Journal of clinical and diagnostic research

Prevalence of Asymptomatic Bacteriuria and its Antibacterial Susceptibility Pattern Among Pregnant Women Attending the Antenatal Clinic at Kanpur, India

R.Sujatha, Manju Nawani

Background: Symptomatic and asymptomatic bacteriuria (ASB) is common in pregnant women. Pregnancy enhances the progression from ASB to symptomatic bacteriuria, which if left untreated, could lead to acute pyelonephritis and other adverse outcomes such as prematurity, postpartum, hypertensive disease, anaemia, UTIs and higher foetal mortality rates. Aim: To identify the prevalence of ASB, the most common causative microorganisms and the antibacterial susceptibilities of the isolated microorganisms at a tertiary care centre at Kanpur, India. Materials and Methods: A total number of 300 asymptomatic pregnant women were screened for ASB by urine culture by using a semi quantitative culture method. Results: In this study, significant bacteriuria was found in only 22 cases (7.3%). Growth of contaminants was seen in 40 cases (13.3%). Among cases which showed positive cultures, 48.9% were primigravidae and 51.1% were multigravidae. Highest incidence was reported in age group of 21-30 years. The predominant organisms which were isolated were Escherichia coli, followed by Klebsiella pneumoniae, Enterococcus faecalis, Staphylococcus aureus and Proteus mirabilis. Escherichia coli, the most common isolate, was found to be only 61% and 70% sensitive to ampicillin and amoxicillin + clavulanate, respectively. Sensitivity to ceftriaxone and ciprofloxacin was 95%, and sensitivity to amikacin was 99%. Hundred percent sensitivity was found for the broad spectrum pencillins, imipenem, and meropenem. Klebsiella pneumoniae, the second most frequent organism which was grown on culture, was only 50% sensitive to ampicillin and amoxicillin + clavulanate. 100% sensitivity was found for cefuroxime, cefepime, ceftriaxone, ciprofloxacin, imipenem and meropenem. Conclusion: Routine urine culture test should be carried out for all antenatal women, to detect asymptomatic bacteriuria, and every positive case should be treated with appropriate antibiotic therapy, to prevent any obstetric complication which is associated with pregnancy.

Prescription Patterns of Hypolipidaemic Drugs in a Tertiary Care Teaching Hospital of Southern India

Sangeetha Raja, Satyajit Mohapatra, J.S Kumar, R Jamuna Rani

Objective: To evaluate the prescribing patterns of hypolipidaemic drugs which were prescribed to patients who visited the department of General Medicine in a tertiary care teaching hospital of southern India. Materials and Methods: A cross-sectional study was done for three months in the department of General Medicine. A total of 506 prescriptions of hypolipidaemic drugs were evaluated, based on the various inclusion and exclusion criteria. The different disease patterns, the types of drugs which were prescribed in those diseases and the WHO prescription indicators, Anatomical Therapeutic Classification as well as the PDD (prescribing daily dose) /DDD (daily defined dose) ratio were calculated. Results: While analyzing the prescriptions, it was found that patients having abnormal lipid profiles (56.9%) and normal lipid profiles (43.1%) were prescribed hypolipidaemic drugs. Diabetes with hypertension (37%) was the most common disease for which hypolipidaemic drugs were prescribed. The average number of drugs per prescription was 3.3±1.33. Atorvastatin was the most common hypolipidaemic drug which was prescribed as monotherapy (53.4%), whereas atorvastatin with aspirin was the most common drug which was prescribed as combination therapy (20%). Atorvastatin was prescribed as underdosed and Rosuvastatin was prescribed as overdosed. Conclusion: This study depicts the use of statins in various disease conditions, both as primary and secondary preventive measures. Such studies should be done to educate the physicians on good prescribing practices and on rational use of hypolipidaemic drugs.

Comparison of Blood Loss in Induced Vs. Spontaneous Vaginal Delivery Using Specialized Blood Collection Bag

Hebbar Shripad, Rai Lavanya, Akshara Mohan

Objective: To compare third stage blood loss in induced vs. spontaneous vaginal deliveries and to correlate the amount of blood loss with the decrease in haemoglobin following deliveries. Setting: Department of Obstetrics and Gynaecology, Kasturba Hospital Manipal, Karnataka, India. Materials and Methods: Blood loss following placental deliveries was measured by using special collection bags in 150 pregnant ladies who delivered vaginally by labour induction and it was compared with that of another 50 women who had spontaneous vaginal deliveries. Haemoglobin values were recorded for each patient prior to labour and after delivery of child. Results: The mean blood loss in induced group was 30 mL more than that in spontaneous group (202 ± 117 mL vs. 172 ± 114 mL), but this was not statistically significant (p=0.12). However, when different methods of induction were compared, oxytocin group was found to have significantly higher blood loss (327 ± 140 mL) as compared to that in other types of labour inductions as well as spontaneous deliveries. Labour induction using prostaglandins did not produce more blood loss as compared to that produced by spontaneous deliveries. Both induced and spontaneous delivery groups showed statistically significant drops in post-delivery haemoglobin values, but the drop was relatively more in induced group as compared to that in spontaneous vaginal delivery group (0.96gm/dL vs. 0.56gm/dL), which appeared to be statistically significant (p=0.001). Conclusion: Labour induction using prostaglandins is safe as compared to oxytocin usage. Accurate estimation of blood loss is important in all types of deliveries, in order to detect postpartum haemorrhage early, so that appropriate measures can be undertaken.

Role of Serum ß–Carotene in the Diagnosis and Prevention of Oral Squamous Cell Carcinoma – A Case Control Study

Prashanthi Chippagiri, Ali IM, Spoorthi Ravi Banavar

Context: Oral squamous cell carcinoma (OSCC) is the most common cancer of the head and neck. It accounts for more than 90% of all malignancies which occur in the head and neck region. The high incidence and mortality rate of oral cancer stimulates continuation of research on finding new diagnostic tools or markers for it. Aim: To evaluate the possible role of serum ß-carotene as a biochemical parameter in the diagnosis of oral squamous cell carcinoma. Materials and Methods: The serum ß-carotene levels in 40 patients with clinically diagnosed and histopathologically confirmed oral squamous cell carcinoma were estimated and the levels were compared with those of 40 healthy controls. The serum ß-carotene levels were estimated by using a spectrophotometer. The data which was obtained was analyzed statistically by using unpaired t-test. Results: Subjects with oral squamous cell carcinoma showed significantly lower levels of mean serum ß-carotene (149.95 ± 61.29) as compared to those seen in controls (278.19 ± 90.12). Conclusion: The results of the present study are encouraging and these suggest that the estimation of the low levels of ß-carotene in the patients with oral squamous cell carcinoma may be a useful diagnostic tool for making the diagnosis of oral squamous Cell carcinoma and thereby improving the prognosis of this dreaded disease.

Organ Dysfunction and Organ Failure as Predictors of Outcomes of Severe Maternal Morbidity in an Obstetric Intensive Care Unit

Background: Most of the maternal deaths are preceded by severe maternal morbidity (SMM). Organ dysfunction and organ failure may occur as part of the pathophysiologic spectrum in SMM. Aim: To determine the predictive and discriminative abilities of the Sequential Organ Failure Assessment (SOFA) scores to determine outcomes in pregnant women with SMM, who were admitted to a maternal ICU. Materials and Methods: A retrospective study design was used to ascertain the diagnostic effectiveness of Sequential Organ Failure Assessment (SOFA) scores. Maximum individual SOFA scores and total maximum SOFA score were compared between women with and without SMM, and in women with SMM who survived or did not survive. Primary outcome measure of interest was maternal mortality. Results: A majority (n=73, 85.88%) of the 85 women in the study had obstetrics related causes.The total maximum SOFA score was significantly higher in women with SMM as compared to that in women without SMM (p<0.001). The total maximum SOFA score showed ability to discriminate pregnant women with SMM who would not survive (AUROC 0.77, 95% CI: 0.46, 1.00). The positive likelihood ratios and accuracy for total SOFA scores of =10 and =12 were 19.20 and 38.40, and 94.20% and 95.65% respectively. The post-test probabilities for maternal deaths in women with SMM for SOFA scores =10 and =12 were 60.01% and 75.01% respectively. Conclusion: The total maximum SOFA score showed good predictive and discriminative abilities for maternal mortality in pregnant women with SMM, who were admitted to ICU.

Correlation of Fetal Abdominal Subcutaneous Tissue Thickness by Ultrasound to Predict Birth Weight

Introduction: Fetal growth abnormality is associated with changes in the soft tissue mass, which is decreased in growth restricted fetuses and increased in macrosomia. Objective: To correlate fetal abdominal subcutaneous tissue thickness (FASTT) measured by ultrasound at term and birth weight and to obtain a cut-off value of FASTT to predict large and small for gestational age babies in our population. Methods: FASTT was measured at the anterior 1/3rd of abdominal circumference by ultrasound after 36 weeks and weight of the baby measured after birth. Results:There was positive correlation between FASTT and birth weight. FASTT of 6.25 mm was sensitive to predict large for gestational age (LGA) babies and had a high negative predictive value; FASTT measurement for prediction of small babies with birth weight < 2500 g was not sensitive. Conclusion: FASTT can be used as an additional indicator to predict large for gestational age babies along with other known birth weight indicators.

Study of Bacterial Meningitis in Children Below 5 Years with Comparative Evaluation of Gram Staining, Culture and Bacterial Antigen Detection

Kala Yadhav ML

Context: Bacterial meningitis is one of the most serious infections seen in infants and children, which is associated with acute complications and chronic morbidity. Infections of Central Nervous System (CNS) still dominate the scene of childhood neurological disorders in most of the developing tropical countries. Aims: To isolate, identify and determine the antibiotic susceptibility patterns of pathogens associated with bacterial meningitis. We also aimed to comparatively evaluate of Gram staining, culture and bacterial antigen detection in cerebrospinal fluid samples. Materials and Methods: Present comparative study included 100 CSF samples of children below the age of 5 years, who were clinically suspected meningitis cases. The samples were subjected to Gram staining, culture and Latex agglutination test (LAT). The organisms isolated in the study were characterized and antibiotic susceptibility test was done according to standard guidelines. Statistical Analysis: It was done by using Gaussian test. Results: Of the 100 cases, 24 were diagnosed as Acute bacterial meningitis (ABM) cases by Gram staining, culture and latex agglutination test. 21 (87.5%) cases were culture positive, with 2 cases being positive for polymicrobial isolates. Gram staining was positive in 17 (70.83%) cases and LAT was positive in 8 (33.33%) cases. Streptococcus pneumoniae was the predominant organism which was isolated and it was sensitive to antibiotics. Conclusion: In the present study, male to female ratio was 1.27:1, which showed a male preponderance. With the combination of Gram staining, culture, and LAT, 100% sensitivity and specificity can be achieved (p < 0.001). Gram staining and LAT can detect 85% of cases of ABM. Bacterial meningitis is a medical emergency and making an early diagnosis and providing treatment early are life saving and they reduce chronic morbidity.

Correlation Between Haemoglobin Level and Electrocardiographic (ECG) Findings in Anaemia: A Cross-Sectional Study

Background: Anaemia affects the body by decreased oxygen (O2) carrying capacity of the blood. There is growing evidence that anaemia contributes to cardiac disease and death. It causes O2 supply – demand myocardial mismatch causing myocardial ischemia. There is diversity of opinion available in literature on reports of electrocardiographic (ECG) changes in anaemia. Aim: To study the ECG changes in anemic population and to correlate ECG changes seen with increasing severity of anaemia. Materials and Methods: In hundred anemic adults, haemoglobin level and resting ECG were recorded. They were grouped according to haemoglobin level. ECG findings and varying severity of haemoglobin (Hb) level of each group were correlated using Pearson’s co-relation co-efficient and association was calculated using Chi-square test. Results: ECG changes in patients with Hb level of 0-5gm% showed ST segment depression in 50-75%, T wave changes in 29-50% and Left Ventricular Hypertrophy (LVH) in 25-30% of patients. Less percentage of patients with 5-7gm% Hb showed such changes, and patients with 7-8gm% Hb, showed no changes. As the Hb level decreased there was more percentage of patients having tachycardia and ECG changes. There was a strong negative correlation between Hb level and tachycardia and ECG changes. Conclusion: Diagnosing anaemia in critical care can be supported by ECG changes like ST depression, T wave changes, with/without associated QRS abnormalities to avoid misdiagnosis and also as dramatic clinical and ECG recovery can be achieved with anaemia correction.

Accessory Gene Regulator Types of Staphylococcus aureus Isolated in Gorgan, North of Iran

Background:Staphylococcus aureus is a gram-positive bacterium that has remained a persistent pathogen, causing infections such as endocarditis, meningitis, and toxic shock syndrome in humans. The accessory gene regulator (agr) system of Staphylococcus aureus is responsible for controlling the expression of many genes that code for virulence factors. In this study, we assessed the S.aureus agr Group, based on their source of isolation, in Gorgan, North of Iran. Materials and Methods:DNA of 194 S. aureus isolates was extracted by lysozyme-phenol chloroform method, which included 85 clinical samples, 58 samples which were isolated from noses of health care workers and 51 cases which were obtained from food products in Gorgan, northern Iran. PCR-based assays were used to evaluate agr locus nucleotide polymorphism for the identification of agr speci fi city Group. Distributions of each agr Group were determined and comparison between different sources was assessed by X 2 . A p-value of <0.05 was considered as signi fi cant. Results:The majority of isolates belonged to agr Group I (43.3%), followed by agr Group III (28.87%), agr Group II (22.68%), and agr Group IV (5.15%). In our study, a majority of S. aureus isolates were recovered from health care workers and food product specimens were of agr Group I and isolates which were recovered from patients were of agr Group III. These differences were statistically signi fi cant (P=0.005). There was no statistical difference between the source of isolation of clinical samples of S.aureus and agr type. Conclusion:Agr Group I was predominant among health care workers and food product specimens in Gorgan, North of Iran, but in strains which were isolated from patients, agr Group III was predominant. Investigating the possible role of agr Group III in Staphylococcus aureus infection in future studies is recommended.

A Comparative Evaluation of the Retention of Tooth Coloured and Stainless Steel Endodontic Posts: An In-vitro Study

Kiran Keswani, Rahul Maria, Rohit Punga

Aims: This in vitro study evaluated: a) the retention of stainless steel posts of 1.5 mm diameter which were cemented with Zinc Phosphate cement versus Glass fiber posts with 1.1 mm, 1.3 mm and 1.5 mm diameters which were cemented with resin cement and b) the effect of change in diameter on the retention of Glass fiber posts with 1.1 mm, 1.3 mm and 1.5 mm diameters. Materials and Methods: Sixty extracted mandibular premolar teeth were endodontically treated and randomly assigned to four groups of fifteen teeth each. In Groups I, II and III glass fibre posts with diameters 1.1 mm, 1.3 mm and 1.5 mm were cemented by using resin cement. In Group IV, stainless steel posts with diameter 1.5 mm were cemented by using zinc phosphate cement. The specimens were tested for tensile loading at a cross head speed of 2.0 mm/min, on a universal testing machine. Statistical Analysis Used: One way analysis of variance and Tukey’s (post-hoc) test. Results: Mean tensile strength from highest to lowest was in the order of Group IV, Group II, Group III, Group I. Statistically significant differences were observed between the mean tensile strengths between Groups I and II, Groups I and III, Groups I and IV, Groups II and IV, Groups III and IV, while non significant differences were observed between Groups II and III. Conclusion: Stainless steel posts were more retentive than glass fibre posts. Glass fibre posts with 1.3mm or 1.5mm diameters provided significantly greater retention as compared to 1.1mm diameter posts.

Human Age Estimation from Tooth Cementum and Dentin

Background:Age estimation is an important factor in the identification of an individual in forensic science. The hard tissues of the human dentition are able to resist decay and degradation, long after other tissues are lost. This resistance has made teeth useful indicators for age calculation. Recent research has indicated that Tooth Cementum Annulations (TCA) may be used more reliably than any other morphological or histological traits of the adult skeleton, for age estimation. Aims:The purpose of this study was to examine the correlation between age and the number of incremental lines in human cementum and to correlate age with thickness of secondary dentin. Materials and Methods:The study sample consisted of 100 teeth. Teeth which were extracted because of periodontal disease and orthodontic, and prosthetic reasons were used in the study. The exclusion criterion was teeth with carious lesions. The age of the individuals at the time of tooth extraction ranged from 25-60 years. Longitudinal ground sections of each tooth were prepared and examined. Statistical Analysis:Correlation between estimated age, which was calculated by using cemental lines and thicknes s of secon dary dentin and actual age, was found by using Pearson’s correlation coefficient. Correlation of increase in thickness of secondary dentin in different age groups was analyzed by ANOVA test. Results:A strong positive correlation was found between the estimated age, which was calculated by using cemental lines and thickness of secondary dentin and actual age. Correlation of increase in thickness of secondary dentin in different age groups was found to be non significant. Conclusion:Countable cemental annulations are present in human teeth. Quantification of cementum annuli is a moderately reliable means which is used for age estimation in humans. As the age advances, the thickness of the secondary dentin also increases; hence, the amount of secondary dentin can also be an indicator of age of an individual.

Evaluation of Palatal Plate Thickness of Maxillary Prosthesis on Phonation- A Comparative Clinical Study

Background: Prosthodontic treatment involves clinical procedures which influence speech performance directly or indirectly. Prosthetic rehabilitation of missing teeth with partial or complete maxillary removable dentures influences the individual voice characteristics like Phonation, resonance etc. Aim: To evaluate the effect of Acrylic palatal plate thickness (1mm-3mm) of maxillary prosthesis on phonation. Materials and Methods: Twelve subjects were selected randomly between the age group of 20-25 years who have full complement of teeth and have no speech problems. Speech evaluation was done under four experimental conditions i.e. Without any experimental acrylic palatal plate (control), with experimental acrylic palatal plates of thickness 1mm, 2mm and 3mm respectively. The speech material for phonation test consisted of Vowels sounds /a/, /i/, and /o/. Speech analysis to assess phonation was done using digital acoustic analysis (PRAAT software). The obtained results were statistically analyzed by One-way ANOVA and Tukey’s multiple post-hoc for comparison of four experimental conditions with respect to different vowel sounds. Results: Mean harmonics to noise ratio (HNR) values obtained for all the Experimental conditions did not show significant difference (p>0.05). In conclusion, an increase in the thickness of the acrylic palatal plate of maxillary prosthesis for about 1mm - 3mm in complete or partial maxillary removable dentures resulted in no significant effect on phonation of vowel sounds /a/, /i/ and /o/. Conclusion: Increasing the thickness of the palatal plate from 1 mm to 3mm has not shown any significant effect on the phonation.

Superparamagnetic-bead Based Method: An Effective DNA Extraction from Dried Blood Spots (DBS) for Diagnostic PCR

Mahmoud Mohammed Sirdah

Introduction:Storing blood as dried spots on filter paper is a trustworthy approach used in genetic screening issues which justifies the necessity for a reliable DNA extraction method. The present work aims to investigate the effectiveness of superparamagnetic-bead based method in extracting DNA from dried blood spots (DBS). Materials and Methods:Sixteen venous blood samples collected in K3-EDTA tubes (400 µl of whole blood) were used for the spotting (4 circles each 100µ l) on Ahlstrom 226 grad filter papers, for extraction and comparison. To ensure effectiveness, the extracted DNA was checked for quantity using the Quant-iT™ dsDNA Broad-Range Assay Kit and for quality by polymerase chain reaction (PCR) amplification of 344 bp segment of the HBB gene. Hybridization assays based on the dynamic allele specific hybridization (DASH) technique for two hemoglobin beta ( HBB ) mutations in genomic DNA extracted from DBS of ß-thalassemia patients were also performed to ensure the quality of extraction. Results:The results revealed a compatible effectiveness of the superparamagnetic-bead based method in extracting DNA from DBS particularly when incubating the DBS with lysis buffers BL+BLM overnight. A mean concentration of 21ng/ µ l was obtained with lysis buffers BL+BLM overnight incubation compared to 5.2 ng/ µ l for 2 h incubation with lysis buffers BL+BLM and 4.7 ng/ µ l when extraction performed using the lysis buffer BLM alone. Moreover, PCR amplification of 344 bp segment of the HBB showed a good quality of the extracted DNA. Conclusion:It was concluded that the superparamagnetic- bead based method is a reliable and effective method for DNA extraction from DBS and can be adopted for genetic diagnostic purposes.

Evaluation of Myofibroblasts By Expression of Alpha Smooth Muscle Actin: A Marker in Fibrosis, Dysplasia and Carcinoma

Bharath Rao K, N. Malathi, Sangeetha Narashiman, Sharada T Rajan

Objective: Evaluation of Myofibroblasts by studying expression of Alpha smooth muscle actin: A marker of Fibrosis, Dysplasia and Carcinoma. Background: Myofibroblasts are cells that have contractile properties and are involved in inflammation, wound healing, fibrosis and oncogenesis in most of the organs and tissues. They are involved in healing and granulation tissue formation which occur after tissue injuries, also produce inflammatory mediators, growth factors and help in extracellular matrix reorganization by secretion of proteins like collagen, fibronectin, etc. Because of their component, Alpha smooth muscle actin ([alpha]-SMA), they are involved in the contraction of extracellular matrix and aid in tissue contraction. The myofibroblasts disappear by apoptosis after completion of repair, but their persistence causes a dysfunction in the repair mechanism, leading to excessive contraction and extracellular matrix (ECM) secretion and thus, fibrosis. The purpose of this study was to evaluate the presence of myofibroblasts in cases of Oral Submucous fibrosis (OSMF), which consisted of very early, early and moderately advanced OSMF, OSMF with dysplasia and oral squamous cell carcinoma (OSCC), by detecting (alpha)-SMA, which is a specific marker for myofibroblasts. Materials and Methods: The study sample consisted of three groups which comprised of 41 cases of OSMF, 10 cases of OSMF with dysplasia and 11 cases of OSCC. All the cases were subjected to immunohistochemistry by using (alpha)-SMA antibody for detection of myofibroblasts. Results: The presence of myofibroblasts was significantly higher in oral squamous cell carcinomas as compared to that in OSMF with dysplasia and OSMF. A statistical significance was also noted between the staining index and age of the individuals and the staining index and duration of the habit. Conclusion: Myofibroblasts play a role in fibrosis, as was seen in OSMF. Activated myofibroblasts secrete proteolytic enzymes and cause matrix degradation, which is instrumental in cancer cell invasion and metastasis. Further studies in which the myofibroblasts are targetted, may help in providing therapeutic regimens in fibrosis, dysplasia and cancer.

Short Term Comparative Evaluation of Antimicrobial Efficacy of Tooth Paste Containing Lactoferrin, Lysozyme, Lactoperoxidase in Children with Severe Early Childhood Caries: A Clinical Study

Background and Objectives: The present study is conducted to compare the anti-microbial efficacy of tooth paste containing lactoferrin, lysozyme, lactoperoxidase (BioXtra ®), a 500ppm fluoride tooth paste, and a non fluoridated tooth paste in children with Severe Early Childhood Caries (S-ECC). Materials and Methods: Study group included 30 children with S-ECC aged 3-5 years. Subjects were randomly selected & divided into three groups of ten each. Group I: Non–fluoride tooth paste, Group II: 500 ppm fluoride tooth paste, Group III: tooth paste containing lactoferrin, lysozyme & lactoperoxidase. Estimation of salivary S. mutans and L. acidophilus levels was accomplished by collecting salivary samples and inoculated on Mitis Salivarius Bacitracin agar (MSB) and Rogosa SL media. Colony Forming Units (CFUs) were counted and the results were tabulated and subjected to statistical analysis. Results: Brushing with tooth paste containing lysozyme, lactoferrin and lactoperoxidase after a week showed highly significant reduction in the CFU counts of both salivary S. mutans and L. acidophilus (p<0.001), whereas 500ppm fluoride tooth paste showed a highly significant reduction in the S. mutans levels (p<0.001), but a significant reduction in L.acidophilus count (p<0.01). Non-fluoride tooth paste showed a highly significant reduction in S. mutans (p<0.001) only, but reduction in the L.acidophilus levels was insignificant (p<0.05). Conclusion: The present study revealed that tooth paste containing lactoferrin, lysozyme, and lactoperoxidase was highly significant in reducing the salivary levels of mutans Streptococci and L.acidophilus in children with S-ECC.

Hypoxia Induced DNA Damage in Children with Isolated Septal Defect and Septal Defect with Great Vessel Anomaly of Heart

Vidya G., Suma H.Y., Vishnu Bhat B., Parkash Chand, Ramachandra Rao K.

Background and Aim:In Congenital Heart Disease (CHD), shunting of blood occurs through the anatomical defects which lead to mixing of oxygenated and deoxygenated blood. Chronic hypoxia which occurs due to the above said mechanism has the potency to cause DNA damage in children with CHD. In chronic hypoxia, there is a liberation of Reactive Oxygen Species (ROS) due to tissue injury as a result of ischemia and induction of hypoxia inducible factor - 1HIF-1 and p53 which in turn activates pro-apoptotic factors leading to alteration in the regulation of pro-apoptotic gene Blc-2 to be involved in causing the DNA damage. The extent of chronic hypoxia and the DNA damage depends on the nature of the anatomical heart defect. Hence, the present case-control study was conducted to find out the DNA damage in children with isolated septal defect and septal defect with great vessel anomaly of heart and to compare the same. Materials and Methods:The study group was categorized into those with isolated septal defects and septal defects associated with great vessel anomaly based on echo-cardiogram. Age and sex matched healthy children were taken as controls. Single- cell gel electrophoresis - Comet Assay of Alkaline Version was performed conventionally and the comets were analyzed using comet score software. Results and Conclusion:The comet metrics was found to be statistically significant in children with isolated septal defect and septal defect with great vessel anomaly when compared with that of the controls. In addition, comet metrics also showed significantly increased DNA damage among children with septal defects associated with great vessel anomaly when compared to isolated septal defects. The data strongly suggests a linear correlation of severity of the anomaly involved with the degree of DNA damage as evidenced by lesser extent of DNA damage in isolated septal defect and greater in septal defect with great vessel anomaly.

Geographical Patterns in Antimicrobial Resistance of Acinetobacter in Clinical Isolates

Naz Perween, Sonal Sehgal, S. Krishna Prakash

Objectives: Acinetobacter spp. has emerged as a threat to the healthcare workers throughout the globe, owing to its property of multidrug resistance. The aim of the present study was to evaluate the antimicrobial resistance patterns of Acinetobacter spp. among indoor and out patients in our hospital and compare the resistance patterns in India and abroad. Materials and Methods: In this retrospective study, which was carried out over a period of one year, a total of 5593 clinical specimens of pus and purulent fluids were examined and antimicrobial resistance pattern for Acinetobacter spp. using Modified Stoke’s were evaluated. Also a comparison was done with the other similar studies. Statistical Analysis: Using the proportions of sensitive and resistant, the statistical analysis was done. The total, mean and percentage were calculated by using SPSS. Results: A high level of antimicrobial multidrug-resistance was found in almost all the clinical isolate. Our study was also found to be concordant with the results of other studies. Conclusion: There is an emerging need for identification of the genes and mechanisms for multidrug resistance among Acinetobacter spp.

A Comparison of Functional Outcomes After Metallic and Bioabsorbable Interference Screw Fixations in Arthroscopic ACL Reconstructions

Atmananda S Hegde, Deepak K Rai, Antony J Kannampilly

Introduction: Anterior Cruciate Ligament (ACL) is as one of the most frequently injured ligaments in the modern contact sports scenario. Graft fixations can be achieved during anterior cruciate ligament (ACL) reconstructions by using either bioabsorbable screws or metal screws. The objective of this study was to compare the functional outcomes after bioabsorbable and metallic interference screw fixations in arthroscopic anterior cruciate ligament reconstructions done by using hamstring grafts. Materials and Methods: This was a prospective, randomized study. Patients in Group 1 received bioabsorbable interference screws and patients in Group 2 received metallic interference screws. Arthroscopic assisted, anterior cruciate ligament reconstructions with the use of hamstring grafts which were fixed proximally with endobuttons and distally with bioabsorbable or metallic interference screws, were undertaken. Progress in functional outcomes was assessed by using Mann Whitney U- test. Functional outcomes in the two groups were compared by using independent t-test. Observation and Results: In each group, there were statistically significant improvements in functional outcomes over successive follow-ups, which were seen on basis on Mann-Whitney U-test. The comparison of functional outcomes between the two groups, done by using independent t-test, showed no statistically significant differences between the two groups at 3 months, 6 months and 1 year of follow-up. p-value <0.05 was considered to be significant in our study. Conclusion: In our prospective study of comparison of functional outcomes between bioabsorbable and metallic interference screws in arthroscopic anterior cruciate ligament reconstructions, which were evaluated by using Tegner activity scale and Lysholm knee scoring scale for a period of 1 year, no statistically significant difference was found. However, further authentication is required by doing long term studies.

Estimation of Lifestyle Diseases in Elderly from a Rural Community of Guntur District of Andhra Pradesh

Samson Sanjeeva Rao Nallapu, T.S.R. Sai

Introduction: Current statistics for the elderly in India give a prelude to a new set of medical, social, and economic problems that could arise if a timely initiative in this direction is not taken by program managers and policy makers. Aim & Objectives: To identify the burden of lifestyle related disease and its pattern among the elderly in a rural population and to look at socio-economic and gender related issues influencing their morbidity. Methodology:This cross-sectional study was conducted during January to June 2012 in two villages under the Department of Community Medicine, NRI Medical College in Guntur District of Andhra Pradesh. A total of 1960 families with a population of 9067 were enumerated. All people, 60 years and above were administered a pretested proforma looking into perceived health status and known disease status. Data was entered in WHO Epi info package and analysed for percentages. Chi square test was applied where appropriate. Results: There were 509 (11.2 percent) elderly female patients and 517 (11.4 percent) male patients (>60 years of age). 52.3 percent of the women and 44.5 percent of the men had some chronic illness. Hypertension was 19 percent and 28 percent in males and females respectively. There was an overall 14 percent of diabetes and 9 percent arthritis. In women, illiteracy, being just a housewife and widowhood were associated with increased lifestyle disease burden. Conclusion: A significant number of elderly are suffering with chronic illnesses even in rural areas. There is a need to highlight the medical and socio-economic problems that are being faced by the elderly people especially the women in India. Rural health programmes need to also put the health problems of the elderly on par with other health related issues.

A Prospective Study of Variability in Glycemic Control during Different Phases of the Menstrual Cycle in Type 2 Diabetic Women Using High Sensitivity C – Reactive Protein

T.S. Gugapriya, S. Karthick, B. Nagarjuna

Introduction: Diabetes mellitus (DM) is one of the metabolic syndromes prevalent worldwide, with more concentration in the Asian region. Many studies have been conducted in order to understand the complex pathogenesis of this disease. Yet, there exists a lacuna in our knowledge about DM. This study aims at establishing the reason for glycemic variation in menstruating Type-2 diabetic women by estimation of C-reactive protein, an inflammatory marker that exhibits significant association with changes in blood glucose levels. Methodology: A prospective study was undertaken in Type-2 diabetic women of reproductive age group to assess the variability of glycemic control during different phases of menstrual cycle using high sensitivity C reactive protein (hs-CRP) as the biomarker. Fifty women were enrolled after satisfying a set of inclusion and exclusion criteria. The fasting blood glucose, hs-CRP concentration and endogenous female hormones were assayed in follicular and luteal phases of the cycle. The observed parameters were analyzed statistically for significant correlation. Observation and Result: The result showed that hs-CRP level significantly correlates with increasing levels of fasting blood glucose level in both the phases of menstrual cycle in Type-2 diabetic women. The significance is statistically stronger during luteal phase of the cycle (r = 0.807; p<0.05). The correlation observed between hs-CRP and Estradiol in follicular phase (r = –0.311; p < 0.05) was not statistically significant. The hs-CRP level increased significantly with progesterone level during luteal phase (r = 0.826; p <0.05). Conclusion: This study concludes that Type-2 diabetic women of reproductive age group encounter a period of poor glycemic control during luteal phase, as shown by statistically high hs-CRP level mediated by endogenous progesterone hormone. Therefore, this study advocates careful monitoring, life style adjustments and drug regime to reduce the fluctuation in glycemic level experienced by Type-2 diabetic premenopausal women in the luteal phase.

Misdiagnosis and Quality of Management in Paediatric Surgical Patients Referred to a Tertiary Care Hospital

Background: The literature on diagnosis and management prior to transfer paediatric surgical patients to a tertiary care center is scarce. In referral centers, it is common to receive patients previously subjected to inadequate or inappropriate health care. Aim: Analyze the prevalence of misdiagnosis and quality of management in patients before being referred and factors related to misdiagnosis and inadequate management. Design: Prospective, longitudinal, comparative study between patients with appropriate and inappropriate submission diagnosis and between patients with adequate or inadequate treatment. Setting: Third level care hospital, Mexico City. Participants: Newborn to adolescents referred to Paediatric Surgery Department. Intervention(s): None. Main Outcome Measure(s): Misdiagnosis and quality of management prior to being referred. Result: Two hundred patients were evaluated. Correlation between submission diagnosis and final diagnosis showed that 70% were correct and 30% incorrect; 48.5% were properly managed and 51.5% inappropriately managed. Incorrect diagnosis was more frequent when referred from first or second-level hospitals and in inflammatory conditions. Patients referred by paediatricians had a higher rate of adequate management. Conclusion: We present the frequency of incorrect diagnosis and inadequate patient management in a highly selected population. Sample size should be increased as well as performing these studies in other hospital settings in order to determine whether the results are reproducible.

A Cross Sectional Study of Sphenoid Sinus through Gross and Endoscopic Dissection in North Karnataka, India

Manisha S. Chougule, Daksha Dixit

Introduction: Sphenoid sinus has got importance due to trans-sphenoid approach to the pituitary gland. This study is an attempt to know the variations in North Karnataka population, through cadaveric dissection and CT scan study. Objective: We want to study variations in sphenoid sinus and its percentage in North Karnataka population. Materials and Methods: Endoscopic examination and dissection of sphenoid sinus was carried out in 30 cadavers (three female and 27 male) using 0º, 30º, 70º rigid nasal endoscopes. Sections were then made in the sagittal plane to confirm the anatomical findings and to take the necessary measurements with millimeter strips. Results: In six of cadavers pre-sellar, in four it was sellar and in 20 it was post-sellar while conchal type of sphenoid sinus was absent. The septa terminated on bone covering internal carotid artery (ICA) in seven cadavers while in two cadavers they terminated on the bone covering Optic nerve (ON). Findings of CT scan study were pre-sellar-8, sellar-14 and post-sellar-37 and in case of one subject left side sinus was conchal. Pneumatization of greater wing of sphenoid was observed in two sinuses, of pterygoid process in four sinuses and of anterior clinoid process in two sinuses. We also found onodi cell in one sinus. Conclusion: Sphenoid sinus shows various types of pneumatisation, and this place the sinus in close proximity to important neurovascular structures that are present around the sinus. Newer techniques are used to confirm surgical landmarks making these techniques very safe.

Relative Risk of Various Head and Neck Cancers among Different Blood Groups: An Analytical Study

Background: Cancer is a unique disease characterized by abnormal growth of cells which have the ability to invade the adjacent tissues and sometimes even distant organs. The limited and contrasting evidence regarding the association of ABO blood groups with the different types of head and neck cancers in the Indian population warrants the need for the present study. Aim and Objective: To assess the relative risk of various Head & Neck cancers among different blood groups. Materials and Method: Three hundred sixty two diagnosed cases of different type of head and neck cancers and 400 controls were selected from four hospitals of New Delhi, India. The information regarding the type of head and neck cancer was obtained from the case sheets of the patients regarding their socio demographic profile, dietary history using a structured performa. The information regarding type of cancer (cases only), ABO blood group was collected. Statistical Tests: The data was analysed using the SPSS 19 version. Chi square test and odds ratio were calculated. The level of significance was fixed at 5%. Results: The O blood group was found to be most prevalent followed by B, A and AB among the cases as well as the controls. Maximum number of oral cancer patients belonged to blood group O followed by B, A and AB. Significant pattern of distribution was seen among the patients of esophageal cancer, laryngeal cancer and salivary gland cancer as well (p=0.003, p=0.000 p=0.112) respectively. Conclusion:The present study reveals that there is an inherited element in the susceptibility or protection against different types of head and neck cancers. Blood group A was found to be a potential risk factor for the development of oral cancers, esophageal cancers and salivary gland cancers while blood group B was found to be a potential risk factor for laryngeal cancers.

Acoustic Noise Levels of Dental Equipments and Its Association with Fear and Annoyance Levels Among Patients Attending Different Dental Clinic Setups in Jaipur, India

Background:Noise is a source of pervasive occupational hazard for practicing dentists and the patients. The sources of dental sounds by various dental equipments can pose as a potential hazard to hearing system and add to the annoyance levels of the patients. The aim of the study was to analyze the noise levels from various equipments and evaluate the effect of acoustic noise stimulus on dental fear and annoyance levels among patients attending different dental clinic setups in Jaipur, India. Methodology:The sampling frame comprised of 180 patients, which included 90 patients attending 10 different private clinics and 90 patients attending a Dental College in Jaipur. The levels of Acoustic Noise Stimulus originating from different equipments were determined using a precision sound level meter/ decibulo meter. Dental fear among patients was measured using Dental Fear Scale (DFS). Results:Statistical analysis was performed using chi square test and unpaired t test. The mean background noise levels were found to be maximum in the pre clinical setup/ laboratory areas (69.23 + 2.20). Females and the patients attending dental college setup encountered more fear on seeing the drill as compared to the patients attending private clinics (p<0.001). Conclusion:The sources of dental sounds can pose as a potential hazard to hearing system. It was analyzed that the environment in the clinics can directly have an effect on the fear and annoyance levels of patients. Hence it is necessary control the noise from various dental equipments to reduce the fear of patients from visiting a dental clinic.

Prevalence and Clinical Characteristics of Hypothyroidism in a Population Undergoing Maintenance Hemodialysis

Klara Paudel

Background: The prevalence of hypothyroidism in persons with chronic kidney disease is documented to be higher, compared to the normal population. However, no data is available about the prevalence rate of hypothyroidism among hemodialysis patients in Nepal. Methods: A cross-sectional analysis was done on consecutive patients enrolled for maintenance hemodialysis in the Hemodialysis Unit of Gandaki Medical College Teaching Hospital, Pokhara, Nepal, during the period of one year (1st January 2011 to 31st December 2011). Total 64 subjects with end stage renal disease were recruited for the study. Thyroid function tests were performed at the time of starting regular hemodialysis. Classical symptoms and signs of hypothyroidism were assessed in all patients. Results: Among the study subjects 17 (26.6%) had serum thyroid stimulating hormone levels above the laboratory reference range (>6.16 µIU/mL). Among them 12 (18.7%) patients had clinically significant symptoms or signs requiring thyroxin replacement. Cold intolerance, constipation, tingling sensation, dry skin, periorbital odema, pericardial effusion, pleural effusion and ascites were found at significantly higher rate in the hypothyroid patient group (p<0.05). Conclusion: The diagnosis of hypothyroidism can be easily missed in the end-stage kidney disease population, because the symptoms of chronic kidney disease and hypothyroidism overlap. In our study we have found high prevalence of hypothyroidism. Clinicians should pay attention on this factor and screen routinely for thyroid disorders in the chronic kidney disease population.

Knowledge and Awareness of Diabetes and Diabetic Ketoacidosis (DKA) Among Medical Students in a Tertiary Teaching Hospital: An Observational Study

Background: The management of Diabetes Mellitus and its important complication Diabetic Ketoacidosis is very crucial in today’s world where the prevalence of Diabetes is very high. Medical students are the pillars of our future healthcare system and it is important to evaluate and update their knowledge and awareness regarding these both conditions. Materials and Methods: This study was a cross-sectional; Questionnaire based observational study conducted in a tertiary care hospital. The respondents were final year MBBS students of that college. Study instrument was a self developed, pre-validated, semi-structured questionnaire. Results: A total of 73 questionnaires were considered for analysis, giving a response rate of 90.12% with 43.83% and 56.16% were male and female respondents respectively. About 81.25% and 90.24% of male and female respondents gave correct answer to question related to the best indicator of glycemic control. Lack of knowledge was seen regarding the world Diabetes day. Approximately 37% of the respondent’s parents were diabetic. Only 12 out of 73 respondents were aware about the factors leading to DKA. 8 out of 73 were aware about investigations to be done in DKA. Around 43.84% of responders knew regarding the proper screening duration in person with risk of diabetes. Conclusion: From the study it was concluded that most of the students have basic knowledge regarding diabetes mellitus, its clinical features and management etc but only 50 % of the respondent were aware about DKA and further teaching and post teaching evaluation are needed in future direction.

Evaluation of Psychological Symptoms in Premenstrual Syndrome using PMR Technique

Veena Jasuja, Geetanjali Purohit, Sameer Mendpara, B.M. Palan

Background: The mood changes surrounding menstrual cycle mainly during luteal phase, known as premenstrual syndrome, have been described as early as the time of the ancient Greeks. Beck Depression Inventory (BDI-II) and State Trait Anxiety Inventory (STAI) are used to study psychological symptoms of anxiety and depression. Aims: To study the psychological parameters and effects of PMR on females with premenstrual syndrome. Settings and Design: It was an experimental study. Materials and Methods: Sixty participants aged between 18 and 40 years, volunteered for this study. Relaxation technique, PMR was given to the study group (Group A, Mean age 24.13±5.69) for one month and control group (Group B, Mean age 28.96±9.42) was evaluated without any intervention. Statistical Analysis Used: Paired students t test. Alpha error was set at 1% level. Results and Conclusion: PMR Group A showed significant decrease in both BDI II and STAI scores (p<0.001), showing benefits of relaxation in reducing anxiety and depression. We conclude that PMR helps to alleviate symptoms of premenstrual syndrome and decreases anxiety and depression as shown by changes in scores of both questionnaires.

Variation in Formation of Superficial Palmar Arches with Clinical Implications

Sheetal Bhimprasad Joshi1, P. Vatsalaswamy, B.H. Bahetee

Background: Knowledge of the variations in the arterial supply of hand has reached a point of practical importance with the advent of microvascular surgery for revascularization, replantation and composite tissue transfers. Arterial supply of hand is derived from two anastomotic arches, formed between two main arteries of forearm i.e. radial, ulnar and their branches, in the palm. Objective: The superficial palmar arch shows variation in formation at the radial side. In the present study we have recorded its data which would help in its clinical and surgical implications. Materials and Methods: In the present study we have studied the formation of superficial palmar arches and their variations in 100 cadaveric hands at Dr. D . Y. Patil Medical College, Pune and B.J. Government Medical College, Pune, India. Result and Conclusion: According to Adachi’s classification the most predominant pattern obseved was of Ulnar type arch (66%). According to Coleman and Anson classification 82% showed complete (Group I) superficial palmar arches and a very low incidence (18%) of incomplete arches (Group II). This suggests that collateral circulation is present in majority of cases. This would result in least number of complications considering radial artery harvesting for coronary bypass. Sub-classification of arches according to Coleman and Anson 1961 indicates that the predominant type in the present study was of Group I (Type B) which is formed entirely by Ulnar Artery (56%). Median artery and ulnar artery forming an incomplete superficial arch under Group II (Type C) having an incidence of 4% was recorded. Thus in such cases radial artery harvesting for coronary artery bypass may prove to be less fatal. This study is an effort to provide data about the formation of superficial palmar arches which has been a centre of attraction for most of the surgical procedures and injuries of the hand.

Rapid Immunochromatographic Test for the Identification and Discrimination of Mycobacterium tuberculosis Complex Isolates from Non-tuberculous Mycobacteria

Vishnu Prasad Shenoy, Chiranjay Mukhopadhyay

Background: A new rapid Immunochromatographic test (ICT) kit (SDBioline TB Ag MPT64RAPID®) developed by Standard Diagnostics, South Korea was evaluated for rapid differentiation of M. tuberculosis from non tuberculous mycobacteria (NTM). It detects MPT 64 antigen in M. tuberculosis isolates using mouse monoclonal MPT 64 antibody. The kit was assessed for routine identification of the Acid Fast Bacilli(AFB) isolated in our laboratory. Materials and Methods: Two hundred eight culture isolates of Mycobacteria were tested using ICT test kit for detection of MPT 64 antigen from liquid and solid culture. H37Rv strain was employed as the positive reference control. Any negative result was referred for confirmation by Gen Probe Accu Probe assay for MTB Complex (Gen-Probe, San Diego, Calif.). Speciation of NTM was performed using genotypic Mycobacterium CM assay (Hain’s life sciences, Germany). Results: Of the 208 culture positive isolates tested, 182 (87.5%) were found positive for Mycobacterium tuberculosis Complex and remaining 26 (12.5%) were considered as NTM. These results were further confirmed by Gen Probe Accu probe assay that served as the reference method for detection of MTBC. H37Rv reference strain was taken as a control for ICT test and molecular tests. The reference strain showed the presence of MPT64 antigen band in the ICT test. Similar bands were formed in all MTBC (182) isolates tested, proving 100 per cent sensitivity and no bands were detected in 48 (100%) NTM isolates tested, proving 100 per cent specificity of the ICT kit. Conclusion: Tuberculosis is a global pandemic. Rapid identification of Mycobacteria as MTB complex or non-tuberculous Mycobacteria from culture is important for treatment of infected cases and drug susceptibility testing of the culture isolate. MPT 64 TB antigen detection using SD Bioline Immunochromatographic test is a simple and cost effective method for differentiation of Mycobacterial cultures as MTB complex from non- tuberculous Mycobacteria.

Root Cause Analysis (RCA) of Prolonged Laboratory Turnaround Time in a Tertiary Care Set up

Kalyan Khan

Introduction: Among the multitude of daily administrative problems which are faced by the modern hospitals today, prolonged Turnaround Time (TAT) of laboratory investigations is a crucial one, which affects patient care as well as patient satisfaction adversely. Aims and Objectives: The specific objectives were to observe the TAT of common laboratory investigations, to identify cause of increased turnaround time and to formulate action plans to rectify increased TAT. Methodology: An observational, RCA study was performed on 100 randomly selected patients. A separate group of 50 patients were assisted to get their investigations done and to reduce the time intervals without actively interfering with the steps. The results which were obtained were accepted as standards. Root cause analysis of the delays which were detected in TAT was done. Time intervals of TAT in the two groups were compared by 2 tailed t-tests done for equality of means. Result and Analysis: All time intervals were high in the study group and they were found to be statistically significant (p<0.05) within a 95% confidence interval of the difference. The maximum time which was needed in the control group was within the interval between the prescription of the investigation by the doctor and writing of the requisition by the Out-patient Department (OPD) staff. For the study population, it was the interval between the writing of the requisition by the OPD staff and the reaching of the patient at the central Laboratory. The standard deviation (27.665) and range (102) were also exceptionally high for this interval in the study group. Conclusion: This study revealed that easy to implement administrative steps would help in reducing the TAT significantly and in improving the quality of services of the central laboratory. These include the setting up of sample collection counters at the outpatient department (OPD) and inpatient department (IPD), employment of minor methods like printing the directions for reaching the laboratory on the OPD ticket, the start of a single prick policy, declaring central laboratory as a separate department and integration of the administrative control under one authority.

Self Care and Medication Adherence among Type 2 Diabetics in Puducherry, Southern India: A Hospital Based Study

Arulmozhi S., Mahalakshmy T.

Background: Micro and macro-vascular complications of Type 2 Diabetes mellitus (DM) could be decreased by maintaining a good glycaemic control, which is dependent on adherence to medication and self care. Aim: (1) To assess medication adherence and adherence to self care among type 2 diabetics who were admitted to a tertiary care hospital (2) To identify factors which were associated with medication adherence. Materials and Methods: This descriptive study involved 150 in-patients of Sri Manakula Vinayagar Medical College and Hospital (SMVMCH), a teaching hospital in Puducherry, southern India. Subjects who had type 2 DM for more than 1 month were included in the study, irrespective of their diagnoses at admission. They were interviewed within 24 hours of their admissions by using a pre-designed, pre-tested, structured questionnaire. The questionnaire included Morisky Medication Adherence Scale (MMAS) and questions for assessing adherence to self care activities. The factors which were associated with medication adherence were identified by Chi-square test and logistic regression. Results: The mean age of the subjects was 54 years. Only 49.3% (95% CI: 41% to 57%) of the diabetics had high medication adherence (MMAS score = 8). Only 22.7% of the diabetics were involved in physical exercise for at least 30 minutes, for at least 4 days in a week. Only 16.7% of them regularly inspected their feet. Around 67.3% of the subjects reported about consuming a diabetic diet for at least 4 days/week. Poor family support showed a significant association with low medication adherence. Conclusion: Only 49.3% of the subjects adhered to anti-diabetic medications. Less than 25% of the diabetics adhered to self care activities such as exercising/walking for 30 minutes on at least 4 days in a week, regularly inspected their feet and provided feet care. Family support played a vital role in medication adherence among the diabetic subjects. Hence, it is important to regularly assess patients for medication adherence and include their families also in counseling sessions.

Colour Doppler Imaging of Ophthalmic Artery and Central Retinal Artery in Glaucoma Patients With and Without Diabetes Mellitus

K. Srikanth, M. Ashok Kumar, S. Selvasundari, M. L. Prakash

Purpose: To assess the ocular blood flow in Diabetic and non-Diabetic Primary Open Angle Glaucoma (POAG) patients. Design: Prospective comparative study. Material and Methods: A total 100 eyes of 50 POAG patients was included in the study and divided into two groups, Group 1 (25 POAG patients without Diabetes mellitus) and Group 2 (25 POAG patients with Diabetes mellitus). Colour Doppler Imaging (CDI) of Ophthalmic artery and Central retinal artery were studied and peak systolic velocity (V max), End diastolic velocity (V min) and Resistivity Index (RI) were assessed. Results: Ocular blood flow in Group 2 showed a reduction in V max, V min and increased RI compared to Group I with a statistically significant reduction in the central retinal artery flow (V max (p=0.01), V min (p=0.07) and RI (p=0.03). Conclusion: CDI showed a significant reduction in the ocular blood flow of POAG patients with Diabetes mellitus.

Comparative Evaluation of the Effect of EDTA, EDTAC, NaOCl and MTAD on Microhardness of Human Dentin – An In–vitro Study

Aim:The aim of this study was to evaluate the microhardness of human dentin by using four irrigating solutions. Materials and Methodos:A total of 40 extracted mandibular premolars were selected and sectioned horizontally in the middle third of the root. Forty specimens of 4 mm thickness were embedded in acrylic resin and polished. Four test groups, each group containing ten specimens were immersed in respective irrigating solution and subjected to vicker’s microhardness test at T0, T2 and T5min. Statistical Analysis:The data obtained were analyzed using the one way ANOVA followed by Tukey HSD method with ap=0.05 as the level for statistical significance. Results:Suggested that there was no statistically significant difference in mean values between four experimental irrigating solutions. Conclusion:Mixture of Tetracycline isomer i.e. Doxycycline, Citric acid and a Detergent (Tween 80) MTAD not altered the microhardness of root canal dentin significantly and seems to be an appropriate irrigating solution, because of its harmless effect on the microhardness of the root canal dentin.

Early Universal Screening for Gestational Diabetes Mellitus

Ramya Neelakandan, Prabhu Shankar Sethu

Objective:To study the prevalence of Gestational diabetes mellitus and to assess the impact of early universal screening to detect Gestational diabetes mellitus. Materials and Methods:Consecutive 1106 pregnant women were screened for Gestational diabetes mellitus at their first prenatal visit during the study period of February 2012 to January 2013. All the women were screened with a initial 50 gram one hour glucose challenge test (GCT) and those women who tested positive were subjected to a standardized 75 gram oral glucose tolerance test(OGTT).The prevalence of Gestational diabetes mellitus and its association with age, infertility, obesity, hypertension, family history of diabetes was studied. The impact of early universal screening for GDM was assessed. American diabetic association (ADA) and International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria for diagnosis of Gestational diabetes mellitus was used in our study. Results:Of the total 1106 pregnant women who were screened with the initial 50 gram one hour glucose challenge test (GCT), 458 (41.4%) had their one hour plasma glucose value >130 gm/ dl. Of the 440 women who responded to and underwent the subsequent 75gram OGTT, 158 (61.2%) had one abnormal value, 73(28.2%) had two abnormal values and 27 (10.5%) had three abnormal values. 64(24.8%) of them had fasting plasma glucose = 92/dl. 36(13.9%) women were found to have GDM in the first trimester (12 weeks), 43 (16.7%) in the 13-18 weeks, 114 (44.1%) in the 19-28 weeks and 65 (25.2%) in the third trimester(28 weeks). The overall prevalence of GDM was 23.3%.There was increased association of GDM with increasing age, parity, family predisposition and infertility. Conclusion:It is evident that there is increased prevalence of GDM in Indian population. Universal screening for GDM is better to routine risk factor based screening and it should be done at the first prenatal visit for early diagnosis of glucose intolerance in pregnancy especially in countries like India. There is increased association of GDM with infertility, advanced age, obesity, family predisposition and parity.

Chemiluminescence and Toluidine Blue as Diagnostic Tools for Detecting Early Stages of Oral Cancer: An invivo Study

Background:There is a need for development and use of diagnostic aids that help the dental specialist more readily identify and assess Potentially Malignant Epithelial Lesions (PMELs) and Oral Squamous Cell Carcinoma (OSCC). This study was done to assess the value of two such commercially available tools: chemiluminescent light kit or ViziLite and 1% toluidine blue. Aims and Objectives:a) To detect epithelial dysplastic changes using chemiluminescene (commercially available as ViziLite) and toluidine blue staining in PMELs and OSCC patients and compare the results obtained with histopathological examination. b) To determine whether these techniques can be used to detect early epithelial dysplastic changes in clinically normal appearing oral mucosa of high risk (with habits) patients. Materials and Methods:A total of 60 patients- 25 patients with PMELs, specifically oral leukoplakia, 10 patients with clinically diagnosed OSCC and 25 high risk patients with no clinically visible lesion, were screened with ViziLite and toluidine blue staining; followed by incisional biopsy. Results:Sensitivity and specificity of ViziLite were calculated to be 95.45% and 84.6% respectively. ViziLite detected early epithelial dysplastic changes in one high risk patient with clinically normal appearing oral mucosa. Sensitivity and specificity of toluidine blue were calculated to be 86.36% and 76.9% respectively. Conclusion:ViziLite was relatively reliable in screening PMELs compared to toluidine blue, and was a useful chair side diagnostic aid.

Low Hemoglobin Level a Risk Factor for Acute Lower Respiratory Tract Infections (ALRTI) in Children

Sheikh Quyoom Hussain, Mohd Ashraf, Juveria Gull Wani, Javid Ahmed

Background: Acute lower respiratory tract infection is a major cause of death in under five years of age, and anemia is the commonest co-factor in pediatric patients seeking medical advice especially in developing countries. Aim: To analyze whether a low hemoglobin level is a risk factor for acute lower respiratory tract infections (ALRTI) in children. Materials and Methods: Prospective case control study on 220 children (110 cases and controls each) was carried out in our children’s hospital (G.B. Pant Hospital), an associated hospital of Government Medical College Srinagar, of Kashmir Northern India. All patients between the age of 1 month to 5 years of age who fulfilled the inclusion criteria were included. We used WHO criteria to diagnose ALRTI among the cases, and age and sex matched patients who did not have respiratory complaints were kept as controls. Patients who had congenital heart diseases, tuberculosis, malignancies, or dysmorphic features were excluded from the study. All patients were subjected to detailed history and thorough clinical examination followed by investigations like complete blood count (CBC), peripheral blood film (PBF) smear, blood culture and sensitivity test, X-ray chest, serum iron and iron binding capacity were done in all cases. Results: Our study had slightly male preponderance 57.3% in study group and 59.1% in control group. Maximum number of children were between 3 months and 23 months both in the study (80.9%) as well as in the control (81.8%) group. In this study hemoglobin level <11 gm/dL was considered low. Mean Hb level was 8.8 gm/dL in the study group and 11.6 gm/dL in the control group. Anemia was found in 71 (64.5%) cases in the study group and in 31 (28.2%) cases in the control group. Anemic patients were found to be 4.6 times more susceptible to ALRTI in our study (Odds Ratio was 4.63), p-value <0.001. Iron deficiency was found in 78.9% of total anemic cases in the study group, p-value <0.001. In the study group, the mean serum iron level was 35.3 mcg/dL in the anemic cases and 57.1 mcg/dL in the non-anemic cases. while in the control group, these values were 52.4 mcg/dL and 62.6% mcg/dL respectively, (p-value <0.01). Conclusion: Anemia, predominantly iron deficiency anemia, was significantly found in ALRTI patients, and these patients were found to be 4.6 times more susceptible to ALRTI. Early and accurate diagnosis of anemia in children suffering from various ailments in particular to ALRTI will serve the mankind in a better way.

Experience with Uroflowmetry in Evaluation of Lower Urinary Tract Symptoms in Patients with Benign Prostatic Hyperplasia

Introduction: Uroflowmetry is a non- invasive urodynamic tool which is widely used for most of the patients with suspected lower urinary tract dysfunction. The severity of lower urinary tract symptoms (LUTS) can be measured reliably by using a number of validated questionnaires, like International Prostate Symptom Score (IPSS). This study was designed to determine the relationship between the parameters of uroflowmetry and symptom severity. Materials and Methods: Fifty patients with LUTS caused bybenign prostatic hyperplasia were evaluated by using uroflowmetry, IPSS, prostate volume estimation. The correlations between these parameters were quantified by means of Spearman correlation co-efficients. Results: Statistically significant correlations were found between the IPSS and results of uroflowmetry (peak flow rate and average flow rate) and post-void residual urine. No correlation was found between the IPSS and results of prostate volume measurements. Conclusion: There was a positive correlation between peak flow rate, as was measured by uroflowmetry and lower urinary tract symptom severity.

A Comparative Study Between Microwave Irradiation and Sodium Hypochlorite Chemical Disinfection: A Prosthodontic View

Kashish Goel, Rupesh Gupta, Jitender Solanki, Meghanand Nayak

Background: Prosthodontic procedures involving dental impressions, stone casts, record bases and prostheses may cause transmission of microorganisms between the patient, the dentist, auxiliary staff and laboratory personnel. In recent times, microwave radiation has gained wider acceptance in the field of applied science and has been used to reduce concentrations of bacteria and fungi, to dry dental casts,and to sterilize preparation media. Objective: This in-vitro study was conducted to compare microwave irradiation and 0.07% sodium hypochlorite chemical disinfection. The study also evaluated the effect of microwave irradiation and 0.07% sodium hypochlorite chemical disinfection on the dimensional stability of Kalstone casts. Materials and Methods: Forty impressions were made and divided into two groups of 20 each. Each group was contaminated with Staphylococcus aureus and Pseudomonas aeruginosa respectively. Each impression was divided into three parts and marked A, B, C. Impressions were then poured in kalastone. Part A of 20 kalastone casts were microwave disinfected, and Part B were chemically disinfected (0.07% NaOCl) while Part C were not disinfected and used as control. Results: On comparing the significant difference was seen in the microbial load between microwave and chemical disinfection (Z=56.480; p<0.001). Conclusion: On the basis of observations made for the antimicrobial assessment the microwave irradiated Kala stone casts proved to be a better disinfection method when compared with 0.07% sodium hypochlorite chemically disinfected incorporated cast. No significant difference was seen in the dimensional stability of Kala stone discs.

Study of Changes in Renal Function by Perindopril and Telmisartan during Treatment of Systemic Hypertension

Manish Kumar, Lalit Mohan, Harihar Dikshit

Background: Angiotensin Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARBs) has been a major therapeutic advance in the management of hypertensive patients. This study was designed to compare adverse effects on renal markers in treatment with two commonly used drugs Perindopril and Telmisartan in cases of Hypertension. This was an ‘observational’ and ‘cross-sectional’ study. Methods: This study was conducted in two groups, Group A (Newly diagnosed hypertensive patients) and Group B (Old but poorly controlled hypertensive), each had 100 patients. In both groups, half the patients were given Perindopril 4 mg OD and half were given Telmisartan 40 mg OD for 24 weeks. If blood pressure was not controlled, dose was titrated to response and increased to 8 mg OD and 80 mg OD for Perindopril and Telmisartan respectively to keep mean arterial pressure between 90–115 mmHg. The adjusted dose was kept constant in both groups. Blood urea, serum creatinine and creatinine clearance was estimated initially and then at 4th, 12th and 24th week. Results: Treatment with Perindopril showed that mean baseline values for blood urea, serum creatinine and creatinine clearance in newly diagnosed and old hypertensive patients were 30.88, 1.37, 64.09 and 33.68, 1.53, 55.98, respectively. After study period these values were 32.24, 1.40, 63.97 and 29.80, 1.46, 59.23 respectively (p value > 0.05). Treatment with telmisartan showed that mean baseline values of blood urea, serum creatinine and creatinine clearance in both group of patients were 30.88, 1.52, 59.31, and 31.72, 1.40, 65.67, respectively. After treatment these values in both groups were 31.92, 1.43, 62.66; and 32.20, 1.46, 61.70, respectively (p value > 0.05). Conclusion: It concluded that both Perindopril and Telmisartan significantly reduces systolic, diastolic and mean arterial pressure without any significant effect on renal function in both newly diagnosed and old hypertensive patients.

Impact of Prehypertension on Left Ventricular Structure, Function and Geometry

Background: Awareness of prevalence, determinants, and prognosis of asymptomatic untreated prehypertension is still lacking especially in India and subcontinent. Aim: The present study was to assess the effects of prehypertension on structure, function and geometrical pattern of left ventricle on the basis of left ventricular mass (LVM), left ventricular mass indexed to height (LVMI/Ht), and relative wall thickness (RWT) recorded by echocardiography based on the American society of echocardiography (ASE) convention. Methods: The study population included prehypertensives (n 61; 31 M, 30 F) and normotensives (n 38; 19 M, 19 F) between age 25 and 65 years, and were assessed by echocardiography. Results: It was observed that the stroke volume (SV), cardiac output (CO), cardiac index (CI), body mass index (BMI), body surface area (BSA), were found to be little elevated but was not significant in hypertensive females compared to normotensives. Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), pulse pressure (PP), mean arterial pressure (MAP), end systolic stress (ESS), and end isovolumetric systolic stress (EISS) were significantly elevated (p<0.001) in female prehypertensives compared to normotensives. Left ventricular mass (LVM) was significantly (p< 0.05) elevated, indicating alterations in cardiac morphology and functions even during prehypertensive stage. However, in prehypertensive males, SBP, DBP, HR, PP, MAP, ESS, and EISS were significantly (<0.001) raised; ejection fraction (EF%) and fractional fibre shortening (FS%) were noted to be within normal range in both sexes. Prehypertensive males showed changes in left ventricular geometry in the form of concentric remodeling (CR-3.22%), eccentric hypertrophy (EH-3.22%) and concentric hypertrophy (CH-12.90%). Prehypertensive females showed (CR-6.66%), (EH-3.33%) and (CH-6.66%). Conclusion: Such findings carry prognostic implication and require further population survey involving a larger group. Early diagnosis of prehypertension will help to take necessary preventive measures to reduce mainly the future cardiovascular complications. The care of prehypertensive subjects should include, to reduce the afterload in order to improve the left ventricular contractile state as early as possible. So it is advisable to do routine echocardiography after the age of 40 years.

Recent Trends in the Sociodemographic, Clinical Profile and Psychiatric Comorbidity Associated with Posttraumatic Stress Disorder: A Study from Kashmir, India

Objective: To estimate the Prevalence of post-traumatic stress disorders (PTSD) among adults in field practise areas of Government Medical College, Srinagar, India. Methodology: The present study was cross-sectional in nature and was conducted in field practice areas of Government Medical College Srinagar. Three blocks of field practice areas of Government Medical College, Srinagar comprising of various villages were selected. Further 10 per cent of these villages were selected by the method of randomization sampling and then 10 per cent of household were taken again by systemic random sampling. In the selected household all adult population (18 years and above) were selected and screened by using General health questionnaires(GHQ). The patients who screened positive for PTSD (post-traumatic stress Disorders) were assessed and diagnosed. From the line listing the positive cases, the prevalence rates were calculated. Results: Of the total 3400 subjects (age=18 years), the prevalence of post-traumatic stress disorders among general population was found to be 3.76%. Prevalence was found to be more in females (Chi-square test=2.086, p>0.05 (Insignificant). Most of cases were found to be in the age group 0-40 years. Most of the cases were married, illiterate and belong to lower socioeconomic class. Death of near one comprised the major traumatic event. Acute onset Post-traumatic stress disorder was the commonest type, previous history of psychiatric illness was found in 12 % of patients and drug abuse was present in 22.6%. Conclusion: Our findings clearly indicates that post-traumatic stress disorders (PTSD) is a prevalent disorder in the developing world, especially in disaster prone regions and in areas of political unrest. Resilience to various traumatic events in Kashmir has developed over the years and this might explain the lower prevalence of Post-traumatic disorder (PTSD) in our study.

Study of Tumour Cellularity in Locally Advanced Breast Carcinoma on Neo-Adjuvant Chemotherapy

Swarup Kumar, Bhawana Ashok Badhe, KM Krishnan, Haritha Sagili

Background: Breast cancer is the most common invasive malignancy which occurs in women worldwide. The advent of neoadjuvant chemotherapy has radically changed the management of locally advanced breast cancer and a complete response is reported to significantly improve disease free survival. Traditionally, clinical response is assessed on basis of tumour size. In this study, an attempt was made to check whether tumour cellularity could be a better prognostic factor and also to check as to what impact the correlation of tumour size with cellularity had on the response assessment in locally advanced breast cancer patients. Materials and Methods: Thirty seven patients with locally advanced breast cancer, who were treated by neoadjuvant chemotherapy during the period of December 2008 to May 2009, were selected for the study and from their case records, tumour size, clinical response and demographic details were gathered. Tumour cellularity was assessed prior to chemotherapy in core needle biopsy sections and it was matched with that seen in subsequent mastectomy specimens. Tumour size and cellularity were then correlated with the different treatment response groups and they were statistically analyzed by using the SPSS, version 13.0 software. Results: After neoadjuvant chemotherapy, the tumour size and cellularity were found to be significantly reduced in breast carcinomas (p<0.05,paired t-test). The relative changes in cellularity which were seen were highly variable between individual patients and different clinical response groups, particularly in the partial response and no response categories. The product of cellularity and size dramatically changed the distribution of residual tumour pathology, thus causing a shift towards a complete response. Conclusion: The current study showed that the product of tumour size and cellularity may be a better prognostic indicator of clinical response in patients with neoadjuvant chemotherapy treated locally advanced breast cancer and that it would enable a new definition for clinical response in the future.

An Assessment of the Level of Awareness, Attitudes, and Opinions of the Medical Students Concerning HIV and AIDS in Malaysia

Rohit Kumar Verma,Shirley Wong, Srikumar Chakr avarthi, Ankur Barua

Introduction: Human Immunodeficiency virus infection (HIV) and Acquired Immunodeficiency Syndrome (AIDS) has become one of the most serious health problems in the world. Medical students awareness, attitudes and opinions must be assessed as they are leading health care professionals who provide treatment and care to the HIV and AIDS individuals. This survey was conducted to assess the level of awareness, attitudes and opinions of third year till fifth year medical students concerning HIV and AIDS from universities around Klang Valley area, Malaysia. Materials and Methods: A total of 327 medical students of third to fifth year took part in the survey. Self prepared and self validated questionnaire was used to assess the study outcomes. Students were asked to fill the consent forms before filling the questionnaires. The results were analyzed by using SPSS version 17. A cross-sectional study among medical students was performed. Data was analyzed with non-parametric spearman’s correlation test to find the difference at p-value < 0.05. Results: A great majority knew that HIV can be spread via tattoo or body piercing (89.3%), from mother to child (97.9%), being a homosexual (93.3%) and even having circumcision for protection (71.9%). Also, they were aware that HIV cannot be transferred via sneezing and cough (95.1%), swimming pools (89.0%), and toilet seats (89.6%). However, only a few were aware of other modes of transmission, such as visiting the barbers (41.3%) , and having blood splashed on outer body surface including mouth and eyes (49.2%). Only a few negative attitudes were shown such as being unsure about keeping close vicinity to HIV patients and being unsure of whether HIV negative people should be allowed to marry HIV positive patients (median=3). Conclusion: An optimal plan of education with awareness campaign and preclinical experiences should be made in the future curriculum to increase the knowledge, confidence and minimize phobia among students.

Prevalence of Metabolic Syndrome in Thai Children: A Cross-sectional Study

Lakkana Rerksupp aphol, Sanguansak Rerksuppaphol

Background: Metabolic syndrome in children has become the focus of many research projects in recent years. The main goal of this study is to evaluate the prevalence of metabolic syndrome in Thai children and its correlation with overweight and obesity. Material and Methods: A cross-sectional study of 348 children enrolled in grade 1 to grade 9 was done in Ongkhaluck province in Thailand. Demographic and anthropometric data were gathered. Blood tests were also performed to check for blood glucose, total cholesterol, and triglycerides. Results: The overall prevalence of metabolic syndrome in our population was 4.0%. Metabolic syndrome was found in 0.7% of non-obese/non-overweight children and 17.6% of obese/overweight children. Participants with metabolic syndrome were found to be significantly older, heavier, and taller and to have higher parameters of adiposity when compared with those without metabolic syndrome. Obesity was significantly correlated with every criterion of diagnosis of metabolic syndrome except Impaired Fasting Glucose (IFG). Conclusion: Findings of this study suggest that the prevalence of metabolic syndrome in Thai children is consistent with other reports from across the world.

Corneal Changes in Diabetic Patients after Manual Small Incision Cataract Surgery

Renu Dhasmana, I.P. Singh, Ramesh C. Nagpal

Background: Diabetics have abnormal corneal morphology along with higher rate of corneal endothelial cell loss and decreased corneal endothelial cell density and early onset of cataract. Aim: To evaluate the changes in corneal endothelium and corneal thickness in patients with diabetes mellitus after Manual Small Incision Cataract Surgery (MSICS) in eyes with brunescent Cataract. Materials and Methods: Sixty eyes of 60 patients with Type 2 diabetes mellitus and 60 eyes of 60 age matched healthy patients of advanced brunescent cataract underwent MSICS were evaluated. All the patients underwent specular microscopy for the corneal endothelial cell count of cornea and central corneal thickness pre-operatively, at one week, six weeks and 12 weeks post-operatively. The morphology, variation in the endothelial size and shape and percentage of hexagonal cells were assessed. Results: The mean pre-operative endothelial count in the control was higher than the diabetic group (p<0.001). The post-operative endothelial count loss in both the groups were statistically significant (one-way ANOVA p<0.001). On comparing post-operative endothelial loss in non-diabetics (8.05%) to diabetic group, the diabetic group had significantly higher endothelial loss (14.19%, p<0.001). There was also a significant increase in central corneal thickness in diabetics as compared to control (p = 0.004). The change in percentage hexagonal cells in diabetic group was significantly higher than in non-diabetic group (p = 0.005). Inter group change in coefficient of variance was not statistically significant (p=0.144). Conclusion: Compared to non-diabetic patients, diabetic patients have more endothelial cells damage after MSICS. Corneal endothelial evaluation of diabetic patients is recommended before any intraocular surgery.

Co-production of ESBL and AmpC ß-Lactamases in Clinical Isolates of A. baumannii and A. lwoffii in a Tertiary Care Hospital From Northern India

Pooja Singla, Rama Sikka, Antariksh Deeep, Deep Gagneja, Uma Chaudhary

Background: Acinetobacter baumannii is an important cause of health care associated infections which are difficult to control and treat, because of widespread antimicrobial resistance which is possessed by this organism. Aim: The aim of the present study was to know the prevalence of ESBLs and AmpC ß-lactamases in clinical isolates of Acinetobacter spp. which were cultured from various clinical specimens by using different phenotypic methods. Settings and Design: Study was conducted over a period of one year at the Microbiology Department of a tertiary care teaching hospital. A total of 100 consecutive, non-duplicate strains of Acinetobacter species which were isolated from various clinical samples were included. Materials and Methods: All the isolates were identified by standard microbiological procedures and antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion technique. Isolates which showed reduced susceptibilities to third generation cephalosporins were tested for ESBL production by CLSI double disc synergy method and also by using sulbactam as an inhibitory agent. Isolates which showed reduced susceptibilities to cefoxitin were tested for AmpC detection by doing AmpC disc test. Statistical Analysis: SPSS, version 17 was used to calculate p-value. If the p-value was <0.05, it was considered to be significant. Results: Out of 100 isolates, 82 were Acinetobacter baumannii and 18 were Acinetobacter lwoffii. ESBL were mentioned in 4% of the Acinetobacter isolates and in 77% of the isolates by using clavulanic acid and sulbactam as inhibitory agents respectively. AmpC ß-lactamase production was detected in 60% isolates of Acinetobacter spp. Co-production of both ESBL and AmpC enzymes were seen in 29% of the Acinetobacter strains. Conclusion: Failure in detecting ß-lactamases contributes to their uncontrolled spread and therapeutic failures. Hence, these ß-lactamases should be detected routinely and they should be reported to clinicians in time, so that inappropriate use of antibiotics can be stopped in time.

Quality Theory Paper Writing for Medical Examinations

Samarth Shukla, Sourya Acharya, Neema Acharya, Tripti Shrivastava, Anita Kale

Aim & Objectives: Developing a tactful paper writing skill, through delivery and depiction of the necessary expressions required for in standard or superior essay writing. Understanding relevance and tact of theoretical expression in exam paper writing Learning Indices of standard or quality theory/essay answer (SAQ/LAQ). Applying knowledge and skill gained through these theory writing exercises and assignments to achieve high or better scores in examinations Methods and Materials:The study subjects were divided into two groups- Group A (17 students) and Group B students (10 students). The students were selected from II M.B.B.S 4th term. Students of Group A were sensitized on how to write a theory paper and went through 4 phases namely pre-sensitization test, sensitization (imparting them with skills of good theory paper writing through home assignments and deliberations/ guidance), post-sensitization test and Evaluation. Students of Group A (17 students) undertook theory tests (twice, i.e. before and after sensitization) and Students of Group B (10 students) who were not sensitized and took the theory test with post-sensitized Group A students (random 10 students). Both groups were given general pathology as the test syllabus, taught to both groups in didactic lectures during the last 6 months. The results of pre and post-sensitization tests from both groups were analyzed. Intra group comparisons (pre-sensitized Group A with post-sensitized Group A) and inter-group comparisons (Non-sensitized group B with Sensitized Group A) were made. Results: Significant results were found between results of pre and Post-sensitization tests in Group A (intra group analysis) and inter-group (Group A and B) Post-sensitization tests, as there was remarkable improvement in student theory paper writing skills post sensitizing the students of Group A. Conclusion: Medical students should be mandatorily guided and exposed to the nuances and tact of writing the theory paper for their examinations, as it definitely gives them better understanding of presentations ultimately improving their score in the theory exams.

Occupational Health Hazards among Sewage Workers: Oxidative Stress and Deranged Lung Functions

Background: Sewage workers, because of their occupation, are exposed to different types of dusts, bio-aerosols, fumes and gases like methane, hydrogen sulfide, sulphur dioxide, etc, which contribute towards oxidative stress and detrimental effects on various body functions, especially lung functions. Aims and Objectives: This study was carried out on sewage workers (who had been working for more than five years). We wanted to study the role of oxidative stress in development of impaired lung functions among sewage workers. Materials and Methods: This cross sectional study was done in a tertiary care hospital (J.N. Medical College) in Aligarh, U.P. Study was done from March 2008 to December 2009. The study group comprised of 62 sewage workers who had been working for more than five years (32 non-smokers and 30 smokers) and 60 control subjects (30 smokers and 30 non-smokers). The pulmonary functions of these workers were assessed by using a MIR (Medical International Lab) Spiro Lab II Spirometer, with subjects in sitting position. Valid written consents were obtained from all the subjects. Malondialdehyde (MDA) is produced as a result of the action of reactive oxygen species (ROS) on the lipids present in the membranes of the cells, especially, contracting muscle cells. Serum MDA levels were assessed as an indirect measure of oxidative stress in these sewage workers and they were compared with serum MDA levels of control subjects. Appropriate statistical tests were applied for analysis of the data which was generated. Observation and Results: There were statistically significant decreases in Peak Expiratory Flow Rate (PEFR), Forced Expiratory Volume in first second (FEV1) and FEV1/FVC percent ratio (<80%) and Forced Expiratory Flow at 25%-75% of volume as percentage of Vital Capacity (FEF 25%-75%). Also, we found statistically significant increased levels of serum MDA in these sewage workers as compared to those in control subjects (with a p-value of <0.05 with a confidence interval of 95%). Conclusion: Our study found that the occupational exposure of the sewage workers to harmful dust, fumes, gases and bio-aerosols contributed to oxidative stress among them. This oxidative stress was one of the mechanisms which led to the development of obstructive impairment of lung functions in these sewage workers.

Cognitive Behavioural Therapy Versus Basic Health Education for Tobacco Cessation among Tobacco Users: A Randomized Clinical Trail

Introduction:Tobacco is the greatest disease-producing product which is known to man and it is a primary cause of many oral diseases and adverse oral conditions. This study was conducted to bring the behavioural changes and to educate individuals about the harmful effects of tobacco. Method:Subjects reporting to the tobacco cessation centre of the Department of Public Health Dentistry and giving a history of tobacco consumption (smoking/smokeless) within past 30 day period were randomized into 2 groups: cognitive behavioural therapy (CBT) group (study group) and Basic health education (BHE) group (control group). Baseline evaluation (of demographic parameters, smoking/ smokeless behaviour) was done and Fagerstrom’s test for Nicotine Dependence (FTND) was used to assess subjects’ nicotine addiction levels. Follow up was done at intervals of 2 weeks and 4 weeks to assess the reduction in the mean FTND score. Appropriate statistical analysis was performed (Paired and Unpaired t-test). Results: Of all the subjects who reported to the department, 40 subjects were recruited in the study. A majority of the subjects were males who belonged to rural areas, who had completed high school and most of them had consumed more than 10 sachets of pan masala daily, for an average of 10 years. In both CBT and BHE groups, significant reductions in mean Fagerstrom scores at 1st and 2nd follow ups from baseline and between 1st and 2nd follow ups were seen. But when both groups were compared, reductions in mean Fagerstrom scores were found to be more in CBT group than in BHE group at all time intervals, though it was not statistically significant. Conclusion: Any intervention given to tobacco users from either CBT or BHE groups, helped the patients in quitting habit of tobacco.

Prevalence of Antibodies to Hepatitis C Virus in Voluntary Blood Donors: Are Women Better Donors?

Dakshayani Padmakar Pandit, Pradhan Pagaro M., Chaudhury Nabamita

Background: Hepatitis C virus (HCV) is transmitted by blood and blood products and it causes a major proportion of transfusion transmitted hepatitis. It can lead to chronic liver disease which has great morbidity and mortality. HCV is responsible for more deaths than Human immunodeficiency virus (HIV). As no vaccine is available and as the treatment is costly and lengthy, with a poor success rate, donor screening remains a very important means of primary prevention of HCV transmission. Aims and Objectives: This study was conducted to know the prevalence of anti-HCV in healthy voluntary blood donors (VBD) in a semi-urban region of western Maharashtra, India with a special focus on female donors. Settings and Design: This was an unlinked, anonymous, retrospective study. Materials and Methods: During January 2006 to December 2012, sera of 17976 VBD, which comprised of 16972 (94.41%) males and 1004 (5.59%) females, were tested for presence of anti-HCV antibody (anti-HCV) by using a 3rd generation ELISA test. Data was statistically analyzed by using Chi-Square for linear trends (Extended Mantel-Haenszel test). - 0.72732. Results and Conclusion: Thirty six donors (0.2%) were positive for anti-HCV. Seroprevalence in males was 0.21%, while that in females was 0%. The positivity of anti-HCV remained stable over the tenure of this study (Chi-Square for linear trends - 0.72732). This region has a lower prevalence of anti-HCV as compared those seen in other states of India. Zero prevalence in women indicated that encouraging women to undergo blood donations would still reduce the transmission of HCV. Detection can be improved by doing better tests like HCV RNA detection and further prevention of HCV transmission can be enhanced.

Clinico-Hematological Study of Acutemyeloid Leukemias

Preethi C.R.

Context: Acute Myeloid leukemia has been of special interest to innumerable workers in the field of cancer research since the blood and haematopoietic tissue can be easily and repeatedly sampled. Aim: • To know the relative incidence of Acute myeloid leukemia among the patients referred for complete haemogram at the Department of Pathology, JJMMC, Davangere, India. • To study the clinical manifestations and their correlation with various types of acute myeloid leukemia. • To study the haematological profiles in acute myeloid leukemia. Settings and Design: This was a hospital based study conducted at haematology unit, Department of Pathology, JJM Medical College, Davangere, India. Materials and Method: The present study was done during the period of June 2006 to May 2008 at haematology unit department of Pathology, JJM Medical College, Davangere, India. Cases from Chigateri General Hospital, Bapuji Hospital and other private hospitals situated in and around Davangere were included for the study. The case selection was based on the clinical features and supported by laboratory evidence. Bone marrow aspiration was subsequently carried out after obtaining written consent from the patient or the guardian. Statistics: The results were expressed in percentage. Results and Conclusion: A total of 1039 patients who were referred to the Department of Haematology out of which 50 patients were diagnosed as Acute Myeloid Leukemia. The present study highlighted that light microscopic features of peripheral smear and bone marrow will still remain mainstay in the diagnosis of acute leukemias.

To Evaluate the Feasibility of Neurotisation of Facial Nerve Branches with Ipsilateral Masseteric Nerve: An Anatomic Study

Context: Facial palsy is a common problem encountered in clinical practice. These patients suffer serious functional, cosmetic & psychological problems with impaired ability to communicate. Functional problems around the eye are usually a first priority for the patient with facial palsy.The nerve to masseter as a direct nerve transfer to the zygomatic branch of facial nerve to reinnervate viable facial muscles within a year after the onset of paralysis has been scarcely reported. This study was contemplated to evaluate the feasibility of neurotisation of zygomatic branch of facial nerve with masseteric nerve branch of the trigeminal nerve Objectives: Establishing the anatomic relationship of masseteric nerve to masseteric muscle, determining feasibility of neurotisation of zygomatic branch of facial nerve using the nerve to the masseter and establishing fascicular correlation of the donor and the recipient nerves. Materials and Methods: Ninteen hemi-faces in ten fresh cadavers (6 Male and 4 Female)were dissected in a forensic morgue and access was by a standard preauricular incision and anterior skin flap is elevated in a subcutaneous plane. Facial nerve and its two main divisions are dissected in its full A*/extratemporal course. Zygomatic branch dissected upto zygomatic arch and the nerve to the masseter is identified within the masseter muscle, dissected proximodistally to isolate it. Feasibility of transfer of this masseteric nerve to the zygomatic branch without using nerve graft is determined. At the completion of dissection, the ends of both nerves are sent for HPE analysis to determine fascicular anatomy and count. Results: The dissection of masseteric nerve was done taking into consideration of 3 axes, that is anteroposterior (x), vertical (y) axes and mediolateral (z) for locating the nerve and for standardization of the dissection. The nerve was cut and stored in glutaraldehyde solution and subjected to histopathologic examination after fixing and staining with Haematoxilin-eosin stain. Donor masseter neve has 7-10 fascicles. Recipient zygomatic branch has 2-3 fascicles. And the buccal branch has 5-6 fascicles. Conclusion: The use of the nerve to masseter offers a simpler ipsilateral alternative for neurotisation of the facial nerve branches in patients who have an early facial nerve paralysis.

Effect of Intravenous Methylprednisolone on Pain after Intertrochanteric Femoral Fracture Surgery

Background: Pain after surgery is one of the major problems in patients with intertrochanteric fracture. This study investigates administration of single-dose Methylprednisolone prior to surgery with the goal of reducing post-operative pain. Materials and Methods: The study was a Double Blind Randomized Clinical Trial. Eighty two patients with stable intertrochanteric unilateral fracture were selected and divided into two groups: one received Methylprednisolone (MP) 125 mg and the other received placebo. Pain was evaluated at rest and 45° flexion of the hip in times 4, 6, 8, 12, 24, 36, and 48 hours and during walking in times 24, 36, and 48 hours after the surgery. Post-operative nausea, vomiting and fatigue and changes in C - reactive protein (CRP) levels before and after the surgery were also recorded. Results: Pain at rest, 45° flexion of the hip and during walking after the surgery was significantly lower in the MP group compared to the control group (p < 0.001). Fatigue (p = 0.002) and changes in CRP (p=0.001) were significantly lower in MP group. Incidence of nausea (p = 0.37), vomiting (p = 0.45) and opioid consumption (p = 0.49) were not significantly different between the two groups. Conclusion: Single-dose methylprednisolone 125 mg (IV) can reduce post-operative pain in patients with intertrochanteric fracture undergoing elective surgery.

Abdominal Hysterectomy: A New Approach for Conventional Procedure

Dilip Kumar Dutta, Indranil Dutta

Objective: The present comparative study helps in developing a new approach to conventional hysterectomy procedure so as to prevent intra-operative and Post-operative complications during the procedure. Materials and Methods: Ligation of uterine and ovarian arteries was performed, prior to abdominal hysterectomy procedures, in Group A (n-1000) and conventional method of abdominal hysterectomy in Group B (n-450) from January 2000 to December 2009. It was a prospective study. Results: In Group A it was noted that traumatic injury to (L) uterine vessel was present in 4 (0.4%) cases and (R) uterine vessel in 3 (0.3%) cases without any noticeable injury to the ovarian vessels, ureters or bladder as compared to in Group B where injury to (L) uterine was noted in 11 (2.4%) cases, ureters in 1 (0.1%) case, bladder in 6(1.3%) cases, hematoma in 10 (2.2%). Post-operative complications were found to be uneventful in Group A. Conclusion: The Present study concludes that ligation of uterine and ovarian arteries, prior to conventional abdominal hysterectomy procedures is found to be extremely safe procedure thereby reducing the risk of intra-operative and post- operative complications.

Primary Failure of Eruption- A Case Report with Cone Beam Computerized Tomographic Imaging

U. Aruna, P.R. Annamalai, Sanjna Nayar, S. Bhuminathan

Tooth eruption is an intricate and complex process which can fail to occur due to several reasons. Failure of tooth eruption in the absence of any systemic condition or any obstruction in the eruptive pathway can be attributed to lack of inherent eruptive potential of the tooth, termed as Primary Failure of Eruption (PFE). This is a rare condition and usually has a genetic etiology. Here we report a rare case in which there is Primary Failure of Eruption in the mandibular right quadrant. There is also mechanical failure of eruption of maxillary right canine and supernumerary teeth palatal to the maxillary central incisors. This association of supernumerary teeth and mechanical failure of eruption along with primary failure of eruption has not been reported so far. Proper diagnosis is very important in cases of Primary Failure of Eruption. There are several diagnostic criteria to identify these cases. Since these cases do not respond to orthodontic force, early diagnosis is of essential importance.

Unusual Case of Vogt-Koyanagi-Harada Syndrome Presenting as Non-specific Headache

Pradeep A.V., Arun Kumar J.S., Naveen K.N., Sonali Rao, Sharan Shetty

Vogt–Koyanagi–Harada syndrome (VKH) is a bilateral intraocular granulomatous panuveitis which is frequently associated with systemic manifestations such as meningismus, tinnitus, poliosis and vitiligo of autoimmune aetiology. Headache by itself, does not fulfill the diagnostic criteria and is insufficient for the diagnosis. A 22-year-old male presented with a 10 day history of headache, followed by decreased vision in both eyes. Slit lamp biomicroscopy revealed sluggishly reactive pupils with anterior uveitis, mild vitritis and hyperaemic discs with bilateral exudative retinal detachments. All uveitis workups were negative. Follow up of three years revealed no neurological or auditory symptoms. Headache alone, followed by decreased vision, before the onset of neurological and auditory symptoms, can be an initial presentation of Vogt-Koyanagi-Harada (VKH) syndrome. VKH should be considered in the differential diagnosis of atypical presentations of headache.

Laparoscopy-Pneumothorax and Ocular Emphysema, A Rare Complication-A Case Report

Suresh Y.V., Anupama Suresh Y., Trevor Francis Sequeira

Occurrence of Pneumomediastinum, pneumothorax, and ocular emphysema is very rare, but developed under General Anaesthesia (GA) immediately after insufflation. A defect in the diaphragm may be the cause. A female patient aged 21-years, with infertility was posted for diagnostic laparoscopy. The extravasation of carbon dioxide at the beginning of the diagnostic laparoscopy resulted in pneumomediastinum, pneumothorax and ocular emphysema. It was assumed that the intraperitoneal carbon dioxide traversed into the mediastinum via a defect in the diaphragm which resolved after abdominal deflation & chest tube decompression.

Rumpel-Leede Phenomenon in a Hypertensive Lady on Amlodipine

Kandan Balamurugesan, Stalin Viswanathan

We are describing a 60-year-old hypertensive lady who developed Rumpel-Leede phenomenon following the use of a tourniquet to obtain a blood sample. History revealed that she was on amlodipine therapy and that spontaneous sun-exposure related purpura was often seen since amlodipine was prescribed. Examinations and investigations provided normal results. She refused consent for a skin biopsy. Symptoms resolved after its substitution with enalapril and dihydrochlorothiazide, without any further recurrence.

Primary Fibrosarcoma of Male Breast: A Rare Entity

Shailaja Shukla, Richa Chauhan, P. Lalita Jyotsna, Manoj Andley

Primary fibrosarcoma of the breast is a very rare tumor. However, amongst the Primary Breast Sarcoma (PBS), it is the most common subtype. We present a case of 28-year-old male with lump in right breast of 7 year duration. The unilateral multinodular mass showed well circumscribed but unencapsulated tumor composed of interlacing fascicles of spindle shaped cells with minimal atypia. Immunohistochemistry revealed positivity for vimentin in the tumor cells. Differential diagnoses and review of literature is discussed.

Functioning Oxyphil Parathyroid Adenoma: A Case Report

Oxyphil parathyroid adenomas are rare and clinical features of patients with this entity are not well defined. We are presenting a case of primary hyperparathyroidism with marked elevation of parathyroid hormone (PTH) and near normal calcium levels, that underwent parathyroidectomy. Histopathology revealed an oxyphil adenoma which showed positivity for PTH on immunohistochemical staining. Post – operatively, there was a significant decline in both PTH and alkaline phosphatase levels. Benign oxyphil adenomas may mimic parathyroid carcinomas, both in terms of clinical features and tumour size; and they should be considered in the differential diagnosis of patients with primary hyperparathyroidism.

Modification of Fixture Mount to be Used as an Impression Coping in Closely Placed Implants

Sudhindra Mahoorkar, Anoop Jain, Cauvery K, Pawan Kumar, Raghavendra Havale

An implant-level impression is often desired for designing and fabricating an implant-supported fixed restoration. This clinical report describes the use of modified press-fit metal implant fixture mount as an impression coping for making an impression of closely placed implants. The fixture mount is easier to manipulate, time saving and more comfortable for both the clinician and patient because the implant fixture mount is connected to the implant by pressing on instead of screwing. As compared to plastic press fit impression coping, metal fixture mount will not distort when modification of fixture mount are required in convergently or closely placed implants. It has the advantage of both the open-tray and closed-tray implant impression techniques.

Hypoglossia- Hypodactyly Syndrome with Short Stature - A Case Report

Manisha Goyal, Ankur Singh, Pratiksha Singh, Seema Kapoor

The Oromandibular Limb Hypogenesis Syndromes (OLHS) comprises a spectrum of disorders involving the tongue, mandible, and the limbs and are characterized by hypoplastic mandible, absence of the lower incisors, hypoglossia, digits and limbs abnormalities ranges from syndactyly to amelia. In this report, we report a case of OLHS with growth hormone deficiency as a cause of short stature, which has not been described previously to the best of our knowledge.

Osteochondroma Arising from the Proximal Fibula: A Rare Presentation

Manoj Kumar, Monika Malgonde, Pramod Jain

Osteochondromas are commonly encountered benign tumours and they are characterized by cartilage capped bony growths that project from the surface of the affected bone. Osteochondromas tend to grow eccentrically rather than centrifugally. We are reporting a case of an 18-year-old male, who had presentation of a large, hard, irregular swelling over anterolateral aspect of his right leg. There was no neurovascular deficit in the extremity. Computed tomography showed that the origin of the tumour was probably proximal fibula. En-block excision of mass was done. A histopathological examination confirmed the diagnosis of a benign osteochondroma. Patient had uneventful recovery without any evidence of recurrence.

Amalgamating Esthetics, Function and Comfort in Full Mouth Rehabilitation – A Case Report

GK Thakral, Rashmi Thakral, Saurabh Arora, Neeraj Sharma, Chetan Chawla

Restoration of aesthetics, function and comfort in badly compromised dentition and its supporting tissues often poses a great challenge. The long term success of such cases depends largely on simultaneous achieving of satisfying aesthetics and a harmonious occlusion. Proper examination, evaluation and diagnosis of the prevailing oral conditions serve as a prelude to a rationalized treatment plan and its ultimate success. Invariably, it also becomes significant to understand and recognize the consequences of long term negligence by the patient. An unattended such condition, apart from causing compromised oral functions may also lead to neuromuscular problems in and around temporo-mandibular joint (TMJ) causing frequent pain in the region and unyielding headaches. Restoring physiologically advised health conditions from habitual positions and functions may require time, patience and effort by both – the patient and the dentist. A complete rehabilitation may also require involvement of more than one disciplines of dentistry. The case report highlights the contributions from prosthodontists, periodontists, endodontists and the radiologist as a team in complete rehabilitation of the patient.

Atypical Carcinoid of Larynx: A Case Study and a Brief Review

P. Dhavala Kumar, Vijayendra Simha N, Sreenivas N

Atypical Carcinoids, Malignancy arising from neuroendocrine cells are among the non–Epidermoid cancers of larynx. The present study reports an interesting and rare case of atypical carcinoid of larynx. An 85-year-old male patient presented with a history of dysphagia. On clinical examination, a provisional diagnosis of cyst larynx was made. But during surgery, the Diagnosis had to be reviewed as benign lesion of the larynx. Histopathological diagnosis was atypical carcinoid. The present study discusses the unusual presentation and unusual clinical diagnosis of these neuroendocrine neoplasms of larynx.

B-Lynch: A Technique for Uterine Conservation or Deformation? A Case Report with Literature Review

Jasmina Begum, P. Pallave, Seetesh Ghose

Postpartum haemorrhage is a leading cause of global maternal mortality and morbidity, accounting for 25-30% of all maternal deaths, and 75-90% of these casualties result from uterine atony. Uterine compressive sutures are a well established measure for control of haemorrhage following atonic postpartum haemorrhage, when medical and non-medical interventions fail. Here, we are reporting a case of secondary infertility in a 24-year-old lady who had undergone an elective caesarean section for central placenta previa in her first pregnancy. She had massive postpartum haemorrhage, for which B-Lynch suture and vessel ligation were done. Subsequently, she failed to conceive for 4 years. This was because of severe pelvic adhesions and uterine deformation which were found intraoperatively, as a consequence of previous use of B-Lynch suture. As no definitive treatment could be offered to her, we suggested her to go for adoption.

An Anatomical Variation of the Lesser Occipital Nerve in the “Carefree part” of the Posterior Triangle

The occurrence of the lesser occipital nerve (LON) at an anomalous location in the “carefree part” within the posterior triangle has been seldom reported in the literature. We are reporting a rare case of location of the LON in the “carefree part” of the posterior triangle, in a 55-year-old formalin embalmed male cadaver. LON, after emerging from the posterior margin of the sternomastoid muscle (SM), ran obliquely towards the trapezius muscle. Here, it hooked around the unusual separated muscle fasciculus of the trapezius, 7.5 cm below the superior nuchal line. Further, LON gave contributions to spinal accessory nerve (SAN): one deep into the SM and another one in the posterior triangle. The knowledge on the unusual location and course of the LON and its contribution to the SAN is significantly important while an anaesthetic blockade is being performed for the management of a cervicogenic headache and a super selective radical neck dissection.

Mixed Fungal Lung Infection with Aspergillus Fumigatus and Candida Albicans in an Immunocompromised Patient: Case Report

Jaya S., Haritha Vipparti

The frequency of invasive, opportunistic mycoses has increased significantly over the past 2 decades. In the immune-compromised host, many fungi, including species of fungi typically considered non-pathogenic, have the potential to cause serious morbidity and mortality. Here we report a rare case of mixed fungal infection of the lung with Candida albicans and Aspergillus fumigatus in a patient on prolonged steroid therapy.

Spontaneous Discharging Umbilical Sinus Secondary to Infected Cystic Teratoma Ovary: An Atypical Presentation

Arpan Choudhary, Samir Shukla, Pragyey Nawlakhey, Romil Jain, Mahim Koshariya

Mature cystic teratomas are the most common ovarian neoplasm in patients younger than 20 years. Its complications include torsion, rupture, infection and malignant degeneration. Infection of teratoma is an uncommon event. We are reporting the first ever case of infected mature cystic teratoma presented as a chronic discharging sinus via umbilicus. 30 years old young primipara presented with complaint of seropurulent discharge from umbilicus for 6 months. Ultrasonography showed right sided complex adnexal mass. Umbilical exploration revealed sinus tract travelling deep into the pelvis attached to right ovarian mass. Salpingo- oopherectomy was done on right side and sinus tract excised. Cut-section of specimen showed heterogeneous mass of soft tissue with intact capsule containing hairs, cheesy white purulent material, fat and cartilage. Biopsy was suggestive of mature ovarian cystic teratoma.

Immediate Implant Loading in Compromised Maxillary Partially Edentulous Arch- A Case Report

Sachhi Ramesh, Veena Patil, Anoop Jain, Reetika Gaddale, Sunil Kumar Mishra

As the aesthetic demands are increasing day by day, demand of immediate restoration or replacement of teeth is also increasing. Because of this, immediate implant placement, along with immediate loading of implant, is a favourite treatment option for patients as well as dentists. This case report discusses the immediate implant loading in compromised maxillary anterior region, in which patient got immediate restoration of edentulous area. More importantly, from the patients’ points of view, immediate loading can produce positive social and psychological effects.

Fatal Necrotizing Soft Tissue Infection by Aeromonas hydrophila

Smita Sood, Vidya Nerurkar

Aeromonas infections in healthy individuals are self limiting, but those in patients with immuno-compromised conditions are frequently associated with significant morbidity and mortality. The current case report describes a fatal case of necrotizing soft tissue infection by Aeromonas hydrophila in an immuno-competent patient.

Goldenhar Syndrome - Review with Case Series

C Seethalakshmi Ashokan, Arathi Sreenivasan, Gopal K Saraswathy

Goldenhar’s syndrome is a rare condition which was described initially in the early 1950s. It is characterized by a combination of anomalies: dermal epibulbar cysts, auricular appendices and malformations of the ears. In 1963, Gorlin suggested the name, oculo-auriculo-vertebral (OAV) dysplasia for this condition and he also included vertebral anomalies as signs of this syndrome. The aetiology of this rare disease has not been fully understood, as it has shown itself to be variable genetically and to be caused due to unclear reasons. Here, we are reporting two cases of Goldenhar’s syndrome, where almost all the classical signs of this rare condition were present.

Behaviour of Disc Oedema During and After Amiodarone Optic Neuropathy: Case Report

A 73-year-old woman with atrial fibrillation treated with Amiodarone presented with Optic Disc oedema in right eye (OD). Using Optical Coherence Tomography (OCT) we describe the impact of this neuropathy on Retinal Nerve Fibre Layer (RNFL). At diagnosis RNFL average was of 188 µ m OD and 77 µ m in the left eye (OS), six months after discontinuation of the drug decreased to 40 µ m in OD and 76 µ m in OS. The RNFL average of OD presented a transient increase during the acute oedema that returned to normal levels during the first month after discontinuation of the drug and fell dramatically to 44 µ m at the second month and 40 µ m at the sixth month. We show there is axonal loss after amiodarone- associated optic neuropathy measured with OCT. The OCT may be used in these patients to document changes in RNFL in the follow-up.

Scar Endometriosis- A Sequel of Caesarean Section

Nanda J Patil, Vijay Kumar, Anita Gupta

Endometriosis is presence of functioning endometrial tissue outside the uterine cavity, usually in the pelvis. However, its occurrence is very rare (0.03%-0.4%) in the scars which follow obstetrical and gynaecological surgeries. We are reporting two cases of scar endometriosis which occurred after caesarean sections. Both cases presented with abdominal pain at caesarean scar sites, one of which gave a cyclical history. Clinical examination revealed painful swellings in both cases, which were misdiagnosed as stitch granulomas. Wide surgical excisions were done and histopathology examination revealed a diagnosis of scar endometriosis. We are presenting these cases because of their rarity, their uncommon sites and difficulty in diagnosing the conditions clinically.

Male Breast Cancer: Presenting as Synchronous, Large, Bilateral Masses

Male breast cancer is a very rare neoplasm which accounts for 1% of all breast cancers. A 70-year-old male presented with a rapidly growing, bilateral breast masses with large size, surface ulceration and bloody discharge. Synchronous bilateral breast cancer was diagnosed by using fine needle aspiration cytology, mammography, ultrasonography and incisional biopsy. Histopathological studies revealed invasive ductal carcinoma (not otherwise specified), which was of grade III in left breast and of grade II in right breast. We are presenting this case with its clinico-pathological findings, as synchronous bilateral breast cancer occurs extremely rarely in males.

Retinal Arterial Obstruction-still Remains an Enigma

Anupama Kakhandaki, Charushila Gejapati, Preetam B. Patil, Vivekanand S.G.

Recurrent Severe Anaemia: A Rare Presentation of Parvovirus B19 Infection

Santokh Singh, Gian Chand, Shiv Charan, Sahil Arora, Parampreet Singh

Secondary pure red cell aplasia is usually seen in immunocompromised hosts or patients who have chronic haemolytic anaemia, which is caused by blood transfusion related transmission. The present patient, a 30-year-old immunocompetent female, presented several times with recurrent severe anaemia, over a period of one and half years. Her history, clinical examination and investigations did not reveal any indigenous drug intake, previous blood transfusions, haemolytic disorders, myeloproliferative disorders, pregnancies, autoimmune diseases or thymoma. She was found to have a thalassaemia minor trait, on the basis of which severity and recurrence of anaemia could not be explained, and on further evaluation, she was diagnosed to have acute aplastic crisis caused by Parvovirus B19 induced, acquired pure red cell aplasia. The co- existence of these two haematological disorders in an immunocompetent, non-transfusion dependent individual is rare, which makes our case report unique.

CBCT Cyst Leasions Diagnosis Imaging Mandible Maxilla

K. Prabhusankar, A. Yuvaraj, C.A. Prakash, J. Parthiban, B. Praveen

The bony anatomy and the soft tissue contours of the maxillofacial region, along with the oro dental tissues, is very complex. In earlier times, analog radiographs of the skull, the mandible and the sinuses, along with intraoral films, were the only tools which were available for dentists. The past decade has seen a revolution in dental imaging, with the introduction of Cone beam computed tomography/cone beam volumetric tomography (CBCT/CBVT). In this article, we have discussed the value of CBCT in diagnosis and treatment planning which we observed in four cases of maxillofacial cystic lesions. It proved to be a multifaceted win-win situation for the diagnostician, the patient and the operating surgeon. The 3D imaging led to a precise pre-operative surgical planning, resulting in a surgery that was minimally invasive, minimally morbid and time saving and at the same time, conservative, yet complete.

Iatrogenic Stenosis of Anterior Nares: A Case Report

Arunkumar J.S., Santosh S. Garag, Shibani Anchan

Stenosis of anterior nares may be congenital or acquired. Acquired stenosis may be caused by the diseases which cause destruction of skin or normal cartilage. The various causes of acquired stenosis of anterior nares are burns, trauma, infections, etc. Iatrogenic stenosis of anterior nares is a rare condition. Doing simple excision of fibrosed tissue, with septoplasty and endoscopic adenoidectomy in a 5-year child, improved nasal breathing. Use of Mitomycin-C topical solution prevents recurrence of fibrosis, with good outcome.

Posterior Reversible Encephalopathy Syndrome in Early Postpartum Women: A Case Report

Vinod S Patil, B.R. Dhamangaonkar, R.C. Pattanshetti, M.M. Patil

Posterior reversible encephalopathy syndrome (PRES) is a rare acute neurologic condition, characterized by acute neurological symptoms. The radiological findings are predominantly seen in the posterior cerebral hemispheres and are reversible with appropriate management. We are reporting a case of a 21-year-old woman (primigravida), who presented with loss of vision, head ache and vomiting on 2nd day of post-caesarean section. Caesarean section was done due to fetal distress. On examination, patient appeared drowsy but arousable, had a blood pressure of 140/114 mmHg, rest of the examination was unremarkable. CT and MRI brain was performed to rule out cerebral venous sinus thrombosis and cortical blindness; imaging and clinical findings were suggestive of posterior reversible encephalopathy syndrome (PRES). She was treated successfully with antihypertensives and showed dramatic improvement.

Report of an Unusual Case: Testicular Involvement of Chronic Myeloid Leukemia 10 Years after the Complete Response

Cem Nedim Yuceturk, Berat Cem Ozgur, Hasmet Sarici, Pelin Borcek, Onur Telli

Testicular extra-medullary myeloid cell tumours are rare tumours presenting in most cases with painless testicular swelling. We present here a case of 21-year-old man with painless scrotal swelling. From his medical history, he was treated by allogenic bone-marrow transplantation and chemotherapy 10 years ago because of chronic myeloid leukemia. The pathology of orchiectomy specimen revealed malign cells with blastic cell infiltration means a late relapse of chronic myeloid leukemia. The patient has been in hematological remission and no evidence of any myeloid disorders by 10 years’ follow up. Although testicular involvement is a rare and an unusual event in blast crisis of chronic myeloid leukemia, extramedullary myeloid cell tumour should be considered in the diagnosis of intratesticular tumours.

Carcinoma Ex-Pleomorphic Adenoma of Parotid Gland with Hepatic Metastasis: Clinico-Radiological Case Report

Manu Dhillon, Divya Tomar, Manu Sharma, Samta Goel, Siddharth Srivastava

Pleomorphic adenoma originally called the mixed tumour is a neoplasm commonly involving major salivary glands. The spectrum of malignancy in pleomorphic adenoma comprises three distinct entities – Carcinoma ex-pleomorphic adenoma, carcinosarcoma and benign metastasising pleomorphic adenoma. Carcinoma ex-pleomorphic adenoma consists of pleomorphic adenoma with a malignant epithelial component. Occasionally, carcinomas ex-pleomorphic adenoma develops metastasis. Here we are reporting a case of benign pleomorphic adenoma arising in parotid gland which turned into malignancy after four years. The patient developed facial nerve paralysis suggesting malignant transformation. Along the course of the disease, the patient developed regional metastasis to lymph nodes and neck and distant metastasis to liver. This case report emphasises the role of advanced imaging modalities in the early diagnosis of the condition and evaluation of metastasis. The patients with this condition should be treated early for favorable outcome and investigated for distant metastasis.

Small Intestine Ischaemia due to Volvulus during Pregnancy

Shantajit Nameirakpam, Shangchungla Keishing, Jaleshwar Laishram, Ranita Devi S.

Small intestine ischaemia caused by volvulus is difficult to diagnose during pregnancy, as the signs and symptoms may be masked by pregnancy. An early diagnosis and a prompt surgical intervention is necessary, as morbidity and mortality of this disorder are significant. We are presenting a case of a 35-year-old pregnant woman with volvulus of small bowel.

An Unusual Branch of Celiac Trunk Feeding Suprarenal Gland - A Case Report

During routine dissection, variation in branching pattern of celiac trunk has been observed in adult 54-year-old male cadaver. Instead of normal three branches an additional branch i.e., Left inferior phrenic artery originated from it as fourth branch. Then it divided into two branches, one directly supplied the diaphragm and other branch divided into three sub-branches. First and second branch entered into the left suprarenal gland at its upper and middle pole and third one finally terminated by supplying to the diaphragm. There is no separate middle suprarenal artery on the left side, but inferior suprarenal artery was as usual. No variations have been found on right side in the lateral branches of abdominal aorta. Such a quadrifurcation of celiac trunk to supply suprarenal gland is quiet unique so far searched in literature.

Epithelial Cyst of the Spleen with Squamous Metaplasia: A Rare Entity

Epithelial splenic cysts are uncommon lesions which occur in the spleen. The aetiopathogenesis of these cysts is not clear. We are reporting a case of an epithelial cyst which occurred in the spleen in a 40-year-old female, which was multiloculated and which had flattened lining epithelium. Some foci showed squamous metaplasia.

Virilizing Cystic Juvenile Granulosa Cell Tumour of the Ovary: A Case Report

Bipin Kumar, Reecha Singh, K.V. Bharathi, Himabindu

We report a rare case of virilizing cystic juvenile granulosa cell tumour of the ovary diagnosed by histopathological examination in a 17-year-old female presented with mass abdomen for two months, growing of the hairs on the face and abdomen and deepening of voice for one year.

Communication between Mylohyoid and Lingual Nerve: An Anatomical Variation

Pranoti Sinha, Binod Kumar Tamang, Rohit Kumar Sarda

Variation in the branching pattern of mandibular division of trigeminal nerve has remain one of the commonest cause among the surgeons for not obtaining adequate local anesthesia in routine oral or dental procedure. In this article, we discuss about a case of an unusual communication between mylohyoid and lingual nerve in a 50-year-old female cadaver seen in a routine dissection in medical college. The details of this anatomical variation and its clinical aspects are discussed.

Subcutaneous Dermatofibroma: A Rare Case Report with Review of Literature

Harjot Kaur, Jasleen Kaur, Karamjit Singh Gill, Rahul Mannan, Swati Arora

A purely Sub-cutaneous benign fibrous histiocytoma (BFH; dermatofibroma) is rarely reported, as it is usually a dermally located mesenchymal tumour and in absence of supportive immunohistochemical (IHC) studies, it is often misdiagnosed. We are describing a case of a 19-year-old female who presented to the skin outpatient department with a painful swelling on the medial side of her thigh. Fine needle aspiration (FNA) revealed a sub-cutaneous spindle cell (mesenchymal) lesion which was corroborated on histopathology, with differentials of BFH and dermatofibrosarcoma protruberans (DFSP). BFH constitutes a diagnostic dilemma for both clinicians and pathologists, because the lesions share common clinical symptoms, radiological characteristics and histological features with many varied entities. For its subtyping and confirmation; immunohistochemical (IHC) studies were undertaken. In the present case, positivity of IHC markers, vimentin and smooth muscle actin emphatically proved that BFH arose exclusively from the subcutaneous region, with no dermal origin. Also, a negative CD34 immunostaining, along with low B-cell lymphoma 2 (Bcl-2) expression ruled out DFSP (both are strongly expressed in DFSP), MFH and other malignant mesenchymal lesions. Negative CD 68 staining ruled out giant cell lesions and their congeners. This case is worth reporting, as it not only describes a rare case presentation of BFH, but as it also highlights the importance of IHC, thus helping to comprehensively clinch the diagnosis by systematically ruling out other differentials.

An Unusually Long Survival of A Patient with Glioblastoma of Spinal Cord: A Case Report

Primary glioblastoma of spinal cord are rare and are associated with poor survival especially in adults. We report a case of glioblastoma of thoracic spinal cord (D3 to D6) in an adult treated with partial resection surgery and radiation therapy with a survival of six years with good quality of life. The patient had paraplegia at presentation but improved after surgery and radiation therapy to grade 4 in both lower limbs. After 5 years, he developed new lesion in a different location of the spine (L1, L2 & L5) along with multiple lesions over entire spine and was treated with radiation therapy and a year later developed a new lesion intracranially in the posterior fossa involving cerebellopontine angle region infiltrating brainstem. He was treated with palliative radiotherapy and is on chemotherapy with Temozolomide and is still alive with ability to do activities of daily living at the time of this report. Radiation therapy provided prolonged local control with effective palliation of symptoms and good quality of life in this patient enabling to do activities of daily living.

Cerebral Phaeohyphomycosis due to Cladophialophora bantiana – A Case Report and Review of Literature from India

Cerebral phaeohyphomycosis is a rare disease caused by dematiaceous fungi. It has poor prognosis irrespective of the immune status of the patient. Cladophialophora bantiana is the most commonly isolated species. We report a case of multiple brain abscesses caused by C. bantiana in an immune competent patient. The diagnosis was based on CT scan of head, direct examination and culture of the aspirate from the abscess. Despite complete surgical resection of the abscesses and antifungal therapy with amphotericin B and voriconazole the patient could not be saved. All the cases of cerebral phaeohyphomycosis due to this rare neurotropic fungus reported from India between 1962 and 2009 have also been reviewed.

Geographic Tongue in Monozygotic Twins

Guna Shekhar M

This article discusses a case of 5-year-old girl monozygotic twins who were suffering from geographic tongue (GT), a benign inflammatory disorder of the tongue which is characterized by circinate, irregular erythematous lesions on the dorsum and lateral borders of the tongue caused by loss of filiform papillae of the tongue epithelium. Whilst geographic tongue is a common entity, reports on this condition are uncommon in the literature. To best of our knowledge, this is the first report which has described monozygotic twins with geographic tongue in the literature.

Multifactorial Relationship of Obesity and Periodontal Disease

Snophia Suresh, Jaideep Mahendra

Obesity is a chronic disease of mutifactorial origin, where there is increase in body fat. Periodontitis is an inflammatory disease of tooth supporting tissues resulting in destruction of periodontal ligament and alveolar bone. Periodontitis and obesity are both chronic health problems and the literature supports this association. A hyperinflammatory state observed in obesity is proposed as a mechanism to explain this association. This low grade inflammation in obese subjects triggers the worsening of non transmissible chronic diseases like periodontitis. So the aim of this article is to get the overview of association between adipose tissue derived cytokines and periodontal disease.

Methods of Postural Assessment Used for Sports Persons

Deepika Singla, Zubia Veqar

Occurrence of postural defects has become very common now-a-days not only in general population but also in sports persons. There are various methods which can be used to assess these postural defects. These methods have evolved over a period of many years. This paper is first of its kind to summarize the methods of postural assessment which have been used and which can be used for evaluation of postural abnormalities in sports persons such as the visual observation, plumbline, goniometry, photographic, radiographic, photogrammetric, flexiruler, electromagnetic tracking device etc. We recommend more and more postural evaluation studies to be done in future based on the photogrammetric method.

Role of Biomarkers in Early Detection of Preeclampsia

Manisha Kar

Preeclampsia (PE) is a pregnancy-related, potentially life threatening condition. The incidence of PE has increased in the past decade, which has been attributed to various predisposing factors. Abnormal placentation is central to the evolution of this disease process. However, the triggering factor for this is still unknown. Interestingly, intense research done in this arena has unveiled the names of some important biomolecules which play important role in the vasculogenesis of the early placenta, namely, vascular endothelial growth factor (VEGF) and placental growth factor (PlGF) and their antagonists, namely, soluble fms-like tyrosine kinase 1 (sFlt-1, also known as sVEGFR1), and soluble endoglin (sEng). Besides these, Renin Angiotensin System (RAS) was also implicated in this disease process. The roles of immune factors, genetic factors have been stressed from time to time. More novel approaches made, have shed light on the upcoming biomolecules. All these endeavours are directed to diagnose PE as early as possible, which is a real challenge. Question remains whether a single set parameters could diagnose a disease entity which is as complex as PE. Therefore, it is imperative to design feasible, predictive test-set utilizing multiple biomarkers.

Transposition of Mandibular Lateral Incisor–Canine (Mn.I2.C) Associated with Hypodontia: A Review and Rare Clinical Case

Transposition is a unique and extreme form of ectopic eruption in which a permanent tooth develops and erupts in the position which is normally occupied by other permanent teeth. Tooth transpositions are rare and they can be complete or incomplete. The aetiology of transposition is still obscure. Various populations have been studied, to determine the prevalence of tooth transpositions. 20% of the transpositions which occur on the maxillary arch involve the canine and the lateral incisor. Although they are rare, transpositions may involve the maxillary lateral and central incisors. Among all transpositions, Mandibular Lateral Incisor-Canine (Mn.I2.C) is the rarest, with a prevalence rate of 0.03%. Although various reports have been published on tooth transpositions, very few have noted the agenesis of teeth, particularly Mn.I2.C and its management. We are reporting a rare clinical case with associated hypodontia.

Laparoscopic Colorectal Surgery: An Update (with Special Reference to Indian Scenario)

G.S. Moirangthem

Laparoscopic cholecystectomy, being already declared as gold standard technique, laparoscopic surgery has advanced far and wide, touching almost every corner of the abdomen. This advancement has gradually expanded to colorectal surgery which is done for malignant diseases as well. However, laparoscopic colorectal surgery has not been accepted as quickly as was laparoscopic cholecystectomy. This is because of its steep learning curve, concerns with oncological outcomes, lack of randomized control trials (RCTs) and initial reports on high port site recurrences which occurred after curative resections. But all these initial concerns have been overcome by doing a series of RCTs globally, in the past decade, that revealed that laparoscopic colorectal surgery for malignant disease offered short term benefits without compromising on oncological principles of radicality of resection, tumour resection margins and completeness of lymph node harvesting as compared to those of open surgery. Favourable post-operative results with respect to less blood loss, less pain, lesser surgical site infections, lesser requirement of analgesics, early return of bowel function and shorter hospital stay in patients who underwent laparoscopic colorectal resections were obtained in studies done on individual series, including those done in India and more recently, in large trials. An update on recent studies done on laparoscopic colorectal surgery by reviewing many RCTs and individual series, including our experiences, was made, to support the advantages of this procedure which were obtained when it was carried out by skilled hands.

Diastematomyelia – A Report of two Cases

Sushil G. Kachewar, Smita B. Sankaye

Diastematomyelia means sagittal division of the spinal cord into two hemi cords. It is a congenital malformation which results from an abnormal adhesion between ectoderm and endoderm. It is more common in females (3:1). This abnormal adhesion which splits the cord may be in the form of fibrous tissue or purely a calcific bar or purely an ossific bar or even a combination of the earlier mentioned entities. The health impacts of this entity are enormous, as the patients may be asymptomatic to begin with, until gradually; progressive spinal cord dysfunction sets in. Imaging plays a vital role in establishing the diagnosis and it may aid in easing the quality of life by making an early diagnosis. The affected individual and the afflicted families need psycho-social guidance and counselling. We are presenting here, imaging findings in two cases of diastematomyelia.

Quantitative Buffy Coat Analysis-An Effective Tool for Diagnosing Blood Parasites

Nishat Hussain Ahmed, Jyotish Chandra Samantaray

Quantitative buffy coat (QBC) analysis, which is based on principle of centrifugal stratification of blood components, is a well-known and a very sensitive technique which can be used for the detection of malarial parasites in peripheral blood. In our experience, this technique is also highly specific for doing speciation of malarial parasite in Indian set up. In addition, this technique was also found to be a sensitive and specific tool for diagnosing filariasis. Lastly, the cellular pattern of buffy coat in QBC, together with other non-specific findings, has many times aided in making correct diagnoses in difficult cases of visceral Leishmaniasis.

A Case of Perianal and Gluteal Scrofuloderma

Rajesh Kumar Reddy, Shankar Ram H.S., Ashwin Pai, Muthukumar

A 47-year-old male presented with multiple perianal and gluteal pus discharging sinuses. On examination, undermined sinus edges, thick and hyperpigmented surrounding skin, sacral tenderness and a lax anal sphincter were noted. Based on clinical, radiological and histopathological evaluations, patient was diagnosed to have sacral tuberculosis with perianal and gluteal scrofuloderma and he was started on anti-tuberculosis treatment.

Morphometry of Suprascapular Notch and its Correlation with that of Scapula

Muralidhar Reddy Sangam, Sattiraju Sri Sarada Devi

Suprascapular notch is the common site for the entrapment of the suprascapular nerve. Suprascapular nerve compression usually presents with vague pain across the scapula or dull shoulder ache. It is more common in over head athletes like volleyball players. Hence the study of morphology and morphometry of the notch is important clinically.

Correction:Efficacy of Rajayoga Meditation on Positive Thinking: An Index for Self-Satisfaction and Happiness in Life

Ramesh M.G., Sathian B., Sinu E., Kiranmai S. Rai, Efficacy of Rajayoga Meditation on Positive Thinking: An Index for Self-Satisfaction and Happiness in Life (Published in Journal of Cilinical and Diagnostic Research. 2013 October: 7(10).2265-2267. In this article Corrections have been done in [Table/Fig-2] and Result have been amended accordingly