Journal of clinical and diagnostic research

A Cross-Sectional Study on the Palmar Dermatoglyphics in Relation to Carcinoma Breast Patients

Aprajita Raizada, Vishwas Johri, T Ramnath, DS Chowdhary, RP Garg

Introduction: Dermatoglyphics is a collective term for all the integumentary features (skin patterning of the fingers, toes, palms and soles) and it applies to the division of the anatomy which embraces their study. Aims and Objectives: The purpose of this study was to examine the predominant finger tip patterns in the patients of carcinoma breast. An attempt is also being made to devise a score to assess the risk variables. Materials and Methods: The fingerprints of 100 carcinoma breast patients were obtained and they were compared with those of 100 females who were not suffering from any malignancy till date. The different quantitative parameters of each hand of both the cancer patients and the controls were studied. The parameters which were included were the fingertip ridge pattern, the ridge count in the individual fingers, the Total Finger Ridge Count (TFRC) and the Absolute Finger Ridge Count (AFRC). Results: There was a significant increase in the arch pattern and a decrease in the radial loops in the right thumb (p<0.001), the left thumb (p<0.001), the left index finger (p<0.001) and the left middle finger (p<0.001). A comparison of all the five fingers of both the left and right hands of the cancer patients with the controls showed an arch pattern (p<0.001) with the highest frequency. The lower values of the TFRC (below 50) were associated with carcinoma breast .The lower values of the AFRC (below 100) were associated with the cancer patients. Conclusion: This study was able to establish a specific finger tip predominance in the Carcinoma breast patients.

A Study on the Serum Adenosine Deaminase Activity in Patients with Typhoid Fever and Other Febrile Illnesses

Sameera Ketavarapu, Uma Ramani G., Prabhavathi Modi

Background: Adenosine Deaminase (ADA) has been suggested to be an important enzyme which is associated with the cell mediated immunity, but its clinical significance in typhoid fever has not yet been characterized. The present study was taken up to evaluate the serum ADA activity in patients of typhoid fever. The levels of ADA were also measured in the patients who were suffering from other febrile illnesses. Material and Method: This was a case control study. The subjects who were included in this study were divided into 3 groups. Group A consisted of 50 normal healthy individuals who served as the controls. Group B consisted of 50 patients, both males and females of all age groups, who were suffering from culture positive typhoid fever. Group C consisted of 50 patients who were suffering from febrile illnesses other than typhoid fever like viral fever, gastro enteritis, malaria, tonsillitis, upper respiratory tract infections, etc. The serum levels of ADA were estimated in all the subjects who were under study. Results: The serum ADA level was found to be increased in the patients of typhoid fever as compared to that in those with other febrile illnesses and in the controls. Conclusion: From the present study, it can be concluded that there was a statistically significant increase in the serum ADA levels in the patients with typhoid.

The Clinical and Biochemical Parameters in Relation to the Serum Neopterin Levels in Indian Children and Adolescents

Srinivasa Nageswara Rao G., Prema Gurumurthy, Sruti E., K.M. Cherian

Introduction: An adverse pattern of blood lipids and cardiovascular abnormalities starts in obese children during childhood and neopterin serves as a marker for cardiovascular disease. Unfortunately, the data for children and adolescents, particularly, in the Indian population, are scarce. The present study aimed at evaluating the levels of serum neopterin in obese and overweight children and adolescents of the Indian population. Methods: The study groups included 296 school going children and adolescents. (96 obese and 97 overweight subjects were compared with 103 normal controls who were aged between 10-17 years). The anthropometric variables, the lipid profile, the fasting serum glucose which was analyzed by using an autoanalyzer and the serum neopterin levels were assayed by HPLC (Shimazdu) by using the method of Palfrey et al., 1993. The serum insulin levels were measured by using ELISA kits. Results: The serum neopterin levels (nmol/l) were elevated significantly in the obese (7.4±1.4) and overweight (6.4±0.8) (p<0.001) children and adolescents than in the controls (4.9±0.9). The serum neopterin levels showed a positive correlation with the BMI (r=0.79), WHR (r=0.5), systolic (r=0.44) and diastolic blood pressures (r= 0.25), insulin (r=0.57), HOMAIR (r=0.55), total cholesterol (r=0.35), triglycerides (r=0.20) and LDL-C (r=0.27) and they showed a negative correlation with HDL-C (r=-0.15) and fasting glucose (r= -0.3). Conclusion: This study revealed a good relationship between serum neopterin and the anthropometric and biochemical parameters. We, therefore, aim to conduct regular camps at schools to counsel and advise the identified overweight and obese children to go for physical exercise and a balanced diet. The implementation of preventive measures from early childhood will have far reaching benefits, as even the prevalence of other obesity related disorders could decline.

Comparison of Urinary Protein: Creatinine Index and Dipsticks for Detection of Microproteinuria in Diabetes Mellitus Patients

Anoop Kumar, Sangeeta Kapoor, R.C. Gupta

Background: Proteinuria has been recognized as one of the earliest signs of renal function deterioration in Diabetes mellitus. Proteinuria occurs due to alterations in the glomerular permeability and later, due to a failure in the reabsorption of filtered protein by the tubular cells. Normally, most of the healthy adults excrete 20-150 mg of protein in urine over 24 hours. Objectives: To find out the normal urinary Protein Creatinine Index (PCI) in healthy subjects, to compare the urinary PCI of diabetic patients with that of healthy subjects and to compare the urinary PCI with dipsticks for the detection of microproteinuria. Material and Methods: This study was conducted on 28 type 2 Diabetes mellitus patients and 40 age and sex matched healthy controls. Freshly collected urine samples were tested qualitatively for the presence of proteinuria by Heller’s test, the sulfosalicylic acid test, heat-coagulation tests and urine dipsticks. Later on, the results were compared by performing a quantitative analysis of the protein in the spot urine samples by the sulfosalicylic acid method. A quantitative analysis of creatinine was done by the modified Jaffe’s test. The PCI was calculated for each of the participant in the study. The Mean and Standard Deviation (SD) of the PCI was calculated and it was compared between the two groups. Results: The normal range of the PCI which was established in this study was 60 to 220. Significantly higher amount of proteins were found to be excreted in urine in diabetic patients (25.37 ± 12.51 mg/dl) as compared to those in normal subjects (8.93 ± 3.54 mg/dl). On comparison of the PCI between the controls and the diabetic subjects, it was found to be significantly elevated in the Diabetes mellitus patients (controls = 114.65 ±47.97 and in the diabetic patients =373.04 ± 98.53) ( p < 0.001). Conclusion: The PCI of a random urine sample can provide a very useful, simple and convenient method for the quantitative assessment of proteinuria, to judge the extent of kidney damage and for avoiding the drawbacks of the 24 - hr urine collections.

A Comparative Study on the Fasting and the Postprandial Dyslipidaemia in Type 2 Diabetes Mellitus

Background and Objectives: Type 2 Diabetes Mellitus (Type 2 DM), which is characterized by a relative insulin deficiency or insulin resistance is associated with a cluster of metabolic abnormalities, which includes glucose intolerance, hypertension, a unique dyslipidaemia, a procoagulant state, and an increase in macrovascular diseases. The present study was conducted to assess the significance of postprandial dyslipidaemia with respect to fasting dyslipidaemia, in the pathogenesis of atherosclerotic changes and possible cardiovascular diseases (CVD) and complications. Materials and Methods and Statistical Analysis: Fifty diagnosed cases of type 2 DM which were in the age group of 35-65 years, which had a duration of diabetes of more than five years, were included in the study and 50 age and sex matched healthy subjects were taken as the controls. In both the study groups, we measured the serum levels of fasting as well as the postprandial lipid profile, which was comprised of the total Cholesterol (TC), triglycerides (TGs), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and the waist-hip ratio (WHI) as the cardiovascular risk factors. The statistical analysis was done by using the Students unpaired‘t’-test. Results: The results of this study showed significantly increased levels of serum total cholesterol, TGs, LDL-C and VLDL-C in the postprandial state as compared to those in the fasting state (p<0.001) and as compared to those in the fasting and the postprandial states of the controls (p<0.001). The serum HDL-C level was significantly lower in the postprandial state as compared to that in the fasting state (p<0.001). Also, the postprandial and the fasting HDL-C levels were significantly lower as compared to the levels in their respective control groups (p<0.001). Conclusion: The findings of the present study indicated that the lipid profile, as a cardiovascular risk factor, was significantly elevated in the postprandial state as compared to that in the fasting state and that it was significantly elevated in the postprandial and the fasting states in the Type 2 DM patients as compared to the levels in their respective control groups. This signified a routine estimation of the postprandial lipid profile, rather than the fasting lipid parameters, in the cardiovascular risk assessment in Type 2 DM.

Association Between Waist Circumference and Serum Triacylglcerol Status in Type 2 Diabetes Mellitus (T2DM): A Study Performed on a Rural Population in Puducherry

Arunkumar Srinivasan, Prabal Joshi, Srinivasan A Raghavan

Introduction: India is on the verge of being the diabetic capital of the world, owing to the increasing prevalence of diabetes in India. The aim of this study was to find the association between anthropometry and dyslipidaemia, with a particular reference to the triacylglycerol levels, besides suggesting a better anthropometric variable. Method: A group of eighty diabetic patients took part in the study. The Waist Circumference (WC), the waist to hip ratio, the serum triacylglycerol (TAG) levels and the glycated haemoglobin (HbA1c) levels were measured and studied. Results: We found out that there was a significant association between the WC and the TAG levels (p-value = 0.030), between high TAG levels and high HbA1c values (p-value = 0.038) with greater accuracy, in favour of the waist circumference. Conclusion: This depicted the fact that a simple measuring tape which is used in measuring the WC, could prove to be a useful and a cost-effective diagnostic approach for monitoring the metabolic complications of type 2 DM.

The Stress-Induced Cardiovascular Reactivity in the Fasting and Fed States of Healthy Young Indian Males

Indu Saxena, Gaurav Kumar, Manoj Kumar, Jayballabh Kumar

Background and Objectives: Low blood glucose levels have been associated with a hostile behaviour. The individuals who show aggressiveness and hostility are more likely to develop hypertension and cardiac diseases. The future hypertension has been linked with a high cardiovascular reactivity to stress. We have investigated the association of the blood glucose levels with the Cardio Vascular Reactivity (CVR) to stress. Methods: 46 volunteers were subjected to stress (which was induced by the cold pressor task) in the fasting state and again, half an hour after the ingestion of 75 grams of glucose. The CVR in both conditions was compared in terms of an increase in the heart rate and the blood pressure. Results: The resting pulse was lower and the blood pressure was higher in the fasting condition, as compared to the values which were obtained in the ½ hour post-prandial condition. The CVR to stress was significantly higher in the fasting condition. Interpretation and Conclusion: The increased resting heart rate and the decreased resting blood pressure in the ½ hourPost-Prandial (PP) condition was due to the higher levels of histamine in the post-prandial state. Low blood glucose levels are associated with a higher CVR to stress. This suggests that the persons are prone to develop future hypertension, those with frank hypertension, and the chronic pain sufferers should avoid prolonged fasts, in order to lower their CVR to the stress stimuli which are encountered in the daily life.

The Aetiology of the Bloodstream Infections in the Patients Who Presented to a Tertiary Care Teaching Hospital in Kathmandu, Nepal

Santwana Pandey, Shahid Raza, Chandra Prakash Bhatta

Background: Bloodstream infections are associated with a significant patient morbidity and mortality. The detection of microorganisms in the patients’ blood has a great diagnostic and prognostic significance. The early positive results provide valuable diagnostic information, based on which the appropriate antimicrobial therapy can be initiated. Objective: To know the aetiology of the bloodstream infections in the Kathmandu Medical College, Nepal and the antibiotic sensitivity patterns of the causative organisms. Materials and Methods: The blood specimens which were received from May 2010 to October 2010 in Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal, were processed and all the positive isolates were included in the study. The isolates were identified by the standard laboratory procedures. The antibiotic susceptibility patterns were determined by the modified Kirby Bauer antibiotic sensitivity method. Result: Of the 1089 blood cultures which were received with the suspected cases of blood stream infections, 138 (12.6 %) were bacteriologically positive. Salmonella serotypes were isolated in 42.7% cases of blood stream infections, followed by Klebsiella pneumoniae in 19.5%, Staphylococcus aureus in 15.9% and others in the rest of the cases. All the gram-negative bacilli isolates showed lower degrees of resistance to amikacin and ofloxacin. All the gram positive isolates were sensitive to amikacin, oxacillin and vancomycin. Conclusion: This study stresses on the need for a continued screening and surveillance in the routine blood culture technique for starting with the empiric therapy for blood borne infections.

Occurrence of the CTX-M, SHV and the TEM Genes Among the Extended Spectrum b-Lactamase Producing Isolates of Enterobacteriaceae in a Tertiary Care Hospital of North India

Maninder Kaur, Aruna Aggarwal

Purpose: The present study was carried out to assess the prevalence of the Extended Spectrum Beta Lactamases (ESBLs) and to characterize the ESBL types which were prevalent in our hospital. Material Methods: 500 gram negative isolates which belonged to the family, Enterobacteriaceae, which were isolated during the study period of 2009 to 2011, were investigated for ESBL production. Clinical isolates from urine (344), pus (109), blood (15), IV/ central line tip (10), sputum (12) and body fluid (10) specimens were processed. The organisms which were identified, included E.coli (351), Klebsiella pneumoniae (74), Klebsiella oxytoca (21), Proteus mirabilis (15), Proteus vulgaris (9) , Enterobacter spp (15) and Citrobacterspp (15). Antimicrobial susceptibility testing was done. The ESBL detection was carried out for all the isolates by the CLSI confirmatory method. The MIC of ceftazidime and ceftazidime plus clavulanic acid was determined by the E-test. Molecular typing of the ESBLs was performed by multiplex PCR among 93 ESBL isolates. Results: 45.8% isolates were found to be ESBL producers by the CLSI confirmatory method and they were confirmed by the E-test ESBL strips. A majority of E.coli in the study possessed the CTX-M genes (59.32%). Among the Klebsiella isolates, a majority were co producers of the ESBL genes; either 2 or all the 3 genes co-existed together. Conclusion: An indiscriminate use of the higher antibiotics should be restricted as far as possible. The infection control programmes should be monitored continuously in hospitals, to contain these ESBL producers. We are reporting the presence of all types of ESBL genes among the Enterobacteriaceae isolates from our hospital setting.

Optimization of PCR–RFLP Directly from the Skin and Nails in Cases of Dermatophytosis, Targeting the ITS and the 18S Ribosomal DNA Regions

Elangovan Elavarashi, Anupma Jyoti Kindo, Jagannathan Kalyani

Purpose: A pan fungal primer targeting the Internal Transcribed Spacer (ITS) region and optimization of PCR-RFLP using a dermatophyte specific primer targeted the 18S ribosomal DNA (rDNA) region were performed for the identification of dermatophyte species and strains directly from clinical specimens. Materials and Methods: One hundred and thirty eight specimens (129 skin scrapings and 9 nail clippings) from clinically suspected cases of dermatophytosis were collected and subjected to direct microscopy and culture. Among them, 66 skin scrapings and 3 nail clippings were processed for genotyping by PCR-RFLP analysis using the Mva I, Hae III and the Dde I restriction enzymes. Results: Of the 138 specimens, 81 specimens were positive for dermatophytosis, the most common one being Trichophyton rubrum (47), followed by Trichophyton mentagrophytes (25) and Epidermophyton floccosum (9). Of the 47 T. rubrum isolates, 10 were T. rubrum var. raubitschekii which were identified phenotypically as urease positive and by DNA sequencing. Since they exhibited minor morphological and physiological features, they have currently been synonymized with T. rubrum. Of the 25 T. mentagrophytes isolates, three were Trichophyton interdigitale, which were identified by DNA sequencing. Among the 66 skin specimens smear, culture and PCR showed the presence of dermatophytes in 36 (54.54%), 42 (63.63%) and 47 (71.21%) cases respectively. Among the three nail specimens, only one was found to be positive for dermatophytosis by smear, culture and PCR. Conclusion: Amplification of the dermatophyte specific primer is appropriate in the identification of dermatophytes directly from the clinical material. PCR targeting the ITS region by using the Mva I and the Dde I enzymes was equally good for the RFLP analysis. However, by using the above three restriction enzymes, no strain variations were detected among the T. rubrum and the T. mentagrophytes strains.

Prevalence of Hypertension Amongst Adult Patients Attending Out Patient Department of Urban Health Training Centre, Department of Community Medicine, Era’s Lucknow Medical College and Hospital, Lucknow

Syed Esam Mahmood, Daya Prakash, J.P. Srivastava, Z.H. Zaidi, Pankaj Bhardwaj

Background: Hypertension is the most common disorder which is encountered in outdoor patients. The existing data suggests that there is an increase in the prevalence of pre-hypertension and hypertension in India. The prevalence of hypertension will increase even further, unless broad and effective preventive measures are implemented. The main objective of this study was to find out the prevalence of hypertension amongst the adult outdoor patients of an urban health centre of Lucknow district. Materials and Methods: This observational, Out Patients Department based study involved a survey on 306 male and 1203 female respondents who were aged 18 years, who attended the Urban Health Training Centre of the Department of Community Medicine, Era’s Lucknow Medical College and Hospital, Lucknow, India. A structured, pretested schedule was used to collect the data with regards to the demographic characteristics and the blood pressure pattern. The Chi- square test and ANOVA were used to analyze the data. Results: The prevalence of hypertension was found to be 44.46%. The proportion of hypertension showed an increasing trend with age. The mean systolic as well as diastolic blood pressure patterns were found to be higher, with an increase in age. Conclusion: Hypertension was found to be highly prevalent among the outdoor patients of an urban health centre of Lucknow. An early detection of hypertension can be facilitated by periodically screening people regularly.

A Study to Assess Economic Burden and Practice of Cell Phone Disposal among Medical Students

Mittal Anuj, Vedapriya Dande Rajasekar, Lavanya Krishnagopal

Context: Our country India is having 919.17 million cell phone users; currently this is the second largest number of cell phone users after China. The youth spend a good amount on talk time and purchasing cell phone handsets. Discarding of cell phone is another issue which needs attention because of generation of e-wastes, which leads to environmental pollution. Aim: To assess economic burden and practice of cell phone disposal among medical students. Methodology: It is a cross-sectional study where self filled questionnaire were given to randomly chosen students. Results: Out of total 311 participants, 133 were males and 178 were females. Mean monthly expenditure of students was Rs. 2787. Out of 311 students only 2 (0.64%) boys were not using cell phones. It was observed that boys are more inclined towards cell phone than girls, as number of previous handsets, money spent on buying handsets and therefore average monthly costs of handsets were significantly higher among boys than girls. Most common reason for frequent changing of handsets was that they were outdated (46.14%). 47.13% of handsets were disposed by exchanging or giving to somebody for use, but 36.57% of handsets were lying waste or thrown away. Conclusion: As noticed that a good amount of money was spent on cell phones, students and parents should be counseled regarding cost effective use of cell phone. An effort should be made to dispose off handset in environment friendly way, which can be done by creating awareness about collection centers and strengthening collection chain.

Compliance to Anti-Diabetic Drugs: Observations from the Diabetic Clinic of a Medical College in Kolkata, India

Background: The poor glycaemic control among the patients with type 2 diabetes constitutes a major public health problem and a major risk factor for the development of diabetes complications. Aim of the Study: To study the compliance rate of the patients with type 2 diabetes to the prescribed medications, to find out its correlation with different socio-demographic factors and other patient characteristics and to find out the reasons behind the non-compliance, if any. Settings and Design: This cross sectional study was conducted on the patients with type 2 diabetes, who Attended the Diabetic Clinic of a Medical College in Kolkata, India. Methods and Material: The patients of type 2 diabetes who attended the diabetes clinic between April to August 2012 were recruited in the study by systematic random sampling and they were interviewed by using the help of a structured interview schedule. The patients who reported taking less than 80% of their prescribed anti-diabetes medicines in the preceding week and had HbA1C of > 7% were considered to be non-compliant. Statistical Analysis Used: The data was analyzed by using the SPSS software. The Chi-square test was used to assess the association of the compliance with the different study variables. A binary logistic regression analysis helped in identifying the factors which contributed to the non-compliance. Results: The compliance rate to the anti-diabetic drugs was found to be 57.7%. A univariate analysis showed that it decreased significantly with increasing age and that it was also significantly lower among males, illiterates, those with a poor per capita monthly income and those who had a longer duration of diabetes. It varied significantly with the type of drugs, being lowest with an oral drug and insulin combination (43.4%). No knowledge on the complications of diabetes was significantly associated with a lower compliance. The binary logistic regression also helped in identifying these as the significant contributory factors. The common reasons behind the non-compliance were forgetfulness (44.7%) and financial constraints (32.7%). Conclusion: It can be concluded that the compliance to anti-diabetic drugs was quite poor among the participants. Increasing age, the male sex, illiteracy, a low monthly income and a longer duration of diabetes were significantly associated with the non compliance. A more concerning fact was the significant association of the non-compliance with the types of drug regimens and a lack of knowledge on the complications of diabetes, which emphasized the role of a repeated patient education regarding the basic aspects of diabetes.

A Study On the Drug Utilization Trends in the Cardiovascular Emergencies in A Tertiary Care Hospital

Objectives: To observe the cardiovascular emergencies which were most frequently treated and to quantify the drug utilization trends in the cardiovascular emergencies, in terms of the Defined Daily Doses [DDD] and the prescribing prevalence in the cardiovascular emergencies. Methods: This prescription based study was undertaken in the Medicine ICU of the government medical hospital. The age, sex, diagnosis (only cardiovascular) and the drugs which were prescribed, were recorded for each patient. Also, the brand names and the generic names of the prescribed drugs were noted. The collected data was analyzed to study the drug utilization trends. Results: It was observed that the most commonly treated cardiovascular disease was IHD. The IHD was more in males than in females who were below 50 years. of age and it was nearly equal in the age groups which were above 50 years. The use of Angiotensin Converting Enzyme (ACE) inhibitors was higher than that of the beta blockers and the calcium channel blockers. The patients with cardiovascular emergencies also had preceding associated diseases like diabetes mellitus and hypertension. Conclusions: The protocol of the management which was followed by the college in the treatment of cardiovascular emergencies was competent enough, as the clinical outcomes of the patients were favourable. But there was a guideline incongruent prescribing behaviour which was statistically significant, for which there is a need to undertake large scale studies.

A Study on the Usage Pattern of Antimicrobial Agents for the Prevention of Surgical Site Infections (SSIs) in a Tertiary Care Teaching Hospital

Afzal Khan A.K, Mirshad P.V, Mohammed Rafiuddin Rashed, Gausia Banu

Context: Inappropriate antimicrobial use increases the incidence of drug resistance, drug toxicity and superinfections, thereby increasing the healthcare costs. Various approaches for rationalizing the antimicrobial therapy, have been suggested. Collection of baseline data on the pattern of the antimicrobial use is usually suggested as the first step in this direction, which will help in identifying the problem areas, which demand our attention. Aims: To study the usage pattern of prophylactic antimicrobials in surgical patients, in order to detect any inappropriateness concerning the selection, timing, redosing and the duration of antimicrobial administration. Settings and Design: A retrospective review of the randomly selected medical records of the general surgical cases over an 8 month period in a tertiary care teaching hospital. Methods and Material: The medical records of 258 patients who had undergone surgical procedures were verified for the appropriateness of the antimicrobial prophylaxis, with respect to the choice of the antimicrobial agent, the time of its administration, the intraoperativere dosing, and the duration of the postoperative use. The obtained data was analyzed and conclusions were drawn with the help of descriptive statistics. Results: The third generation cephalosporins were used preoperatively in all the 258(100%) patients through the intravenous route. In addition, 77(30%) patients received metronidazole or amikacin. The antimicrobials were administered half an hour to one hour before the surgery. No intraoperative redosing was given. The duration of the postoperative prophylaxis was extended to 36 hours or more in 248(96%) of the cases. Conclusions: The timing of administration of the preoperative dose was appropriate and well delegated to the operating room nurse. The intra operative dose was appropriately omitted. The main concern was the increasing use of the third generation cephalosporins and the unnecessary prolonged duration of the postoperative prophylaxis, which needed to be addressed.

The Knowledge, Attitude and the Perception of Prescribers on the Rational Use of Antibiotics and the Need for an Antibiotic Policy–A Cross Sectional Survey in a Tertiary Care Hospital

Ambili Remesh, A.M Gayathri, Rohit Singh, K.G.Retnavally

Background: Antibiotics are prescribed frequently and there is always an overuse with a risk of resistance and increasing costs. Rational drug prescribing is essential for minimizing the health care costs and for reducing the resistance. The implementation of a strict antibiotic policy by all the health care institutes is being made mandatory nowadays. An improving awareness among the prescribers which can be created through educational interventions, can promote the rational use of antibiotics. Hence, we considered it worthwhile to study the knowledge, attitude and the perception of the practitioners towards a rational antibiotic use. Materials and Methods: All the registered practitioners who were working in the hospital setting and were willing to give written informed consents, were enrolled in the study. All the participants who were enrolled in the study during a one month period, had to fill up a predesigned, structured and validated questionnaire which was used to assess the knowledge, attitude and the perception among physicians towards the rational use of antibiotics. Results: About 65% of the participants who provided complete information in the questionnaire, were included in analysis. Among them, more than 50 % agreed on the existence of an essential drug list, on the knowledge about new antibiotics and on prescribing antibiotics rationally and on the interpretation of the culture and the sensitivity results. A majority strongly agreed that they ensured that their patients completed the course, that they provided counselling and that they took special interest in the proper use of antibiotics. There was a consensus on the overuse, issues of resistance, and on the input from fellow colleagues. Conclusion: The participants in our study had knowledge about the rational use of antibiotics, an attitude to prescribe drugs as per the essential drug list and a perception that antibiotics were being overused and that rational drug prescribing had an important role in the antibiotic resistance.

To analyze the Impact of Serial Prescription Audits with Active Feedback on Quality of Prescription Behaviour

Naresh Jyoti, Sharanjit Kaur

Material and Methods: A serial prescription audit in four cycles (three months each) was conducted at Jhalawar Medical College and Hospital and at Chintpurni Medical College and Hospital for two years, one year in each hospital. One cycle included the prescriptions which were collected by using a digital camera from the outdoor patients department every month (n=250 per month), for three months regularly. A baseline prescription audit, as a cross-sectional survey, was done on the last date of the first month. Re-audits were done on the last date of the 2nd and 3rd months, which concluded one cycle. One cycle was followed by three months of no prescription audit. In total, four cycles were completed in two years. The parameters which were observed were- (a) the formats of the prescriptions (b) the WHO drug core indicators and (c) the legibility of the prescriptions. The clarity of the prescriptions was decided upon by the consensus group. A continuous evaluation and a feedback process were carried out every month by analyzing the prescriptions, based on the extent of conformity to the “WHO Guide to Good Prescribing” and the updated list of the “WHO Essential Medicines.” The data was analyzed by using the Chi-square test. Results: There was a significant improvement in the formats of the prescriptions in terms of the quality of the completeness and the rationality at the end of the 2nd and 3rd months of each cycle. Similarly, the WHO drug core indicators improved with every re-audit in each cycle (p < 0.05). Overall, the total percentage of the core indicators significantly improved in the 2nd and 3rd months as compared to the 1st month in all the cycles (p < 0.05). The clarity of the prescriptions improved in the successive re-audits. There was a sudden decline in the improvement in all the parameters in the first month of the 2nd, 3rd and the 4th cycles as compared to that in the 2nd and 3rd months of the previous cycles. Conclusion: Serial prescription audits and an active feedback definitely improve the prescription behaviours in the therapeutic decision making. But discontinuing the prescription audits begins to reverse the improvement in the prescription behaviours.

Psychosocial Morbidities in School Going Adolescent Girls: A Study from a South Indian City

Gayathri Hemanth Aradhya

Introduction: Adolescents form about 20-30% of our population. Like the children of any other ages, adolescents have the so called usual problems and problems which are specific for their age and developmental peculiarities. The present study was undertaken to assess the prevalence of the psycho-social problems of adolescent girls and to counsel the girls with problems or those who were problem prone. Methods: This was a cross-sectional study in which 500 adolescent girls from 6 higher secondary schools were selected via a simple random sampling method. A psychiatrist was consulted before the study was undertaken. A pre-designed profoma was given to be filled up and the data was analyzed later. Results: Sixty percent of the girls were in the age group of 14 to 15 years. Depression was noted in 10 girls (2%), symptoms of anxiety were noted in 5 girls (1%), stuttering and a poor concentration were observed in 10 girls ( 1% each), 2 girls (0.4%) came from broken families, 5 girls (1%) were suffering from anorexia nervosa, 3 girls (0.6%) were suffering from bulimia nervosa and 10 girls (2%) had pychosomatic symptoms. 5 girls (1%) reported interpersonal violence among their hostelmates. Conclusion: Finding out the prevalence of the psychosocial problems among adolescent girls and counselling them appropriately can decrease the major psychosocial morbidities which are prevalent in the community.

The Antihypertensive Efficacy of Chlorthalidone and Telmisartan in Indian Hypertensive Patients who were Uncontrolled with Hydrochlorothiazide and Telmisartan Combination-A Prospective and an Open Label Study

Suresh V Sagarad, Sudha Biradar Kerure, Chaitanya Kumar S, Ramakrishna MR

Objective: The primary objective of this study was to evaluate the antihypertensive efficacy of the chlorthalidone and telmisartan combination in Indian hypertensive patients who remained uncontrolled after taking the hydrochlorothiazide and telmisartan combination. Methods: A total of 100 eligible patients were enrolled in this prospective, open label study. The patients were given telmisartan (40 mg) and chlorthalidone (12.5 mg), who had not achieved the target blood pressure (140/90 mmHg) despite taking the combination of telmisartan (40 mg) and hydrochlorothiazide (12.5 mg). The assessment was done at the end of 4 weeks and 8 weeks. Results: The mean SBP and DBP after taking telmisartan (40 mg) and hydrochlorothiazide (12.5 mg) were 154.88±9.57 (range 144 to 160) mmHg and 99.37±2.78 (range 92 to 106). At the end of 4 weeks of being on telmisartan (40 mg) and chlorthalidone (12.5 mg), the mean SBP and DBP were 145.56±5.12 (range 134 to 158) mmHg and 95.14±4.27 (range 84 to 100) mmHg. Significant falls in the SBP (5.32±2.64) and DBP (4.18±2.48) were noted at the end of the 4 week therapy. They were sustained at the end of 8 weeks also. The SBP target (<140 mmHg) was achieved in 24 % patients. The DBP target (<90 mmHg) was achieved in 19% patients. The combined SBP and DBP target (<140/90 mmHg) was achieved in 15% patients. No significant clinical adverse events were reported. Similar falls in the SBP and DBP were noted in the subgroups (smokers, females, diabetics, etc). Conclusions: The hypertensive patients who do not achieve the target blood pressures on telmisartan and hydrochlorothiazide can be switched on to the telmisartan and chlorthalidone combination. This combination is effective and well tolerated.

The Serum Gamma Glutamyl Transpeptidase - A Non invasive Diagnostic Bio Marker of Chronic Anicteric Non Alcoholic Liver Diseases

krishnamurthy H.A.

Background: The serum gamma glutamyl transpeptidase (GGT) levels rise and return to normal levels later in the chronic anicteric non alcoholic liver diseases than the transaminases levels. So, the estimation of GGT is of some value in monitoring the progress of acute to chronic hepatitis, when the values persist in high levels. Aims and Objectives: To evaluate the serum GGT levels in patients with chronic anicteric non alcoholic liver diseases and to show that it can be used as a noninvasive diagnostic biomarker for the diagnosis of chronic anicteric non alcoholic liver disorders. Materials and Methods: This was a case control study, in which 50 cases and 50 controls were selected.The liver function tests with a special reference to the serum level of GGT were measured in the laboratory for both the cases and the controls and the serum GGT levels of the cases were compared with those of the controls. The Chi-square and the Fisher exact tests were used to find the significance of the proportions of the study parameters between the cases and the controls. The Student’s t test (two tailed) was used to find the significance mean pattern of the study parameters between the cases and the controls. Results: The mean serum GGT level was 38.73±11 IU/L in the cases and in the controls, it was 20.42±9 IU/L(p<0.001).The mean value of serum ALT was 41.37±12.5 vs 16.3±8iu/l(p<0.001), that of AST was 28.14±8 vs 17.56±8.5iu/l(p<0.05), that of total bilirubin was 0.9±0.3 vs 0.5±0.2mg/dl and that of serum albumin was 4.17±0.6 vs 4.5±0.75gm/dl, as were seen in the cases and the controls respectively. Conclusion: The serum gamma glutamyl transpeptidase level was elevated more consistently along with the alanine transaminase level in all types of anicteric nonalcoholic chronic liver diseases. The alanine transminase level has already been proved to be a marker in the diagnosis of chronic anicteric nonalcoholic liver diseases. So, in view of the persistent elevation, along with the high sensitivity, the elevated gamma glutamyl transpeptidase level can also be used as a noninvasive bio marker of chronic anicteric nonalcoholic liver diseases for both diagnostic and therapeutic purposes.

The Correlation Between Psychiatric Disorders and Women’s Lives

Fusun Sevimli Bursalioglu, Nazan Aydin, Esra Yazici, Ahmet Bulent Yazici

Objective: Psychiatric disorders are important factors which affect the quality of life: employment rates, interpersonal and intrafamilial communications, marriage, child-bearing, parental skills and many other social – cognitive areas in different ways. Psychiatric disorders like schizophrenia, bipolar affective disorder and depressive disorder have a negative impact on women’s lives. This study has compared the relationship between these mental illnesses and the liabilities of women’s lives. Methods: For the purpose of this study, 61 schizophrenics, 35 bipolar and 40 unipolar female patients and 60 healthy controls from a university hospital of eastern Turkey were evaluated with SCID- I, a family environmental scale and a personal information questionnaire. Results: The women with psychiatric disorders had higher rates of unemployment, shorter durations of marriage and lower numbers of parity, as compared to their healthy counterparts, especially after the onset of their illnesses. The schizophrenia and bipolar groups are at risk due to the psychotropic medications which they take during pregnancy. The onset or the exacerbations of illnesses during the postpartum period are also seen more in the schizophrenia and the bipolar groups. However, the patients did not use medicines more than the healthy controls during lactation. The schizophrenia and bipolar groups seem to be failing in using reliable methods of contraception. This data is important due to the traditional and the socio-economical structure of eastern Turkey, which may interrelate with the results. Conclusion: Women have to play various roles in life and they have various challenges which are related to these roles. The female psychiatric patients should be evaluated in the special perspective of ‘being women’, along with other clinical parameters. The evaluation of the social, cultural and the economic aspects and the collaborative teams of different clinical disciplines which are related to women’s mental health would be beneficial.

Association between Oro-Facial Defects and Systemic Alterations in Children Affected by Marfan Syndrome

Background: It is important to establish an early diagnosis of the Marfan Syndrome (MFS) for providing an adequate pharmacological or surgical therapy. Nevertheless, this diagnosis may be complex, given the multi-organic involvement of this disease. Aims: In this work, we evaluated the oral phenotype in a group of paediatric patients with a clinical diagnosis of MFS, to quantify the association of the oro-facial defects with other systemic alterations. Settings and Design: Paediatric subjects who were aged, with a clinical diagnosis of MFS, were selected from our regional Marfan monitoring unit. Methods and Material: All the patients were subjected to Paediatric Dentistry examinations and a radiological screening with Panoramic and Cephalometric X-Rays. The aortic dilation (Aortic Z-score value), the hyperlaxity of the ligaments and scoliosis were evaluated by cardio-surgical and orthopaedics specialists. Statistical Analysis: The correlations between the oral and systemic alterations were analyzed by using the y² test for the nominal variables. Results and Conclusions: We found a significant correlation of the Aortic Z – score with multiple oral defects which included retrognathia, malar hypoplasia, cross bite, oral respiration and an ogival palate. An association of the oral defects with hyperlaxity of the ligaments and scoliosis was also found. Thus, the data suggested that dentists should be more involved in a multidisciplinary approach, to provide an early MFS diagnosis in paediatric patients.

A Two Trunked Brachial Plexus: A Case Report

Rajan Kumar Singla, Ravi Kant Sharma, Bhagya Shree

The brachial plexus is a major and a complicated plexus at the root of the neck. It is formed by the ventral primary rami of the C5, C6, C7, C8 and the T1 spinal nerves. During the routine under graduate dissection of the right upper limb of an adult female cadaver, a variant pattern of a two trunked brachial plexus was encountered. The upper trunk was formed by the fusion of the C5 and the C6 roots. The C7 root, instead of continuing as the middle trunk, joined with the roots of C8 and T1 to form the lower trunk. On the left side, the usual pattern of the brachial plexus was seen. The knowledge on such variations are of interest to anatomists, clinicians, anesthesiologists and especially, to surgeons. These are of immense importance during surgical explorations of the axilla and the arm region and also during nerve blocks. It also helps the clinicians in getting a proper understanding of some previously unexplained clinical symptoms. Further, the ontogeny and the phylogeny of this entity have been discussed in detail.

A Rare Finding of the Superficial Palmar Arch-Developmental and Clinical Significance

Alok Saxena, Kishore Kumar Agarwal, Biswabina Ray, Samuel Pyrtuh

The ulnar artery provides a major blood supply to the hand in the form of the superficial palmar arch, with the assistance of the radial artery. A rare pattern of the superficial palmar arch was observed in a formalin fixed, male cadaveric left hand. The ulnar artery was only involved in the formation of this arch, which provided three common palmar digital arteries which ran into the second, third and the fourth spaces between the corresponding digits and one proper palmar digital artery which ran along the ulnar side of the little finger. The main trunk of the ulnar artery bifurcated to supply the thumb and the index finger. The superficial branch of the radial artery did not participate in the arch formation. The arch was completed by the radial artery proper on the dorsolateral surface of the hand, after joining the point of bifuracation of the ulnar artery.

Pleural Tuberculosis Mimicking Inflammatory Pseudotumour

Arul P., Renu G’Boy Varghese, Anita Ramdas

A pseudotumour is a rare presentation of bronchopulmonary tuberculosis which occurs in immunocompetent patients, which can simulate malignancy, both clinically and radiologically, and may cause delay in its diagnosis and treatment. The incidence of bronchopulmonary pseudotumours was found to vary from 2-4%, as was seen in various studies. A mycobacterial pseudotumour of the pleura is a rare entity. We are reporting a case of a pleura based tubercular pseudotumour in a 59 years old patient who presented with a four month history of the nonspecific symptoms of cough and chest pain. The radiological investigations showed that a pleural based mass lesion was occupying the right lower hemithorax. The initial biopsy was suggestive of a hyalinizing variant of an inflammatory pseudotumour. The follow-up surgical resected mass was consistent with the features of a tubercular granuloma. The clinical presentation and the histopathological findings have been presented, with a brief review of the literature. Due to its varied and unusual presentation, bronchopulmonary tuberculosis should always be kept in mind when a patient with a similar clinical and a radiological picture is being evaluated.

Pleomorphic Adenoma of the Lacrimal Gland in an Eleven Years Old Girl

Ananthalakshmi Vijayakumar

We are presenting a case of pleomorphic adenoma of the lacrimal gland in a 11 years old girl. This is a rare presentation. Pleomorphic adenoma is the most common epithelial tumour of the lacrimal gland, which represents 12% of all the lacrimal fossa lesions. It typically presents in middle age and is rare in children who are under the age of sixteen years, with only a few previously reported cases.

Post Thyroidectomy Suture Granuloma: A Cytological Diagnosis

Anita P. Javalgi, Surekha U. Arakeri

There are known post thyroidectomized complications, a suture granuloma being less frequent, with its late complication mimicking recurrent thyroid cancer. A suture granuloma is a benign, granulomatous inflammatory reaction that occurs due to the use of non absorbable suture. It constitutes one of the late complications which altogether make up less than 2% of its incidence. A suture granuloma is similar to a foreign body reaction and it usually develops slowly as a painless, palpable asymptomatic mass over the years. It mimics a cancer recurrence or a lymph node metastasis. Here, we are reporting a case of a post thyroidectomy suture granuloma in a 46 years old lady who presented with a painless swelling in the lateral neck, with a past history of thyroidectomy 5 years back.

Extragenital Aggressive Angiomyxoma of the Axilla and the Chest Wall

Bhavna Nayal, Lakshmi Rao, Anuradha C.K Rao, Swati Sharma, Rajgopal Shenoy

Aggressive angiomyxomas are uncommon mesenchymal tumours which most often arise in the perineal and the pelvic regions in women. Extragenital aggressive angiomyxonas are extremely rare. We are reporting a young male with an aggressive angiomyxoma which involved the axillary region and extended into the anterior chest wall, which demonstrated its characteristic histomorphological features. The diagnosis was confirmed by immunohistochemistry. A careful histological examination, along with immunohistochemistry, aids in diagnosing this lesion and differentiating it from tumours which have similar histologies.

The Cytological Diagnosis of Extra-Oral Plasmablastic Lymphoma: A Rare Entity

Kanthilatha Pai, Lakshmi Rao

Non-Hodgkin’s Lymphomas (NHLs) which are associated with the Acquired Immunodeficiency Syndrome (AIDS) are heterogeneous. Plasmablastic Lymphoma (PBL) was first recognized as an aggressive, invariably fatal subtype of Non-Hodgkin’s Lymphoma which occurred mostly in patients with AIDS, with distinct histomorphologic and immunophenotypic findings, which affected the jaw and the oral mucosa exclusively. Subsequently, there have been case reports which have described extra-oral plasmablastic lymphomas in the lung, jejunum, caecum, nasal mucosa, etc. We are reporting a case of this rare subtype of diffuse large B-cell lymphoma which presented as a soft tissue mass, which we believe is the first case to be diagnosed by FNAC.

An Idiopathic Membranous IVC Obstruction: Presenting as a Variant of the BCS

Amirtha Ganesh B., Ravi Cherian Mathew, AnanathaKrishnan N.

An Inferior Venacaval (IVC) lumen obstruction, whether it is partial or complete, is not a common phenomenon and it may be caused by the thrombosis or compression which may result from neoplastic or non neoplastic masses. There are cases which are idiopathic and which are typically referred to as membranous obstructions of the IVC. Here, we are presenting a 40 years old male with multiple tortuous veins over the abdomen, with non healing ulcers in the leg for 12 years, without ascites, who underwent a successful percutaneous transluminal balloon dilatation of the IVC membrane which was located above the hepatic veins, which resulted in a successful palliation of his symptoms.

Bilateral Primary Fallopian Tube Carcinoma with the Classical Clinical Features: A Case Report

Neetha Vyas M., Supriya Rai, Lakshmi Manjeera, Darshith Shetty

Bilateral primary fallopian tube carcinoma is a rare diagnosis in our gynaecological practice. Very often, the diagnosis is mistaken for an ovarian carcinoma or a tubo-ovarian mass. A correct, preoperative diagnosis is made only in 4% of the cases. This is due to the nonspecific symptoms. The Latzko’s triad of a watery vaginal discharge, a colicky lower abdominal pain and a pelvic mass is typical of a fallopian tube carcinoma, but this triad is noted only in less than 15% of the patients. Here, we are reporting such a case where the patient presented with all the classical features of a primary fallopian tube carcinoma. This case is also being reported for it’s extreme rarity.

A Case Report on A Myomectomy which was Done During A Caesarean Section

Shyamsundar, Ratnamala M. Desai, Pavitra

Uterine myomas are being observed in pregnancy more frequently now than in the past, because many women are delaying child bearing till their late thirties, which is the time for the greatest risk of the myoma growth. Traditionally, obstetricians are trained to avoid myomectomies during caesarean sections as severe haemorrhages can occur, which may often necessitate hysterectomies. Pedunculated fibroids which can be easily removed are an exception. Here, we are reporting one case of a myomectomy which was done during a caesarean section.

Torsion of the Fallopian Tube and the Haematosalpinx in Perimenopausal Women- A Case Report

A Bharathi, Mangala Gowri

An isolated fallopian tube torsion is a rare, often difficult to diagnose, but significant cause of acute lower abdominal pain in women of the reproductive age group. It is rare in the perimenopausal age group. We are presenting a literature review and the case of a 47 years old woman who presented with a sudden onset of acute lower abdominal pain . Her clinical examination revealed an 8x8 cm, tender, cystic mass in the left lower quadrant, with positive cervical movement tenderness. MRI revealed a gross hydrosalpinx with a small left ovarian cyst. With a diagnosis of left adnexal torsion, an emergency laparotomy was performed, which revealed an isolated left fallopian tube torsion which necessitated a left salpingo-oophorectomy. A tubal torsion should be suspected in females with acute lower abdominal pain, of any age group, especially in those with predisposing factors like pelvic infections, tumours and surgeries which include tubal ligation. Laparoscopy is the preferred modality for the diagnosis and treatment of a tubal torsion.

An Interesting Case of Eosinophilic Meningitis

Angiostrongylus cantonensis is one of the causative agents of eosinophilic meningitis. Humans get infected when they ingest raw or partially cooked snails or monitor lizards (Varanus bengalensis). There is a popular belief that the tongue and the liver of the monitor lizard has aphrodisiac properties. A 20-year-old man was admitted to our hospital with a history of fever, headache and vomiting. His cerebrospinal fluid revealed eosinophilia. He gave a history of the ingestion of a monitor lizard, ten days prior to the onset of the symptoms. So, a diagnosis of eosinophilic meningitis due to Angiostrongylus cantonensis was made. He was treated with oral albendazole and prednisolone. His symptoms improved gradually within two weeks from his admission.

A Delayed Traumatic Diaphragmatic Hernia Presenting With a Bowel Obstruction 20 Years Postinjury

Jonas P. DeMuro

A delayed Traumatic Diaphragmatic Hernia is a rare diagnosis. A 38 years old male presented to our emergency department with an acute bowel obstruction. He had a prior trauma laparotomy twenty year’s prior, which was reportedly negative. He required preoperative resuscitation for his severe hypokalaemic, hypochloraemic metabolic alkalosis, and acute renal failure. He underwent operative reduction of the incarcerated contents, and a primary permanent suture repair of the defect. The principles of the diagnosis of the delayed traumatic diaphragmatic hernia, and the operative repair of this entity have been reviewed.

Colon Obstruction due to an Anticoagulant Induced Intramural Haematoma- A Rare Case Report

Lancelot Lobo, Rakesh Koudki, Kishan Prasad HL, Balakrishna Shetty

A spontaneous, intramural, intestinal haematoma is a rare complication of the anticoagulant therapy. We are reporting here, a rare case of a 63-years-old male, who presented with intestinal obstruction which was caused by an intramural and a submucosal colonic haematoma, which had resulted from warfarin administration. This patient rapidly improved after taking conservative treatment. A history of anticoagulant use with a prolonged INR value in patients who present with abdominal pain, should alert the physicians or surgeons to search for this entity. It is extremely important to recognize this syndrome at its early stages, to avoid an unnecessary operation, since the outcome is usually excellent after a conservative treatment.

Syringocystadenoma Papilliferum of the Scalp in an Adult Male – A Case Report

Mima Maychet B. Sangma, Simon David Dasiah, Ramachandra Bhat V.

Syringocystadenoma papilliferum is a benign adnexal skin tumour of the apocrine or the eccrine type with characteristic histological features and varied and non-distinct clinical findings. It is relatively a rare neoplasm, which is called as a childhood tumour, since it usually appears at birth or during puberty. A case of syringocystadenoma papilliferum of the scalp in an adult male has been presented, which was clinically diagnosed at first as keratocanthoma of the scalp but was later histologically confirmed as syringocystadenoma papilliferum.

Bullous, Fixed Drug Eruption to Ciprofloxacin: A Case Report

Sonia Pramod Jain, Pramod Ajit Jain

Adverse reactions to medications are extremely common and display a characteristic clinical morphology such as fixed drug eruption (FDE), Stevens-Johnson syndrome, urticaria, morbilliform exanthem, hypersensitivity syndrome, pigmentary changes, lichenoid, dermatitis, acute generalized exanthematous pustulosis, photosensitivity, vasculitis etc. Here we report a case of a 60 year old male who presented to us with multiple bullous eruptions over both the hands and feet after oral ingestion of ciprofloxacin.

Melioidosis with a Pericardial Effusion, which Relapsed as a Chest Wall Abscess: A Rare Presentation

Melioidosis, which is caused by a soil saprophyte, Burkholderia pseudomallei, is most prevalent in the south–west coast of India. Although it is frequently seen in immunocompromised patients, melioidosis can occur in apparently normal individuals. Melioidosis can involve almost any organ. A relapse of melioidosis is usually associated with a poor adherence to the eradication therapy, a multifocal involvement and bacteraemia. A relapsing melioidosis is usually known to follow a similar pattern of organ involvement in the first and second episodes of the infection. We are discussing here, a rare case of melioidosis in a 38-year-old construction-worker, with no risk factors, who presented initially with a pericardial effusion. It relapsed 6 months after he completed the prescribed eradication therapy for 3 months, as an anterior chest wall abscess. The author recommends a high index of suspicion for the relapsed melioidosis cases, inspite of the primary episode being non-bacteraemic and compliant with the recommended therapy, in order to avoid further complications.

Alveolar Soft Part Sarcoma-A Histological Surprise in a Male Patient who was Suspected to have Breast Cancer

Alveolar Soft Part Sarcoma (ASPS) is a very rare type of soft tissue sarcoma. Its cell of origin is unclear. It usually presents in the second to fourth decade of life. The most common reported sites of ASPS are the lower extremities, the head and the neck. Because of the rarity of this disease, there is no standard treatment plan. Surgical excision with negative margins is considered as the treatment of choice. We are reporting a rare presentation of ASPS as a male breast lump.

SLE Developing in a Follow-Up Patient of Kikuchi’s Disease: A Rare Disorder

Anupam Patra, Sujit Kumar Bhattacharya

Kikuchi’s disease or the Kikuchi-Fujimoto Disease (KFD) is a very rare, self-limiting, benign form of histiocytic necrotizing lymphadenitis, which is mostly seen in young females. We are presenting a case of Systemic Lupus Erythematosus (SLE) which occurred after 2 years in a patient of Kikuchi’s disease during a follow-up examination.

Incidentally Detected Isolated Unilateral Pulmonary Artery Agenesis

Senthil Kumar Aiyappan, Upasana Ranga, Saveetha Veeraiyan

We are reporting here, a case of an incidentally detected, isolated, unilateral pulmonary artery agenesis on contrast enhanced Computed Tomography (CT) of the chest in a 39-year-old male patient.

Adherence and Non-Adherence to Treatments: Focus on Pharmacy Practice in Nepal

Suresh Bastakoti, Saval Khanal, Bibek Dahal, Nirmala Tilija Pun

Nepal is one of the developing countries having many limitations in providing the quality health services to its population. In many countries, improvement in patients’ adherence to the pharmacotherapy had been one of major outcome of quality pharmaceutical services. Till date, very less thing has been done in this area in Nepal; so it seems mandatory to improve the patient adherence to the treatment plans. Adherence to the medical therapy can be explained by the extent of the behavioral coincidence to the medication and non-medication regimen by a patient whereas compliance and concordance are two different models of patient adherence to the therapy. Compliance model suggests that patients have been brought responsible for being unable to follow ‘doctor’s order and concordance tempts to measure the degree of agreement between patient and his or her clinician about the nature of illness and the best possible therapy for the welfare of the patient. Non-adherence to the therapy may lead to different problems as consequences of non-adherence in four different level- individual, institutional, societal and national levels. Although some programs like, “Direct Observation Treatment, Short-course (DOTS) for tuberculosis, implementation of antiretroviral treatment schedules for HIV patients and pediatric vaccination models,” are the examples of attention towards the cases of noncompliance in Nepal. It has long been faced its limitations in the forms of either untrained manpower or lack of good documentation of patients’ adherence to therapy or high illiteracy rate or unaffordibility of patients to their treatment or lack of pharmaceutical care services.

The Relationship Between Periodontitis and Systemic Diseases – Hype or Hope?

Mani Ameet M.,Tejnani Avneesh H.,Pawar Babita R.,Marawar Pramod P.

Investigations have definitely acknowledged a clinically relevant two-way relationship between periodontitis and certain systemic diseases and conditions, which are significant for the dentist in the daily practice and for a physician as well. This review article yields the most up-to-date information on the role of periodontal diseases in systemic diseases, that include cardiovascular diseases and atherosclerosis, diabetes mellitus, respiratory diseases and unfavourable pregnancy outcomes. It debates the role of diabetes and smoking in the periodontal tissues.

The Malnutrition Inflammation Complex Syndrome-The Micsing Factor in the Perio-Chronic Kidney Disease Interlink

Nithya Anand, Chandrasekaran S.C, Md.Nazish Alam

The patients who undergo Maintenance Haemodialysis (MHD) have a high prevalence of Protein-Energy Malnutrition (PEM) and inflammation. Because these two conditions often occur concomitantly in the MHD patients, they have been referred to together as the Malnutrition-Inflammation Complex Syndrome (MICS) or Malnutrition-inflammation atherosclerosis, to underscore the atherosclerotic complications of this entity. MICS is also reported to correlate with a poor outcome, including a decreased quality of life, refractory anaemia and significantly greater rates of hospitalization and mortality in the MHD patients .Indeed, MICS may be the major cause of the paradoxical exposure-outcome association, which is also known as reverse epidemiology of the cardiovascular disease risk factors in the maintenance dialysis patients. Periodontitis is a chronic inflammatory disease of the supporting tissues from the dentition, which results from the infection of and the interaction of selected bacterial species with the components of the host response in disease-susceptible individuals as the haemodialysis (HD) patients. Only in recent years, did an emerging evidence link the dental infection, especially periodontitis, to an increased risk of atherosclerosis and thrombosis. In the HD patients, studies have been showing a positive link between periodontal disease and systemic inflammation on correlation between the levels of CRP and immunoglobulin G of Porphyromonas gingivalis. Recent researches have confirmed that the periodontal health is poor in haemodialysis patients and that it correlates with the markers of malnutrition and inflammation.

Awareness and Knowledge of Common Oral Diseases Among Primary Care Physicians

T. Sarumathi, B. Saravanakumar, Manjula Datta, Thilagavathi Nagarathnam

Objective: The objectives of this study were to examine the level of awareness of the common oral disease amongst the primary care physicians in Chennai, India and to study the proportion of the routine oral examination among them. Method: This study was a cross-sectional, self administered, questionnaire survey which was done among 70 primary care physicians of Chennai, India. The questionnaire assessed the proportion of the routine oral examination and the knowledge and the awareness about the common dental problems among the primary care physicians. Result: This study showed moderate awareness about the signs and symptoms of the common oral diseases. There appeared to be a low awareness about the treatment of limited mouth opening and the causes of white patches. 85.9% of the doctors said that they routinely examined the oral cavity; 4.2% said that they sometimes did so. 4.2% of the sample said that they did not perform a routine oral examination, whilst another 4.2% said that they examined the throat only. Conclusion: The information which was gleaned from this study can help in developing a focused module which is aimed at the practising primary care physicians, and to suggest appropriate additions to the curriculum of the medical graduates, so as to enable an early detection, an appropriate referral, and an ultimately improved oral and general health of our population.

Creating a Single-Visit, Fibre-Reinforced, Composite Resin Bridge by Using a Natural Tooth Pontic: A Viable Alternative to a PFM Bridge

Ambica Khetarpal,Sangeeta Talwar,Mahesh Verma

Background:The rehabilitation of an anterior tooth space presents a confronting situation. Several modalities are presently available to address the challenge of an immediate replacement of a missing anterior tooth. These include a removable temporary acrylic prosthesis or resin-bonded bridges. Fibre-Reinforced Composite (FRC) bridges are preferable if they are fixed and if a cost-effective tooth replacement is desired. Also, they provide an aesthetic and a conservative treatment choice as the abutment teeth require a minimal or no preparation. Methods:This article is describing two cases with an immediate replacement of the maxillary incisor teeth by a single visit technique, with the use of FRC Resin (Ribbond) bridges and natural tooth crowns as pontics. Results and Conclusions:The procedure was completed at the chair side, thereby avoiding the laboratory costs. A two year follow up of the cases has shown a successful outcome. Creating an adhesive FRC bridge by using a natural tooth pontic is a successful treatment option for the direct aesthetic replacement of missing anterior teeth

Non-Syndromic Oligodontia of Primary and Permanent Dentition: 5 Year Follow Up- A Rare Case Report

Joyson Moses, Deepa Gurunathan, B.N. Rangeeth, K.S Kannan

Oligodontia designates the congenital absence of six or more permanent teeth, excluding the third molars. Oligodontia of primary and permanent dentition is a rare observance. This case report describes the missing teeth in primary and permanent dentition of an 8 year old boy. Early diagnosis, and comprehensive treatment planning with good coordination and timing of the individual treatment phases are decisive for a successful treatment outcome.

The Perspectives on Including Palliative Care in the Indian Undergraduate Physiotherapy Curriculum

Zubia Veqar

According to the guidelines which were published by WHO in 2008, palliative care has been defined as “An approach that improves the quality of life of the patients and their families who face the problems which are associated with life-threatening illnesses, through the prevention and relief of suffering by means of an early identification, an impeccable assessment and the treatment of pain and other problems, physical, psychosocial and spiritual” . The intervention which is provided as a part of the palliative care has to be provided by health professionals who strictly work as a part of multidisciplinary team and have been specifically trained to an optimal level of competency in the field. The impairment of the physical function and pain are two key problem areas in palliative care, which a physiotherapist deals with. Is a physiotherapist who is trained in India, trained to work as an efficient member of the team in this field? This article deals with the following: 1. What is palliative care and what is its importance? 2. A multidisciplinary approach to palliative care 3. The scenario of palliative care in India 4. The role of physiotherapy in palliative care. 5. The current scenario of physiotherapy education vis a vis palliative care.

Unusual ‘Tick Mark’ Calcification on Chest Radiograph in Rheumatic Heart Disease – CT Imaging Revealing Pericardial Calcification

The identification and the interpretation of subtle opacities on chest radiographs are challenging for clinicians. At times, especially when they are found incidentally, some opacities may be considered as artefacts or insignificant and they are neglected. In the present case, an unusual ‘tick mark’ - shaped dense opacity was incidentally found over the cardiac shadow, and CT imaging revealed pericardial calcification. Pericardial, valvular and atrial calcifications in rheumatic heart disease have been described in the literature.