sex matched healthy controls for analysis of LATS2 mRNA gene expression level by Real Time-Quantitative Polymerase Chain Reaction (RT-QPCR) technique. Data were analysed using IBM SPSS advanced statistics version 22.0 (SPSS Inc., Chicago, IL). <b>Results:</b> The expression level of LATS2 gene was significantly higher in AML patients compared to controls (p<0.001). The results showed positive association between LATS2 gene and hepatomegaly and splenomegaly. Mean expression level of LATS2 was higher in patients with hepatomegaly and splenomegaly. The difference was statistically significant (p<0.05). LATS2 gene expression level associates with follow-up of patients as the present study revealed lower LATS2 gene expression (77.45&#177;100.29) in the 40 patients who achieved complete remission (66.7%) than in the 8 patients (13.3%) who achieved partial remission as their mean expression level was (147.18&#177;160.24) compared to higher LATS2 gene expression (239.83&#177;281) in the 12 AML patient (20%) who didn’t achieve CR. The difference was statistically significant (p=0.002). <b>Conclusion:</b> This study established that LATS2 gene expression was higher in AML patients with extramedullary infiltration. So, LATS2 gene might be a valuable new marker in the diagnosis and prognosis of AML patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=XC08-XC12&id=13456 https://doi.org/10.7860/JCDR/2020/42848.13456 Hormone Replacement Therapy (HRT): Utilisation Rates, Determinants and Impact on Health-Related Quality of Life in a Multi-Ethnic Asian Population Baolin Pauline Soh, Ryan Eyn Kidd Man, Yih Chung Tham, Eva Fenwick, Tze Tein Yong, Tien Yin Wong, Ching Yu Cheng, Ecosse L Lamoureux <b>Introduction:</b> Hormone Replacement Therapy (HRT) is widely prescribed to provide relief from unpleasant climacteric symptoms, however for several decades, the benefits and risks of HRT have been debated. Most of the current HRT literature is focused on western population, with very less available information on Asians. <b>Aim:</b> To examine the HRT utilisation rate, determinants and impact on Health-Related Quality Of Life (HRQOL) in a multi-ethnic Asian population in Singapore. <b>Materials and Methods:</b> A total of 3408 women from the Singapore Epidemiology of Eye Diseases study, comprising Chinese (n=1215), Malay (n=1091) and Indian (n=1102) were included in the analyses. HRT utilisation was self-reported and HRQOL was assessed using the EuroQoL-5 Dimensions questionnaire. Multivariable logistic and linear regression models were used to elucidate the determinants of HRT utilisation and its association with HRQOL, respectively. <b>Results:</b> The age-standardised HRT utilisation rate was 8.80%, with majority being Chinese. Aged between 50-69 years, have reading literacy, of Christian religion and history of oophorectomy were independent determinants of HRT utilisation. Ethnicity-stratified analyses found that monthly income (&#x2265;SG$1,000) in Indians, and older age of menstruation cessation in Chinese, were independently associated with HRT utilisation. Malay, Indian and Chinese women using HRT had worse mobility, pain/discomfort, and anxiety/depression, respectively, compared to non-users. <b>Conclusion:</b> HRT utilisation rates in this Asian sample were relatively low compared to most Western countries, and with the Chinese being the highest users. The factors associated with HRT utilisation appeared to be multifactorial and usage is associated with poorer HRQOL in some aspects, varied by ethnicity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=QC08-QC15&id=13463 https://doi.org/10.7860/JCDR/2020/42545.13463 Assessment of Maternal Serum Levels of Vascular Endothelial Growth Factor and Placental Growth Factor in Threatened Abortion: A Case Control Study Sugandha Dev, Alpana Singh, BD Banerjee, Gita Radhakrishnan, Rachna Agarwal <b>Introduction:</b> Vascular Endothelial Growth Factor (VEGF) and Placental Growth Factor (PlGF) are implicated in the pathophysiology of Threatened Abortion (TA). VEGF family regulates placental angiogenesis and maternal spiral artery remodelling whereas PlGF is an important regulator of decidual angiogenesis and is a mediator of trophoblast function. Earlier studies have investigated role of these markers in patients with TA but no definite consensus has been reached. Moreover there is limited data from our population. <b>Aim:</b> To assess the maternal serum levels of VEGF and PlGF in patients with TA compared to uncomplicated pregnancy. <b>Materials and Methods:</b> This was a case control study conducted in a tertiary care hospital of Northern India in which total 40 TA patients and 40 controls were analysed. A 3 mL of peripheral blood sample was collected from each case and control. The plasma was separated and quantification of VEGF and PlGF was done by using ELISA kits in cases and in age and gestational age matched controls. <b>Results:</b> Serum VEGF level was significantly lower in cases compared to controls (30.65&#177;9.41 pg/mL vs. 64.55&#177;16.67 pg/mL, p<0.001) irrespective of their gestational age. TA patients also had lower serum PlGF level (263.54&#177;68.108 pg/mL vs. 341.83&#177;112.704 pg/mL, p<0.001). But no definite trend was found in VEGF and PlGF levels with increasing gestational age. <b>Conclusion:</b> Maternal serum VEGF and PlGF level was low in patients with TA compared to uncomplicated pregnant women regardless of gestational age. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=QC16-QC18&id=13464 https://doi.org/10.7860/JCDR/2020/42720.13464 Influence of Social Media on the Patients for Choosing the Dental Clinic- A Cross-sectional Survey Omar Hamad Alkadhi, Nawaf Khalid Aleissa, Mohammed Khalid Almoharib, Saad Ahmed Buquayyid <b>Introduction:</b> Social media has great potential in marketing, including dentistry. The choice of dental clinic by the patients is a complex phenomenon and depends on various factors. Many studies have been done to find the factors which influence the clinic selection but not much literature exists to assess the relationship of social media in it. <b>Aim:</b> To evaluate the influence of social media on the patients for choosing the dental clinic. <b>Materials and Methods:</b> This cross sectional study was conducted in Riyadh city with the help of self-administered and closed ended questionnaire. Patients visiting the dental hospital were asked about demographic information and questions related to use of social media and factors that are most important to him/her when looking at the account of his/her dentist on social networking sites. Chi-square test was used to compare differences in social media effect and use between gender and age and level of significance was kept at p<0.05. <b>Results:</b> Total number of respondents were 442 (167 males and 275 females) Significant difference was found only to use Instagram where 10% of females reported when searching for dental clinics compared to males (3%) (p<0.05). Most of the patients considered recommendations from friends\family as a very important factor (n=236) and quality of website and online reviews were also considered important (n=279 and 241, respectively). Chi-square test was used to compare differences in social media effect and use between gender and age with cut-off point set at (0.05). <b>Conclusion:</b> With the increasing trend of revoluntionary social media usage, it is now essential for dentist to be marketing their practice at these platforms; also to keep up with the futuristic trends. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZC32-ZC34&id=13466 https://doi.org/10.7860/JCDR/2020/43457.13466 Active Matrix Metalloproteinase-8 Chair Side Mouth Rinse Test, Health Behaviour and Oral Health in Finnish Adolescent Cohort Teija Raivisto , Timo Sorsa , Ismo T Räisänen , Timo Kauppila , Hellevi Ruokonen , Taina Tervahartiala , Jari Haukka, Anna Maria Heikkinen <b>Introduction:</b> Even adolescents have early signs of periodontitis, an infectious inflammatory disease. Young patients at risk must be identified for the preventive interventions and treatment at enough early. <b>Aim:</b> To find out whether participants at risk for subclinical periodontitis could be identified using an active Matrix Metalloproteinase-8 (aMMP-8) chairside mouth rinse test, and to study if health behaviour and oral health are linked to the test result in Finnish adolescents. <b>Materials and Methods:</b> This study was carried out at the H&#228;meenlinna Health Center in South Finland in 2017-2018. Altogether 125 participants gave their consent to the study. Adolescents (14-15-year-old) were randomly divided into the control group (n=55) and the test group (n=70). All participants&#39; oral health was examined, and they filled a questionnaire. The aMMP-8 chairside mouth rinse test was performed for the test group. Test positives were followed four monthly for a year. Data analysis was performed by IBM SPSS Statistics Version 25 by different statistical tests, including the Mann Whitney U test, the Friedman&#39;s test, the Dunn-Bonferroni test and the Wilcoxon test. <b>Results:</b> Visible Plaque Index Percentage (VPI%) was significantly higher in test positives (p=0.005). Bleeding On Probing Percentage (BOP%) reached almost statistically significant difference (p=0.052). Periodontal treatment intervention decreased aMMP-8 levels assessed by a change in the test stick result from positive (+) to negative (-) during follow-up time. <b>Conclusion:</b> The aMMP-8 chairside mouth rinse test identified and alarmed adolescents with poor oral hygiene at risk for subclinical periodontitis without detectable and visible manifestations of the illness, such as deepened periodontal pockets. The aMMP-8 test is fast, inexpensive, predictive, easy to use and follow the effectiveness of intervention of subclinical periodontitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZC35-ZC39&id=13467 https://doi.org/10.7860/JCDR/2020/43031.13467 Sensitivity of <i>Staphylococcus aureus</i> and <i>Pseudomonas aeruginosa</i> to Blue Light Irradiation for Possible Role in Antimicrobial Therapy Radhika Sudhir, Abhijeet Mane, Meera Modak <b>Introduction:</b> Due to the escalation of antibiotic resistant pathogens, non-antibiotic approaches to clinical treatment are being investigated, particularly phototherapy. In this study, 470 nm blue light was examined as an antimicrobial agent against various isolates of <i>S. aureus</i> and <i>P. aeruginosa</i> in vitro. <b>Aim:</b> To determine the adequacy of blue light as an antimicrobial agent against the two pathogens infamous for rapid development of drug resistance. <b>Materials and Methods:</b> ATCC strains of each organism, along with 25 strains of each from patient isolates, were collected. Isolates were suspended in peptone water at 0.5McF, and then inoculated on plates of Mueller-Hinton agar (control and experimental plate). Antibiotic sensitivity of each isolate was determined with 7 common antibiotics, following which, experimental plates were irradiated with a 470 nm Light Emitting Diode (LED) for 60 minutes. Plates were then placed in incubators overnight at 37&#xb0;C. Zones of inhibition for each experimental plate were compared with the control to determine any action of the blue LED with the antibiotics. Results of the study were analysed using paired t-test where p<0.05 and was calculated for all drugs which showed significant increase in zones of inhibition following 470 nm blue light irradiation. <b>Results:</b> Results demonstrated an increase in zones by 0 to 6 mm, though this was predominantly seen in isolates of <i>P.aeruginosa</i>. The action of the LED was particularly significant with Linezolid for <i>S.aureus</i> and Imipenem for <i>P.aeruginosa</i>, where there was a mean increase of 2 mm and 3 mm, respectively. Comparison of Ciprofloxacin in both pathogens demonstrated a greater increase of zones in plates of <i>P.aeruginosa</i> (2.23 cm) as compared to <i>S.aureus</i> (1.27 cm), suggesting greater sensitivity of this organism to the 470 nm light. <b>Conclusion:</b> This study determined that 470 nm blue light does demonstrate a species-specific inhibitory effect on <i>S.aureus</i> and <i>P.aeruginosa</i> and can act synergistically with antibiotics. With further research regarding its mechanism of action and safety, blue light therapy may be implemented into clinical treatment of skin, wound and burn infections as an adjunct to antibiotics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=DC21-DC26&id=13449 https://doi.org/10.7860/JCDR/2020/42937.13449 Study to Evaluate the Role of Inflammatory Biomarker- IL-6 in Obstructive Sleep Apnea in Correlation with Apnea-Hypopnea Index Deepanjali Sharma, Deepak Kumar Shah, Anju Bharti, JK Mishra <b>Introduction:</b> Many biomarkers are associated with the Apnea-Hypopnea Index (AHI) in the majority of the studies, but most of the explored approaches were not able to identify definitive biomarkers of Obstructive Sleep Apnea (OSA) morbidity. <b>Aim:</b> To evaluate the correlation of AHI with inflammatory biomarker-Interleukin-6 (IL-6). <b>Materials and Methods:</b> Adult patients above 18 years of age, and suffering from OSA or had history suggestive of OSA were included in the study. IL-6 was measured by ELISA kit and immunoassay equipment. Polysomnography (PSG) study was done which included sleep stages, Heart rhythm monitoring, Leg movements recording, Breathing monitoring. Obstructive apnea was taken as cessation of airflow for at least 10 seconds with persistent respiratory effort. Descriptive statistical methods were used such as computing percentage, mean, standard deviation, pivot tables, and correlation. <b>Results:</b> A total number of 46 patients with OSA were evaluated. Out of 46 patients, 9 (19.57%), 6 (13.04%) and 31 (67.39%) patients belonged into mild, moderate and severe AHI, respectively. ELISA for IL-6 was done in 41 patients. The value ranged from 20.92 to 4145.23 pg/mL with SD&#177;1769.32 and with mean of 1427.94. Average values of biomarker IL-6 was 675.26 pg/mL, 1261.19 pg/mL, 1658.58 pg/mL in mild, moderate and severe OSA respectively. There was a positive correlation between AHI severity and IL-6 with correlation value. <b>Conclusion:</b> In this study, IL-6 appeared to exhibit a favourable profile for a biomarker aiming to discriminate OSA in adult patients. However more large scale studies are required to establish a definitive correlation between OSA and IL-6. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=EC11-EC14&id=13450 https://doi.org/10.7860/JCDR/2020/43021.13450 Developing an E-learning Model for Nursing Education Shahin Raoufi, Houman Manoochehri, Nahid Zarifsanaiey, Malahat Nikravanmofrad <b>Introduction:</b> Technology has revolutionised higher education and transformed traditional approaches to teaching and learning. However, application of e-learning in any discipline including nursing requires a model. <b>Aim:</b> To develop an e-learning model for nursing education. <b>Materials and Methods:</b> In this descriptive-analytical study, three stages were followed between June 2017 to December 2018. In the Stage one: review of literature and library search was used in databases of ERIC, PubMed, Science Direct, ProQuest, Scopus, and Google Scholar and Iranian databases of SID, Magiran and Iran Medex using to find available 65 models and their features. In the Stage two, semi-structured interviews with 26 experts in e-learning and quantitative content analysis of the interviews were used, and in the Stage three: The validity of the model was determined by with 12 experts in e-learning and Delphi method, and finally, the model was presented. <b>Results:</b> Seven general components including education, infrastructure, support, culture, ethics/law, evaluation, and learner with 31 subcomponents were determined in stages one and two. They were then used in the development of thee-learning model which was validated by Delphi method. <b>Conclusion:</b> The principles of pedagogy were used to develop this model in an understandable and simple manner. Therefore, it can be used in many disciplines. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=LC11-LC16&id=13451 https://doi.org/10.7860/JCDR/2020/43134.13451 Microbiological Analysis of Skin and Soft Tissue Infections and their Antibiogram in a Tertiary Care Teaching Hospital in Mumbai, India PM Ukey, Susheela Ramraj Chaurasia, Vishal Ghanshyam Gharde, Aarti Raghunath Sangale <b>Introduction:</b> Wound infections, an important cause of morbidity and mortality are associated with longer hospital stay resulting in increased cost on healthcare system. Studies on pus or wound culture can guide the clinicians to select the proper antibiotic which can reduce the development of resistance due to improper antibiotic usage. <b>Aim:</b> To study the microbiological profile and antimicrobial susceptibility pattern of various isolates obtained from wounds, abscesses, tissues, and tissue aspirates in a tertiary care teaching hospital. <b>Materials and Methods: </b>This was a retrospective study conducted in the Department of Microbiology over a period of one year, from January to December 2017. Data were collected from the records, on a total of 880 samples received from various wards, ICU and OPD. As per the hospital protocol, they were processed aerobically using the standard microbiological culture techniques. Statistical analysis was done by counts and percentages using MS Excel version 2010. <b>Results:</b> During study period, out of total 880 samples, 574 (65.23%) samples were positive for growth. Out of 574 samples, 38 (6.62%) showed polymicrobial growth. The total number of isolates was 612 (69.54%) in which 375 (61.27%) were gram negative bacteria, 233 (38.07%) were gram positive bacteria whereas, 04 (0.65%) were fungal isolates. Overall the most common bacterial organism was Staphylococcus aureus 134 (22.04%). Among gram negative bacteria, the most common isolate was Pseudomonas aeruginosa 110 (29.33%) whereas, MSSA 75 (32.19%) predominated among the gram positive bacteria. All 4 (100%) fungal isolates were non-albicans Candida species. All Gram positive isolates were sensitive to Vancomycin (100%) and Linezolid (100%). The antibiotic sensitivity of the Pseudomonas aeruginosa displayed that majority of them were sensitive to Meropenem 85 (77.27%) and Piperacillin-Tazobactum 72 (65.45%). <b>Conclusion:</b> The most common pathogen isolated was Staphylococcus aureus. All gram positive isolates were sensitive to Vancomycin and Linezolid. Hence, Vancomycin and Linezolid were the most promising drugs against gram positive bacteria. The most common gram negative pathogen was Pseudomonas aeruginosa and the majority of them were sensitive to Meropenem and Piperacillin-Tazobactum. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=DC17-DC20&id=13447 https://doi.org/10.7860/JCDR/2020/42972.13447 Development and Validation of Persian Risk Assessment Tool using National Comprehensive Cancer Network Guideline for Colorectal Cancer Screening Roya Dolatkhah, Saeed Dastgiri, Mohammad Asghari Jafarabadi, Hossein Mashhadi Abdolahi, Bita Sepehri, Masoud Shirmohammadi, Faris Farassati, Mohammad Hossein Somi <b>Introduction:</b> Despite evidence that early diagnosis of Colorectal Cancer (CRC) reduces the associated death burden, screening programs are uncommon even in developed countries. <b>Aim:</b>To develop and validate a simple, practical and efficient tool to improve CRC risk assessment by identifying moderate- and high-risk disease. <b>Materials and Methods:</b> The National Comprehensive Cancer Network guideline has been used to develop the CRC risk assessment tool. Content validity was assessed by a panel of 10 experts by generating a Content Validity Index (CVI), which was recorded quantitatively as the proportion of experts who agreed that the item was relevant, before calculating the Content Validity Ratio (CVR) per item. <b>Results:</b> The CVI was in the range 0.7-1 and the acceptable CVR was in the range 0.4-1. The overall mean CVI and CVR values were 0.93 and 0.62, respectively. Changes were made according to the experts’ recommendations, and the final online Persian questionnaire was assessed for face validity by 15 individuals (general population voluntarily). Only a few items subsequently needed modification and expansion. <b>Conclusion:</b> The Persian Risk Assessment tool is simple, quick, and easy to apply to different clinical categories and subcategories of CRC and can even be self-administered. This is the first translated tool in Persian version, usable in Iran. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=LC01-LC05&id=13433 https://doi.org/10.7860/JCDR/2020/42726.13433 Eruption Time of Permanent Teeth among Kurds Aged 5-15 Years in Duhok Governorate- Kurdistan Region, Iraq Hoger M Najman, Samim A Al-Dabbagh, Zana Q Omer <b>Introduction:</b> Tooth eruption time is affected by many factors. Eruption time of teeth and its sequence is important as part of dental treatment planning in Paediatric Dentistry, Orthodontics, as well as in Forensic Dentistry to estimate age of the child. <b>Aim:</b> To estimate the eruption time of permanent teeth among school children aged 5-15 years in Duhok Governorate-Kurdistan Region, Iraq; in order to obtain a baseline data for treatment planning in clinical dentistry. <b>Materials and Methods:</b> This was a cross sectional study comprising of 1418 healthy Kurdish children of both genders; 718 males and 700 females who were randomly selected by simple random method and examined from two kindergartens, four primary and four secondary schools in Duhok Governorate. The children were clinically assessed for tooth emerging through the oral mucosa. The mean and standard deviation of tooth eruption time for each tooth was estimated. <b>Results:</b> Eruption time of permanent teeth tended to be earlier in girls than boys except for the teeth 11,14,15,21,24,25,31,34,35,36,41 and 44. The sequences of eruption of permanent teeth were 1-6-2-4-3-5-7 in the mandible, and 6-1-2-4-5-3-7 in maxilla in boys whereas it was 6-1-2-3-4-5-7 in the mandible, and 6-1-2-4-3-5-7 in the maxilla in girls. <b>Conclusion:</b> The study provides information on eruption time for each tooth among Kurds children which can be useful in treatment planning in Paediatric and Orthodontic Dentistry. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZC18-ZC22&id=13434 https://doi.org/10.7860/JCDR/2020/42562.13434 Utility of Histochemical and Immunohistochemical Profile in Grading of Squamous Cell Carcinoma of the Oral Cavity Miheer Milind Jagtap, Samarth Shukla, Sourya Acharya, Ankita Tamhane, Arvind Bhake <b>Introduction:</b> Oral Squamous Cell Carcinoma (OSCC) accounts for approximately 90% of all the oral malignancies and a major cause of morbidity and mortality worldwide. The study utilises the Anneroth’s multifactorial grading system with Argyrophilic Nucleolar Organiser Region (AgNOR) score and the p53 expression as adjuncts; emphasising on the enhanced efficiency rendered by nuclear proliferative indices is the gold standard method of histomorphological grading of OSCC. <b>Aim:</b> To analyse the relationship between the histomorphological grading (Anneroth’s grading) and the nuclear proliferative markers that is AgNOR and p53 protein in OSCC. <b>Materials and Methods:</b> Total 98 cases of OSCC were investigated. The histomorphological grading was done according to the Anneroth’s system. The AgNOR score was quantified by counting the mean number of AgNORs per cell. The p53 expression was graded as score 0 to 3 according to the percent of cells showing positive p53 immunostaining. <b>Results:</b> An increasing trend in the mean AgNOR count and p53 expression was observed with progressing histological grade of OSCC. <b>Conclusion:</b> The nuclear proliferative indices (AgNORs and p53) serve as reliable predictive markers and can be used as an adjunct to the gold standard Anneroth’s histomorphological grading system of OSCC. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=EC01-EC05&id=13396 https://doi.org/10.7860/JCDR/2020/42221.13396 Randomised Comparative Study between C-MAC D Blade and McCoy Blade Laryngoscope for Intubation with Manual Inline Axial Stabilisation Athmanathan Mohan, Ranjan R Venkatesh, Sagiev Koshy George, Anju Annie Paul, Vinu Mervick Alfred, Leenu Grace Ninan <b>Introduction:</b> Patients with suspected cervical spine fracture or cervical pathology, utmost care has to be taken while intubating these patients to prevent further cervical cord injury. Protective measures include application of rigid collar, a forehead tape and manual inline stabilisation. Application of these manoeuvres reduces the cervical spine movement, making it more difficult to intubate. <b>Aim:</b> To compare the performance of McCoy blade with C-MAC D blade for endotracheal intubation in patients with simulated cervical spine injury. <b>Materials and Methods:</b> One hundred and twenty adult patients were randomly allocated into two groups to achieve tracheal intubation with McCoy (group M=sixty patients), or C-MAC D video laryngoscopes (group C=sixty patients). The ASA patients of grade I-II undergoing elective surgery for having immobilised cervical spine using manual inline axial cervical spine stabilisation technique were enrolled in the study. Patient&#8217;s Comparative data on the total time to intubate (Z-test), Cormack-Lehane (CL) laryngoscopic view (Chi-Square test), number of optimising manoeuvres (Yate&#8217;s corrected Chi-Square test) and haemodynamic variables (Z-test) were recorded in both groups. <b>Results:</b> The time taken for tracheal tube insertion was significantly longer with C-MAC D blade group of thirty eight seconds compared with McCoy blade group which was thirty one seconds. There was an increase in heart rate at first and second minute in both the groups which returned back to normal after five minutes. Good grade glottic visualisation was obtained with both the laryngoscopic blades. <b>Conclusion:</b> C-MAC D blade as well as McCoy blade forms an effective tool for the airway management of suspected cervical spine injured patients with cervical immobilisation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=UC06-UC09&id=13443 https://doi.org/10.7860/JCDR/2020/40088.13443 Early Childhood Development Programs in Low Middle-Income Countries for Rearing Healthy Children: A Systematic Review Mahalaqua Nazli Khatib, Abhay Gaidhane, Mahjabeen Ahmed, Deepak Saxena, Zahiruddin Quazi Syed <b>Introduction:</b> Early Childhood Development (ECD) includes physical, social, emotional, cognitive and motor development in first eight years of life. Positive parenting, strong families, and encouraging, stimulating environments are critical to a child&#39;s early development. <b>Aim:</b> To assess the efficacy of stimulation programs for improving ECD in Low and Middle-income Countries (LMICs). <b>Materials and Methods:</b> Observational and randomised controlled trials that examined the efficacy of different programs for improving ECD in LMICs were included. Studies were identified through systematic searches of bibliographic databases in July 2018 and were further updated in February 2019. The findings of the included studies were narratively described. <b>Results:</b> The evidences in hand indicate that early stimulation interventions can avert early inequalities and encourage cognitive and socio-emotional development in young children and can also improve maternal outcomes. These effects tend to sustain over a long term. More research is also required to identify the comparative effectiveness of different modes of delivery and cost-benefit of early stimulation interventions. <b>Conclusion:</b> Current evidences advocate that interventions for improving ECD can help in preventing the loss of development in disadvantaged children and those amendments can ensue quickly. The health sector can play a crucial role as it has the potential to reach families, and can provide efficient interventions for optimum child development. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=LE01-LE07&id=13445 https://doi.org/10.7860/JCDR/2020/42134.13445 Spatial Cluster Models: Model to Predict Disease Casual Association with Physical, Social and Environmental Risk Factors in Public Health Research Gladius Jennifer Hirudayaraj, M Bagavandas Spatial clustering will help us to identify spatial pattern and also predict geographical factors associated with disease. Spatial cluster models are classified as Global, Local and Focused clusters. This article aims to discuss various types of spatial cluster models such as Moral I, Gery &#39;C, Tango EET, CUSUM, GAM, K function, Scan statistic and other with suitable examples which will sensitise the medical researchers about this technique. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=YE01-YE03&id=13452 https://doi.org/10.7860/JCDR/2020/43191.13452 The Role of Date Palm Fruit in Improving Human Health Muneera Qassim Al-Mssallem Despite the fact that date palm (<i>Phoenix dactylifera</i> L.) fruits are characterised by a high content of carbohydrates, the quality of their carbohydrates results in a low glycaemic response. In comparison to common fruits consumed such as strawberries and guava, Date Palm Fruits (DPFs) have exhibited the highest antioxidant activity. DPFs have been shown to act effectively as free radical scavengers due to their content of bioactive compounds such as phenolic acids, carotenoids, flavonoids, and polyphenols. These bioactive substances can absorb and neutralise free radical intermediates resulting from oxidation reactions in the human body. The vital action of DPF constituents contributes significantly in reducing physiological cellular damage and protecting the human body against oxidative stress-related diseases such as cardiovascular diseases, neurodegenerative diseases and cancer. From this point, it can be concluded that regular consumption of DPFs may be associated with a reduced risk of some chronic diseases due to the antioxidant, antimicrobial, antidiabetic, anticancer, and antimutagenic activities of DPFs. In fact, DPFs have been widely used since ancient times in folk medicine to treat various health conditions, demonstrating the importance of DPFs as a nutraceutical and a source of functional nourishment. This review aims to consolidate most of the work carried out on DPFs in terms of their contents of nutrients and biologically active components such as phenolic compounds, with special emphasis on their functions in improving general health. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=OE01-OE06&id=13442 https://doi.org/10.7860/JCDR/2020/43026.13442 A Review on the Status and Challenges of Doctoral Programs with Special Attention to Iran Shokrollah Assar, Mohsen Rezaeian, Gholamhossein Hassanshahi The aim of this narrative review was to consider the status and challenges of doctoral programs in the world with specific attention to Iran. In most parts of the world, everyone who is looking to pursue a doctoral degree has a special interest in research works and to expand the boundaries of knowledge. Obtaining a Doctor of Philosophy (PhD) degree, means that a person has undertaken, to develop a science along with the attempts made by other scholars in the same field. The program entails a scientific report to be prepared independently by a PhD applicant who has undertaken a research project as a part of his/her own PhD program. A PhD course/program is expected to provide a new and significant contribution in developing a narrow field of study. In some disciplines, a dissertation may develop an innovation or a new approach. To fulfill the requirements of PhD programs, PhD students are often confronted with various challenges and problems such as stress, feeling of being isolated from others, financial difficulties and lack of sufficient communication with their supervisors, not to mention potential unemployment problems that they may face in the future. The number of Iranians with a PhD degree working in the business sector is on the rise. So, this holds promise for resolving the country’s dilemmas and having only a higher degree cannot solve current problems and speeding up a better future for Iranian society. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=JE01-JE05&id=13403 https://doi.org/10.7860/JCDR/2020/42905.13403 A Rare Case of Concrescence of Upper Left Second and Third Molar Abdul Kalam Azad, Ann Mary George, Anoop Mayya, Sabna Abdul Majeed Concrescence is the fusion of two or more teeth by cementum alone after the formation of the crown. Concrescent teeth are reported to be found mostly in the posterior maxilla. The presence of concrescent teeth may have influence on diagnosis and treatment planning. The unforeseen complications arising from this condition may result in legal complications. The purpose of this article is to report a rare case of concrescent upper left second and third molar discovered accidentally upon routine extraction, explore the potential complications and discussion of similar cases described in the literature. Even though dental concrescence is found very rarely, it is important that clinicians are informed about its presence to ensure that whenever possible, it is diagnosed prior to surgical intervention. If the clinicians fail to diagnose and neglect to inform the patients regarding the potential risks, the patient may suffer tooth loss and complications leading to potential legal action against the clinician. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=ZD01-ZD02&id=13400 https://doi.org/10.7860/JCDR/2020/43009.13400 Pranic Healing as a Complimentary Therapy in Stage-4 Metastatic Cancer-A Case Study Anuradha Nittur, Raghavan Ganapathi The case report has been presented to demonstrate the positive response to Pranic Healing intervention by subjects suffering from cancer. Pranic Healing, a no touch, no drug, energy based system of complimentary healing was introduced on a 63-yearold female patient of carcinoma breast with brain metastasis, along with other forms of therapy. The patient was also advised to follow the Meditation on Twin Hearts<sup>©</sup> during the healing sessions. Pranic Healing was introduced around a month after diagnosis of metastatic breast cancer. Six weeks of Pranic Healing treatment helped reduce the size and spread of the cancer dramatically. The case report provides a promising example of Pranic Healing intervention in preventing spread of metastatic cancer and possibly complete healing from cancer. Further large scale studies are recommended. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=January&volume=14&issue=1&page=XD03-XD04&id=13432 https://doi.org/10.7860/JCDR/2020/42423.13432