Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Hemichorea Hyperglycaemia Basal Ganglia Syndrome in a Patient with Type 1 Diabetes Mellitus: A Rare Case Report Swathi Gurursamy, Kalaimani Sivamani, Selvaraj Pitchai, Ameya S Chogle Hyperglycaemia induced involuntary movements are uncommon in clinical practice though Chorea Hyperglycaemia Basal Ganglia syndrome (CHBG) or Non-ketotic Hyperglycaemic Hemichorea (NHH) is being reported with increasing frequency due to the clinical awareness and widespread availability of neuroimaging. Prompt recognition of CHBG is essential, since correction of hyperglycaemia usually leads to early resolution of the involuntary movements. It is usually seen in elderly patients with uncontrolled Type 2 diabetes mellitus who present acutely with hemichorea or hemiballismus. It is rarely reported in Type 1 diabetes mellitus. Here, the author presents a 25-year-old male patient diagnosed with Type 1 diabetes mellitus with persistent chorea involving the left upper and lower extremity in whom the movement disorder persisted despite correction of hyperglycaemia. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OD01-OD02&id=13810 https://doi.org/10.7860/JCDR/2020/44147.13810 An Autopsy Case Report of Von Hippel-Lindau Syndrome-Type 2C Masquerading as Pre-eclampsia and Resulting in Maternal and Foetal Mortality Gwendolyn Fernandes, Varsha Deshpande A 23-year-old female with seven months pregnancy, presented with gestational hypertension associated with mild proteinuria and was diagnosed clinically as pre-eclampsia and referred to tertiary care centre. She also had progressive breathlessness and giddiness. On examination, pallor, Blood pressure (BP) of 180/100 mm Hg and crepitations in left lower lung were noted. Laboratory investigations revealed neutrophilic leucocytosis and a profile of Disseminated Intravascular Coagulation (DIC). An ultrasound (USG) of the abdomen showed a gravid uterus with Intrauterine Foetal Death (IUFD) and a left adrenal mass. The clinical diagnosis was acute hypertensive heart failure with severe pre-eclampsia. She was put on three anti-hypertensives and ventilatory support, but she succumbed to her illness, within three days of admission. A complete autopsy was performed. The autopsy revealed hypertensive heart disease with marked left ventricular hypertrophy, severe coronary atherosclerosis, cystic bilateral adrenal pheochromocytoma, a cystic para-aortic paraganglioma, a pancreatic Neuroendocrine Tumour (NET) with lymph node metastasis. Hence, a diagnosis of DIC with refractory hypertension in Type 2C Von Hippel-Lindau (VHL) syndrome was established. VHL syndrome is an autosomal dominant disorder caused by germline VHL mutation which leads to development of various tumours. VHL disease is classified into four subtypes and VHL type 2C has predominantly pheochromocytomas without haemangioblastoma and Renal Cell Carcinoma (RCC). As the patient mimicked pre-eclampsia clinically, the diagnosis of VHL was missed. Bilateral adrenal cystic masses with gestational hypertension should be thoroughly evaluated, at the earliest, for familial pheochromocytomas or VHL syndromes as they may prove fatal. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ED01-ED03&id=13827 https://doi.org/10.7860/JCDR/2020/44565.13827 Thyrotoxic Periodic Paralysis Suresh Sinha, Nagarajan Raghupathy Thyrotoxic periodic paralysis is not uncommon in people of Asian origin. It presents as sudden onset paralysis resulting from hypokalemia due to intracellular shift of potassium because of thyroid hormone sensitive Sodium-Potassium ATPase. A 34-year-old male with history of weight loss, palpitation and increased sweating for three months presented with sudden onset weakness of both lower limbs, two hours post-dinner. On investigation, he was found to be having hypokalemia as well as thyrotoxicosis. His potassium was corrected and was put on non-selective beta blocker and carbimazole. The patient improved within 24 hours and was discharged with advice to continue with Inderal and Carbimazole and report after one month. Hyperthyroidism should be included in differential diagnosis of sudden onset lower limb weakness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OD06-OD08&id=13836 https://doi.org/10.7860/JCDR/2020/44218.13836 An Aggressive Urothelial Carcinoma in a Horseshoe Kidney- A Case Report Sana Fathima, Sulata Manjunath Kamath Evidence of horseshoe kidney in Indian population is 1 in 600-800 individuals. Horseshoe kidney is predisposed to complications by virtue of its ectopic position, malrotation and associated vascular and ureteral anomalies. Incidence of Renal Cell Carcinoma (RCC) in a horseshoe kidney is same as that in general population. Other pelvic tumours, transitional tumours, Wilms tumour and carcinoids show a greater frequency. High grade urothelial carcinomas are quite rare with a few case reports available. An index case of 75 yeal old male presented with renal mass in an incidentally diagnosed horseshoe kidney on radiologic imaging. The case has been highlighted due to its poorly differentiated tumour morphology and aggressive nature. Further, immunohistochemistry was done to arrive at a correct diagnosis for appropriate treatment. The tumour cells showed positivity for Cytokeratin 7 (CK 7) and CK 5/6. They were negative for p63, PAX-8 (Paired-box gene 8). Also, it is technically difficult to excise large-sized renal mass in an anomalous kidney https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ED04-ED06&id=13846 https://doi.org/10.7860/JCDR/2020/44296.13846 High Ferritin in a Critically ill COVID-19 Patient: The Calm before Cytokine Storm Safa Saki, Mustafa Salam Mawih Corona Virus Disease of 2019 (COVID-19) is spreading throughout the world and the United States with confirmed cases in all 50 states. Cytokine Release Syndrome (CRS), or cytokine storm, is being increasingly reported with severe cases of COVID-19 patients and is a common cause of death in these patients. Hereby, authors report a case of critically ill COVID-19 patient who developed cytokine storm. She had a remarkable increase in inflammatory markers and went into multiorgan failure and death in less than 48 hours. Among inflammatory markers, ferritin has a high sensitivity for CRS. This case report sheds light on the importance of following the level of inflammatory markers (especially ferritin) closely in COVID-19 patients. The goal is to diagnose CRS before the patient goes into a full cytokine storm and multiorgan failure, as it may be too late to react then. Even when the patient is clinically stable, a high ferritin level could be the calm before the storm. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OD03-OD05&id=13829 https://doi.org/10.7860/JCDR/2020/44846.13829 Rare Presentation and Successful Management of Cerebral Sinus Venous Thrombosis in a Patient with Sickle Cell Trait Khalid Khan, Anuj Chaturvedi Cerebral Venous Thrombosis (CVT) is an uncommon cause of stroke and is generally present with headache. It is very difficult to diagnose it in initial stage due to its widely varying clinical features, risk factors, radiological findings and outcomes. Early diagnosis of CVT and its treatment can reduce the disease progress, its burden and risk of acute and long-term complications including mortality. A 23-year-old male patient was admitted from casualty department with complaints of severe generalised headache and photophobia since one week and four episodes of Generalised Tonic Clonic Seizures (GTCS) with post-ictal confusion and drowsiness since two days. All investigations were insignificant for the cause except that he was a sickle cell trait (AS pattern), that lead to CVT related headache and convulsion. He was treated with hydration in the form of intravenous fluids, warfarin, mannitol and syrup glycerol, Tab. Sodium bicarbonate and Tab. Hydroxyurea. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OD09-OD10&id=13842 https://doi.org/10.7860/JCDR/2020/44722.13842 Endodontic Management of a Tooth with Severe External Root Resorption using Injected Non-setting Calcium Hydroxide Paste: A Case Report Orlando Aguirre Guedes , Tiago Luan Henrique , Pollyana Sousa Lôbo El Zayek , Andreza Maria Fábio Aranha , Helder Fernandes de Oliveira External Root Resorption (ERR) is a pathological condition that can lead to tooth loss if not diagnosed and treated correctly. Calcium Hydroxide Ca(OH)<sub>2</sub> is an intracanal medicament, which is used in cases of teeth with pulp necrosis, peri-radicular lesions and ERR. This paper describes the endodontic management of a tooth with severe ERR using injected non-setting Ca(OH)<sub>2</sub> paste. A 28-year-old patient was referred for endodontic evaluation of tooth 47, which presented an extensive composite resin restoration and was negative to cold test. Panoramic and periapical radiographs revealed the presence of a filled pulp chamber, calcified root canals, ERR on the mesial and distal roots, and apical periodontitis in the mesial and distal roots. The diagnosis of asymptomatic apical periodontitis and severe ERR was established, and conventional root canal treatment combined with non-setting Ca(OH)<sub>2</sub> dressing was chosen. After five months, no more discharge from the root canal was observed, and a decrease in the size of the periapical lesion and arrest of ERR was detected. The root canal was filled, and the patient was referred for restoration. At the 6-months follow-up, radiographic examination evidenced periapical repair and containment of the ERR process. Chemomechanical root preparation in association with a non-setting Ca(OH)<sub>2</sub> dressing protocol allows positive outcomes during the management of severe ERR associated with pulp necrosis and periapical inflammation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZD01-ZD04&id=13858 https://doi.org/10.7860/JCDR/2020/44299.13858 Craniofacial and Oral Features of Williams Syndrome- A Rare Case Report G Geethanjali, Amarshree A Shetty, Amitha M Hegde Williams syndrome is a rare genetic disorder that occurs due to deletion on chromosome 7q11.23. The prevalence is said to be 1:7500-1:20,000. The typical presentation of the syndrome includes dysmorphic facial features, cardiovascular malformations and intellectual disability. Craniofacial features of these children include short anterior cranial base, protrusive maxilla, increased Mandibular Plane- Occlusal angle, steep mandibular plane and reduced ratio of posterior to anterior facial height. The unique characteristics of these children are over friendliness, out-going personality, hyper-acusis and tendency to get easily distracted. This is a unique case of Williams syndrome in an eight-year-old female patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZD05-ZD07&id=13870 https://doi.org/10.7860/JCDR/2020/44283.13870 Malignant Warty Lesion at Cervix in Asymptomatic Postmenopausal Woman- A Case Report Sangam Jha, Vidhi Vanya, Tarun Kumar Verrucous carcinoma is a rare variant of cervical carcinoma, usually occurs in postmenopausal group. Aetiology is still not understood but it is thought to be associated with chronic irritation and inflammation. Histological diagnosis is usually difficult since the pathologic findings may be benign especially if biopsy specimen contains only surface epithelium. Prognosis of this histological subtype is better compared to the well-differentiated Squamous Cell Carcinoma (SCC) of cervix. Author present a case of verrucous carcinoma where patient came for routine check-up and on pelvic examination; cervix was replaced by friable, cauliflower like warty growth, clinically staged as stage 1B. Punch biopsy was taken from the growth and it reported benign pathology but due to high index of suspicion, repeat biopsy was taken and second histopathology also reported benign pathology. Contrast Enhanced Computed Tomography (CECT) whole abdomen was advised as clinical picture and Histopathological Examination (HPE) was not matching. CECT reported mass confined to the cervix, features consistent with carcinoma cervix. So, the patient underwent radical hysterectomy with pelvic lymphadenectomy. Final histopathology reported verrucous carcinoma of cervix. Patient is under regular follow-up and free of disease since 1 year. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=QD01-QD03&id=13871 https://doi.org/10.7860/JCDR/2020/44338.13871 Role of Radiologist in Diagnosis of Neonatal Small Left Colon Syndrome: A Case Report Ibrahim Haruna Gele, Muhammad Baba Sule, Sadisu Mohammed Maaji, Abubakar Musa, Muhammad Abacha Neonatal small left colon syndrome is a well-defined functional disease of the lower colon and it results in signs and symptoms of intestinal obstruction. It is an uncommon cause of neonatal intestinal obstruction characterised by an abrupt transition of intestinal caliber at or near the splenic flexure. More than 50% of affected patients are born to mothers with diabetes. We report a five-day-old neonate who presented with abdominal distension and vomiting diagnosed to have small left colon syndrome by contrast enema. He had surgical resection of the narrowed segment and anastomosis with subsequent resolution of symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=TD01-TD02&id=13867 https://doi.org/10.7860/JCDR/2020/43118.13867 Giant Glomus Tumour of the Forearm- An Unusual Occurrence Ammar Muizzuddin Manas, Mohd Yazid Bajuri, Suryasmi Duski, Chye Ping Ching Glomus tumour is a rare small benign lesion which is typically located at fingertip. Most patients with glomus tumour have delayed diagnosis. Recognition of the classical triad of glomus tumour which include paroxysmal pain, exquisite tenderness to touch and cold intolerance; and advanced imaging like MRI and biopsy would help in making the diagnosis. Here, a case of an elderly patient is reported who had a painful right forearm swelling for three years which progressively increased in size. The size of the swelling was unusually large for glomus tumour. Unfortunately, during the same time period he suffered from acute coronary event. MRI revealed subcutaneously located lobulated soft tissue mass. Surgical biopsy with marginal excision was done. Histopathological examination revealed small uniform rounded cells surrounding capillary vessels, consistent with the diagnosis of glomus tumour. There was no recurrence up to 2 year of follow-up and his cardiac symptoms also stabilised. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=RD01-RD03&id=13868 https://doi.org/10.7860/JCDR/2020/43732.13868 Rare and Under Reported Causes of Bacteremia: Case Series from a Tertiary Health Care Centre of Northern India Sweta Singh, Chinmoy Sahu, Sangram Singh Patel With increasing medical interventions, immunosuppressants, hospital stay and antibiotic use; people are finding increased cases of hospital acquired infections. Bacteremia and sepsis are important cause of morbidity and mortality in tertiary health care centres. Majority of bacteremia are caused by the Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp (ESKAPE) pathogens. However, in some cases hospital environment bacteria can cause bacteremia and sepsis, especially in immunocompromised patients. Each bacterium is unique with specific antibiotic susceptibilities. So, accurate identification up to species level is important for management of infections. Automated culture and identification systems like VITEK and Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) helps a lot in these processes. Here, the authors presents a case series of bacteremia caused by rare bacteria; namely Campylobacter coli, Sphingomonas paucimobilis, Paenibacillus thiaminolyticus and Cuprividus gilardii. All bacteria were grown in bactec culture and identifications were confirmed by MALDI-TOF MS and drug susceptibility testing was done by VITEK-2. All the patients were having co-morbidities and antibiotic history. Patients responded to guided antibiotic therapy. The authors reiterate that increased suspicion of infection by these bacteria, especially in bacteremia cases of patients have co-morbidities (like agammaglobulinemia, end stage renal disease, diabetes mellitus, kidney failure, etc). Latest identification techniques like VITEK and MALDI-TOF MS should be utilised for diagnosis and treatment of these infections. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=DR01-DR04&id=13818 https://doi.org/10.7860/JCDR/2020/44536.13818 Health Strategies that could Boost Industrial Productivity in India Amidst the COVID-19 Crisis Hemant Jain, Kaushik Bharati, Aarti Garg, Sunanda Das <b>INTRODUCTION</b> The Coronavirus Disease-2019 (COVID-19) pandemic is currently wreaking havoc across the globe and has affected 213 countries and territories <a href=#fr1 name=ft1>(1)</a>. This has led to widespread lockdowns that are having a dramatic impact on the society, which has in effect, come to a grinding halt. The livelihoods of daily wage earners and deprived and underprivileged people from the economically weaker strata of society have been particularly affected. Job cuts have become the norm and are likely to become much worse in the near future. For example, as per the data available from the Centre for Monitoring Indian Economy (CMIE) in Mumbai, unemployment reached the highest level of 27.1% in the week that ended on 3 May 2020. The wage labourers and small businesses have been worst hit by the lockdown. A staggering 90 million people in India lost their livelihoods within a span of just one month <a href=#fr2 name=ft2>(2)</a>. <b>IMPACT OF LOCKDOWNS ON INDIAN INDUSTRY</b> The lockdowns have led to a complete shutdown of many industries, which could jeopardise the Indian economy. However, some industries are in the process of being reopened in a phased manner during the current Lockdown 4.0. However, an industrialist known to the authors has highlighted the problems associated with operating a factory during the current COVID-19 crisis. As per the recommendations of the Ministry of Labour and Employment, Government of India, currently the maximum limit of industrial workers who can be employed is 33% of the total workforce <a href=#fr3 name=ft3>(3)</a>. However, he further added that the remaining 67% of employees would still need to be paid their full salary, despite the fact that they may not be working. This would greatly increase the financial burden of companies and could even lead to bankruptcy. In order to troubleshoot these and other problems associated with reopening industries, representatives of 12 employer&#8217;s associations, including CII, FICCI and ASSOCHAM, interacted with the Labour Minister through video-conferencing to make some headway in the discussions <a href=#fr4 name=ft4>(4)</a>. In the meantime, Labour Law Reforms have led the Ministry of Home Affairs (MHA), Government of India to relax workplace norms, which is likely to benefit both the industries, as well as the workforce [2,5]. <b>HEALTH STRATEGIES TO PROTECT INDUSTRIAL EMPLOYEES</b> This editorial proposes some strategies from a health perspective to overcome some of the hurdles associated with re-opening factories and help industrialists to optimise their workflow. Some of these health strategies are discussed below. <b>Using Personal Protective Equipment (PPE) <a href=#fr6 name=ft6>(6)</a></b> Personal Protective Equipment (PPE) are protective gears designed to safeguard the health of employees by minimising the exposure to biological agents. Components of PPE include coveralls, goggles, face shields, masks, gloves, and head covers. &#8226; Coveralls: Coveralls are designed to protect the entire body of an individual from exposure to chemicals or infectious agents, such as the current Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), the causative agent of COVID-19. Coveralls provide 360-degree protection by covering not just the torso and limbs, but also the head and feet. Hence, potentially harmful pathogens are prevented from gaining entry into the body. Coveralls that are currently being used by medical professionals for protection against SARS-CoV-2 infection are unlikely to be suitable for industrial purposes. Firstly, medical coveralls are made of non-woven materials, such as polyester or polyethylene, which makes the wearer feel very hot. Considering the fact that factories are naturally much hotter than medical settings, the heat inside the coverall is likely to be unbearable for the wearer, thereby drastically reducing work efficiency. Secondly, since these coveralls are disposable (single-use) and cost anywhere between INR 200 and INR 1,000, these would be much too expensive and therefore infeasible for use in industrial settings <a href=#fr7 name=ft7>(7)</a>. An alternative solution is to use coveralls that are specifically designed for industrial use. Firstly, these are made of woven materials, usually 100% cotton fabric, thereby appreciably reducing the temperature inside the coverall. Secondly, these are washable and therefore can be re-used, without having to discard after a single use. Moreover, these are also comparatively cheaper, with an average price ranging between INR 300 and INR 800 <a href=#fr8 name=ft8>(8)</a>. These combined factors- multiple-use and lost cost- will significantly bring down the overall running cost of the factory. Images of typical medical and industrial coveralls are presented below <a href=tableview.asp?id=13820&img_src=13820_1.jpg target=_blank>(Table/Fig 1)</a>. &#8226; <b>Goggles and face shields:</b> SARS-CoV-2 is transmitted through airborne droplets and aerosols generated by coughing or sneezing of an infected individual. When these droplets/aerosols containing the infectious virus come in contact with mucous membranes of the eyes, nose and mouth, an unaffected person becomes infected. This is how the infection spreads in the community, similar in fashion to a chain reaction. Therefore, protecting the mucous membranes of the eyes, nose and mouth by wearing goggles and face shields can effectively stop the virus from entering the body. By way of design, the frame of the goggles should be flexible and provide a tight seal with the skin around the eyes and surrounding areas of the face. &#8226; <b>N95 respirator masks:</b> SARS-CoV-2 and other respiratory viruses mainly infect the upper and lower respiratory tracts. Therefore, preventing the entry of infectious droplets or aerosols into the respiratory tract can prevent infection. In this regard, the role of masks is crucial for halting transmission through the respiratory route. The N95 respirator facemasks would be most effective for industrial employees. These masks are so called because they are &#8216;not resistant to oil&#8217; (hence &#8216;N&#8217;) and filters out 95% of airborne particles (hence &#8216;95&#8217;). In case of factories where employees may be exposed to oil fumes, R95 masks, which are &#8216;resistant to oil&#8217; would be better suited than N95 masks. The very high efficiency of these facemasks is capable of protecting against respiratory droplet- or aerosol-mediated transmission of the virus. These masks are designed in such a way that they are (i) close-fitting, (ii) provide good breathability due to fitted expiratory valves, (iii) possess a cup-shaped structure so that they don&#8217;t collapse against the mouth, (iv) possess nose clips to ensure a good seal, and (v) have clearly demarcated inner and outer surfaces, so that the wearer doesn&#8217;t make any mistake while putting on the mask. &#8226; <b>Gloves:</b> If a person touches a surface contaminated with SARS-CoV-2 from an infected person, the virus can spread by inadvertently touching the eyes, nose, or mouth. Here, gloves play a vital role in preventing viral transmission. Importantly, the gloves will not only provide protection against the virus, but also against industrial toxicants. The type of gloves that should be used will vary according to the type of industry. Employees who perform tasks involving bulky machinery, would need to wear heavy duty gloves that are hardy and resistant to wear and tear. However, in case of tasks that require fine dexterity, close-fitting rubber gloves akin to surgical gloves would be more suitable. Ideally, these should be made of nitrile, rather than latex. Nitrile gloves are more suitable because they are resistant to chemicals, including disinfectants such as chlorine. On the other hand, the major disadvantage of latex gloves is that they can cause allergic reactions in susceptible individuals due to contact dermatitis. Moreover, non-powdered gloves are preferable than powdered gloves. &#8226; <b>Head covers:</b> Industrial coveralls generally don&#8217;t have a head cover. So, a separate head cover that covers the head and neck will be needed. It should be ensured that all the hair fits inside the head cover. <b>Practicing Personal Hygiene</b> &#8226; <b>Hand washing or hand sanitization:</b> Adequate hand washing facilities and alcohol-based hand sanitizers should be made available to the employees, which should be used after taking off gloves, especially before eating. In this context, it may be mentioned that the lunchtime needs to be staggered over an extended period of time in order to prevent overcrowding of the canteen, so that social distancing measures are not compromised. &#8226; <b>Showering:</b> Showering facilities should be installed so that employees can take a shower before donning and after doffing PPEs, especially coveralls. Male and female employees will have separate showering areas. Personal lockers designated for each employee should be present for storing their clothes to prevent cross-contamination. <b>Other Strategies</b> &#8226; <b>Thermal scanners:</b> Installation of thermal scanners or hand-held temperature monitors at the entry-point of the factory will play a vital role in screening employees for fever, which is a common primary symptom of COVID-19. A medical officer may be present for supervision. &#8226; <b>Quarantining boxes containing consignments:</b> Since COVID-19 can be transmitted by touching contaminated surfaces, it is important that the employees don&#8217;t unnecessarily touch packages. Packages and crates are generally made of cardboard and wood respectively. It has been scientifically proven that SARS-CoV-2 survives on cardboard for 24 hours and wood for up to 4 days <a href=#fr9 name=ft9>(9)</a>. Therefore, keeping packages under quarantine for the specified time period, would ensure that they are safe to handle and also alleviate the need for sanitization by spraying disinfectants. &#8226; <b>In-house laundry facility:</b> Since hygiene and sanitation are of the utmost importance for tackling COVID-19, the employee&#8217;s coveralls should be scrupulously cleaned after single-use. Hence, an in-house laundry facility should be available to carry out this vital task. An overview of how the factory workers are expected to conduct themselves within the factory premises by maintaining the highest standards of personal hygiene is depicted in the flowchart <a href=tableview.asp?id=13820&img_src=13820_2.jpg target=_blank>(Table/Fig 2)</a>. <b>ADMINISTRATION, COMMUNICATION AND SAFETY</b> Administration, communication and safety issues will be handled by staff designated for the purpose, as highlighted below: &#8226; <b>Administrative health officer:</b> An administrative health officer should be appointed, who will be responsible for the overall supervision and smooth running of the facility. He will oversee the activities of the workers, as well as look after their general health and wellbeing. He will also dedicate his time for properly documenting the day-to-day activities in the factory. He will maintain a log book that will contain all information, pertaining to the daily functioning of the factory in minute detail, so that nothing is missed. This record will be proof that the factory is operating as per government norms and regulations. In case of any untoward incident, he will be answerable to the higher authorities. Moreover, if any litigations are filed against the factory, the onus will lie with him to tackle the associated legal issues. &#8226; <b>Communication intermediary:</b> A person should be appointed to act as an intermediary between the employees and the manager, who would monitor the progress of work remotely. The intermediary will don the same PPE that medical professionals wear, thereby offering maximal protection against the virus. Additionally, he will wear a helmet fitted with a camera, headphone and mouthpiece, by means of which he will be able to transmit all audio-visual data to the manager, who would be situated within the safety of his office. The importance of the intermediary lies in the fact that it relieves the manager to do his paperwork, without having to shuttle between the factory floor and his office. Having to do this would be a logistical nightmare as it would require repeatedly donning and doffing PPE as these are mandatory on the factory floor, while at the same time, unnecessary and impractical to wear within the office. Another added advantage of having an intermediary is that the manager could monitor the factory activities remotely through video, even from the comfort of his home, given the difficulty of commuting during the lockdown. &#8226; <b>Safety officer:</b> A safety officer should be appointed, who will be responsible for all occupational health and safety issues. Some of the areas that he will handle include management, monitoring, advising, and reporting of all issues pertaining to the safety of all the employees. He will also be responsible for training of factory personnel through orientation programs so that they become more engaged and aware about safety issues at the workplace. Depending on the unit size and available resources, the safety officer and administrative health officer can be the same person. In this regard, one of the personnel from the Human Resource Department could take on this role. <b>IMPEDIMENT IN IMPLEMENTATION OF PROTECTIVE STRATEGIES</b> The major impediment, as highlighted by an industrial insider, is the cost-factor involved in implementing the protective measures. However, in case of protection of employees against COVID-19, the investment will be worthwhile, as &#8216;all&#8217; the employees can be employed at the same time, which would reduce running costs in the long-term. Moreover, it may be argued that industries invest heavily on fire-fighting equipment to ensure safety of its employees, then why not for COVID-19? Fire-fighting equipment doesn&#8217;t come cheap. In fact, a price analysis indicates that the cost of installation of fire sprinklers in India is approximately INR 2,500 per sq. feet. Also, fire extinguishers cost approximately INR 6,000 per piece. Besides these, there are additional costs for smoke detectors (INR 2,400 per piece) and alarm systems (INR 10,000 per piece), among other minor fire-fighting accessories <a href=#fr10 name=ft1>(10)</a>. With reference to COVID-19, another important health aspect needs to be kept in mind while deciding whether to invest in purchasing protective equipment. This is on the issue of rapid transmission of COVID-19. In the absence of protective gear, there is a real possibility that if a single employee becomes infected, then everyone could become infected due to working in close proximity. This could lead to closure of the factory, which would cause huge financial losses for the company. <b>MAJOR BENEFITS OF IMPLEMENTATION OF PROTECTIVE STRATEGIES</b> &#8226; <b>Alleviation of the need for social distancing:</b> By ensuring that all protective measures are in place, all the employees will be able to work in close proximity without any danger of becoming infected. Therefore, these measures will ensure that stringent social distancing protocols will no longer be mandatory within the factory. &#8226; <b>Optimal utilisation of workforce:</b> The suggested protective measures will enable employers to utilise the maximal workforce. This will increase output by optimising the workflow. Moreover, this will mean lesser job cuts. &#8226; <b>Profits:</b> In the long-run, profits are likely to rise due to increase in productivity arising from utilisation of the full strength of the workforce. Such precautions are not only going to help ward off risk of COVID-19 but will also work against other infectious diseases <a href=#fr11 name=ft11>(11)</a>. This will lead to a healthier workforce. <b>SIZE OF THE OPERATING UNITS</b> The economic and human resource costs of this strategy may be easier to bear for very large units. However, the relative marginal costs associated with these measures can be onerous for micro, small, and medium enterprises (MSME). Bathrooms and locker areas may pose problems for mid-size units (having around 50 workmen). Washing or sanitation areas may be difficult to carve out in small units with 30 or less workmen. These small and medium size units make up a large proportion of the labour and workforce and hence some innovation is required to scale these solutions down to their levels (perhaps by creating shared facilities for them or units pooling in resources to create such common complex). Government officials and regulators will need to aid the adoption of these measures and also provide incentives to smaller units for their implementation. <b>CONCLUSION(S)</b> It is quite evident that implementation of health interventions in Indian industries is likely to benefit all stakeholders- employers, employees and the Indian economy at large. Importantly, the major employer&#8217;s associations, including CII, FICCI and ASSOCHAM have suggested that the workforce should be increased from the existing 33% to 50%, upon reopening of the factories. The authors are optimistic that by implementing the health strategies highlighted in this editorial, it would be plausible to increase the workforce well above the 50% mark- may be even as high as 100%, thereby leading to workflow optimisation, increasing productivity, as well as helping to boost the Indian economy. Hence, this will be a &#8220;win-win&#8221; situation for everyone. <b>Acknowledgement</b> The authors wish to extend their gratitude to the industrialists who kindly provided their expert opinions and insights during the preparation of the manuscript. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=AB01-AB04&id=13820 https://doi.org/10.7860/JCDR/2020/10825.13820 Anecdote from Editors Desk Anecdote 7- The Dilemma with Un-named Payments Sunanda Das, Aarti Garg This anecdote is about a technical aspect of the association between a journal and its authors. The manuscript instructions and related information to guide authors are always available on every journal&#8217;s website. There are certain untold directives which are thought to be of common knowledge and hence get no mention in print or online. One such matter is related to the online payment for article publication charges. Transacting money online requires some specific and important identifiers. These are to identify the payee and reason for payment. At times depositors forget to write the accompanying matter that would help the receiver trace the payment and link it to the specific account. This leads to a lot of unnecessary task on the part of the receiver. It requires an extensive search and often some assumptions too. In todays&#8217; world of M-commerce, typographical errors and inadvertent exclusion of identifiable information are not unusual. A user would tap into his mobile and finish off the transaction without realising the slips that he made, until much later. In JCDR, authors have to pay publication charges after the article is accepted for publication and there are no APCs. To quote from a latest incident, we received a payment from an account which was not registered with JCDR. The name mentioned as payee also did not exist among the author list. The account section of the journal office had to dedicate one staff for half a day, solely to trace the amount to the respective article. Still we could not link the payment to the article. The IT team then ran a code to find the name among authors of past and on-going submissions. This resulted into one match and the author was found to have published with us two years back. Finding no other way and needing respite from this mystery, we called up this author to confirm. We assumed that he might be among the co-authors (only corresponding authors&#8217; names are tagged with every manuscript). But soon we were back to where we left, since the author denied having any submission under process with us. The matter is still unresolved and we pray that the depositor would call us soon to know about the status of article and thus bringing an end to the anonymity. Another incident was when a new name popped up in the account department that had paid international charges. This however, could be resolved within a week, when the author called up asking for status of his article. He amused us by saying that the name is not registered in JCDR since it was his friend who paid the amount on his behalf. As a protocol, we mention in the mail (acceptance for publication) that the authors must fill the &#8216;Payment Details&#8217; on Author Dashboard. By doing so, the account section automatically gets an update about the amount, name of payee, article ID and transacting bank details. Alternatively, if the author sends us details in email then also we link it to the correct manuscript. Some authors attach a screenshot of the transaction page to their mails. Not so rarely, we receive payments which are untagged, have no ID (JCDR creates Unique IDs for every submission) and even via non-corresponding author accounts. Such payments with no identifiers cause inadvertent delay in publication. No matter how fast and timely all the steps are followed and even the most diligent of authors would not help an article if the ultimate publication charges remain untraced. Besides this, a journal faces a risk of being named negligent. An author might not even know the reason why the article was not published even after timely payment. It lies on the table of the editorial and remains stationary unless the author first makes a move. In JCDR, we have faced this situation quite a number of times. Majority of the incidences were when the payments were done from another person&#8217;s account whose name was not registered with us or was not among the authors. Adding to our woes, the corresponding author did not fill in the necessary details in the respective article account dashboard, neither inform us about the payment. Retrospectively, we found that it happened at least one or two times a month in the last year. Thus, it becomes imperative for us to write this anecdote to inform about the lapse and what difficulties it is associated with. This is for both the authors and the editorials, and from the later we would like to know about their experience or suggestions on the matter. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=AB05-&id=13894 https://doi.org/10.7860/JCDR/2020/12622.13894 Functional and Aesthetic Full Mouth Rehabilitation using Monolithic Zirconia- A Case Report Noha Morsy, Mohammed El-Kateb A 23-year-old female patient presented to the Outpatient Clinic of Conservative Dentistry Department, Alexandria University, Egypt. The patient complained of poor facial and dental appearance and mobility of lower incisors. Patient history did not reveal any current medical conditions or a family history, any previous injury or trauma and no previous interventions were made to treat the patient. With extraoral examination, no TMJ symptoms, muscle pain, or tenderness was found. Analysis of facial appearance was performed using photos, no horizontal or vertical asymmetry was noted, and the patient presented a class I skeletal pattern. Intraoral examination detected abnormal shape and size of teeth with spaced anterior teeth and low labial frenum attachment that greatly impaired aesthetics while the enamel had normal opacity and texture which led to excluding amelogenesis and dentinogenesis imperfecta <a href=tableview.asp?id=13861&img_src=13861_1.jpg target=_blank>(Table/Fig 1)</a>. Smile analysis revealed a wide smile zone and a gummy smile. Probing depth was &#8805;5 mm for anterior teeth and &#8805;2 mm for posterior teeth with thick gingival biotype. Panoramic radiograph and cone beam tomography cross-sectional view confirmed a severe horizontal bone loss, PDL widening of mandibular incisors and oblique fracture of lower left central incisor. The radiographs also detected an impacted upper left canine <a href=tableview.asp?id=13861&img_src=13861_2.jpg target=_blank>(Table/Fig 2)</a>. The patient had severe trauma from occlusion causing wear and mobility of lower incisors. Occlusal analysis revealed that no disocclusion of incisors during lateral excursive movements and absence of proper anterior guidance (canine or group function protection) leading to an abnormal overload of lower incisors, mobility, periodontal damage, and fracture of teeth <a href=#fr1 name=ft1>(1)</a>. An assessment of vertical dimension was performed. Facial sagittal view of the patient displayed mandibular pseudo-prognathism which might be a sign of vertical dimension loss. In addition, the vertical dimension was measured at rest and in occlusion as the distance between two fixed points at the tip of the nose and the chin using a metal gauge. The subtraction of the two values revealed a loss of the vertical dimension with increased inter-occlusal space up to 4 mm <a href=#fr2 name=ft2>(2)</a>. The treatment plan decided was to extract the lower incisors, and restoring them with monolithic zirconia fixed partial denture with canines and premolars as abutments, in addition to, extract the impacted canine and restoring it with monolithic zirconia fixed partial denture with upper left central, lateral and first premolar as abutments, and restoring the rest of teeth with monolithic zirconia single crowns. The treatment plan was explained to the patient along with the possible alternative procedures as implant replacement of incisors, and orthodontic extrusion of impacted canine instead of extraction. The patient preferred the first plan considering the time frame of the treatment and the choice to avoid surgery. Informed consent was obtained for the treatment plan as well as for the possible publication of the case. The high labial frenum attachment was repositioned surgically to provide a space for a planned surgical crown lengthening and to improve the aesthetics. Face bow record (Hanau Wide-Vue, Whip Mix, USA), centric relation record and eccentric records were used to mount diagnostic casts to the semi-adjustable articulator (Hanau Wide-Vue, Whip Mix, USA). The incisal pin was raised 3 mm and the diagnostic wax-up was made, the lower occlusal plan was adjusted in the wax using the Broadrick flag method and a putty index <a href=tableview.asp?id=13861&img_src=13861_3.jpg target=_blank>(Table/Fig 3)</a> <a href=#fr3 name=ft3>(3)</a>. The wax-up was duplicated onto stone casts (Elite Stone, Zhermack, Italy) and vacuform matrices were fabricated from thermoplastic sheets (Patterson Tray Material, Patterson Dental, USA). Surgical crown lengthening was performed using the vacuform matrices as a guide. A functional mock-up was fabricated using the vacuform matrices and light cure composite (Te-Econom Plus, Ivoclar Vivadent, Germany), enamel was roughened with a diamond point followed by acid etching and bonding, the vacuform matrices were filled with composite, seated on the teeth and light-cured for 40 seconds from each tooth aspect, then finished and polished, occlusion was checked in centric and eccentric using articulating paper. The purpose of the mock-up was to motivate the patient, raise the vertical dimensions and keep the bite raised when preparing the teeth as each quadrant was prepared and temporised in a separate visit to avoid patient exhaustion <a href=tableview.asp?id=13861&img_src=13861_4.jpg target=_blank>(Table/Fig 4)</a>. After the teeth of both arches were prepared and temporised, the patient could wear the temporary restorations for 3 months, and the patient was instructed to perform all functional activities like chewing, speech, avoid biting hard objects and perform oral hygiene measures. The patient was informed to expect discomfort and pain during the first weeks due to raised vertical dimension. After 3 months the final impressions were taken to fabricate the final restorations for molars of both sides. Impressions for both arches were taken using monophase polyether impressions (3M Monophase, 3M Deutschland GmbH, Neuss, Germany). Facebow and centric records were obtained while the bite and VD were stabilised by the provisional restorations on premolars and anterior teeth. The working casts were poured, mounted using facebow record and centric record, and scanned using a laboratory scanner (Ceramill map 400, Amann Girrbach AG, Austria). CAD/CAM Monolithic zirconia crowns were fabricated (Ceramill zolid fx multilayer, Amann Girrbach AG, Austria), the crowns were tried-in for seating and proximal and centric occlusal contacts before glaze. A custom incisal table was fabricated from alginate impressions (Chromaclone, Ultradent Products, USA) over the provisional restorations of both arches to replicate the anterior guidance of the temporary restorations. This custom incisal table was used to readjust the occlusal morphology and cusp angle of the fabricated CAD/CAM crowns for the molars before final glaze and cementation <a href=tableview.asp?id=13861&img_src=13861_5.jpg target=_blank>(Table/Fig 5)</a>. After cementation of final crowns for molars, final impressions were taken to fabricate anterior crowns and fixed partial dentures using monolithic zirconia using the same workflow applied for fabrication of the posterior crowns. All final restorations were bonded using zirconia primer (Z-Prime Plus, Bisco, Inc., USA) and resin cement (TheraCem, Bisco, Inc., USA) <a href=tableview.asp?id=13861&img_src=13861_6.jpg target=_blank>(Table/Fig 6)</a>. The patient accommodated to the new vertical dimensions and displayed no complains during a 1-year follow-up period, in addition, clinical and radiographic examinations revealed excellent results [Table/Fig-7a,b]. Monolithic zirconia is a novel ceramic material introduced to overcome the problem of veneer chipping in porcelain fused to zirconia restorations in addition to excellent aesthetics and strength <a href=#fr4 name=ft4>(4)</a>. The alternative treatment option was to extract the lower incisors with ridge augmentation and implants, and to extrude the impacted canine orthodontically followed by fixed zirconia restoration for both arches to re-establish vertical dimension, aesthetics, and occlusion. This alternative was refused by the patient as it would take a longer period of treatment. While the executed plan was less traumatic, consumed less time and the patient was satisfied with the results. However, long term studies about the clinical success of monolithic zirconia mainly fixed partial dentures are rare in the literature which necessitates a long follow-up for this case <a href=#fr6 name=ft6>(6)</a>. Group function occlusion in lateral excursions was created in this case because the patient had a short canine which will also serve as an abutment for the lower fixed partial denture <a href=#fr6 name=ft6>(6)</a>. Monolithic multilayered zirconia was selected in this case to achieve adequate strength and aesthetics mainly for the long span of lower anterior fixed partial denture <a href=#fr4 name=ft4>(4)</a>. Few clinical reports described the use of monolithic zirconia for long span and full-arch cases, two studies by Amin S et al., and Fisselier F et al., reported a case of full-mouth rehabilitation with monolithic zirconia prosthesis, the treatment showed similar results to the current case report [7,8]. Long-term follow-up for the case was planned for abutments and long-span fixed partial denture re-evaluation. Monolithic zirconia can be used successfully for such cases requiring aesthetic and functional rehabilitation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZJ01-ZJ03&id=13861 https://doi.org/10.7860/JCDR/2020/44822.13861 Role of TRUS and MRI in the Detection of Prostate Cancer-A Prospective Study Kanika Bhambri, Alok Kumar Pandey, Anupam Jhobta, Amit Bhambri, Sanjiv Sharma, Balraj Singh, Kailash Barwal <b>Introduction:</b> Prostate cancer ranks second among all cancers affecting men. Common diagnostic tests like Transrectal Ultrasound (TRUS) and Prostate-Specific Antigen (PSA) are suboptimal for diagnostic purpose. Magnetic Resonance Imaging (MRI) has a promising role in detection, guidance for targeted biopsy and staging of prostate cancer. <b>Aim:</b> To evaluate the role of TRUS and MRI in the detection of prostate cancer and to ascertain if any functional parameter or union of parameters is of any utility in detection of prostate cancer. <b>Materials and Methods:</b> A prospective study was conducted which included fifty patients who underwent TRUS and 1.5-T MRI before being subjected toTRUS-guided biopsy. Imaging was compared with histopathological results. The sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio for each of the investigation was calculated. <b>Results:</b> The accuracy of the model combining all the imaging variables {T2-weighted imaging (T2WI), MR spectroscopy (MRS), Diffusion-Weighted Imaging (DWI), Apparent Diffusion Coefficient (ADC) and Dynamic Contrast-Enhanced (DCE) MRI} in predicting prostate cancer was 94%, which was higher than the diagnostic accuracy of each variable considered alone (DWI, 92%; ADC, 92%; MRS, 88.0%; DCE-MRI, 92%; and T2WI, 72%). TRUS had a diagnostic accuracy of 80%, sensitivity of 100.0%, specificity of 67.7%, PPV of 65.5% and NPV of 100.0%. <b>Conclusion:</b> TRUS had a high sensitivity and negative predictive value but a low specificity. MRI had both high sensitivity and specificity especially when the combination of functional sequences was used. But, the addition of a third functional technique does not further improve detection. Thus, a limited number of functional sequences are needed in every MRI study for prostatic cancer. However, DWI being the most valuable should be included as one of the sequences. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=TC10-TC14&id=13862 https://doi.org/10.7860/JCDR/2020/31898.13862 Infertile Semen Bacterial Isolates and their Local Multiple Antibacterial Resistance Pattern in Lagos, Nigeria Christian Azubike Enwuru, Bamidele Iwalokun, Nkechi V Enwuru, Oliver Ezechi <b>Introduction:</b> Infertility affects about 15% of couples globally and male contributory factor accounts for 20-30% of such cases. Antibacterial treatment is recommended for infertility of bacterial aetiology. However, Multidrug Resistance (MDR) of the organisms could impair the effectiveness of such infertility treatment. <b>Aim:</b> The present study researched on the MDR pattern of bacteria from semen of infertile men in Lagos, Nigeria. <b>Materials and Methods:</b> This was a controlled cross-sectional study, where in-vitro antibiotic sensitivity tests were conducted on consecutive bacterial isolates from prospective infertile and fertile semen control groups, using Clinical and Laboratory Standard Institute’s (CLSI) interpretative criteria. Antibacterial resistance was expressed in % and semen quality of “before and after” treatment was compered using t-test, p-value <0.05, at 95% confidence interval. <b>Results:</b> A total of 174 (117 Gram positive and 55 Gram negative and 2 yeast-like cells) mainly Staphylococcus spp. and Escherichia coli were studied, between 2009 and 2014. The Gram-positive cocci showed low resistance to Cefoxitin (9.2%) and Fluoroquinolone (45.9%); while Penicillin showed the highest resistance (98.37%). Within organisms’ total resistance rates of 98.3% Amoxicillin (AMX), 89.7% Cloxacillin (CXC), 87.2% Nalidixic acid (NAL) and 83.7% Sulfonamide (Cotrimoxazole) (COT) were recorded. The most prevalent Gram negative isolate (E.coli), showed 100% resistance to AMX, 95.8% Erythromycin, 95.8% Streptomycin, 91.7% amoxicillin/clavulanic acid, 83.3% tetracycline and 83.3% NAL. The most prevalent Gram positive isolate (S. aureus) had resistance rates 97% for AMX, 92.6% NAL, and 91.2% CXC among others. All MDR strains had MICs ranging 4-256 mg/L to the panel of antibiotics tested. <b>Conclusion:</b> There is concurrence in the pattern of MDR in this study to those seen across the world; however, increasing rates were apparent, probably due to lack of effective control policies. There is need for drug surveillance and control in Nigeria. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=DC16-DC22&id=13863 https://doi.org/10.7860/JCDR/2020/41926.13863 Prevalence of <i>Toxocara</i> spp. Eggs in Soil Samples of Public Parks of Ilam City, Iran Soghra Viesy, Jahangir Abdi, Zahra Rezaei, Mohamad Karimian <b>Introduction:</b> Toxocariasis, also known as Visceral Larva Migrans (VLM) syndrome, is a parasitic disease caused by the ascaris larva migrans of dogs and cats, especially <i>Toxocara canis</i>. The eggs of this parasite enter the human body through contaminated food, water, and soil. <b>Aim:</b> To determine the prevalence of <i>Toxocara</i> spp. eggs in the soil of public parks in Ilam city, Iran. <b>Materials and Methods:</b> In this descriptive cross-sectional study, 40 soil samples (100 grams per sample from the depth of 3 to 5 cm) were randomly collected from 10 public parks of Ilam city in the summer season of 2018. After washing, grinding, and separating large particles from the samples, parasitic eggs were isolated using 150-micron filters and sucrose flotation method. The data was analysed using SPSS 20 software. <b>Results:</b> Five of ten parks (50%) were contaminated with <i>Toxocara</i> spp. eggs. From 40 soil samples collected from the public parks, 16 (40%) were contaminated with <i>Toxocara</i> spp. eggs. Most of the contaminated samples were collected from walking and flowering areas in all the parks. Microscopic studies showed an average of 1-4 <i>Toxocara</i> spp. eggs per microscopic field in each sample indicating 4 to16 eggs per 100 grams of soil in each contaminated park. <b>Conclusion:</b> Due to the high level of contamination with <i>Toxocara</i> spp. eggs in Ilam city parks, it is necessary to prevent dogs and cats from entering to lawns and playgrounds in public parks by fencing. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=DC23-DC25&id=13864 https://doi.org/10.7860/JCDR/2020/44035.13864 Prospect of Bay Leaf (<i>Syzygium Polyanthum</i>) Extract in Reducing Ischemia and Inflammation in Animal Model of Myocardial Infarction: An Experimental Study Refli Hasan, Gontar Alamsyah Siregar, Dharma Lindarto <b>Introduction:</b> Bay leaf (<i>Syzygium polyanthum</i>) was thought to have potential to treat cardiovascular disease traditionally. Myocardial Infarction (MI) characterised by sudden blockage of coronary artery due to atherosclerosis rupture and following MI, several changes could happen such as expression of Hypoxia-Inducible Factor (HIF) 1a, immune cell infiltration, cytokine release, and fibrosis. <b>Aim:</b> To study the effect of bay leaf extract on HIF-1&#945;, immune cell infiltration, IL-10 level, and fibrosis in animal model of MI. <b>Materials and Methods:</b> An Experimental study using animal model of MI was conducted in December 2019. Thirty two Wistar rats were surgically manipulated to have MI. Rats were then divided into two groups: treatment group (with bay leaf extract administration) and control group. Neutrophil and macrophage distribution, collagen (fibrosis) distribution, and HIF-1&#945; expression were examined in infarcted muscle. Additionally, serum was taken to measure IL-10 level. Observation was conducted on day 1, day 4, day 7, day 14 after MI episode. Independent t-test was used to compare serum IL-10 level between groups. Statistical significance was set at p<0.05. <b>Results:</b> Lower HIF-1&#945; expression was seen in treatment group since day 1, showing better response to ischemia. As for inflammation, decreased neutrophil distribution, increased macrophage distribution was observed in treatment group. Significant increases in IL-10 level were also noticed since day 1 in treatment group (p<0.05 in all observation day). Lower fibrosis was also noticed from day 1 in treatment group. All these effects were further seen in day 4, day 7, and day 14. <b>Conclusion:</b> Bay leaf extract has potential in reducing ischemia, inflammation, and cardiac fibrosis in animal model of MI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OC21-OC24&id=13865 https://doi.org/10.7860/JCDR/2020/44462.13865 Efficacy and Comparison of 256-Slice Dual Source CT Angiography with Catheter Coronary Angiography at Different Heart Rates without using Beta Blockers Neeraj Jain, Udit Chauhan, Lalendra Upreti, Sunil Kumar Puri <b>Introduction:</b> Coronary Artery Disease (CAD) is a leading cause of morbidity and mortality in India as well as worldwide. CT angiography is an excellent imaging modality for evaluation of CAD. Previous studies with 64 or lesser slice CT scanner have failed to show consistent and optimal Image Quality (IQ) at Heart Rate (HR) more than 70 bpm and required beta blockers. <b>Aim:</b> To evaluate the diagnostic accuracy of 256-slice Dual Source CT Angiography (DSCTA) in comparison with Catheter Coronary Angiography (CCA) in evaluation of Coronary Arteries (CA) in patients with clinical suspicion of CAD and to study its effectiveness at higher HR without using beta blockers. <b>Materials and Methods:</b> This cross-sectional study was conducted on patients (n=46) with suspected CAD using ECG triggered 256-slice Dual Source Computed Tomography (DSCT) over a period of nine months. Patients were sub grouped according to HR (Group I: 50-70 (18 patients), Group II: 71-90 (24 patients) and Group III &#8805;91 (8 patients). A total of 48% patients had HR of 71-90 bpm while 16% had HR &#8805;91 bpm. Scan protocols included prospective ECG triggering (HR <75 bpm) and retrospective spiral scan protocols (HR >75 bpm). CA segments were analysed for IQ on a 4 point scale (1 is worst while 4 is best) by two independent readers who were blinded to the patient details. Accuracy to detect significant luminal stenosis was correlated with CCA (gold standard). Statistical significance of the study was established by Chi-square test (p<0.05). <b>Results:</b> The mean HR and Standard Deviation (SD) in the study was 76&#177;13.7 bpm (range 54-105). Out of 675 CA segments analysed mean IQ score and SD in medium (71-90 bpm) and high HR (&#8805;91 bpm) groups were 3.55&#177;0.62 and 3.25&#177;0.62 which were comparable to IQ in low HR group (3.84&#177;0.36). This indicates excellent IQ even at HR of &#8805;91 bpm (p<0.05). The mean IQ score of entire study group was 3.88&#177;0.33. Right Coronary artery (RCA) showed best IQ score in each category followed by Left Anterior Descending (LAD) and Left Circumflex (LCX). Inter-observer agreement analysis was performed using Kappa analysis to determine agreement between DSCTA readers. Kappa values for low, medium and high HR groups were 0.866, 0.842 and 0.836. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and accuracy for detecting significant stenosis in medium and high HR groups were 95%, 99.2%, 98.4%, 98.7%, 98.9% and 94.3%, 98.9%, 96.9%, 97.6%, 97.9%, respectively. <b>Conclusion:</b> 256-slice DSCTA is a reliable technique with high sensitivity, specificity, PPV and NPV for assessment of CA even at higher HR without using beta blockers. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=TC15-TC19&id=13866 https://doi.org/10.7860/JCDR/2020/42906.13866 Evaluation of the Vertical Marginal Fit of CAD-CAM Zirconia, Pressable Lithium Disilicate, CAD-CAM Cobalt Chromium and Direct Metal Laser Sintered Cobalt Chromium Copings- An Invitro Comparative Analysis Nikita Kandi, Ajay Sabane, Abhijit Patil <b>Introduction:</b> The longevity, durability and success of conventional fixed partial dentures and single crowns have been known to be attributed to the marginal fit of these restorations. Therefore, many studies lay emphasis on accurate marginal fit of the crowns. It has been the focus of various investigations in literature. However, there is limited literature comparing marginal accuracy CAD/CAM zirconia, Pressable Lithium Disilicate, CAD/CAM Cobalt-Chromium and Direct Metal Laser Sintered (DMLS) copings. <b>Aim:</b> Verification and comparative evaluation of the vertical marginal adaptation of CAD/CAM Zirconia, Pressable lithium Disilicate, CAD/CAM Cobalt-Chromium and DMLS copings. <b>Materials and Methods:</b> This invitro study was planned with an aim to evaluate the vertical marginal adaptation of CAD/CAM Zirconia, Pressable Lithium Disilicate, CAD/CAM Cobalt-Chromium and DMLS copings. A custom- made metal master model was prepared simulating the shape and dimension of tooth preparation resembling a first premolar using a Computer Numerically Controlled (CNC) milling machine. An elastomeric impression of the custom-made stainless steel model was made with addition silicone using dual mix/double step technique. All impressions were poured in Type IV dental stone and 60 stone dies were obtained. The samples were divided into four groups and each group had 15 samples (stone dies)- CAD/CAM zirconia (Group A), Pressable Lithium Disilicate (Group B), CAD/CAM Cobalt Chromium (Group C), and Direct Metal Laser Sintered Cobalt Chromium copings (Group D).The marginal fit was analysed at four reference marks on the working die stone model i.e., 0&#176; (Buccal surface), 90&#176; (Mesial Surface), 180&#176; (Lingual surface), and 270&#176; (Distal surface) on the stone die using a stereomicroscope. Comparison between groups was done by using one-way ANOVA test followed by a Post-Hoc Tukey-Kramer multiple comparisons test. <b>Results:</b> The mean marginal gap (in &#956;m) for Group A was 53.185&#177;25.83, respectively. The mean marginal gap (in &#956;m) of Group B was 66.08&#177;22.27, respectively. The mean marginal gap (in &#956;m) of Group C was 108.62&#177;23.93, respectively. The mean marginal gap (in &#956;m) of Group D was 28.54&#177;13.53, respectively. Tukey&#8217;s post-hoc analysis showed that the mean difference in the vertical marginal gap in Group C and the other three groups was statistically significant (p<0.05) i.e., marginal discrepancy of group C was more than Group A , Group B and Group D. <b>Conclusion:</b> The marginal fit of DMLS copings is more accurate as compared to CAD/CAM Zirconia, Pressable Lithium Disilicate and CAD/CAM Cobalt-Chromium copings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZC30-ZC36&id=13872 https://doi.org/10.7860/JCDR/2020/44354.13872 Role of Multi-Detector Computed Tomography Urography in Evaluation of Renal Tract Abnormalities KR Shankar, S Mythri <b>Introduction:</b> Computed Tomography Urography (CTU) is currently the modality of choice for imaging the urinary tract. Advanced CTU allows a thorough evaluation of the kidneys, ureters, urinary bladder and other structures simultaneously. Common conditions investigated by means of CTU include renal calculi, renal cancer, congenital kidney and ureter abnormalities, and certain renal inflammatory conditions. <b>Aim:</b> To evaluate the efficacy of Multi-Detector Computed Tomography (MDCT) urography in diagnosing renal tract abnormalities and correlation of the imaging data with clinical features. <b>Materials and Methods:</b> It was a descriptive study conducted between November 2017 and November 2019 involving fifty patients, aged 18-80 years with various renal abnormalities. This was a descriptive study involving both outpatients and inpatients. Triphasic examinations were carried out, including noncontrast, contrast enhanced and delayed images using a multidetector-row CT scanner. Chi-square and Fisher&#8217;s-Exact Test were used to assess the significance of study parameters. <b>Results:</b> Of the 50 suspected cases, 48 (96%) had renal tract abnormalities. The most common diagnosed condition was urolithiasis (36%), followed by congenital abnormalities (24%), renal masses/cysts/infections (14%), and bladder pathology/collecting system abnormalities/postoperative complications (16%). Urolithiasis was characterised by severe abdominal pain. Patients having renal masses in the urinary tract exhibited haematuria and weight loss. In case of congenital renal abnormalities, the clinical features were not significantly correlated. <b>Conclusion:</b> MDCT urography is a very useful tool for diagnosing renal tract abnormalities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OC25-OC29&id=13873 https://doi.org/10.7860/JCDR/2020/44561.13873 N-Terminal Pro Brain Natriuretic Peptide in Assessment of Severity of Coronary Artery Disease in Patients with Non ST Elevation Acute Coronary Syndrome Hesham Mohammed El Ashmawy, Mohammed Ahmed Sadaka, Gehan Magdy Youssef, Abdulkarem Saeed Hassan <b>Introduction:</b> N-Terminal pro Brain Natriuretic Peptide (NT-pro BNP) is an important biomarker in the management of patients with heart failure. Several studies reported its importance as a predictor of morbidity and mortality in Acute Coronary Syndrome (ACS) patients. <b>Aim:<b> To compare serum NT-proBNP levels in Non ST Elevation Acute Coronary Syndrome (NSTE-ACS) patients and controls and to assess the relation between Nt-proBNP and the severity of Coronary Artery Disease (CAD) in patients with NSTE-ACS including unstable Angina (UA) and Non ST Elevation Myocardial Infarction (NSTEMI). <b>Materials and Methods:</b> Sixty NSTE-ACS patients and 20 matched control without significant obstructive CAD were included in the study. Cardiac enzymes, blood urea, serum creatinine, serum NT-proBNP were measured in all patients immediately before coronary angiography. Gensini score and Syntax score were calculated for all study patients. The NSTEACS patients were followed-up for six months for Major Adverse Cardiovascular Events (MACE) including mortality, myocardial infarction, heart failure, stroke, revascularisation by primary percutaneous coronary intervention or Coronary Artery Bypass Grafting (CABG). <b>Results: </b>The mean serum NT-proBNP in NSTE-ACS (UA and NSTEMI) patients was significantly higher (662.7±635.2) pg/mL than that in the control (102.3±96.4) pg/mL, p<0.001. The effective cut-off value for the diagnosis of CAD was 139 pg/mL, Area Under Curve (AUC)=0.950, 95% CI: 0.890-1.00). The serum NT-proBNP was correlated with the severity and complexity of CAD as measured by Gensini score (r=0.496, p<0.001) and Syntax score (r=0.443, p<0.001). The mean value of NT-proBNP in patients with six months MACE was insignificantly higher than in patients without six months MACE with Interquartile Range (IQR) of 418.5 (139-2037) vs. 366 (175-3237) pg/mL, p=0.970. <b>Conclusion:</b> NT-proBNP was correlated with the severity and complexity of CAD in NSTE-ACS with preserved left ventricular systolic function, but it has no impact on six months MACE. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OC30-OC34&id=13874 https://doi.org/10.7860/JCDR/2020/44674.13874 Effect of Vacuum Assisted Closure System on Wound Healing Duration in Parastomal Wounds: A Retrospective Study Afig Gojayev, Ogün Ersen, Ümit Mercan, Ali Ekrem Ünal <b>Introduction:</b> In cancer patients, wound healing is seriously impaired due to cachexia and tumour-related catabolism. Therefore, several surgical complications may develop in patients with malignant diagnosis. Parastomal wounds are also among the most frequent surgical complications in this patient group which causes serious deterioration of the patients’ quality of life. Various factors influence the duration of parastomal wound healing and multiple methods are used in its treatment. Among them, new method is the treatment with the VacuumAssisted Closure (VAC) system. <b>Aim:</b> To examine the effect of VAC system on the duration of wound healing in parastomal wounds. <b>Materials and Methods:</b> A retrospective study was conducted in which the data of 31 patients who underwent surgery with a diagnosis of intra-abdominal malignancy at the surgical oncology clinic between January 2010 to January 2018, and who developed a parastomal wound were evaluated retrospectively, through the hospital database. The patients’ clinical and demographic data, peristomal skin complications and the applied treatment methods were determined from the hospital database. The effect of the patient-related factors and the VAC treatment on the duration of wound healing was analysed. The patients whose data could not be accessed and had no stoma complications were excluded from the study. In this study, analyses were performed using IBM SPSS statistical version 23.0. <b>Results:</b> A total of 38 patients developed parastomal wounds. The seven patients whose data could not be accessed were excluded from the study, so 31 patients who developed parastomal wounds, participated and out of them 10 (32.2%) were men and the mean age was found as 51.77&#177;15.23. There were 20 patients with ileostomy and 11 patients with colostomy. The most frequent diagnosis in the patient population was colorectal cancer. The VAC treatment was applied to 14 (45.2%) of the patients, the others were applied conventional wound care methods. When the relationship between clinical, demographic data, parastomal wound treatment methods and the durations of wound healing were viewed, the effect of being above 65 years of age (p=0.044), presence of Diabetes mellitus (DM) (p=0.012), and having a Body Mass Index (BMI) value of 25 or above (p=0.046) on parastomal wound healing was found to be statistically significant. Parastomal wound healing took a longer time in these patients. When the VAC treatment and other conventional wound treatment methods were compared, the duration of hospital stay was found to be short, statistically and significantly, in the VAC group (p=0.016). <b>Conclusion:</b> In malignant patients, being above the age of 65, the presence of DM and having a BMI value of 25 and above lengthen the duration of parastomal wound healing. The healing duration in parastomal wounds treated with VAC is shorter than other conventional methods. Thus, VAC is a successful and feasible method in parastomal wound treatment. Although, the results of this retrospective study are helpful in predicting and managing parastomal wounds, but prospective, randomised and large-scale studies are needed. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=PC12-PC15&id=13859 https://doi.org/10.7860/JCDR/2020/44399.13859 To What Extent Buccal Mucosal Graft Can Shrink Immediately after Harvesting during Substitutional Urethroplasty for Stricture Urethra? Arpan Choudhary, Prashant Patel, Avinash Pratap Singh Thakur, Fanindra Singh Solanki <b>Introduction:</b> Long segment stricture urethra is a difficult urological disease to treat. Substitutional urethroplasty utilising the Buccal Mucosal Graft (BMG) has shown promising results. Still up to one fourth of the patients can develop recurrence in the long term. Shrinkage of BMG immediately after harvesting, is a less studied phenomenon. It may compromise the tension free placement of BMG over the urethral defect, especially in long strictures. This may ultimately affect the final outcome. <b>Aim: </b>To study postharvest shrinkage of the BMG in patients undergoing substitutional urethroplasty. <b>Materials and Methods: </b>A prospective observational study was conducted during the study period from 2018 to 2020. All 18 patients of substitutional urethroplasty with BMG were enrolled. The baseline clinical profile was noted. Preharvest size of BMG was calculated and marked over the Buccal Mucosa (BM). Postharvest size was measured immediately after graft removal from the oral cavity. Changes in the donor area were also assessed. Alteration in BMG size and donor site area was analysed using paired t-test. Alterations in tobacco and non-tobacco users were compared using an unpaired t-test. Descriptive data were presented in the form of mean, range, percentage and standard deviation. Statistical analysis was completed using SPSS software, version 21.0 (IBM Corp, NY, USA). Statistical significance was kept below 0.05. <b>Results:</b> There were 18 cases which were finally available for analysis. Mean age was 32.9&#177;14.2 years. Balanitis Xerotica Obliterans (BXO) was the most common aetiology. Pan-anterior stricture was found in 9/18 of cases. Mean pre and postharvest BMG size was 7.7×1.8 and 6.9×1.6 cm, respectively. An 8.8% decrease in length (p<0.001&#42;&#42;) and 10.8% decrease in width of BMG (p<0.001&#42;&#42;) occurred after harvesting, which were statistically significant. A significant Increase in the donor site area was also seen (18.5%, p<0.001&#42;&#42;). <b>Conclusion:</b> A shrinkage of around 9% in the length and 11% of the width was seen in BMG after harvesting. The study suggests taking an extra 10% of measured size of BMG, in order to compensate for the expected shrinkage. The donor site area also increases and can be left open to heal by itself. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=PC16-PC20&id=13860 https://doi.org/10.7860/JCDR/2020/44680.13860 Midbrain Pons Ratio- A Diagnostic Tool for Progressive Supranuclear Palsy Mappilaveetil Sayed Jabir, Anjamparuthikal Aboobakar Haris <b>Introduction:</b> Progressive Supranuclear Palsy (PSP) is a Parkinsonism plus syndrome. PSP has different clinical features, it is unresponsive to levodopa and have poor prognosis compared to classical Parkinson’s Disease (PD). However, in clinical practice accurate diagnosis of parkinsonian syndromes are difficult especially when the patient presents early during the course of illness. Diagnosis of each condition is important since it affects patient’s management, rehabilitation and prognosis. Magnetic Resonance Imaging (MRI) is especially useful tool in parkinsonian syndromes, since it identifies changes produced by the neurodegeneration. Rostral midbrain atrophy is seen in PSP. Midbrain pons ratio helps to identify the atrophy involving midbrain, thus helps in differentiating PSP from other causes of parkinsonism. <b>Aim:</b> To investigate the utility of midbrain diameter and midbrain pons ratio in mid-sagittal sections of MRI for differentiation of PSP from other neurodegenerative parkinsonism. <b>Materials and Methods:</b> This was a cross-sectional study conducted in Department of Neurology, Government Medical College, Kottayam, Kerala, India. Of all the patients who presented with clinical features of Parkinsonism, 124 patients who met the inclusion criteria were selected for the study. Comparison was made between the values obtained in clinically diagnosed patients with PSP (n=30), PD (n=30), Multiple System Atrophy (MSA) (n=30), Corticobasal Degeneration (CBD) (n=4) and normal Controls (n=30). These patients underwent MRI and the mid-sagittal T1 weighted MRI images were obtained; the diameter of midbrain and pontine base as well as midbrain-topons ratio was calculated. Quantitative analysis of five groups were done using Analysis of Variance (ANOVA) with post-hoc Tukey correction. <b>Results:</b> Mean age of patients in PSP was 59.47±3.86 years. The mean midbrain diameter was found to be lower in PSP, measuring 7.8±0.83 mm (p<0.001) with reduction of the midbrain-to-pons ratio. The mean midbrain pons ratio was found to be lower in PSP, measuring 0.45±0.03 in comparison with the other parkinsonian syndromes (p<0.001). <b>Conclusion:</b> Midbrain pons ratio and midbrain diameter in MRI is a simple measurement for differentiating PSP from other degenerative parkinsonian syndromes https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OC09-OC12&id=13844 https://doi.org/10.7860/JCDR/2020/45044.13844 Evaluation of Aetiology and Outcome of Acute Kidney Injury in a Tertiary Care Hospital of India- A Prospective Observational Study VS Gaurav Narayan, SG Ramya, Sonal Rajesh Kumar, SK Nellaiappa Ganesan <b>Introduction:</b> The Acute Kidney Injury (AKI) is a rapid decline in renal filtration function. The aetiological spectrum, prevalence of AKI and outcome is highly variable. This variation exists due to the difference in the criteria used, study population and demographic features. Huge differences are noted when AKI is compared in developing and developed countries. Hence, it is important to analyse the spectrum of AKI to facilitate earlier diagnosis and treatment which shall help in improving the outcome. <b>Aim:</b> To study the prevalence, aetiology and outcome of AKI in the medical intensive care. <b>Materials and Methods:</b> This was a prospective observational study conducted in a medical intensive care for 18 months where 1490 patients were screened and 403 patients were included as AKI by KDIGO criteria. History, examination, appropriate investigations and treatment details including dialysis were noted. The serum creatinine levels were obtained every day, to know the time of onset of AKI, at the time of death or discharge, and after one month for patients who turned up for follow-up. Patients were categorised based on outcome as survivors and nonsurvivors. Survivors were divided into as fully recovered and partially recovered and those who left the Intensive Care Unit (ICU) against medical advice were termed as lost to follow-up. <b>Results:</b> A total of 403 patients (27.04% of 1490) of medical intensive care admissions were found to have AKI. Sepsis was the most common cause of AKI. At the end of the month, 78.4% of AKI patients fully recovered, 1.2% partially recovered and the mortality was 14.9%. Mortality was higher in AKI associated with chronic medical conditions like cardiac failure, chronic liver disease and stroke. <b>Conclusion:</b> If treated early, AKI is mostly reversible. Regional differences in AKI should be studied extensively and local guidelines should be formulated by experts for prevention and early treatment, to improve the disease outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OC13-OC16&id=13845 https://doi.org/10.7860/JCDR/2020/45161.13845 Evaluation of Functional Outcome of Management of Proximal Humerus Fractures by Different Treatment Modalities Sudhir Shyam Kushwaha, Ambrish Thakur, Yasir Ali Khan, Amit Verma, Farid Mohammed, Ashish Kumar <b>Introduction:</b> Proximal humerus fractures account for 4-5% of all fractures and could be managed both conservatively and surgically. As much as 85% minimally or non-displaced fractures can be managed conservatively. In spite of early union and exercise programme by conservative treatment, the problem of shoulder stiffness is common. To overcome stiffness, early mobilisation is mandatory which is not possible in conservative treatment before three weeks. Therefore, surgical intervention is needed for early mobilisation and early return of function. <b>Aim:</b> To compare the functional outcome between the four common methods of managing proximal humerus fractures namely locking plate, Joshi External Stabilisation System (JESS), percutaneous K-wire fixation and conservative method. <b>Materials and Methods:</b> Patients with proximal humerus fracture above 18 years of age between August 2011 to August 2013 were included in the study. The study population was divided into four groups viz., Group A, B, C, D depending on the mode of treatment by locking plate, external fixator, K-wire fixation and conservative method of treatment, respectively. The patients were followed-up at 3 weeks, 6 weeks, 12 weeks, 18 weeks and thereafter every 6 weeks’ interval till 9 months. After union, cases were evaluated radiologically and clinically for functional results by using the Swanson Shoulder Score and Constant Scoring System (Modified). <b>Results:</b> At the end of the study there were 17 patients in the Group ‘A’, 7 patients in the Group ‘B’, 7 patients in the Group ‘C’ and 11 patients in Group ‘D’. At 9 months of follow-up according to modified constant shoulder score the percentage of excellent score in group A was maximum. Group B and Group D had maximum number of good scores. The mean constant shoulder score increased in all groups at 9 months of follow-up as compared to 3 months of follow-up except in group D. Similarly, according to Swanson’s shoulder score, group A had the maximum number of excellent scores. <b>Conclusion:</b> From the above study it can be concluded locking plates are an excellent modality of treatment of proximal humerus fractures with excellent union rate and early mobilisation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=RC01-RC05&id=13830 https://doi.org/10.7860/JCDR/2020/27961.13830 Oral Health Impact Profile and Self-Perception of Patients in Brazil with Implant-Supported Prostheses Bruno Briancini Mattiello, Marcia Borba, Diego José Gambin, Thamiris Nogueira Sacker, Joao Paulo De Carli, Micheline Sandini Trentin <b>Introduction:</b> Implant supported prosthetic rehabilitation could re-establish the comfort and bring a confident smile to patients, allowing them to eat properly and to lead a social life free of traumas and complexes. <b>Aim:</b> To verify which type of implant-supported rehabilitationoverdenture or fixed denture effectively restores the comfort of the lower arch of partial edentulous patients. <b>Materials and Methods: </b>A cross-sectional clinical study was performed in patients with completely edentulous lower arch treated with either overdenture (2 implants) or fixed denture (5-6 implants), obtained from a sample from Southern Brazil. The study sample was composed of 37 volunteers who met the inclusion and exclusion criteria. Half of them were rehabilitated with overdenture (O- ring and bar) and the other half with fixed denture (Branemark protocol). A clinical evaluation was performed to obtain the Index of Plaque (PI) and bleeding on probing indexes (BI). Three questionnaires were applied to quantify the patient’s level of satisfaction with their prosthetic treatment (OHIP-EDENT and masticatory ability questionnaires) up to one year after installation of the prosthesis. Results were analysed by the Mann-Whitney test (a=0.05). <b>Results: </b>All treatments were considered satisfactory regarding masticatory ability. However, fixed dentures had a statistically higher level of satisfaction compared to overdenture. There were significant differences in the mean PI and BI index between the groups. <b>Conclusion:</b> Both rehabilitation treatments increased the satisfaction and improved the oral health and masticatory ability of edentulous patients. However, although patients rehabilitated with fixed dentures presented higher level of satisfaction, they also showed higher plaque and bleeding on probing indexes. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZC24-ZC29&id=13857 https://doi.org/10.7860/JCDR/2020/44291.13857 Turnover Intention Factors among Private Hospital Nurses in Indonesia Rindu, Syukri Lukman, Hardisman Dasman, Hafizurrahman, Adang Bachtiar <b>Introduction:</b> The most critical problem faced by the health care system is the shortage of workers. This phenomenon is due to the release of employees. The number of turnover rate in private hospital is high due to which hospitals management face problems in the field of nursing. <b>Aim:</b> To determine turnover intention and factors behind turnover intention among private hospital’s nurses who worked in Jakarta, Indonesia. <b>Materials and Methods:</b> This cross-sectional study was conducted from March to September 2018 in two private hospitals in Jakarta, Indonesia, involved 97 nurses. Data were collected by employing a set of self-administered structured questionnaires and were analysed using Partial Least SquareStructural Equation Modelling (SEM-PLS technique). <b>Results:</b> The results showed that there was a significant negative influence on organisational commitment to turnover intentions (-0.496). The higher the nurse’s organisational commitment, the lower was the nurse turnover intention. The better the job characteristics of nurses, the lower was the nurse turnover intention (-0.213). There was a significantly positive influence of job characteristics on job satisfaction (0.499). The higher the job satisfaction of nurses, the higher was the organisational commitment (0.374). <b>Conclusion:</b> The findings show that the influence of nurses’ work commitment has the greatest direct influence in influencing the turnover intention. Hospital need to increase nurses’ organisational commitment through their job satisfaction. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=IC01-IC04&id=13869 https://doi.org/10.7860/JCDR/2020/44088.13869 Characteristic of Anaemia in Hypothyroid Pregnant Females: A Case-control Study Salamah Parveen Imteyaz, Bijli Nanda, Manisha Jindal, Mohammad Jaseem Hassan <b>Introduction:</b> Anaemia is the most prevalent haematological abnormalities associated with thyroid disorders and it is often the first sign of hypothyroidism. Pregnancy is frequently associated with anaemia; most commonly iron deficiency anaemia, followed by dimorphic anaemia. Pregnancy complicated by the development of hypothyroidism could be further associated with a higher incidence of anaemia. <b>Aim:</b> To determine the incidence and characteristic of anaemia in pregnancy associated with hypothyroidism. <b>Materials and Methods:</b> This case-control study was conducted in a Medical college hospital during January 2015 to January 2016. A total of 272 pregnant women were enrolled in the study by random sampling of all pregnant females attending Out Patient Department of our hospital. Serum Thyroid Stimulating Hormone (TSH) level was used to detect thyroid function abnormalities. Complete Blood count was done. Peripheral blood smear was stained by Leishman stain and subsequently studied under microscope for morphological classification of anaemia. Anaemia was further classified according to the Haemoglobin (Hb) level into mild, moderate and severe anaemia. Unpaired t-test, Pearson’s correlation test and chi-square test have been used in the study for analysis and comparison of various parametres. p-value <0.05 considered level of significance. <b>Results:</b> Out of total of 272 subjects selected for the study, 207 were euthyroid and 65 were hypothyroid. Of the 65 hypothyroid subjects, 19 were in the first trimester, 25 in the second trimester and 21 were in the third trimester. The mean TSH of euthyroid group was 2.49±1.35 mIU/L and hypothyroid group was 6.27±3.6 mIU/L (p-value 0.0001). Mean Hb of Euthyroid was 10.16 g/dL, while mean Hb of hypothyroid subjects was 8.92 g/dL and this difference was significant (p<0.001). A total of 191 (70.22%) out of 272 pregnant subject were found to be anaemic. About 131 (63.28%) out of 207 of euthyroid patients were anaemic, while 92.31% of hypothyroid patients (60 out of 65) showed anaemia. A significant association was found between Hypothyroidism and anaemia (p-value <0.0001). The mean Thyroid stimulating hormone value of anaemic patients was 3.98±1.02, which is significantly higher (p<0.0001) than TSH value of 2.65±0.98 as seen in non-anaemic patients. The majority of anaemia cases in both euthyroid and hypothyroid groups were found to be of moderate severity. Dimorphic anaemia was the most common type of anaemia morphologically in both euthyroid and hypothyroid subjects. It was also the most common type of anaemia in all three trimesters. <b>Conclusion:</b> The incidence of anaemia was higher in the hypothyroid group compared to the euthyroid group. Thus, it is very important to study the incidence and type of anaemia in hypothyroid pregnant females, so that appropriate early nutritional and medicinal intervention can be taken so as to prevent the morbidity and mortality in these patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=CC05-CC08&id=13877 https://doi.org/10.7860/JCDR/2020/44984.13877 Determination of the Variance of Complex Calculated Clinical Chemistry Tests; Application in Calculated Low Density Lipoprotein and Atherogenic Index of Plasma Christina Tsigalou, Maria Panopoulou, Anastasia Grapsa, Alexandros Karvelas, Kostas G Anagnostopoulos <b>Introduction:</b> Measurement uncertainty is the random error component of the measurement and is an interval around the measured value, into which the true value lies with some probability. <b>Aim: </b>To determine the uncertainty in the calculation of Low Density Lipoprotein Cholesterol (LDL) cholesterol and the Atherogenic Index of the Plasma (AIP). <b>Materials and Methods: </b>A total of four samples with varying levels of total cholesterol, HDL and triglycerides were measured 34 times in a row to get repeated measurements. The variance of LDL and AIP were determined and compared using three different methods: the empirical distribution, error propagation (using first order Taylor approximation and for AIP second order too) and bootstrapping. <b>Results:</b> The empirical and error propagation variances were essentially identical but the bootstrap variance was lower for both calculated parameters for all samples. Distributions of cholesterol, HDL and triglycerides with constant mean and increasing variance were used to determine the measurement uncertainty using all methods mentioned above. The bootstrap variance was lower than the error propagation variance, for AIP the second order error propagation variance was very near the first order one and all the variances fluctuated in tandem. <b>Conclusion:</b> For complex calculated tests it would be more appropriate to use the bootstrap approach, especially in nonlinear functions, since the error propagation approach may overestimate or in other cases underestimate the measurement uncertainty. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=BC11-BC16&id=13879 https://doi.org/10.7860/JCDR/2020/45298.13879 Clinico-mycological Evaluation of Dermatophytes in a Tertiary Care Hospital of Saurashtra, Gujarat, India Gopee E Makwana, Manish Mathur <b>Introduction:</b> Dermatophytes and opportunistic fungi are common skin infection mainly affecting superficial layers of integument with rare systemic involvement. The higher prevalence in India is supposedly due to the hot and humid climatic condition, occupation and low socio-economic status. Recent upsurge in fungal infections are due to increased incidence of immunosuppressive state. <b>Aim:</b> To study the clinical manifestation and mycological evaluation of dermatophytosis. <b>Materials and Methods:</b> The present cross-sectional observational study was conducted during December 2007 to October 2009 in MP Shah Medical College and GG Hospital, Jamnagar, Gujarat, India. Samples were taken from 200 patients with clinically diagnosed dermatophytosis. Depending on the site of lesion, samples from skin, hair or nail were taken. These samples were than examined directly under microscope and cultured on Sabouraud’s Dextrose Agar (SDA) and Cornmeal Agar (CMA). Descriptive statistics like mean and percentages were used to infer results. <b>Results:</b> Out of 200 patients, 177 (88.5%) samples were positive by Potassium Hydroxide (KOH) mount while 127 (63.5%) samples were positive by culture. Most common species of dermatophytes identified was <i>Trichophyton rubrum</i> followed by <i>Trichophyton mentagrophytes</i>. Agricultural workers were found to be more prone to dermatophytic infection and males (61%) were more commonly affected than females (39%). <b>Conclusion:</b> Dermatophytosis is a common superficial mycotic infection in Saurashtra region where hot and humid climate, poor socio-economic condition and compromised personal hygiene play an important role in fungal growth. In the present study, tinea corporis was found to be the most common clinical type with <i>T. rubrum</i> being the commonest isolated species. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=DC26-DC29&id=13880 https://doi.org/10.7860/JCDR/2020/43639.13880 Measurement of Resting Energy Expenditure with Indirect Calorimetry and Predictive Equations in Healthy Young Adults: A Cross-sectional Study Harsha Soni, Sudhanshu Kacker, Neha Saboo, Karampreet Buttar, Jitender <b>Introduction:</b> Resting Energy Expenditure (REE) is the main determinant of energy requirements. An inaccurate estimation of REE can lead to the over or under-prediction of energy requirements. Indirect calorimetry is considered as the gold standard for the assessment of REE. The most of the predictive equations which are formed, are from the studies conducted on Caucasian people while on Asian population these studies are very limited. <b>Aim:</b> To compare the REE measured by indirect calorimetry and predictive equation in healthy young adults. <b>Materials and Methods:</b> A cross-sectional study was done on 100 healthy young adult participants from November 2018 to May 2019, of age group 18 to 25 years to measure REE using indirect calorimetry and predictive equations (Harris-Benedict’s, Schofield, FAO/WHO/UNU and Mifflin-St. Jeor equations). Statistical analysis was carried out using SPSS version 16.0. Unpaired student t-test for comparison of data and Bland Altman test to check for validity of predictive equations were applied. <b>Results:</b> The mean value of REE using Indirect calorimetry was 1994.20±577.33 and that of using four Harris-Benedict’s, Schofield, FAO/WHO/UNU and Mifflin-St.Jeor equations were 1638.15&#177;335.64 kcal/day, 1636.21&#177;359.85 kcal/day, 1636.93&#177;367.59 kcal/day and 1582.41&#177;251.29 kcal/day, respectively. Thus, the highest mean difference between values of REE obtained using predictive equation and indirect calorimetry was 411.79&#177;326.04 kcal/day with respect to Mifflin-St.Jeorand’s and the lowest mean difference was 356.05&#177;241.69 kcal/day with respect to Herris Benedict’s equation. <b>Conclusion:</b> Predictive equations underestimated the REE of young adults when compared with that measured by indirect calorimetry. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=CC09-CC12&id=13881 https://doi.org/10.7860/JCDR/2020/43680.13881 Assessment of the Impact of Varying Durations of Computer Usage on Dry Eye Parameters in Employees of a Tertiary Care Teaching Hospital of Uttar Pradesh, India Amit Kumar Jain, Dadan Ji Pandey <b>Introduction:</b> Dry eye (keratoconjunctivitis sicca) is a common disorder of the tear film having multifactorial aetiology. Nowa-days, a large portion of population is affected with Dry Eye Disease (DED) because of substantial increase in usage of computers and digital devices. <b>Aim:</b> To evaluate the effect of varying durations of computer usage on parameters of DED. <b>Materials and Methods:</b> In this prospective study, total 120 participants were divided into two groups. Group I (n=58) included participants who used computer daily for less than six hours while group II (n=62) included those who used computer for more than six hours daily. Routine eye examination was done and dry eye parameters i.e., Ocular Surface Diseases Index (OSDI), Schirmer Test (ST) and Tear Film Break Up Time (TFBUT) were performed and analysed for any significant difference between groups I and II using unpaired t-test. SPSS 16.0 was used and p-value <0.05 was considered as statistically significant. Pearson’s correlation test was performed to analyse correlation of OSDI score with TFBUT and ST values. <b>Results:</b> Mean OSDI scores in group I and group II were 37.39&#177;8.98 and 49.54&#177;11.7 (p<0.001), respectively; while TFBUT values were 10.19&#177;2.27 seconds and 8.12&#177;2.9 seconds (p<0.001), respectively. ST values were 12.82&#177;3.32 mm in group I and 10.80&#177;3.86 mm in group II (p=0.0027). Significant inverse correlation between OSDI score and TFBUT values was found in both group I (r=-0.557, p<0.001) and group II (r=-0.439, p<0.001). Similarly, correlation of OSDI score with ST values in group I (r=-0.787, p<0.001) and group II (r=-0.320, p=0.011) was also inversely significant. On the basis of OSDI score, 38 (65.5%) participants in group I and 54 (87.08%) participants in group II had severe dry eye. According to TFBUT values 12 (20.68%) participants in group I and 29 (46.77%) participants in group II and as per ST values 17 (29.31%) participants in group I and 30 (48.38%) participants in group II had severe dry eye. <b>Conclusion:</b> Usage of computer or digital displays more than six hours per day is a potential cause for the development of severe DED. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=NC01-NC05&id=13824 https://doi.org/10.7860/JCDR/2020/44260.13824 Effect of Application Time of Two Different Disinfectants on the Surface Roughness of an Elastomeric Impression Material Tahir Karaman, Faruk Oztekin, Samet Tekin <b>Introduction:</b> Pathogens, such as cytomegalovirus, hepatitis B virus, hepatitis C virus, herpes simplex virus types 1 and 2, and human immunodeficiency virus are transmitted, threatening the health of dental laboratory workers, especially as a result of saliva and blood contact of patients. To prevent cross-infection, impression materials should be disinfected at the end of the impression process in the mouth. <b>Aim:</b> To study the effect of application time of sodium hypochlorite and quaternary ammonium-based disinfectant solution on the surface roughness of an elastomeric impression material. <b>Materials and Methods:</b> In this in-vitro study done during March 2020, 10 disc-shaped samples were used in each group, with a total of 110 samples obtained from a light body elastomeric impression material with dimensions of 15×3 mm. The samples were kept in a sodium hypochlorite solution (Wizard; Rehber Kimya, Istanbul, Turkey) at concentrations of 1% and 5% for 1, 5, 10, and 30 minutes and in a quaternary ammonium-based disinfectant (Zeta 7 Solution, Zhermack SpA, Italy) for 10 and 30 minutes. Surface roughness measurements were taken with a profilometer device. The data obtained were statistically analysed by Kolmogorov-Smirnov test and Wilcoxon signed rank test for dependent/paired groups for the continuous data. The significance level was set to &#945;=0.05. <b>Results:</b> A statistically significant difference was found between the control group and the 1% sodium hypochlorite (30 min p-value 0.037), and 5% sodium hypochlorite (30 min p-value 0.017). The statistical evaluation of the surface roughness of the samples with different concentrations of sodium hypochlorite and the same times was done and found statistically significant at 30 mins, p-value 0.021. <b>Conclusion:</b> The prolonged application of the sodium hypochlorite disinfectant at 1% and 5% concentrations caused a significant increase in the light body elastomeric impression material’s surface roughness. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZC10-ZC13&id=13828 https://doi.org/10.7860/JCDR/2020/44752.13828 Retrospective Study of Three-Port versus Standard Four-Port Laparoscopic Cholecystectomy: A Single Surgical Unit Experience of 1456 Patients Vivek Srivastava, Mumtaz Ahmad Ansari, Vijay Kumar Shukla, Somprakas Basu <b>Introduction:</b> Although laparoscopic surgeries have proven beyond doubt their benefit in terms of early recovery, better patient care and cost-effectiveness, the quest for reduction in either the size or number of ports still continues. <b>Aim:</b> To compare the safety, outcome, and advantages between three-port versus four-port Laparoscopic Cholecystectomy (LC) in acute and chronic cholecystitis. <b>Materials and Methods:</b> Medical records of 1456 patients that underwent LC (three- or four-port) for acute and chronic cholecystitis from January 2015 to December 2019 (60 months) were retrospectively analysed. All patients were given the same anaesthetic drugs for induction and maintenance, with standard anaesthetic protocol. The results were compared for both the techniques in terms of operating time, conversion rate, intraoperative complications, immediate postoperative complications, pain score, analgesic requirement and hospital stay. <b>Results:</b> Total 1456 patients underwent LC; 1282 were female and 174 were male. The mean age of the patients was 39.2 years (range 18-70 years). The three-port LC technique was performed on 816 (56.04%) patients, while the traditional four-port LC technique was performed on 640 (43.96%) patients. Visual Analog Score (VAS) in the postoperative period at six hour was 2.11&#177;0.82 in three-port group versus 3.17&#177;1.12 in four-port group, this suggests that there was a significant difference in pain in these two groups in the early postoperative period (p<0.001). In three-port group, the requirement of analgesic drug was significantly less as compared to four-port group (2.86&#177;0.98 versus 3.22&#177;0.87; p<0.001). There was no statistically significant difference in the mean operating time, duration of hospital stay, intra and postoperative complications, days to return to normal activity, satisfaction score and conversion rate (p=0.087, p=0.061, p=0.578, p=0.555, p=0.572 and p=0.145, respectively). <b>Conclusion:</b> Three-port LC is a feasible, effective and safe technique that further enhances the surgical outcome in terms of postoperative pain, fewer needs for analgesic medication. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=PC01-PC03&id=13826 https://doi.org/10.7860/JCDR/2020/44484.13826 Effects of Pre-Procedure Activated Dimethacone on Mucosal Visibility during Oesophagogastroduodenoscopy: A Case-Control Study AK Koushik, V Saketh, P Ganesh, S Shanmughanathan <<b>Introduction: </b>Dimethicone enhances diagnostic accuracy in Oesophagogastroduodenoscopy (EGD). Various regimens have been tried to ease the procedure for better mucosal visibility. <b>Aim:</b> To evaluate the efficacy of activated dimethicone in improving endoscopic visibility. <b>Materials and Methods:</b> The present prospective study was carried out from February 2017 to February 2018 in a tertiary teaching hospital, Chennai, India. A total of 2917 patients aged 18-70 years were enrolled for this study. The participants were divided into group S (1540 patients) and group C (1377 patients). Group S received activated dimethicone 30 minutes before the procedure and group C underwent procedure without any pre- procedure preparation. The mucosal visibility score was evaluated in both the groups. Statistical analysis was conducted using IBM SPSS statistics (version 23.0). Unpaired student’s t-test and Pearson Chi-Square test are used for statistical analysis of the data and in both, p<0.05 was considered as significant level. <b>Results:</b> The mucosal visibility score in oesophagus, stomach, antrum and duodenum was significantly better in group S patients compared to group C patients. Duration of endoscopy was significantly (p-value 0.0005) shorter (7.95 min) in the group S compared with the group C (8.17 min). The amount of flush used was on an average 3 mL less for group S than group C, which was also significant (p-value 0.0005). <b>Conclusion: </b>Activated dimethicone pre-preparation to EGD significantly increased the mucosal visibility during procedure and decreased the endoscopy duration. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OC01-OC04&id=13819 https://doi.org/10.7860/JCDR/2020/44807.13819 Comparative Efficacy of Structured Games and Behavioural Parent Training on Working Memory in Children with Attention Deficit Hyperactivity Disorder: A Pilot Study Raghumahanti Raghuveer, Ruchi <b>Introduction:</b> Attention Deficit Hyperactivity Disorder (ADHD) may develop during the preschool years of the child and extend into adulthood. ADHD also leads to impaired Working Memory (WM) creating problems in various functions. <b>Aim:</b> To compare the effectiveness of behavioural parent training and structured games on WM of children with ADHD. <b>Materials and Methods:</b> This prospective interventional study was conducted in 18 schools of Ghaziabad city, Uttar Pradesh, India. Seventy subjects were selected based on Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria. Group A (n=35) received structured games and Group B (n=35) received Behavioural Parent Training (BPT). Seguin Form Board Test Time (SFBTT) was recorded as outcome on baseline and 5<sup>th</sup> week. Student&#8217;s paired and unpaired t-test was done. SPSS 22.0 version was the software used and p<0.05 was considered as level of significance. <b>Results:</b> Analysed data showed significant results within structured games group with t=2.355, p<0.05, and no significant result within BPT group with t=-0.776, p>0.05. Between group comparison showed significant difference with t=-2.804, p<0.05. <b>Conclusion:</b> Training of WM in form of structured games can be an effective method when compared to BPT in children with ADHD. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=YC01-YC04&id=13807 https://doi.org/10.7860/JCDR/2020/43576.13807 Comparison of Antimicrobial Susceptibility Testing Methods for Colistin against Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital of Southern India D Sarumathi, Deepashree Rajashekar, Apurba Sankar Sastry <b>Introduction:</b> The emergence of resistance to colistin urges the need for standardised invitro susceptibility testing methods for colistin, both for patient care and also for epidemiological purpose. Many challenges have been faced by clinical laboratories in performing and interpreting Antimicrobial Susceptibility Testing (AST) methods for colistin. To overcome the challenges, a rapid and reliable method is required to carry out AST for colistin. <b>Aim:</b> To determine the degree of agreement and types of errors associated with various colistin antimicrobial susceptibility methods such as commercial Broth Microdilution (BMD) method (MIKROLATEST- Erba Mannheim colistin MIC kit) and in-house Rapid polymyxin NP test (named after P. Nordmann and L. Poirel) with the reference in-house BMD method. <b>Materials and Methods:</b> The study was carried out in a tertiary care hospital in southern India from July 2018 to July 2019. The isolates from Enterobacteriaceae family showing resistance to carbapenem were selected for the study. A total of 294 clinical isolates were collected and subjected to two test methods (Commercial BMD method and Rapid polymyxin NP test) and finally the comparative analytical study was done by comparing the results of the test methods with reference in-house BMD method. The statistical analysis was carried out with the help of Stata version 14 using kappa statistics. <b>Results:</b> Susceptibility results of 294 isolates included Escherichia coli (n=67), K.pneumoniae (n=195), Enterobacter spp. (n=23), Citrobacter spp. (n=9) were evaluated for three methods according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) published clinical breakpoints. Overall, categorical agreement of commercial BMD with reference in-house method was 91.1% with very major error 2.7% and major error 6.1% and essential agreement was 83.3%. With the Rapid polymyxin NP test, categorical agreement, sensitivity and specificity were 92.5%, 93.1% and 92.3% respectively. <b>Conclusion:</b> This study helps in introducing less laborious, faster and reliable susceptibility method for colistin. This will guide the clinicians in appropriate and judicious use of colistin so that mortality and morbidity will be reduced drastically https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=DC01-DC05&id=13808 https://doi.org/10.7860/JCDR/2020/43889.13808 Comparison of E-cadherin and CD56 Expression in Papillary Thyroid Carcinoma and Non-Neoplastic Thyroid Lesions Sumi Thomas, Divya Surendran, Joy Augustine <b>Introduction:</b> Papillary Thyroid Carcinomas (PTC) are the most common among thyroid malignancies. The incidence of this tumour is rapidly increasing around the world. Kerala has the highest incidence of this tumour in India. Abnormalities in adhesion molecules, E-cadherin and CD56 have recently been implicated in thyroid tumourigenesis. Sometimes the diagnosis of PTC is difficult, as there are a good number of histological variants and some may be encapsulated. In such situations, evaluation of the expression of adhesion molecules like E-cadherin and CD56 are useful in accurate diagnosis. <b>Aim: </b>To study the Immunohistochemical Expression of E-cadherin and CD56 in PTC, its adjacent normal thyroid tissue and other non-neoplastic thyroid lesions. <b>Materials and Methods:</b> This was a descriptive study conducted at Amala Institute of Medical Sciences, Thrissur from January 2018 to June 2019. Seventy six thyroidectomy specimens (38 each of PTC and Non-neoplastic lesions) were studied after satisfying the inclusion and exclusion criteria. Microscopic examination of the Haematoxylin and Eosin stained sections were done for selecting the representative tissue block to immunostain for E-cadherin and CD56. Statistical analysis was performed using Chi-square test and Fisher’s-exact tests. P-value of <0.05 was considered as significant. <b>Results:</b> E-cadherin expression was negative in 37 cases of PTC. Only two non-neoplastic lesions were negative for E-cadherin( p-value of 0.021). No significant correlation was observed between E-cadherin expression and poor prognostic factors (tumour diameter, multifocality, extrathyroidal extension and lymph node metastasis). All PTC cases showed negative CD56 expression. A total of 34 out of 38 Non-neoplastic cases showed positive CD56 staining (significant p value=0.011). In non-neoplastic lesions, E-cadherin and CD56 were preserved. CD56 showed highest specificity (100%). <b>Conclusion:</b> PTC was characterised by decreased or absent expression of E-cadherin as compared to the adjacent thyroid tissue. CD56 expression was uniformly negative in all the PTC cases. CD56 marker had highest specificity (100%). In follicular patterned thyroid lesions, CD56 as a single marker may be useful for identifying PTC from other thyroid lesions in daily practice. To conclude, CD56 negativity and E-cadherin loss can assist in decision making of difficult cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=EC01-EC05&id=13809 https://doi.org/10.7860/JCDR/2020/43912.13809 Variations of Biceps Brachii Muscle and its Clinical Importance Jolly Agarwal, Krishna Gopal <b>Introduction:</b> Biceps brachii is one of the functionally important muscles of front of the arm. As the name indicates biceps brachii is having two heads of origin and it inserts on the posterior surface of radial tuberosity. Variations may be present in the form of additional heads of origin or they may be present at its insertion. These variations may affect action of muscle and may cause compression of nearby neurovascular structures. <b>Aim:</b> To determine the variation in anatomy of biceps brachii with respect to its origin, insertion and its nerve supply. <b>Materials and Methods:</b> The present osteological study was conducted on 32 arms of embalmed cadavers (including both right and left) of Department of Anatomy, SRMS IMS, Bareilly, Uttar Pradesh, India from 2015-2018 period. The dissection of arm was done according to standard guidelines and biceps brachii muscle was cleaned. The origin, insertion and nerve supply of biceps brachii muscle was observed and noted for any variation. <b>Results:</b> In the present study an additional head of origin of biceps on right and left side of two cadavers were found. In present study inferomedial origin of biceps brachii was found. The present study also showed the presence of musculotendinous slip at its insertion. This slip was going towards the muscle belly of pronator teres. <b>Conclusion:</b> There are numerous variations seen in biceps brachii which can put a surgeon in dilemma and it may result in iatrogenic injuries. Hence, it is important to have a knowledge about its variations so that such injuries can be prevented. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=AC01-AC03&id=13811 https://doi.org/10.7860/JCDR/2020/45170.13811 Antimicrobial Agents Administration among Patients with Extensively Drug-resistant <i>Pseudomonas aeruginosa</i> Infection in Intensive Care Unit in Tertiary Care: A Hospital-based Study Somkiattiyos Woradet, Bhunyabhadh Chaimay, Nuntiput Putthanachot, Narongchai Sangsa, Phatsaraporn Sirisa <b>Introduction:</b> Infections caused by Extensively Drug-resistant Pseudomonas aeruginosa (XDR-PA) is a medical problem worldwide. In Thailand, the incidence of XDR-PA bacteremia remains and is continuously increasing. <b>Aim: </b>To investigate an association between antimicrobial agent administration and the treatment of XDR-PA infection among patients admitted in Intensive Care Unit (ICU). <b>Materials and Methods:</b> A hospital-based analytic crosssectional study was performed from January 2014 to December 2015. Of these, 47 cases diagnosed with XDR-PA bacteremia infection and 94 controls without XDR-PA infection were enrolled. Data were retrieved and retrospectively reviewed from medical records of the patients hospitalised in the ICU at Roi-Et Hospital, Thailand. Multiple logistic regressions were used and perform to investigate an association between antimicrobial agent administrations for treatment of XDR-PA infection. <b>Results:</b> Third generation Cephalosporin (OR=1.99; 95%CI: 1.22 to 4.13), Ciprofloxacin (OR=3.40; 95%CI: 1.24 to 9.49) and Carbapenem (OR=4.66; 95%CI: 2.04 to 10.64) were more likely to be administrated for treatment of XDR-PA infection among patients. <b>Conclusion:</b> Antimicrobial agents associated with the treatment of XDR-PA bacteremia infection among patients were third generation Cephalosporin, Ciprofloxacin and Carbapenem. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=LC01-LC04&id=13813 https://doi.org/10.7860/JCDR/2020/43539.13813 Dietary Predictors of Anaemia among Children Aged 12-35 Months Abhishek Agarwal, Tanveer Bano, Sunil Kumar Garg, Harivansh Chopra, Seema Jain, Ganesh Singh <b>Introduction:</b> Children especially during the early years of life should have increased dietary iron and protein that needs to accommodate growth, development and the accompanying expansion of blood volume. An average Indian child can take up-to 2.5 to 3.5 mg iron per day leaving a deficiency of 4-6.5 mg/day deficiency of iron while 33% of Indian children are still suffering from protein malnutrition. This deficiency of iron and protein leads to high burden of Nutritional Anaemia in Children. <b>Aim:</b> To find the average daily dietary consumption of iron and protein among the children aged 12-35 months and its association with anaemia. <b>Materials and Methods:</b> The present cross-sectional study was carried out among 200 children aged 12-35 months (prevalence 79%, relative precision 7.5%, 95% CI) residing in a sub-centre village of Meerut district, Uttar Pradesh, India. The study was carried out between May 2016 and November 2017. Dietary information was collected by 24 hour recall method done for two consecutive days on a pretested, predesigned and semi-structured questionnaire. Iron and protein content in food was calculated as per ICMR guidelines, 2010, data was analysed using epi-info software 3.7.2. <b>Results:</b> The present study inferred that mean dietary intake of iron (2.10&#177;1.08) mg/day and protein (18.23&#177;0.38) mg/day among the selected population is way less than the body daily dietary requirements (5-9 mg/day) and (10-14 gm iron/day). This inadequacy in diet is reflected as high prevalence of anaemia 155 (77.5%) and malnutrition 67 (33.5%) in this age group. <b>Conclusion:</b> Dietary intake of iron, consumption of haem iron and non-heme iron and protein intake are not only but an important determinant of anaemia in children. Despite best of diet a child is unable to meet the dietary requirement of iron and lands up in anaemia. In this background, a daily iron supplementation regimen may play an important role to combat this disease burden. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=LC05-LC08&id=13814 https://doi.org/10.7860/JCDR/2020/43623.13814 Effectiveness of the Greater Palatine Nerve Block for Anaesthetising Anterior Palate: A Prospective Study Gopinath Thilak Parepady Sundar, Tripthi Prakash Shetty, Bhanuprakash Bylapudi, Vikram Shetty, Chrysl Castellino, Ashish Rai, Arvind Karikal, Pratiksha Shetty <b>Introduction:</b> Local Anaesthesia (LA) is the mainstay of any routine dental extraction. Accomplishing optimum anaesthesia with least pain and anxiety to patients is a challenge. Hence, modification of technique and application of routine dental LA to enhance patient comfort is the need of the hour. In this pursuit, a prospective cohort study was carried out to evaluate the effectiveness of greater palatine nerve block as an alternative to nasopalatine nerve block in anaesthetising the anterior palatal mucosa and to achieve optimum palatal anaesthesia. <b>Aim: </b>The primary outcome variable is to assess the extent of the anaesthetic effect of greater palatine nerve block in maxillary anterior palatal region. <b>Materials and Methods:</b> A total of 100 patients scheduled for the extraction of ipsilateral anterior and posterior maxillary teeth were included in this prospective study between June 2017 to June 2019. Palatal anaesthesia for all the extractions done was achieved only with greater palatine nerve block. After an interval of five minutes, the extent of palatal anaesthesia from the posterior palatal tissue to the anterior region was evaluated for both subjective and objective symptoms. Pain on the palatal mucosa was assessed using Numerical rating scale of 0-10. Post-evaluation, depending on the proposed tooth of extraction, buccal anaesthesia was achieved with Posterior superior alveolar nerve block for posterior teeth and infraorbital nerve block for anterior teeth. <b>Results:</b> Of the 100 patients administered with greater palatine nerve block, it was observed that in 36 patients (36%) had effectiveness in anaesthesia till central incisor, 28 (28%) patients had effectiveness in anaesthesia till lateral incisor, 20 (20%) patients had effective in anaesthesia till the canine and 16 (16%) patients anaesthetic effects were limited to posterior teeth. Overall, 84% had varied degree of positive anterior anaesthesia with greater palatine nerve block alone. <b>Conclusion:</b>Greater palatine nerve block was effective in providing anaesthesia to the posterior region till the premolars, with the extended complete anaesthesia in the anterior region with similar action as the nasopalatine nerve block administered to anaesthetise the anterior palate for extraction of the anterior teeth. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZC07-ZC09&id=13815 https://doi.org/10.7860/JCDR/2020/43673.13815 Comparison of Coagulation Profile in Type 2 Diabetic Patients with Good Glycaemic Control and Poor Glycaemic Control Binia Sherin, Bhuvanamha Devi Ramamurthy, Muthu Sudalaimuthu, Shivashekar Ganapathy <b>Introduction:</b> Diabetes Mellitus (DM) is a global health problem, characterised by high levels of glucose in blood with impairment of carbohydrate, fat and protein metabolism. Patients with DM have a high risk of developing atherothrombotic events. This leads to initiation and progression of microvascular and macrovascular complications. <b>Aim:</b> To compare the coagulation profile parameters in patients with Type 2 DM with good glycaemic control (Glycated Haemoglobin (HbA1c) <7) and poor glycaemic control (HbA1c =7) and to evaluate the association of coagulation profile and glycaemic control in diabetic patients. <b>Materials and Methods:</b> This study was conducted in a tertiary care hospital of Southern India on 84 patients among which 42 were Type 2 Diabetics with good glycaemic control and 42 were Type 2 Diabetics with poor glycaemic control. Blood samples were collected from the individuals chosen for the study and analysed for coagulation profile including Bleeding Time, Platelet Count, Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT), fibrinogen and d-Dimer. Statistical analysis was done by unpaired student’s t-test using SPSS 21.0. <b>Results:</b> In the present study, it was observed that Bleeding Time, aPTT and fibrinogen concentration were increased (statistically significant, p<0.05) in Type 2 Diabetics with poor glycaemic control when compared with Type 2 Diabetics with good glycaemic control. No significant changes were noted in Platelet Count, PT and d-Dimer among the two study groups. <b>Conclusion:</b> The alteration in coagulation profile of Type 2 Diabetic people has shown that hyperglycaemia leads to abnormalities in the coagulation and Type 2 Diabetic patients with poor glycaemic control are at high risk for developing atherothrombotic and haemorrhagic events. So, evaluation of coagulation profile in diabetic patients may help the clinicians in early intervention to prevent the initiation of microvascular and macrovascular disease at the earliest. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=EC06-EC08&id=13816 https://doi.org/10.7860/JCDR/2020/44329.13816 Prevalence and Associated Factors of Major Depressive Disorder among Pulmonary Tuberculosis Patients Ramya Keerthi Paradesi, Shaik Ekramulla, Narasimha Reddi Kamuju, Nageswara Rao Nallapaneni, Sharatath Srikanta <b>Introduction:</b> The prevalence of psychiatric morbidity in patients with pulmonary Tuberculosis (TB) is significantly high. Major depressive disorder is the most common among them. The psychiatric morbidity is related to the duration of illness, the degree of incapacitation and the knowledge of (sputum) Acid Fast Bacilli (AFB) positive status. <b>Aim:</b> To assess the prevalence of depression in patients suffering from pulmonary TB and to study the relationship between depression and socio-demographic variables. <b>Materials and Methods:</b> The study sample consisted of 120 patients suffering from pulmonary TB. The socio-demographic data was individually collected from them. Mini International Neuropsychiatric Interview (MINI) scale was used for screening Psychiatric morbidity in pulmonary TB patients and International Classification of Disease (ICD)-10 criteria were used to confirm the diagnosis and to assess the severity of depression in the study group. The data was analysed by using &#8216;descriptive&#8217; and &#8216;inferential&#8217; statistics. For categorical variables, the values were represented as number and percentages. To test association between the groups chi-square test was used. The p-value <0.05 was considered as statistically significant. <b>Results:</b> Total 43.3% of patients suffering from pulmonary TB showed psychiatric morbidity. The mean age of the population was 38.41 years. No significant statistical correlation was found between socio-demographic variables and depressive disorders except socio-economic status. Class III socio-economic status (Sodhi and Sharma scale) had significant influence on prevalence of depression. The clinical variables, duration of illness, type of treatment, sputum status and complications of pulmonary TB showed statistically significant relationship on prevalence of depression. <b>Conclusion:</b> As depression ominously influences the course and outcome of the pulmonary TB with serious consequences, an early identification and intervention will prove productive. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=VC01-VC04&id=13817 https://doi.org/10.7860/JCDR/2020/44393.13817 Electrochemical Sensing for Examining Vitamin D3 based on MIP using NOVA 1.7 and Autolab PGSTAT 302N Saveri Singh , Naresh Batra , MA Ansari , Shabana Urooj <b>Introduction:</b> An electrochemical sensor has the ability to transform the associated data containing electrochemical reactions into a reliable representative signal. The electrochemical sensors can be classified into potentiometric, conductometric, and ampere-metric or Volta-metric. Although, there are various electrochemical techniques for the detection of Vitamin D3, there is still a need for a simplified and cost-effective method. An electrochemical sensor provides great sensitivity towards the detection of the analyte. <b>Aim:</b> To fabricate an electrochemical sensor for the detection of Vitamin D3. The sensor used Molecular Imprinted Polymer (MIP) based Screen Printed Carbon Electrode (SPCE). <b>Materials and Methods:</b> The SPCE used was a three-electrode system consisting of silver working electrode, silver reference electrode and a counter carbon electrode. The reagents used in the experiment was p-Phenylenediamine, resorcinol and Vitamin D3 that were applied in a particular amount onto the SPCE. The process of electropolymerisation was carried out in order to form a non-conductive layer. Cavities were gradually formed on the surface of SPCE. A mediator was used to obtain reliable results for the detection of Vitamin D3. It is evident from the existing literature that the number of scans of electropolymerisation holds a significant role in this process. The procedure was applied for the formation of non-imprinted electrode in the absence of the analyte. <b>Results: </b>The presence of the template i.e., Vitamin D3 was recorded using the developed electrochemical sensor. The current decreased on rebinding of Vitamin D3 which resulted in the change of redox peak of ferricyanide. This signified the sudden increase in concentration of Vitamin D3 specifying its presence. <b>Conclusion:</b> The results obtained specifies the great sensitivity of the electrochemical sensor towards the template i.e., vitamin D3. The clinical relevance of such electrochemical sensors is that they produce simple, accurate and reproducible results which can be used to optimise the care of patients https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OC17-OC20&id=13847 https://doi.org/10.7860/JCDR/2020/44347.13847 A New Non-touch Technique (Partha's Technique) of Administering Spinal Anaesthesia in Paediatric Age Group- A Pilot Study S Parthasarathy, Indubala Maurya <b>Introduction:</b> Paediatric spinal anaesthesia is often the technique of choice in many short duration surgeries. However, the failure rate is higher with spinal anaesthesia in children than in adults. <b>Aim:</b> To evaluate if a non-touch technique of paediatric spinal anaesthesia can reduce anaesthetic failure. <b>Materials and Methods:</b> A pilot study was done in 10 paediatric patients from January 2018 to July 2018 in Mahatma Gandhi Medical College and Research Institute, Puducherry, India. Ten children posted for infra-umbilical surgeries in the age group of 4-10 years were given a sedative premedication with a combination of Pethidine and Midazolam They were kept in lateral position with the back much inside the edge of the table so that there was a considerable space between the table edge and the baby. Identification of the L3-L4 space was done by touching the patient. The 25-gauge quincke needle was pricked and the hub was held with the hand in the table without touching the patient. <b>Results:</b> The anaesthesia was successful with adequate level in all the patients; T8 in five patients and T10 in the other five patients. There were no significant side effects. <b>Conclusion:</b> From this pilot study on 10 patients, it can be suggested that the novel non-touch Partha’s technique is feasible and more successful with absent failure rate when administering spinal anaesthesia in the paediatric age group. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=UC04-UC06&id=13848 https://doi.org/10.7860/JCDR/2020/44452.13848 Smile Aesthetics among Late Adolescents: Perspective of Adolescents, General Dentists and Orthodontists Kavitha Odathurai Marusamy, Ullal Anand Nayak, Prathibha Anand Nayak, Saravanan Ramasamy <b>Introduction:</b> An adolescent’s personal experiences, peer influences and social environment can affect their preference towards smile aesthetics and have influence apart from the opinion of their orthodontists. <b>Aim:</b> To evaluate and compare the preferences regarding smile arc, gingival display, midline symmetry, shape and size of incisor teeth, buccal corridor space and smile index of adolescent subjects between late adolescents, general dentists and orthodontists. <b>Materials and Methods:</b> A total of 52 orthodontists, 111 general dentists and 275 adolescents (156 females, 119 males) had participated in this cross-sectional study from 1st September 2019 to 31st January 2020. Each participant was shown a photo album consisting of 5 sets of photographs of male and female adolescent subjects and was asked to rate them on 7 selected variables. The data obtained was subjected to comparison between the groups using Chi-square test. <b>Results:</b> While assessing smile of the female subject, other than the incisal edge position, the intergroup comparisons of gingival display (p=0.0001), midline symmetry (p=0.0001), shape of incisor teeth (p-value=0.0001), buccal corridor space (p=0.001), ratio of central: lateral incisor (p=0.016) and smile index (p=0.0001) were statistically significant. While assessing smile of the male subject, the intergroup comparisons of incisal edge position (p=0.0001), gingival display (p=0.001), midline symmetry (p=0.007), shape of incisor teeth (p-value=0.0001), buccal corridor space (p=0.0001), ratio of central: lateral incisor (p=0.0001) and smile index (p=0.0001) were statistically significant. Orthodontists’ accepted gingival display of 0-2 mm, midline deviation up to 2 mm and buccal corridor space of upto 5 mm and upto 25% increase in smile index in both genders. <b>Conclusion:</b> The Orthodontists and dentists have more similarities than differences in comparison to adolescents with respect to the smile preferences of adolescent subjects. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZC18-ZC23&id=13849 https://doi.org/10.7860/JCDR/2020/44486.13849 Fetomaternal Outcome in Twin Pregnancies: A Retrospective Analysis from a Tertiary Care Center Kamlesh Kumari, Minakshi Misra, Ambika Jhanwar, Asha Kumari <b>Introduction:</b> Twin pregnancies are among the major challenges faced by obstetricians globally. Increased maternal and foetal morbidity is observed with an increase in the incidence of twin pregnancies. Due to elevated rates of complications, a larger number of caesarean sections are performed in twin pregnancies in comparison to singleton gestation. <b>Aim:</b> The study aimed to find out the incidence of twin pregnancy with associated maternal risk factors and foetal outcome in the study population. <b>Materials and Methods:</b> This retrospective observational study was carried out at JNU Hospital and Medical College, Jaipur for a period of 4 years from December 2015 to December 2019. A total of 70 mothers, who presented with twin pregnancy, were included in this study. Data were collected from hospital records regarding maternal age, parity, whether spontaneous or assisted conception, gestational age, pregestational Body Mass Index (BMI) and family history. Details of maternal and foetal complications that occurred during the antenatal period and labour as well as the mode of delivery were collected and analysed. Statistical significance was considered if the p-value was =0.05. Qualitative data were represented as rate and proportions, while quantitative data were represented as mean and standard deviation. <b>Results:</b> A total of 70 mothers with twin births, resulting in 140 babies during the 4 years study period were included. A total of 4240 deliveries overall during the study period, gave a twin pregnancy incidence rate of 16.5 in 1000 deliveries. Preterm labour (25.4%), anaemia (26.8%) and hypertension (22.5%) were common problems. The most common indication for caesarean delivery was foetal malpresentation (37.8%) The mean weight of the first twin was 2.12±0.35 kg while the mean weight of the second twin was 1.97±0.30 kg. Among foetal complications, Intrauterine Growth Restriction (IUGR) was seen in 11.4% and birth weight discordance in 21.4% of children. A low Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score was noted in 21.4% of babies, while 12.9% of babies died in the early neonatal period. <b>Conclusion:</b> Maternal complications during twin pregnancy were mainly preterm labour, diabetes, hypertension and anaemia. Caesarean section was the main mode of delivery in this study with significant association with hypertension and preterm labour. Foetal complications were in the majority related to IUGR. More vigilance during the antenatal period and labour is needed for proper selection of mode of delivery. Active foetal surveillance and intervention with appropriate neonatal care can improve fetomaternal outcome. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=QC01-QC05&id=13850 https://doi.org/10.7860/JCDR/2020/44917.13850 Prevalence of Allergic and Non-allergic Asthma in Kumaun Region of Uttarakhand, India: A Cross-sectional Study Poonam Kumari, Ram Gopal Nautiyal, HK Thakar <b>Introduction:</b> Asthma is a heterogenic disease, commonly divided into allergic and nonallergic asthma. It affects people of all age group and is associated with impaired lung function. Previously, it was thought that asthma is a disease of developed countries but at present, world scenario has changed and its prevalence in developing countries is rapidly increasing. Asthma shows large geographical variations in terms of prevalence, severity and mortality. <b>Aim: </b>To establish the prevalence of allergic and nonallergic asthma in adults of Kumaun region of Uttarakhand (India) and to evaluate whether the peripheral blood cell count is associated with the severity of lung impairment in both the subtypes (allergic and nonallergic) of asthma. <b>Materials and Methods:</b> This cross-sectional study was carried out jointly in Department of Physiology and Department of Respiratory Medicine, Government Medical College, Haldwani, Uttarakhand (India), during the period from October 2015 to January 2017. A total of 125 patients of both sexes age above 18 years, who attended the OPD of Respiratory Medicine and diagnosed asthma by the physician were enrolled in the study. The patients associated with tuberculosis, worm infestations, other allergic diseases and systemic diseases were excluded. History of Allergic Rhino-Conjunctivitis (ARC) was used for allergic sensitisation and to define allergic asthma. Classification of severity of airflow limitation was done according to Global Initiative for Asthma (GINA) guidelines. Absolute Leukocyte Counts was determined by using the formula: Absolute leukocyte count=Differential leukocyte count/100×Total leukocyte count. One-way ANOVA followed by Tukey HSD post-hoc analysis and Chi-square was done. Level of statistical significance was set at p-value <0.05. <b>Results:</b> The prevalence of allergic asthma was more in 79 patients (63.2%), in comparison to nonallergic asthma in 46 (36.8%) and it (allergic asthma) was more common in males than females (54:25). Mean age of allergic and nonallergic group asthma patients were 51.00±14.31 and 56.11±13.14 years, respectively. In allergic asthma patients, blood eosinophil count increased significantly (p=0.001) the severity of lung impairment increased and no significant changes were observed in other blood cell counts while in nonallergic asthma over-all neutrophil count was significantly high (p=0.044) with increase in severity. Nonallergic asthma also showed increasing trend of eosinophil count as the severity of airway obstruction increased but there were no significant changes in other counts. <b>Conclusion:</b> The prevalence of allergic asthma is high in comparison to nonallergic asthma among adults of Kumaun region of Uttarakhand, India and it is more prevalent among males in both the groups. Peripheral blood leukocyte count might be used as biological marker to differentiate allergic asthma from nonallergic asthma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=CC01-CC04&id=13851 https://doi.org/10.7860/JCDR/2020/45014.13851 Effect of Electronic Cigarettes on the Carriage of Selected Organisms in the Nasal and Oral Cavity in Comparison to Tobacco Smokers and Non-smokers Hamed Alzoubi, Mohammad Abu-Lubad, Asma'a Al-Mnayyis, Anas Satari, Mohammad Alzobi, Mohammad Al Ramadneh, Dua'a Jarajreh <b>Introduction:</b> The use of Electronic Cigarettes (ECs) has been increased over the last years but their long term effects on health and microbiota has not yet been explored fully. <b>Aim:</b> To examine the oral and nasal microbial profile and antibiotics susceptibility in the ECs users, smokers and nonsmokers and to assess the microbial contamination of the ECs juice. <b>Materials and Methods:</b> Nasal and oral swabs were collected from 30 non-smokers, 30 tobacco smokers and 30 from candidates who have been using ECs for more than six months. Nasal Methicillin Susceptible Staphylococcus aureus (MSSA) and Methicillin Resistant Staphylococcus aureus (MRSA), and oral Streptococcus viridans and Candida albicans were isolated and identified using standard laboratory methods. ECs juice was also cultured to test for microbial presence and the antibiogram for all isolated bacteria was carried out by disc diffusion or broth dilution methods according to Clinical and Laboratory Standard Institute (CLSI) guidelines. The statistical analysis was performed with Stata Statistical Software: Release 13. <b>Results:</b> MSSA was isolated from 9 (30%) non-smokers, 5 (16.7%) ECs users and 2 (6.7%) smokers, respectively. Only 1 (3.3%) MRSA was isolated from a smoker. Streptococcus viridians was detected in 14 (46.7%) non-smokers, 9 (30%) ECs user and 5 (16.7%) smokers. Candida albicans was isolated from 7 (23.3%) smokers, 3 (10%) ECs users and in 1 (3.3%) non-smokers. When both groups of ECs users and smokers were compared to nonsmokers; the statistical intergroups difference in carriage of MSSA and Streptococcus viridans using Chi-Square test was only significant in the smokers group (p-value <0.05), while the difference in carriage of MRSA and Candida albicans in both ECs users and smokers was not statistically significant compared to non-smokers (p-value <0.05). The cultures of ECs juices showed no growth. The highest resistance among MSSA isolates was for fusidic acid (43.8%) and the least was for mupirocin and linezolid (0%). Among Streptococcus viridans, the highest resistance was to penicillin (68%) and the least was for vancomycin (7.1%). <b>Conclusion:</b> The effect of ECs on carriage of MSSA and Streptococcus viridans commensals was not significant compared to non-smokers. Therefore, ECs might be less harmful on microbiota compared to tobacco smoking. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=DC11-DC15&id=13852 https://doi.org/10.7860/JCDR/2020/45034.13852 Awareness and Perception of Undergraduate Students towards Risk Associated with Wireless Electromagnetic Field Radiation Exposure in Enugu, South-East Nigeria: A Cross-sectional Study Emeka Kevin Mgbe, Chinenye Glory Mgbe, Chuks Enyereibe Ajare, Amaka Obiageli Nnamani <b>Introduction:</b> Use of telecommunication equipment (cell phone or mobile phone, tablets, walkie-talkie, ipads, ipods, android) has been on the increase globally. There is an estimate of over 145 million active subscribers on record in Nigeria. Hence, there is need for correct information about the associated risk of Electromagnetic Field (EMF) exposure of equipment so as to curb its debilitating effects. <b>Aim:</b> To evaluate the level of awareness and perceived health risks of EMFs exposure (Radiation) among undergraduate students&#8217; of various discipline. <b>Materials and Methods:</b> The Health Belief Model (HBM) was used with descriptive cross-sectional research design from March 2017-November 2018 to evaluate awareness and perception of EMF radiation exposure. Structured questionnaire, focus group discussion and in-depth interviews with a predominantly 1-5 scale grading was applied in data collection. Data analysis was conducted using Statistical Package for Social Science (SPSS) version 14 with correlation coefficient (r) and Chi-square test (&#967;<sup>2</sup>) of p-value <0.05 as significant. <b>Results:</b> A total of 576 undergraduate students from six tertiary institutions in Enugu State, Eastern Nigeria were recruited for the study. A total of 43% were males while 57% were females. Even though majority (93.9%) of the respondents rightly defined the meaning of EMF as a wave that transmits energy through space or material medium, only 34.6% had significant awareness of the radiation effect of this equipment. About 82% of respondents kept their telecommunication equipment close to their body thereby increasing exposure to EMF. The correlation coefficient (r) is 0.806 and the p-value <0.05 shows that there is a high positive relationship between risk reduction strategies like use of hand-free/ear piece etc., and level of awareness among students. There was significant positive correlation between awareness of EMF radiation and faculty of studies as well between perceived EMF risk and year of study (Each p-value <0.05). <b>Conclusion:</b> Increase in the level of health education is a key to reduction of risk of EMF exposure (Radiation) among undergraduate telecommunication equipment users and this invariably applies to the entire general population. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=TC01-TC09&id=13853 https://doi.org/10.7860/JCDR/2020/43369.13853 Correlation of Erectile Dysfunction and Lower Urinary Tract Symptoms among Men at Urology Clinic of a Tertiary Care Institute in South-East Nigeria Joseph Amauzo Abiahu, Timothy Uzoma Mbaeri, Jideofor Chukwuma Orakwe, Alexander Maduaburochukwu Ekwunife Nwofor <b>Introduction:</b> Available literature suggests an association between Lower Urinary Tract Symptoms (LUTS) and sexual dysfunction especially Erectile Dysfunction (ED). LUTS, either alone or in combination with ED, represents a considerable problem for ageing men. An understanding of correlation between LUTS and ED in these ageing men will be useful in their routine care. <b>Aim:</b> To determine the incidence of ED and its correlation with LUTS in adult male patients attending the Urology clinic in a Tertiary Care Hospital. <b>Materials and Methods:</b> This was a cross-sectional study of 110 consecutive patients with LUTS recruited from the urological clinic. The data were collected, while ED and LUTS were assessed with the 5-Item Version of the International Index of Erectile Function (IIEF-5) and International Prostate Symptom Score (IPSS) questionnaire forms respectively. Findings were subjected to linear regression and Pearson’s chi-square tests, using Statistical Package for Social Sciences (SPSS) version 17. <b>Results:</b> The mean age of patients was 65.8±7.95 years. The incidence of ED among LUTS patients was 63.6%. There was positive correlation between ED scores and voiding phase, filling-storage phase and total LUTS scores. The severity of ED and graded LUTS score revealed no significant association between the severity of ED and that of voiding phase and fillingstorage phase LUTS. Conversely, severity of ED was significantly related to the severity of total LUTS score. <b>Conclusion:</b> ED is common amongst adult patients with LUTS. Its severity worsens with worsening LUTS. The management of patients with LUTS should therefore involve evaluation and treatment for ED. This calls for increased awareness of these conditions to both the doctor and the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=PC04-PC07&id=13854 https://doi.org/10.7860/JCDR/2020/44094.13854 A Comparative Study of Topical Diltiazem (2%) with Topical Glyceryl Trinitrate (0.2%) as a Conservative Treatment for Anal Fissure Nisar Ahmad Ansari, Almol Bhore, Osman Musa <b>Introduction:</b> An anal fissure is defined as a split in the mucosa extending from the anal verge towards the dentate line and most common proctologic symptom. The management of anal fissures is diverse and range from non-operative techniques like dietary changes, topical ointments (2% diltiazem, 0.2% glyceryl trinitrate), botulinum toxin injections and sitz baths to surgical intervention. <b>Aim:</b> To evaluate and compare the efficiency of Topical Glycerine Nitrate (0.2%) with Topical Diltiazem (2%) in patients with anal fissures. <b>Materials and Methods:</b> Out of 100 patients of anal fissure, 50 were selected for treatment with topical application of 2% Diltiazem and were classified as Group I while rest 50 selected for topical application of 0.2% Glyceryl trinitrate and were classified as Group II. Patients were followed for a period of six weeks (weekly follow-up) to evaluate the healing effect of above two topical ointments. <b>Results:</b> On follow-up at week six, patients relieved of all the complaints were assessed as fully cured and patients still having any of the complaints were assessed as partially cured. Full cure was observed in significantly higher proportion of cases of Group I as compared to Group II (88.0% vs. 68.0%), rest of the patients of both the groups had partial cure. Majority of the patients of both the groups did not observe any side effects (Group I-94.0% and Group II-84.0%), remaining patients of Group I reported side effects of Itching (6.0%) while remaining patients of Group II reported headache as side effect (16.0%). Difference in side effects of patients of above two groups was found statistically significant. <b>Conclusion:</b> Findings of the present study indicated that topical diltiazem (2%) was more effective as compared to glyceryl trinitrate (0.2%) for conservative treatment of anal fissure. Diltiazem was capable to provide full relief of complaints within six weeks to majority of the cases (88.0%). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=PC08-PC11&id=13855 https://doi.org/10.7860/JCDR/2020/44238.13855 Intermittent Subcutaneous Morphine for Postoperative Analgesia Following Coronary Artery Bypass Grafting CN Namitha, Manjunath R Kamath, Ananda Bangera, M Gopala Krishnan, B Amith Kiran <b>Introduction:</b> An effective postoperative pain management is of utmost importance following cardiac surgery. Various agents, routes and modes are available for the treatment of postoperative pain. Subcutaneous route of administration is an easy and effective method of postoperative analgesia with improved patient satisfaction and lesser side effects compared to intravenous route. <b>Aim:</b> To evaluate the efficacy of Subcutaneous Morphine (SCM) as postoperative analgesia following Coronary Artery Bypass Grafting (CABG). <b>Materials and Methods:</b> This study was designed as a retrospective analytical survey from June 2015 to June 2017. Medical records of all patients over 18 years of age who underwent coronary artery bypass grafting were reviewed. Patients belonging to ASA PS I, II and III, patients above 18 years of age and those posted for coronary artery bypass grafting were included in the study. Patients were divided into two groups: SCM group and Paracetamol (PCT) group, depending on the primary analgesia they received. The two groups were compared using Student’s t-test for normally distributed continuous data or non-parametric tests if the data were not normally distributed. Categorical data were compared by Fisher’s-exact test. The p-values <0.05 were considered statistically significant. <b>Results:</b> A total of 102 records were reviewed, out of which 49 patients received SCM and 53 patients had received PCT as their primary postoperative analgesia. It was observed that PCT group required more additional analgesia (intravenous fentanyl/ tramadol) than SCM group which was statistically significant with p-value of <0.001 and the duration of Cardiac Intensive Care Unit (CICU) stay was more in PCT group with p-value of 0.001. Postoperative side effects were significantly more in PCT group. <b>Conclusion:</b> SCM can be effectively administered intermittently for postoperative analgesia following CABG with similar haemodynamic stability and minimal side effects as compared to intermittent intravenous PCT https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=UC01-UC03&id=13837 https://doi.org/10.7860/JCDR/2020/44277.13837 Emerging Resistance among Uropathogens: Is Fosfomycin Revival the Best Hope? Sonali Bhattar, Priyanjali Shingare, Richa Anjleen Tigga, Shariqa Qureshi, Vikas Sharma <b>Introduction:</b> Increasing bacterial resistance and the non-availability of newer antimicrobial agents have necessitated the re-evaluation of old antimicrobial agents. Although an old antibiotic, Fosfomycin gives a ray of hope as it has a unique property of not sharing structural similarity with other antibiotics and with no cross-resistance. <b>Aim:</b> To retrospectively evaluate the invitro activity of Fosfomycin against Extended-Spectrum Beta-Lactamase (ESBL) producing and Carbapenem Resistant Enterobacteriaceae (CRE). <b>Materials and Methods:</b> The study period was from December 2018 to November 2019. Antibiotic sensitivity was carried out according to the Clinical and Laboratory Standards Institute (CLSI) guidelines using the automated Vitek-2 Compact (Bio-Merieux, France). Fosfomycin susceptibility was determined by E-test (Biomereiux, India). The interpretive criteria according to CLSI for Fosfomycin is given only for <i>E.coli</i> and not for other Enterobacteriaceae, hence the results were interpreted as per CLSI criteria given for <i>E. coli</i> (i.e., susceptibility at a Minimum Inhibitory Concentration (MIC) of &#8804;64 &#956;g). <b>Results:</b> Overall, 91.07% (102/112) isolates were susceptible to Fosfomycin with 91.67% (88/96) susceptibility for ESBL producing Enterobacteriaceae and 87.5% (14/16) for CRE. Fosfomycin has shown good invitro activity against ESBL producers as well as CRE. <b>Conclusion:</b> Fosfomycin showed promising results as a re-emerging antibiotic for the treatment of Urinary Tract Infection (UTI) because of its unique mechanism of action, low incidence of resistance, oral availability with single-dose administration and little tendency to display cross-resistance to other antibiotics. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=DC06-DC10&id=13838 https://doi.org/10.7860/JCDR/2020/44367.13838 Complications Associated with Osmotic Therapy in Acute Stroke Patients- A Prospective Longitudinal Observational Study Sudhan Rackimuthu, Pawan Raj Pulu Ishwara, Sucharitha Suresh <b>Introduction:</b> Mannitol is one of the most frequently used drugs to treat cerebral oedema resulting from ischemic and haemorrhagic strokes. Mannitol administration is associated with complications such as Acute Kidney Injury (AKI) and electrolyte imbalance. <b>Aim:</b> To study effect of mannitol therapy on electrolyte levels and renal function in acute stroke patients. <b>Materials and Methods:</b> The present prospective longitudinal observational study was carried out from January 2019 till September 2019 in Father Muller Medical College, Mangalore, India. After taking informed consent, patients with acute stroke who received mannitol were recruited into the study. Nature of the stroke, presence of comorbidities and dosage of mannitol given were recorded. Serum electrolytes, Serum urea and creatinine were recorded at admission and on fifth day. Serum urea was measured by enzymatic photometric method using urease and glutamate dehydrogenase and serum creatinine was measured by Jaffe’s kinetic method. Comparison of data among different groups was performed using student t-test, ANOVA test, Mann-whitney test and Pearson test. The p-values <0.05 were taken as statistically significant. <b>Results:</b> Total of 72 patients were included in the study. Mean age was 57.7&#177;14.6 years and male: female ratio was 2.27:1. Of the total study subjects, 16 suffered from diabetes (22.22%), 40 from hypertension (55.55%). Ischemic stroke was seen in 41.66% patients and haemorrhagic stroke was seen in 58.33% of the patients. The dose of mannitol administered to all the patients was less than 1 gram/kg/day (low dose mannitol). Cumulative dose of mannitol was 180±177.3 grams. Serum sodium levels were significantly lower on fifth day compared to admission (p-value 0.030) whereas serum potassium and chloride levels were not significantly changed during therapy. There was statistically significant elevation in serum urea levels from admission to fifth day (p-value <0.001) whereas creatinine levels were not significantly altered. Total cumulative dose was compared to serum electrolyte levels and urea and creatinine at admission and fifth day and no significant changes were found. On analysing comorbidities, electrolyte fluctuations were more common in diabetics and Chronic Kidney Disease (CKD) patients whereas renal function parameters were abnormal in diabetics, CKD and hypertensive patients. None of the patients needed any corrective measures to treat the dyselectrolytemias or altered renal function. <b>Conclusion:</b> Low dose mannitol therapy does not produce any significant electrolyte or renal function abnormality in patients with acute stroke. Careful monitoring may be required while treating patients with additional comorbidities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OC05-OC08&id=13839 https://doi.org/10.7860/JCDR/2020/44376.13839 Association of BMI and HDL Cholesterol in Relation to Glycated Albumin in Type 2 Diabetes Mellitus Suresh Babu Kondaveeti, Santosh Jagtap, Shilpa Kumar, Ankit Kumar Tiwari, Dipali Khopade, Anita Kadam, Priyanka Ladi, Sachin Rathod <b>Introduction:</b> The main issue with the morbidity and mortality of type 2 diabetes is its associated health complications. In the last decade Glycated Albumin (GA) emerged as an extinguished marker for short-term glycaemic control. <b>Aim:</b> To Quadrate the association of Body Mass Index (BMI) along with HDL-cholesterol to GA in Type 2 diabetic cases. <b>Materials and Methods:</b> Total of 50 diabetic cases (Group 1) and 50 healthy non-diabetic control subjects (Group 2) recruited for the study between November 2017 to December 2018, which includes both males and females. Serum samples of both the groups were analysed to assess the lipid profile to GA levels along with BMI. Variations among groups was compared using student t-test by calculating r-values of the parametres and the pearson coefficient was calculated with significant p value at <0.05. <b>Results: </b>The levels of High-Density Lipoprotein (HDL) cholesterol in group 1 when compared with group 2 were significantly lower. Both BMI and GA showed negative correlation with HDL-C levels in both the groups. (p values 0.051 and 0.331 respectively). To boot, there was a statistically undeviating reciprocity of Low Density Lipoprotein (LDL) cholesterol to GA levels, BMI to LDL-cholesterol and BMI to Triglycerides (TG). There was a statistically significant correlation between GA and BMI (r=0.240, p<0.0001) and there was a statistically significant negative correlation between GA and HDL-cholesterol (r=-0.286, p<0.051) in diabetic patients (group 1). The association between GA and LDL-cholesterol (r=0.271, p<0.0001) was also been found statistically significant in group 1. <b>Conclusion:</b> The present study suggests that GA can be adapted as a reliable prospective biomarker that endures the potentiality in prognostication of serum lipid levels in diabetic patients and also BMI is the key formidable feature of dyslipidemia in type 2 diabetic cases https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=BC07-BC10&id=13840 https://doi.org/10.7860/JCDR/2020/44488.13840 Association of Life Style and Sociodemographic Parameters with Plasma Heavy Metals in Apparently Healthy Adult in Ebonyi State, South East Nigeria Emmanuel Ike Ugwuja , Henry Chukwuemeka Uro-Chukwu ,Ikechukwu Chidiebere IkAraoha , Miriam Obiageli Aniagolu <b>Introduction:</b> Lifestyle and sociodemographic parameters have been recognised to play important roles in human exposure to heavy metals and metal toxicity in both environmental and occupational setting. <b>Aim:</b> To determine the association of life style factors and sociodemographic parameters with plasma heavy metals; arsenic (As), cadmium (Cd), copper (Cu), iron (Fe), lead (Pb), nickel (Ni), selenium (Se) and zinc (Zn) in apparently healthy individuals. <b>Materials and Methods:</b> Randomly selected subjects (n=301) from 130 political wards in the 13 Local Government Area of the State, were studied. Structured questionnaires were used to collect sociodemographic data while anthropometric parameters were collected using standard techniques. Metal concentrations were determined in blood plasma using atomic absorption spectrophotometer. One-way Analysis of Variance (One-way ANOVA) was use to analyse the data and p =0.05 was considered significant. <b>Results:</b> The observed mean levels of heavy metals were: As (0.21&#177;0.02), Cd (0.37&#177;0.04), Cu (156.49&#177;2.16), Fe (132.66&#177;2.14), Pb (1.13&#177;0.12), Ni (0.06&#177;001), Se (0.14&#177;0.01) and Zn (94.32&#177;1.10) µg/dL. Plasma levels of heavy metals were affected by body mass index (BMI), age, educational level and occupation. However, there was no significant (p>0.05) difference in the levels of heavy metals between males and females, smokers and non-smokers and alcohol consumers and non-consumers. Plasma As and Cd were significantly negatively associated with age and BMI. <b>Conclusion:</b> It is concluded that indicators of socioeconomic status have effect plasma levels of heavy metals with levels of toxic metals raised while the levels of essential trace elements were low. Dietary diversification in addition to prevention of exposure is advocated. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=BC01-BC06&id=13832 https://doi.org/10.7860/JCDR/2020/43784.13832 Reproductive Health Care Information Seeking Behaviour among Educated Indian Youth- A Cross-sectional Analysis of an Indian University Shubhika Jain, Momina Zulfeen, Samarth Goyal, Nikita Sethi, Deeksha Pandey <b>Introduction:</b> Indian youth is achieving great advancements in terms of education and awareness, but sexual and reproductive health services in India are poorly placed and doctors still play the main role in delivering reproductive health information. Indian adolescents (aged 10-19 years) represent over one-fifth of the population, the consequences of ignoring their reproductive health would affect the country&#8217;s economy and growth. <b>Aim:</b> To assess the insight, attitude and preference of reproductive health care among educated youth of Manipal region. <b>Materials and Methods:</b> This was a cross-sectional questionnaire based survey involving a sample population of 200, aged between 17-26 years, collected over a period of six months, conducted in an Indian University. The population may be representative of educated Indian youth belonging to middle and high socio economic groups. The study required the research participants to fill the questionnaire that contained 10 questions along with basic demographic data. Each of the 10 questions were specific and precise, directed towards five main domains- &#8216;insight&#8217;, &#8216;attitude&#8217;, &#8216;preference&#8217;, &#8216;reason&#8217; and &#8216;suggestion&#8217; The questionnaire was pretested for reliability and validity. SPSS 20.0 software was used for analysis. Descriptive statistics were used to calculate frequencies and the mean scores were compared using student&#8217;s t-test. All tests were two-sided sided and p-value of <0.05 was considered significant&#8221;. <b>Results:</b> Insight among students above 21 years of age was significantly better with 37 (80.43%) choosing health care over web and non-web sources, whereas 114 (74.02%) of participants below 21 years of age recommend internet over other options. A total of 8 participants of >21 years actually went to health care for their sexual health related issues as compared to 18 of <21 years. participants. Most students found lack of privacy to be the most important factor preventing them from seeking health care. <b>Conclusion:</b> Informal Health care seeking behaviour is prevalent among the students, younger students and Non-science students are more likely to seek web-based sources than formal health care. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=LC09-LC13&id=13833 https://doi.org/10.7860/JCDR/2020/43864.13833 Surface Hardness of Nanohybrid and Microhybrid Resin Composites Cured by Light Emitting Diode and Quartz Tungsten Halogen Light Curing Systems: An Invitro Study Anuradha Vitthal Wankhade, Sharad Basavraj Kamat, Santosh Irappa Hugar, Girish Shankar Nanjannawar, Sumit Balasaheb Vhate <b>Introduction:</b> New generation composite resin materials have revolutionized the art of aesthetic dentistry. The clinical success is dependent on effective polymerisation and surface hardness which in turn are dependent on the performance of Light Curing Units (LCU). This study utilises surface hardness as a measure of degree of polymerisation of composite resins achieved by LCUs. <b>Aim:</b> To evaluate the difference in surface hardness of nanohybrid and microhybrid resin composites cured by light curing systems, Light Emitting Diode (LED) and Quartz Tungsten Halogen (QTH). <b>Materials and Methods:</b> In this invitro experimental study, two types of hybrid composites (Nanohybrid and Microhybrid) were tested for surface hardness by using two different light curing systems (LED and QTH). All the Nanohybrid and Microhybrid specimens were cured using LED and QTH LCUs, thus giving four combinations. A total of 60 specimens (6 mm diameter and 2 mm depth) were prepared using Teflon mould with 15 samples for each combination. Surface hardness was measured on upper and lower surface after 24 hours and hardness ratio was calculated. Data was analysed using independent t-test for intergroup comparison. Level of significance was kept at 5%. <b>Results:</b> Surface hardness of resin composites cured by LED LCU was greater than those cured by QTH LCU. Additionally, the hardness value was greater for the upper surface. Nanohybrids showed better surface hardness than Microhybrids for both the LCUs. <b>Conclusion:</b>Nanohybrid composite resins and LED system were found to be more effective in terms of surface hardness as compared to their counterparts. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZC01-ZC06&id=13834 https://doi.org/10.7860/JCDR/2020/43875.13834 An In-vitro Assessment of Effect of Interaction Between Local Anaesthetic Solution with Sodium Hypochlorite on the Sealing Ability of Root Canal Obturation Urmila Banshbahadur Chauhan, Tipturmanjunath Mangala, Rushikesh Mahaparale, Adish Saraf, Sneha Mali, Sagar Pawar, Vincia Dsouza, Shubham Mandhane <b>Introduction:</b> Endodontic treatment failures are caused by persistent or secondary infection due to inefficient cleaning or re-infection of the obturated root canal system because of coronal or apical leakage. Intrapulpal Injection (IPI) technique is the most commonly employed supplemental anaesthetic procedure and NaOCl is considered as gold standard irrigating solution. Therefore, this study was designed to explore the action of precipitate form by interaction between LA and Sodium Hypochlorite (NaOCL) on sealing of root canal obturating material. <b>Aim: </b>To evaluate the effect of precipitate formed by interaction of local anaesthetic solution and NaOCl on the sealing ability of root canal obturation, using a push-out bond strength test. <b>Materials and Methods:</b> This was an in-vitro study from October 2019 to January 2020. In this study, forty single rooted premolars were selected and were randomly distributed equally into 4 groups with 10 specimens in each group, based on the test solutions employed. All the teeth were decoronated and the root length was standardised. Group I - irrigated with saline only, Group II- treated with 2% lidocaine hydrochloride with adrenaline 1:100,000 (2% LA) followed by 3% NaOCl, Group III - 2% LA followed by saline and 3% NaOCl, Group IV- 3% NaOCl followed by saline. All root canals were than instrumented using ProTaper Universal rotary system upto F3 and obturation was done using AH plus sealer and GuttaPercha. Sealing ability was evaluated using a micro push-out bond strength, with the help of a universal testing machine and data were analysed statistically. <b>Results:</b> One-way analysis of variance (ANOVA) showed that there is highly significant difference among the various groups (p <0.0001). Within the experimental groups, Group II showed minimum mean push out bond strength (16.39&#177;2.40) as compared to Group III (21.83&#177;1.25) and Group IV (22.50&#177;2.12). <b>Conclusion:</b> Interaction of LA with NaOCl forms precipitate which blocks the dentinal tubules and reduces the mean push out bond strength. It is recommended to irrigate thoroughly with saline after intrapulpal injection (2%LA) before irrigating with NaOCl https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZC14-ZC17&id=13835 https://doi.org/10.7860/JCDR/2020/43932.13835 Tragedy of Errors- An Analysis of Human Factor in Medical Errors Manika Agarwal, Sharat Agarwal William Shakespeare wrote a play &#8220;Comedy of error&#8221;, but this is about medical error which may often result in tragic outcome. We often read about medical errors and sometimes realise in our clinical practice that an error has been committed by us or our team leading to an adverse event. Sometimes, these errors are due to lack of knowledge and sometimes due to improper communication and misinterpretations. The aim of this manuscript is to analyse the causes of medical errors, which may vary from irrational prescription, attitudes of arrogance in seniors and juniors leading to communication gaps, bad hand writings or wrong patient selection for surgical intervention for economic benefits. Use of Artificial intelligence, Data mining and Medical informatics can rectify errors of improper assessment and irrational prescription. Self-introspection and spirituality can prevent errors arising from attitudes of arrogance, fear, greed and pride in medical professional. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=IG01-IG03&id=13841 https://doi.org/10.7860/JCDR/2020/44554.13841 Molecular Mechanism of Oral Submucous Fibrosis induced by Arecoline: A Literature Review Lin Cui, Xinjia Cai, Junhui Huang, Huiling Li, Zhigang Yao Oral Submucous Fibrosis (OSMF) is an oral mucosal disease with lamina propria collagen hyperplasia as the main pathological change, which belongs to Oral Potentially Malignant Disorders (OPMDs). Areca nut is identified as a class I carcinogen with complex components. Arecoline is the main component of areca nut which plays an important role in the pathogenesis of OSMF. Through the review of literature, it is shown that arecoline can lead to the change in level of cytokines in oral mucosa, which further leads to the imbalance of collagen metabolism. This article reviews the molecular mechanism research progress of arecoline in promoting the pathogenesis of OSMF in recent years, including Transforming Growth Factor-ß (TGF-ß) and Reactive Oxygen Species (ROS) associated with increased collagen production, Matrix Metalloproteinase (MMP) and Tissue Inhibitor of Metalloproteinase (TIMP) associated with reduced collagen degradation, hypoxia and microvascular related factors and in order to provide reference for the treatment of the disease at the molecular level. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZE01-ZE05&id=13856 https://doi.org/10.7860/JCDR/2020/44276.13856 Clinical Effects of Vitamin D on the Control of Bronchial Asthma-Is it Relevant? Gajanan S Gaude, Sreenija Kummarganti, Jyothi Hattiholi Bronchial asthma is one of the most common chronic respiratory disease worldwide, and is characterised by different phenotypic variations. Acute exacerbations in bronchial asthma are common and leads to repeated hospitalisations leading to increase in direct costs of asthma and thus preventing exacerbations should be an important consideration. Vitamin D has an immunomodulatory action and its deficiency has been associated with asthma epidemics. We hereby critically review the clinical benefits of vitamin D in the control of bronchial asthma and in exacerbations. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OE01-OE04&id=13823 https://doi.org/10.7860/JCDR/2020/42250.13823 Where do we Stand on the Molecular Diagnostics for the Detection of Human Papillomavirus? A Comprehensive Review Pushkal Sinduvadi Ramesh, Sowmyashree Krishnamurthy, Sunita Shrestha, Devananda Devegowda Human Papillomavirus (HPV) infection plays a vital role in the development of various cancers and imposes a burden on the global health. Detection of HPV infection is a challenge to the healthcare industry as they cannot be cultured and their fascinating life cycle limits the accuracy of serological methods. Hence, molecular assays are the gold standard for the accurate viral detection and genotyping. Currently, various methodologies are available with great sensitivity and specificity and are even clinically validated as screening tools. However, there are only a few that are approved by the US Food and Drug Administration and much more are suitable only for research. At present, the molecular methods available mainly depend on signal amplification, nucleic acid amplification and hybridisation assays for detecting and genotyping HPV infection, all with their own advantages and drawbacks. There is further scope for the development of more reliable, cost-effective diagnostic techniques that can harness the power of next genome sequencing, mutation analysis and may further improve the chances of early detection and prevention of HPV related cancers. This review summarises the present knowledge on currently available molecular diagnostic tests for the detection and genotyping of HPV infection and their possible utility in a clinical setting. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=BE01-BE06&id=13825 https://doi.org/10.7860/JCDR/2020/44371.13825 Mindfulness and Menopause- A Review Timi Thomas, Neetha Kamath, Ajay Kumar Mind-body therapies hold several advantages from the viewpoint of security, fulfilment, implementation and possible ancillary social and psychological health benefits. Side effects and risks of mind-body practice are generally nominal, implementation costs are little and most mind-body therapies can be performed by a broad range of populations, including overweight and sedentary menopausal women. The use of mind-body therapies for the alleviation of a menopausal symptoms is becoming increasingly common because of the perceived therapeutic benefits. The practice of mindfulness allows the participants to be aware of the present moment without concern for past or future consequences. Several researchers have discovered that being mindful may be helpful for menopausal women struggling with irritability, anxiety and depression. The purpose of this article aimed at reviewing the literature which studies the impact of the mindfulness-based training on menopausal symptoms among women during their climacteric period. Many midlife women try out practices like relaxation techniques, breathing exercises and yoga to help them get through these difficult times during their transitional period of life. Although these daily practices probably do not relieve symptoms such as hot flashes, they might improve overall wellbeing and help them sleep better. The literature was searched using databases such as CINAHL, Pub Med, Pro-Quest and Google scholar. The search terms used were: menopause, menopausal symptoms, mindfulness, quality of life and midlife transition. In India, the practice of mindfulness is not very well known among the menopausal women, so the aim of this review was to show a pathway to the primary health care workers like physicians, counsellors and the nurses, who can guide them about the practice of mindfulness thereby improving the quality of life. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=QE01-QE03&id=13831 https://doi.org/10.7860/JCDR/2020/43721.13831 Nutraceuticals to Support Immunity: COVID-19 Pandemic- A Wake-up Call Venkatesh Dasari, Kiran Dasari The COVID-19 pandemic is spreading throughout the world, infecting thousands of people every day. This public health emergency has got world and regional organisations, governments and health care systems working tirelessly to try to control the spread of the virus and managing the already infected individuals adequately. These events have made everyone realise the policy of “<i>Prevention is better than cure</i>”, as the best way to fight this pandemic. There are many guidelines for common people, issued by many respected organisations, but most of them are focused on personal hygiene and prevention of the spread the virus. Only minimal focus has been given towards the role of immunity in this scenario and more importantly the role of nutrition in supporting immunity. In this article, it has been attempted to describe the term ‘Nutraceuticals’ and discuss in detail a few nutraceuticals which are well documented to support immune functions of the body. The article has tried to shed some light on the fact that these nutraceuticals deserve to be promoted amongst the masses, to support the immunity required against infectious diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=OE05-OE09&id=13843 https://doi.org/10.7860/JCDR/2020/44898.13843 Are Countries with Lockdown and Social Distancing Implementation Showing a Decline in COVID-19 Cases? Shivananda B Nayak, Omkar Chaudhary The Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2), previously known as 2019 Novel Coronavirus (2019 nCoV) originated in the city of Wuhan, China and has spread rapidly around the world, sending billions of people into lockdown. Consequently, the World Health Organisation (WHO) declared the Coronavirus Disease (COVID-19) a pandemic. Given the rising concerns around the COVID-19 pandemic, many countries sent people into lockdown and advised precautionary measures like social distancing, handwashing with soap and water or using an alcohol-based hand sanitiser. Many countries realised that lockdown is the only solution to stop the spread of this dangerous disease. In many countries, the government and the health care professionals working day and night to identify infected people, test, and quarantine those showing symptoms of COVID-19. Government agencies and health care workers in many countries are also advising people to keep a social distance of at least six feet from person to person and sanitise their hands if they touch anything coming from outside the home, and certainly before touching their faces. The implementation of these systems has helped in preventing the spread of the disease and reduce the number of infections of COVID-19 at any given time point (i.e., &#8220;flatten the curve&#8221; representing the number of COVID-19 cases). This review highlights the potential impact of putting people into lockdown and social distancing in the prevention of spreading COVID-19 disease and reducing the prevalence of COVID-19 cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=LE01-LE03&id=13875 https://doi.org/10.7860/JCDR/2020/44825.13875 Safe Biochemical Testing of COVID-19 Samples: A Clinical Lab Perspective Pratibha Misra, Kapil Bhatia, Rakhi Negi, Bhasker Mukherjee, MK Sibin The current COVID-19 pandemic has not only greatly burdened healthcare system globally but also exposed the medical and paramedical staff to risk of infection. Although the major mode of transmission of this highly infectious disease is via close contact with an infected person i.e., droplet infection due to coughing/sneezing and aerosol generation, few research articles have shown presence of SARS-CoV-2 in blood and serum. This poses a potential risk to health care professionals who are handling these samples. Once the suspected/confirmed case of COVID-19 is admitted in the hospital setting, it requires a battery of clinical chemistry investigations. Laboratory has a vital and indispensable role to play in the management of COVID-19 patients as several biochemical markers are used for prognostication as well as monitoring and guiding treatment in the critical patients. Hence, this evaluation was undertaken to have protocols based on robust recommendations and guidelines to be followed while handling the potentially infective samples in the clinical laboratories in order to ensure safety of the staff. However, these recommendations are based on the limited and rapidly evolving knowledge available at the moment and hence need to be reviewed periodically. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=BI01-BI03&id=13878 https://doi.org/10.7860/JCDR/2020/44996.13878 COVID-19 Lockdown Strategy: Implications for Respiratory Infection Outbreaks in Future Bhanu K Bhakhri Since the outset of this century, the world has witnessed around half a dozen respiratory infectious illness outbreaks, the world. The current COVID-19 pandemic is undoubtedly the one with maximum impact as well as the most closely observed by the world, being the era of advanced medical technologies, robust communication and transport systems. Its global progression and the gamut of human efforts against it certainly provide vitalinformation for better preparation againstsuch outbreaks in future. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=LI01-LI02&id=13821 https://doi.org/10.7860/JCDR/2020/45037.13821 Dexmedetomidine Associated with Intraoperative Floppy Iris Syndrome in Ophthalmic Surgery Inci Dersu Dear Editor, Through this letter, we intend to report Intraoperative Floppy Iris Syndrome (IFIS) findings related to Dexmedetomidine, which is an alpha-2 adrenergic anaesthetic agent. It is an FDA approved sedative agent in the same class with Clonidine, but has 8 times more alpha-2 receptor affinity than Clonidine [1,2]. It is a relatively new drug for ophthalmic surgery sedation. Originally, it was approved for and used in the Intensive Care Unit settings. Owing to less inhibitory effects on the respiratory system, there is considerable interest regarding its use in short operative procedures as well. A loading infusion of 0.5 mcg/kg over 10 minutes is recommended for ophthalmic surgery [1,2]. Five cataract patients (age range: 55-75; females: n=3; males: n=2), without current or remote history of Tamsulosin (with the exception of one patient) or Clonidine use, are described herein. In all cases, the pupils were found well dilated with mydriatics (phenylephrine: 2.5%, cyclopentolate: 1%, tropicamide: 1%) in the preoperative holding area. The procedures were performed under topical anaesthesia and intravenous sedation with dexmedetomidine. At 5-10 minutes into the surgery, the pupils became constricted and quite suddenly, the iris became floppy. Despite the administration of intracameral epinephrine, the pupils remained only 3-4 mm dilated. This created challenge during the next 15-20 minutes to complete the cases. They all required suturing of the main corneal temporal incision to prevent iris prolapsing. Postoperative day 1, pupils were regular size in 2 patients and dilated in 3 patients. There was various amount of iris atrophy due to surgical trauma. Although vision recovered to 20/25 with higher dose of topical steroids in all cases, surgical pupil was observed in 3 patients. Alpha-2 agonists agents inhibit sympathetic system centrally causing bradycardia and hypotension while causing miosis by decreasing the sympathetic activity on iris dilator muscles. Brimonidine and clonidine, both alpha-2 agonist, has been associated with miosis, and topical brimonidine is utilised for this propriety following refractive surgery related glare <a href=#fr3 name=ft3>(3)</a>. The IFIS has been described first with alpha-1 adrenergic antagonists by Chang DF and Campbell JR [4,5]. In addition to tamsulosin, other alpha-adrenergic antagonist, antipsychotic agents have been associated with this syndrome <a href=#fr6 name=ft6>(6)</a>. The known effect of medications on pupil size would help surgeons to predict and optimise pupil size intraoperatively. However, acute onset of miosis as observed in this report with intravenous agent infusion may cause potential problems for the surgeon. We believe that dexmedetomidine may have played role in abrupt constriction of the preoperatively well dilated pupils. According to our knowledge, there have not been any previous publications regarding pupil complications during cataract surgery related to dexmedetomidine administration for anaesthesia. However, only one report indicated that pupil size remained unchanged with the administration of this agent. In this report, subjects were under opium supplemented general anaesthesia and pupil size remained stable at 2 mm after addition of the dexmedetomidine <a href=#fr7 name=ft7>(7)</a>. Further investigation of this agent and its effect on the pupil size is recommended. Meanwhile, communication with anaesthesiologist before intravenous introduction of agent may be crucial in the event this anaesthetic medication gains more widespread use for ophthalmic cases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=NL01-&id=13876 https://doi.org/10.7860/JCDR/2020/44860.13876 Retracted: 2016 Sep:10(9): UC08-UC12 <b>Soniya Biswas, Reetu Verma, Vinod Kumar Bhatia, Ajay Kumar Chaudhary, Girish Chandra, Ravi Prakash,</b> Comparison between Thoracic Epidural Block and Thoracic Paravertebral Block for Post Thoracotomy Pain Relief (Published in Journal of Clinical and Diagnostic Research. 2016 Sep, 10(9): UC08-UC12) The article had to be retracted as the data has errors which could mislead the readers. This error was brought to the editorial notice, post-publication by one of the reader. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2020&month=July&volume=14&issue=7&page=ZZ01-ZZ01&id=13882 https://doi.org/10.7860/JCDR/2020/.13882