Journal of clinical and diagnostic research

Dr. A.P.J Abdul Kalam- “A Man Beyond Science”

Pranay Tanwar, Ritesh Kumar

Correction:2013 Nov: 7(11):). : 2567-2569

Ashraf Direkvand-Moghadam, Molouk Jaafarpour, Ali Khani, Comparison Effect of Oral Propranolol and Oxytocin Versus Oxytocin Only on Induction of Labour in Nulliparous Women (A Double Blind Randomized Trial). (Published in Journal of Clinical and Diagnostic Research. 2013 Nov: 7(11):). 2567-2569 In this article changes have been done in the Authors name. Names and surname have been placed in correct order for correct citation.

Oral Cancer Knowledge, Attitudes and Practices: A Survey of Undergraduate Medical Students in Himachal Pradesh, India

Vikas Fotedar, Shailee Fotedar, Manish Gupta, Kavita Manchanda, Mukesh Sharma

Background: Oral cancer is the sixth most common cancer among Indian males and the third most common cancer among Indian females. Early detection of oral cancers makes them more amenable to treatment and allows the greatest chance of cure. Lack of awareness among the health care providers is the most significant factor in delaying diagnosis and treatment of oral cancer. So the aim of the study was to assess the knowledge, attitude and practices of oral cancer among undergraduate medical students in Indira Gandhi Medical College, Shimla, India. Materials and Methods: A cross-sectional questionnaire study was conducted among 186 undergraduate medical students between the third to fifth years in Indira Gandhi Medical College, Shimla. The questionnaire consisted of 15 questions, five each on knowledge, attitudes and practices. The data were analysed by Statistical Package for the Social Sciences version 16. Test used were t-test, Chi-square and ANOVA. Results: The response rate of the study was 96.5%. The mean knowledge percent of the sample was good. Mean knowledge percent was higher in females than males. Higher percentage of students in 5th year (internship) had excellent knowledge. The knowledge and practices about risk factors was not satisfactory. One hundred and twenty four (66.6%) of the subjects disagreed/strongly disagreed that their knowledge regarding the prevention and detection of oral cancer is current adequate. One hundred and seventy six and (94.6%) agreed/strongly agreed that there is need for additional training/information regarding oral cancer. Conclusion: It can be concluded that though the mean knowledge of the population was good but the knowledge and practices about risk factors had to be reinforced among these students so that they can help the patients in tobacco and alcohol cessation and contribute in prevention of oral cancers.

Dimensional Changes of Alginate Dental Impression Materials-An Invitro Study

Manisha M Kulkarni, Ram U Thombare

Background: Dentists are always looking ahead for more dimensionally stable material for accurate and successful fabrication of prosthesis in this competitive world. Arrival of newer materials and increased material market puts dentists in dilemma for selection of material. Aim: The study evaluated the effect of variations in time of pour and temperature on dimensional stability of three brands of commercially available alginates. Materials and Methods: Velplast, Marieflex & Zelgan alginate impression materials were evaluated by measuring dimensional accuracy of the master cast. A die was prepared and mounted on the apparatus for the ease of impression making. The prepared casts were categorized into five groups and made up of three brands of alginate impression material with variation in time of pour viz: immediate, 20&40 minutes interval and with varying temperature of 250C, 300C & 400C. Results: Impressions showed least distortion at varying degrees of temperature for 20 minutes, but the values obtained by storing of alginate impressions for 20 minutes at 300C were found to be nearly accurate than the values obtained by storing of impression at 400C. However, storing showed shrinkage of impressions. Conclusion: Marieflex showed better accuracy in comparison with other two materials. Maintenance of temperature and humidity play key role during storage & transport to prevent distortion. But the study suggests immediate pouring which will minimize the distortion. The manipulation instructions, temperature of mixing water, environment & water powder ratio also plays key role in minimizing the distortion.

Optical Whole-Genome Restriction Mapping as a Tool for Rapidly Distinguishing and Identifying Bacterial Contaminants in Clinical Samples

Richard R. Chapleau, James C. Baldwin

Introduction: Optical restriction genome mapping is a technology in which a genome is linearized on a surface and digested with specific restriction enzymes, giving an arrangement of the genome with gaps whose order and size are unique for a given organism. Current applications of this technology include assisting with the correct scaffolding and ordering of genomes in conjunction with whole-genome sequencing, observation of genetic drift and evolution using comparative genomics and epidemiological monitoring of the spread of infections. Here, we investigated the suitability of genome mapping for use in clinical labs as a potential diagnostic tool. Materials and Methods: Using whole genome mapping, we investigated the basic performance of the technology for identifying two bacteria of interest for food-safety (Lactobacilli spp. and Enterohemorrhagic Escherichia coli). We further evaluated the performance for identifying multiple organisms from both simple and complex mixtures. Results: We were able to successfully generate optical restriction maps of four Lactobacillus species as well as a strain of Enterohemorrhagic Escherichia coli from within a mixed solution, each distinguished using a common compatible restriction enzyme. Finally, we demonstrated that optical restriction maps were successfully obtained and the correct organism identified within a clinical matrix. Conclusion: With additional development, whole genome mapping may be a useful clinical tool for rapid invitro diagnostics.

Anaesthetic Efficacy of Topical Benzocaine Gel Combined with Hyaluronidase for Supplemental Intrapulpal Injection in Teeth with Irreversible Pulpitis- A Double Blinded Clinical Trial

Objective: Intrapulpal injection technique is one of the most commonly employed method to achieve profound pulpal anaesthesia during an endodontic procedure. To determine if the topical application of benzocaine gel along with hyaluronidase to the pulp chamber could reduce the pain felt with the intrapulpal injection technique. Materials and Methods: Two hundred patients with chronic irreversible pulpitis undergoing endodontic treatment for mandibular first molars in which the primary anaesthetic technique failed were selected and randomly divided into 2 groups. In the control group intrapulpal injection was administered with backpressure. In the experimental group topical application of 20% benzocaine gel mixed with hyaluronidase was done over the exposed pulp following which intrapulpal injection was administered with backpressure. Pain assessment was done on a visual analogue scale. Results: There was statistically significant difference (p<0.001) between the two groups. The mean value in the control group corresponded to the pain perception "strong”, whereas that of the experimental group corresponded to the pain perception "weak”. Conclusion: Topical application of 20% benzocaine gel mixed with hyaluronidase to the exposed pulp reduces the pain encountered with the intrapulpal injection.

Evaluation of Choroidal Thickness and Volume during the Third Trimester of Pregnancy using Enhanced Depth Imaging Optical Coherence Tomography: A Pilot Study

Background: During pregnancy the maternal choroid is exposed to the multiple haemodynamic and hormonal alterations inherent to this physiological condition. These changes may influence choroidal anatomy. In this study a quantitative assessment of overall choroidal structure is performed, by constructing a 3-dimensional topographic map of this vascular bed. Purpose: To compare the thickness and volume of the maternal choroidal in the third trimester of pregnancy with that of an age-matched control group of women. Materials and Methods: Twenty-four eyes of 12 pregnant women in the last trimester and 12 age-matched healthy controls (24 eyes) were included. Optical coherence tomography in enhanced depth imaging mode was used to construct maps of the choroid of the macular area. Choroidal thickness and volume were automatically calculated for the 9 subfields defined by the Early Treatment Diabetic Retinopathy Study (ETDRS). A comparative analysis between the two groups was performed using the two-way ANOVA test. Results: The average thickness of the choroid for the entire ETDRS area of the pregnant group was 295.15 ±42.40µm and 271.56 ±37.65µm in the control group (p=0.051). The average choroidal volume was 8.05 ±1.12mm3 and 7.46 ±1.03mm3, respectively (p=0.067). Although the choroid of the pregnant group had larger thickness and volume in all subfields compared to the control group, this difference was statistically significant only in three regions - the central subfield, minimum foveal thickness and inferior inner macula (p<0.05). Conclusion: Our study suggests that in the third trimester of pregnancy the choroid may be subjected to physiological changes in structure. Whether these changes are a result of hormonal and/or haemodynamic adaptations of pregnancy remains to be studied.

Nine-Months Clinical Outcome of Biodegradable Polymer Coated Sirolimus-eluting Stent System: A Multi-Centre “Real-World” Experience

Background: The main culprit in first-generation drug eluting stents is ‘durable’ polymer, whose continuous presence may impair arterial healing and ultimately have a negative impact on late outcomes. The main enigma behind the biodegradable polymer usage is its degradation after elution of drug. This reduces adverse events in unselected patients with complex coronary artery lesions treated with biodegradable polymer coated sirolimus-eluting stents. Aim: The aim of the INDOLIMUS-G Registry was to evaluate safety and efficacy of the Indolimus (Sahajanand Medical Technologies Pvt. Ltd., Surat, India) sirolimus-eluting stents in large cohorts of unselected patients with complex coronary artery lesions. Materials and Methods: It is a multi-centre, non-randomized retrospective registry with a clear aim of evaluating safety and efficacy of the Indolimus sirolimus-eluting stents in consecutive patients enrolled between April 2012 and May 2014. The primary end-point of the study was major adverse cardiac events (MACE), which is a composite of cardiac death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR) and stent thrombosis (ST) at the end of follow-up. Clinical follow-up were scheduled at the end of 30-days, 6-months, and 9-months period. Results: The mean age of enrolled patients was 52.6 ± 11.0 years. A total of 1137 lesions were intervened successfully with 1242 stents (1.09 ± 0.30 stent per lesion).The average stent length and diameter was 27.42 ± 9.01 mm and 3.12 ± 0.36 mm respectively. There were 740 (73.40%) male patients, indicating their high prevalence. Diabetes, hypertension and totally occluded lesions were found in 372 (36.90%), 408 (40.47%) and 170 (16.86%) patients, respectively. This showed that study also included high risk complex lesions and not ideal recruited lesions. The incidence of MACE at 30-days, 6-months and 9-months were 3 (0.30%), 18 (1.80%) and 22 (2.20%) respectively. At 9-months, TLR was found in 6 (0.50%) patients. There were 2 (0.20%) cases of ST, 10 (1.0%) cases of MI and 4 (0.40%) cases of cardiac death at 9-month follow-up. Conclusion: The lower incidence of MACE, TLR and ST at 9-month follow-up clearly delineates safety and efficacy of Indolimus SES in large cohorts of unselected patients with complex coronary lesions.

Osteoplastic Reconstruction for Post Traumatic Thumb Amputations Around Metacarpophalangeal Joint

Smitha Siram Segu, Swapna Nachiket Athavale, Peddi Manjunath

Introduction: Loss of a thumb due to trauma warrants replantation which is the best method of reconstruction. When replantation is not possible, thumb reconstruction is the procedure of choice. The level of thumb amputation guides the type of reconstruction. There are five goals for reconstructing a thumb: restoration of (1) functional length (2) stability (3) mobility (especially opposition) (4) sensibility and (5) aesthetic appearance. Aim: This study was conducted to evaluate the functional outcome of two main techniques of osteoplastic thumb reconstruction (1) Osteocutaneous distally based radial forearm flap (2) Groin flap with iliac crest bone graft. Materials and Methods: Total 13 patients underwent osteoplastic reconstruction in the duration from August 2012 to December 2014. Thumb reconstruction was done using distally based radial forearm osteocutaneous flap in 7 patients and two staged reconstruction by groin flap with iliac crest bone graft in 6 patients. Postoperatively results were assessed in terms of range of motion, hand grip, functional recovery, donor site morbidity and patient satisfaction. Results: All reconstructive thumbs were functionally acceptable. Cosmetically, donor site morbidity was an issue for 2 patients with radial forearm flap and 1 patient with groin flap. Suture line dehiscence and plate exposure required intervention in local anaesthesia in one patient with radial forearm flap. After reconstruction absence of pain, temperature and touch sensation were observed. Conclusion: We suggest that osteoplastic reconstruction is a reliable procedure in terms of stability, length, strength and opposability if basal joint is intact. Most of the patients in this study were manual labourers who went back to previous occupation and were able to use their thumb for daily activities for earning livelihood.

Changes in Capacity and Performance in Mobility Across Different Environmental Settings in Children with Cerebral Palsy: An Exploratory Study

Shraddha Diwan, Jasmin Diwan, Ankita B. Bansal, Pankaj R. Patel

Background: Children with cerebral palsy, although having similar diagnosis, varies in their abilities & level of functioning within & across different environmental context e.g. home, school or community setting. Capacity (what a child can do in standardized, controlled environment) may or may not be the same as performance (what a child actually does do in her/her daily environment). Materials and Methods: After getting approval from Institutional Ethic’s Committee (IEC), 63 children with cerebral palsy (4-16 year, mean 7.4 year with SD 0.39) of all clinical types, Gross Motor Functional Classification System (GMFCS) level I-V were examined for mobility using Gross Motor Functional Measure 88 (GMFM). Motor capacity was assessed in clinical setting by highest of 3 GMFM items attained, i.e., crawling (44), walks with support (68) & walks without support (70). Motor performance was measured by Functional Mobility Scale version 2. Result: On analysis of motor capacity 42.85% children were walking without support, 15.87% were able to crawl & 26.98% were able walk with support in clinical setting. Spearman’s Correlation was done between GMFM item 70 with FMS 5 (home setting) to check correlation of capacity with performance & was found to be significantly correlated (r=0.586, p=0.04). All three GMFM items were correlated with FMS 5, 50, 500 & found positively correlated. For community setting (FMS 500), 52.38% children were lifted by parents & only 6.34% were using wheel chair mobility. A total of 21.87% patients were able to walk with or without support & still lifted by parents in school or community setting. Conclusion: Change in capacity and performance of mobility exists mainly in school and community setting in studied population. Context should be given importance to prioritize rehabilitation process.

Electromyographic Evaluation of the Effect of Lined Dentures on Masticatory Muscle Activity in Edentulous Subjects

Aim: The purpose of this study was to examine changes in relative electromyographic (EMG) activities of temporal and masseter muscles after relining the dentures with silicone and acrylic-resin based denture liners. Materials and Methods: Conventional complete dentures were fabricated for 20 edentulous patients. One month after completing adjustments of the dentures, electromyography of the masseter and temporalis muscle during maximum intercuspation was recorded. The dentures were then relined with a silicone denture liner and after an adaptation period of one month, were again subjected for electromyographic evaluation. Further, the dentures were relined with acrylic denture liner and subjected to electromyographic evaluation. Data was analysed using Statistical Package for Social Sciences (SPSS) version 15.0. Intergroup comparisons were done using ANOVA followed by post-hoc assessments using Tukey HSD test. Results: Mean amplitude and duration with conventional dentures was found to be significantly lower as compared to silicone lined and acrylic lined dentures for all the comparisons. Statistically, no significant difference between silicone lined and acrylic lined dentures was observed for any of the comparisons. Conclusion: Within the limitations of this experimental design, it was concluded that relining significantly increases electromyographic activity of the masseter and temporalis muscles. Thus, resulting in an improved biting force, chewing efficiency and masticatory performance. There were no significant differences between silicone and acrylic based denture liners for both electromyographic variables.

Morphology of Sigmoid Colon in South Indian Population: A Cadaveric Study

Stelin Agnes Michael, Suganthy Rabi

Introduction: Sigmoid volvulus is a common etiological factor in acute large bowel obstruction. The increased length of sigmoid colon is attributed as one of the causes of sigmoid volvulus. Aim: The aim of this study was to find the morphology of sigmoid colon in South Indian population using cadavers. Materials and Methods: The present study was performed with 31 cadavers used for teaching purpose. The sigmoid colon was classified into classical, long-narrow and long- broad types by their disposition in the abdominal cavity. The sigmoid loop’s relation to pelvic brim was also observed and grouped as pelvic and suprapelvic in position. The length of sigmoid colon along the mesenteric and antimesenteric border, height and width of sigmoid mesocolon in relation to the pelvic brim and the root of mesentery were measured in the study. Results: The study showed that the majority of the sigmoid colons fell into the classical type (47.6%). The sigmoid colon in pelvic position was significantly more prevalent. The mean length of sigmoid colon was 15.2 ± 4.4cm and 19.2 ± 6cm considering the pelvic brim and root of mesentery as reference points of measurement respectively. The mean length along antimesenteric border was 22.3 ± 7.9cm and 25 ± 8.7cm along the same reference points. The mean length of mesocolon height was 6.5 ± 3cm with reference to pelvic brim and 7.3 ± 3cm with reference to root of Sigmoid mesocolon respectively. The mean width of mesocolon was 7.4 ± 3cm (pelvic brim) and 8 ± 2cm (root of Sigmoid mesocolon) There was a positive correlation of sigmoid colon length with the height of the mesocolon. The gender analysis showed that males had statistically significant longer sigmoid colon and mesocolon. Conclusion: This study documents that the South Indian population has a more classical type of sigmoid colon and that the anatomical dimensions of sigmoid colon and its mesocolon is significantly longer in males.

Short Term Safety and Tolerability of a Fixed Dose Combination of Olmesartan, Amlodipine and Hydrochlorothiazide

J. C. Mohan, Rishi Jain, Vijay Chamle, Amit Bhargava

Objective: To assess the short term safety and tolerability of a fixed dose combination (FDC) of olmesartan, amlodipine and hydrochlorothiazide (OAH) in real-world clinical setting in India. Materials and Methods: Physicians were requested to provide eight weeks observational clinical event data of the patients prescribed with FDC of Olmesartan (20/40mg), Amlodipine (5mg) and hydrochlorothiazide (12.5mg) in the prescription event monitoring (PEM) forms. Data on patients’ demographics, indication for FDC, concomitant medication and other relevant history was also collected and was analysed with descriptive statistics. Results: Two hundred thirty eight physicians provided data of 4763 patients. Mean age of the population was 55±7 years and males were 59.3%. The commonest indication for the FDC was uncontrolled hypertension (60.7%). Diabetes and dyslipidemia were present in 37.9% and 35.1% respectively.Concomitant medications included statins (42.3%), oral anti-diabetic (33.7%) and antiplatelet agents (24.7%). Pedal oedema (0.29%) was the most common adverse event (AE) reported followed by headache (0.16%), giddiness (0.15%), light headedness (0.15) and stroke (0.15%). Other less common (0.04%) reported AEs were tiredness, dizziness, gastritis, hypersomnia, hypoglycaemia, lower respiratory tract infection (LRTI), weakness, diarrhea, labyrinthitis, urinary tract infection, hyponatremia and hypotension. Occurrence of AEs was more common in patients with uncontrolled hypertension (60.74%). Conclusion: The FDC of olmesartan, amlodipine and hydrochlorothiazide prescribed most frequently for patients with uncontrolled hypertension and co-morbidities was found to be safe and well tolerated over a short period of observation.

Aerobic Bacteriological Study of Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Hariom Sharan

Background: The natural history of chronic obstructive pulmonary disease is characterized by frequent exacerbations. Majority of exacerbations are infectious and bacteria responsible for 30-50% of these cases. The purpose of this study was to determine the bacteriology of acute exacerbations of chronic obstructive pulmonary disease in hospitalized patients in our institution and their antibiotic susceptibility pattern to formulate cost effective antibiotic strategy and reducing the emergence of drug resistance. Materials and Methods: One hundred and seven clinically diagnosed cases of acute exacerbations of chronic obstructive pulmonary disease admitted in medicine, tuberculosis and chest wards were selected for the study. Direct gram stain was done for all sputum samples. The suitable sputum samples were cultured. Identification of organism and antimicrobial susceptibility testing was done by standard microbiological techniques. Results: Our study showed growth of pathogenic organisms in 41.12% cases. Males (67.29%) are more affected than females (32.71%). Gram negative bacilli were more isolated than gram positive cocci. The commonest isolate was Klebsiella pneumoniae 15 (38.46%), followed by Staphylococcus aureus 9 (23.08%), Streptococcus species 6 (15.39%), Pseudomonas aeruginosa 4 (10.26%), E.coli 2 (5.13%), Acinetobacter species 2 (5.13%) and Enterobacter species 1(2.56%). The antibiotic susceptibility reveals that vancomycin, linezolid, azithromycin and clarithromycin were most effective drugs for gram positive cocci, meropenem & piperacillin-tazobactam for gram negative bacilli and amikacin & levofloxacin for both gram positive cocci & gram negative bacilli. Conclusion: In developing country like India acute exacerbations of chronic obstructive pulmonary disease is common in adults more than 50 years of age due to smoking habits and high indoor pollution. This leads to a major impact on the quality of life of patients with the condition. They are a major cause of hospital admission and health care utilization.

Modified Computed Tomography Severity Index for Evaluation of Acute Pancreatitis and its Correlation with Clinical Outcome: A Tertiary Care Hospital Based Observational Study

Background: Acute Pancreatitis is a very common condition leading to the emergency visits in both developed and developing countries. Computed Tomography plays a pivotal role in the diagnosis and subsequent management of pancreatitis. The modified CT severity index includes a simplified assessment of pancreatic inflammation and necrosis as well as an assessment of extra pancreatic complications. Aim: To study role of modified computed tomography severity index in evaluation of acute pancreatitis and its correlation with clinical outcome. Materials and Methods: This was a hospital based prospective correlative study done on patients of all age groups referred to the Department of Radio diagnosis from the various indoor and outdoor departments of the hospital, with clinical/Laboratory/ultrasonography findings suggestive of acute pancreatitis. The severity of pancreatitis was scored using Modified CT severity index & CT severity index and classified into mild, moderate and severe categories. Total of 50 patients of acute pancreatitis presenting to the emergency department of our hospital were included in the study. Clinical outcome parameters for correlation collected from respective referral departments included, the length of hospital stay (in days), need for surgical intervention, need for percutaneous intervention (aspiration and drainage), evidence of infection in any organ system (combination of a fever > 100°F and elevated WBC >15,000/ mm³ ), evidence of organ failure (PaO2 < 60 mm Hg or need of ventilation, systolic BP of < 90 mm Hg, serum creatinine of >300µmoles/L or urine output of < 500 ml / 24 h) and death. Results: The age of the patients in the study group was in the range of 17 to 80 years. Maximum patients were in the age group 40-50 years (42.0%). The mean age was 42.32 years. Out of 50 cases, 33 (66%) were male and 17 (34%) were females with a male to female ratio of 2:1. Cholelithiasis was found to be most common aetiological factor for acute pancreatitis in 40% cases. Alcoholic pancreatitis was seen in 36% of cases. Together cholelithiasis and alcoholism accounted for 76% of cases. Pleural effusion was the most common extra-pancreatic complication, 28 patients (56%), followed by ascites. Majority of patients were categorized as severe pancreatitis (44%). 38% patients were grouped into moderate pancreatitis and 18% were categorized in mild pancreatitis. The outcome parameters in terms of length of hospital stay, need of intervention, development of infection, and development of organ failure were more in patients with higher modified CT severity index. Conclusion: In conclusion CECT was found to be an excellent imaging modality for diagnosis, establishing the extent of disease process and in grading its severity. The Modified CT Severity Index is a simpler scoring tool and more accurate than the Balthazar CT Severity Index. In this study, it had a stronger statistical correlation with the clinical outcome, be it the length of hospital stay, development of infection, occurrence of organ failure and overall mortality. It could also predict the need for interventional procedures.

Invitro Antibacterial Activity of the Prosopis Juliflora Seed Pods on Some Common Pathogens

Saeed Tajbakhsh, Alireza Barmak, Faezeh Vakhshiteh, Marzieh Gharibi

Introduction: Prosopis juliflora is probably the most widespread species of genus Prosopis and it is a good source of compounds that have been shown to be pharmacologically active. This plant has been used as a traditional treatment for several diseases. Aim: To investigate the in-vitro antibacterial activity of the P. juliflora seed pods from Bushehr, South West of Iran. Materials and Methods: In the present study, the antibacterial activity of P. juliflora seed pods extract was tested against Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli and Pseudomonas aeruginosa. The minimum inhibitory concentration (MIC) of the extract was determined for each test microorganism. Results: P. juliflora seed pods extract exhibited antibacterial activity against all four test organisms. The MIC of the extract was 0.312 mg/ml and 0.078 mg/ml for S. aureus and S. epidermidis, respectively and 1.25 mg/ml for both E.coli and P.aeruginosa. Conclusion: P. juliflora seed pods from Bushehr, South West of Iran could be an appropriate source of antibacterial compounds that makes it a promising candidate for further studies.

Evaluation of Ica Gene in Comparison with Phenotypic Methods for Detection of Biofilm Production by Coagulase Negative Staphylococci in a Tertiary Care Hospital

Background: Biofilm producing bacteria are responsible for several chronic infections and are difficult to treat as they show much greater resistance to antibiotics. The major virulence factor determining the pathogenicity of CoNS has now well defined and found to be biofilm production. Objective: The study was conducted to isolate and characterize Coagulase Negative Staphylococci (CoNS) and their ability to form biofilms was evaluated by phenotypic and genotypic methods. Materials and Methods: A total of 96 clinical isolates of CoNS were characterized and subjected to biofilm detection by tissue culture plate method (TCP), tube method (TM), congo red agar method (CRA) and PCR. Results: Staphylococcus epidermidis was the most commonly isolated species 76(79.17%). The ica gene was present in 35 (36.45%) of CoNS isolates which were detected as biofilm producers by TCP. Biofilm producing isolates showed higher antibiotic resistance(72.1%). Majority of biofilm producers had strong association with medical device related infections. Conclusion: To compare PCR based dectection method for presence of ica genes with TCP, the test share the specific identification rates. The sensitivity and specificity of TCP method in detection of biofilm was high in comparison with TM and CRA. TCP can be recommended as a general screening test for biofilm detection.

Comparative Evaluation of Shear Bond Strength of Luting Cements to Different Core Buildup Materials in Lactic Acid Buffer Solution

Aim and Objectives: The core buildup material is used to restore badly broken down tooth to provide better retention for fixed restorations. The shear bond strength of a luting agent to core buildup is one of the crucial factors in the success of the cast restoration. The aim of this invitro study was to evaluate and compare the shear bond strength of luting cements with different core buildup materials in lactic acid buffer solution. Materials and Methods: Two luting cements {Traditional Glass Ionomer luting cement (GIC) and Resin Modified Glass Ionomer luting cement (RMGIC)} and five core buildup materials {Silver Amalgam, Glass ionomer (GI), Glass Ionomer Silver Reinforced (GI Silver reinforced), Composite Resin and Resin Modified Glass Ionomer(RMGIC)} were selected for this study. Total 100 specimens were prepared with 20 specimens for each core buildup material using a stainless steel split metal die. Out of these 20 specimens, 10 specimens were bonded with each luting cement. All the bonded specimens were stored at 370c in a 0.01M lactic acid buffer solution at a pH of 4 for 7days. Shear bond strength was determined using a Universal Testing Machine at a cross head speed of 0.5mm/min. The peak load at fracture was recorded and shear bond strength was calculated. The data was statistically analysed using Two-way ANOVA followed by HOLM-SIDAK method for pair wise comparison at significance level of p<0.05. Results: Two-Way ANOVA showed significant differences in bond strength of the luting cements (p<0.05) and core materials (p<0.05) and the interactions (p<0.05). Pairwise comparison of luting cements by HOLM-SIDAK test, showed that the RMGIC luting cement had higher shear bond strength values than Traditional GIC luting cement for all the core buildup materials. RMGIC core material showed higher bond strength values followed by Composite resin, GI silver reinforced, GI and silver amalgam core materials for both the luting agents. Conclusion: Shear bond strength of RMGIC luting cement was significantly higher than traditional GIC luting cement for all core buildup materials except, for silver amalgam core buildup material. RMGIC core material showed highest shear bond strength values followed by Composite resin, GI Silver Reinforced, GI and Silver Amalgam core materials irrespective of luting cements.

HIV Status Disclosure Among People Living with HIV in the Era of Combination Antiretroviral Therapy (cART)

Introduction: As patients with HIV live longer due to Combination Anti-Retroviral Therapy (cART) serostatus disclosure becomes an important issue. Disclosure can have both positive and negative outcomes. Disclosure of HIV status has been associated with better adherence to medication and reduction in levels of psychological distress. Stigma and disruption of family relationships are barriers for disclosure. Most studies regarding disclosure status have been conducted in West. There are many cultural differences in Indian society when compared to west. There is a dearth of research in the field of disclosure of HIV infection in India. Aim: To determine the prevalence of HIV status disclosure among people living with HIV (PLHIV) in South India. Materials and Methods: This descriptive cross-sectional study was done in the hospital attached to Kasturba Medical College (KMC), Mangalore, India from May–June 2013. PLHIV of age more than 18 years were included. During the study period 111 consecutive patients who consented for the study were enrolled. Statistical Analysis: Data was collected using a pre-tested interviewer administered semi structured questionnaire. Data collected was analysed using SPSS Version 11.5 statistical software. Descriptive statistics were done and the results are presented as proportions and mean. Results: The mean age of the study population was 44.86 ± 10.8 years. Majority of the study subjects were men 76 (68.4%). Out of 111 study subjects, 102 (91.9%) had disclosed their HIV status to at least one person while 9 (8.1%) had not disclosed their HIV status to anyone. Disclosure on doctor’s advice was the main reason for 56 (54.9%) participants to disclose their HIV status. The main reason for non-disclosure was fear of shame in family. Conclusion: Disclosure rate was high in our study in the era of cART. Society must stop discriminating against PLHIV so that they can disclose their serostatus and gain access to care and treatment services without any fear of stigma. In our study the main reason for disclosure was doctor’s advice which clearly states the importance of the commitment of doctors in creating awareness among PLHIV about the need for voluntary disclosure.

Enteric Duplication Cysts in Children: A Clinicopathological Dilemma

Aim: Enteric duplication cysts are rare and uncommon congenital malformations formed during the embryonic period of the development of human digestive system and are mainly encountered during infancy or early childhood, but seldom in adults. The clinical presentation is extremely variable depending upon its size, location and type. We present six cases of enteric duplication cysts with diverse clinico-pathological features. Materials and Methods: This study was carried out in the Department of Pathology and Department of Paediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India for a period of 2 years (January 2013 - December 2014). We retrospectively analyzed six patients of enteric duplication cysts based on data obtained, which consisted of patient’s age, sex, clinical presentation, radiological features, operative findings and histopathology report. The data collected was analyzed by descriptive statistics. Results: Six children between age range of 3 days to 10 years had enteric duplication cysts. Two had ileal and one each were of pyloroduodenal, colonic and rectal duplication cyst. In one patient a presumptive diagnosis of enteric duplication cyst was made. Radiology played an important contributory role in diagnosis of these cysts in all the patients but histopathology proved to be gold standard for its confirmation. All these patients were managed by surgical excision. The postoperative and follow up period in all the cases was uneventful. Conclusion: It is important to be aware and make a definitive diagnosis of this rare congenital anomaly as they can present in various clinical forms and can cause significant morbidity and even mortality if left untreated by causing life threatening complications.

Inducible Clindamycin Resistance among Clinical Isolates of Staphylococcus aureus from Sub Himalayan Region of India

Introduction: Clindamycin is an alternative antibiotic in the treatment of Staphylococcus aureus (S.aureus) infections, both in infections by methicillin susceptible and resistant (MSSA and MRSA) strains. The major problem of use of clindamycin for staphylococcal infections is the presence of inducible clindamycin resistance that can lead to treatment failure in such infections. Aim: To determine inducible and constitutive clindamycin resistance among clinical isolates of S. aureus in a tertiary care centre of sub Himalayan region of India. Materials and Methods: A total of 350 isolates of S. aureus from various clinical samples were subjected to routine antibiotic sensitivity testing by Kirby Bauer disc diffusion method. Methicillin resistance was detected by cefoxitin (30µg) disc. All isolates were subjected to inducible clindamycin resistance was by Clinical Laboratory Standards Institute (CLSI) recommended D test. Results: Among 350 S.aureus isolates, 82 (23.42%) were MRSA and 268 (76.57%) were MSSA. Erythromycin resistance was detected in 137 (39.14%) isolates. Erythromycin resistance in MRSA and MSSA was 71.6% and 29.36% respectively. Overall clindamycin resistance was seen in 108 (30.85%) isolates. Constitutive MSLB phenotype predominated (29.62% MRSA; 13.38% MSSA) followed by iMLSB (28.39% MRSA; 9.29% MSSA) and MS phenotypes (13.58% MRSA; 6.69%MSSA). Both inducible and constitutive clindamycin resistance was significantly higher (p=0.00001, 0.0008 respectively) in methicillin resistant strains than in methicillin susceptible strains. Conclusion: The present study gives a magnitude of clindamycin resistance among clinical isolates of S. aureus from this region of the country. Our study recommends routine testing of inducible clindamycin resistance at individual settings to guide optimum therapy and to avoid treatment failure.

A Pilot Study of Cerebral and Hemodynamic Changes During Sedation with Low Dose of Thiopental Sodium or Propofol in Patients with Acute Brain Injury

Siamak Yaghoobi, Marzieh Beigom Khezri, Azam Mohammadi Alamouti

Background: One of the most important therapeutic maneuvers in head injury patients is to maintain Intracranial Pressure (ICP) and Cerebral Perfusion Pressure (CPP) within normal levels. Aims: To compare the effects of low dose of thiopental sodium and propofol on reducing ICP and CPP in patients with head injury that scheduled for neurosurgical interventions. Settings and Design: Using a randomized, crossover pilot study, we enrolled patients with head injury that scheduled for neurosurgical interventions admitted to ICU unit of a teaching hospital during 2010 to 2011. Materials and Methods: In this pilot study, patients randomized into two equal groups. The first group received bolus injection of thiopental sodium 2 mg/kg and a maintenance dose of 2 mg/kg/h and the second group was given a bolus dose of propofol 0.5 mg/kg followed by propofol infusion 20 µg/kg/min. All of patients were given dexamethasone 8 mg at time of catheter insertion. ICP measurement catheter was inserted for each patient and ICP, CPP, SPO2 and MAP were recorded hourly for a period of 6 hours. Results: There was no significant difference in sex and age between the two study groups (p>0.05). The mean ICP, CPP, SPO2 and arterial blood pressure were found to be similar with no significant difference between both groups (p>0.05). Conclusion: Both propofol and thiopental sodium were equally effective in monitoring and maintaining CPP and MAP and eventually an ideal SPO2.

Comparison of Effect of C-Factor on Bond Strength to Human Dentin Using Different Composite Resin Materials

Background: The study was planned to assess the use of low shrinkage composites for restoring cavities with high configuration factor (C-factor) which are subjected to high stresses. Aim: The aim of the study was to evaluate the effect of C- factor on tensile bond strength to human dentin using methacrylate based nanohybrid and low shrinkage silorane composite. Materials and Methods: In this study 40 non carious human molar teeth were selected and assigned into two main groups - cavity (Class I cavity with high C-factor) and flat group (flat surface with low C-factor). Two different composite materials- methacrylate based and silorane low shrinkage composite were used to restore the teeth. Dentin surface was treated, adhesive application was done and composite was applied as per manufacturer’s instructions. Samples were stored in distilled water then subjected to tensile bond strength measurement using universal testing machine. Results: Statistical analysis was done using Independent sample t-test. The mean bond strength in methacrylate based and silorane composite was significantly higher in flat preparation (Low C-factor) than cavity preparation.The mean bond strength in both cavity (High C-factor) and flat preparation(Low C-factor) was significantly higher in silorane than in conventional methacrylate based composite. Conclusion: The bond strength of composites to dentin is strongly influenced by C-factor and type of composite resin material used.

Potential for Hospital Based Corneal Retreival in Hassan District Hospital

Context: In developing countries, corneal diseases are the second leading cause of blindness. This corneal blindness can be treated through corneal transplantation. Though the present infrastructure is strong enough to increase keratoplasty numbers at a required rate, India has largest corneal blind population in the world. So a constant supply of high quality donor corneal tissue is the key factor for reduction of prevalence of corneal blindness. Considering the magnitude of corneal blindness and shortage of donor cornea, there is a huge gap in the demand and supply. Aim: To study the potential for hospital based retrieval of donor corneal tissue in Hassan district hospital after analysing the indicated and contraindicated causes of deaths, so that hospital corneal retrieval program in Hassan district hospital can be planned. Materials and Methods: The cross-sectional, retrospective and record-based study included all hospital deaths with age group more than two years occurred during one year period (January 2014 to December 2014). Data regarding demographic profile, cause of death, treatment given and presence of any systemic diseases were collected. The causes of deaths which are contraindicated for the retrieval of corneas were analysed and noted. The contraindications were based on the NPCB guidelines for standard of eye banking in India 2009. Results: Out of 855 deaths, number of deaths in males (565) was greater than females (290). Numbers of deaths were highest between 41-60 years age group (343). Deaths due to HIV, septicaemia, meningitis, encephalitis, disseminated malignancies were contraindicated for corneal retrieval. Corneas could be retrieved from 736 deaths out of 855.Potential for corneal retrieval in a period of one year in Hassan District hospital was 86%. Conclusion: Hospital corneal retrieval program has got a great potential to bridge the gap between the need for the cornea and actually collected corneas which will contribute enormously in eliminating corneal blindness. In present study there was 86% potential for corneal retrieval among the hospital deaths.

A Morphometric Study of the Patterns and Variations of the Acromion and Glenoid Cavity of the Scapulae in Egyptian Population

Wael Amin Nasr El-Din, Mona Hassan Mohammed Ali

Background: Owing to its many variations, scapula became one of the most interesting bones of the human skeleton. Aim: To measure acromial and glenoid morphology in to describe their anatomical patterns and variations in Egyptians to establish possible morphofunctional correlations related to race, geographic region and literature data. Materials and Methods: One hundred and sixty scapulae of unknown age and sex were studied. Morphological shapes of the tip of the acromion; types of acromion; and morphological shapes of the glenoid were evaluated. Length and width of the scapulae, length, breadth and thickness of the acromion process and distances of the acromio-coracoid and acromio-glenoid in addition to glenoid diameters were measured. Statistical Analysis: The morphometric values of the two sides were analysed using an unpaired t-test. Statistical significance was set p= 0.05. Results: The intermediate shape of the acromion presented with the highest incidence, while the cobra shaped presented with the lowest distribution in both sides. The oval shaped glenoid cavity presented with the highest incidence while the inverted coma shaped showed the lowest incidence. These results are in match with other population. However, the morphometric values of the scapula, acromion process and glenoid cavity were higher than reported in Turkish and Indians. Conclusion: Our data are important to compare Egyptian scapulae to those from various other races that could contribute to demographic studies of shoulder disease probability and management in Egyptian population.

A Study of Variations in the Origin of Obturator Artery and its Clinical Significance

Akshara Venmalassery Rajive, Minnie Pillay

Introduction: The large number of organs and anatomical structures within the cramped pelvic cavity makes the study of vascular pattern and their variations of much importance in this particular anatomical region. Clear awareness of the vascular anatomy of pelvis is critical in surgeries performed here, which require ligation of the arteries concerned and also because such anomalous origins may cause profuse bleeding during surgical procedures. This is particularly true with regard to the variations in the origin of the obturator artery, while performing pelvic and groin surgeries. Aim: The aim of the present study was to find out the prevalence of normal and aberrant origins of obturator artery and to describe its surgical implications. Materials and Methods: The study was carried out on fifty hemipelvises of embalmed cadavers and the origin and course of the arteries were traced and noted. Results: Of the 50 pelvic halves, in 27 specimens, the obturator took origin from the anterior division of internal iliac artery. Remaining 23 specimens showed variations. The origin of the obturator artery was from the inferior epigastric artery in 11 cases, from the common stem of the internal iliac artery and the external iliac artery in 2 cases each, from the posterior trunk of the internal iliac artery in 5 and one each from superior gluteal, inferior gluteal, and internal pudendal artery. Conclusion: The present study indicates that the origin of the obturator artery is highly variable. It can take origin from the stem of the internal iliac artery or from its anterior or posterior division, or from one of the branches of the divisions. It can also take origin from external iliac artery or its inferior epigastric branch. Advancements in diagnostic and surgical techniques in obstetric procedures and urogenital interventions make it essential to have a clear-cut understanding of the vasculature in the abdomen and pelvis.

Angiotensin II Levels in Gingival Tissues from Healthy Individuals, Patients with Nifedipine Induced Gingival Overgrowth and Non Responders on Nifedipine

Anitha Balaji, Thodur Madapusi Balaji, Suresh Ranga Rao

Context: The Renin Angiotensin system has been implicated in the pathogenesis of Drug Induced Gingival Overgrowth (DIGO), a fibrotic condition, caused by Phenytoin, Nifedipine and Cyclosporine. Aim: This study quantified Angiotensin II levels in gingival tissue samples obtained from healthy individuals, patients on Nifedipine manifesting/not manifesting drug induced gingival overgrowth. Materials and Methods: Gingival tissue samples were obtained from healthy individuals (n=24), patients on nifidipine manifesting gingival overgrowth (n= 18) and patients on nifidipine not manifesting gingival overgrowth (n=8). Angiotensin II levels were estimated in the samples using a commercially available ELISA kit. Results: Angiotensin II levels were significantly elevated in patients on Nifedipine manifesting gingival overgrowth compared to the other 2 groups (p<0.01). Conclusion: The results of the study give an insight into the role played by Angiotensin II in the pathogenesis of drug induced gingival overgrowth.

Risk Factors Affecting the Prognosis in Patients with Pulmonary Contusion Following Chest Trauma

Chaudhury Alisha, Gaude Gajanan, Hattiholi Jyothi

Introduction: Thoracic injury and its complications are responsible for as much as 25% for blunt trauma mortality. Pulmonary contusion occurs in 30%–75% of these cases. Despite advances in pulmonary care and intensive care management pulmonary contusion still contributes to higher mortality and morbidity for patients with severe injuries. Aim: To assess the outcome of pulmonary contusions in patients with chest trauma and various factors determining mortality in these patients. Materials and Methods: A retrospective case study, over a period of one year, of all chest trauma cases with pulmonary contusions confirmed by X-rays or CT scan of thorax, were included in the study. All the cases were assessed for age, associated injuries, APACHE II score, SAPS II score, SOFA score, paO2/Fio2 ratio, fracture of ribs, presence of haemothorax or pneumothorax, ventilator and ICU days and finally hospital outcome. Results: A total of 16 cases of pulmonary contusions were included in the study. Five patients died during the ICU stay and 11 survived. All patients had associated injuries. There was significant difference seen in APACHE II score (p<0.001), SAPS II score (p<0.001), SOFA score (p<0.001), paO2/Fio2 ratio (p<0.022) and ventilator days (p<0.001) among the survivors and non-survivors. However, no significant difference was seen in presence of fracture of ribs and presence of either haemothorax or pneumothorax. Conclusion: The risk factors that were associated with higher mortality in patients with pulmonary contusions following chest trauma were APACHE II score, SAPS II score, SOFA score, paO2/Fio2 ratio and ventilator days. Close monitoring to improve the gas exchange and better fluid management will help in improving the survival in these patients.

Study on Diastolic Dysfunction in Newly Diagnosed Type 2 Diabetes Mellitus and its Correlation with Glycosylated Haemoglobin (HbA1C)

Abhay Kumar Chaudhary, Girish Kumar Aneja, Shubhra Shukla, Syed Mohd Razi

Introduction: Left ventricular diastolic dysfunction (LVDD) represents the first stage of diabetic cardiomyopathy preceding changes in systolic function, reinforcing the importance of early examination of ventricular function in individuals with diabetes mellitus (DM). This cross-sectional study was conducted to determine the incidence of asymptomatic LVDD in newly diagnosed normotensive cases of type 2 diabetes subjects, and its relation to glycosylated haemoglobin (HbA1C), age at the time of diagnosis, body mass index (BMI) and serum total cholesterol. Aim and Objective: To study the incidence of left ventricular diastolic dysfunction (LVDD) and its correlation with HbA1C in normotensive, newly diagnosed type 2 diabetic patients. Materials and Methods: This cross-sectional study was done in western U.P. on 100 patients of newly diagnosed (within 1 month) type 2 DM between patients 30 and 60 years of age, visiting the Medicine and Endocrinology outpatient Department of LLRM Medical College, Meerut. Patients with established type 2 diabetes and already taking antidiabetic treatment, cardiac diseases like valvular heart disease, ischemic and hypertensive heart disease, congestive heart failure, cardiomyopathy, renal failure, chronic pulmonary disease, severe anaemia and haemoglobinopathies were excluded from the study. These patients were informed about the study and informed consent was obtained before proceeding with the investigations. Patients selected were evaluated with relevant investigations like fasting and post prandial blood sugar, HbA1C level, lipid profile and 2D echocardiography to assess LVDD. These selected patients were divided in 2 groups; one with left ventricular diastolic dysfunction (LVDD) and second group of subjects without LVDD. Various parameters like HbA1C, age, body mass index and serum cholesterol were evaluated between these 2 groups. Statistical analysis was performed using Student t-test, Chi-square and Fisher Exact-test. Results: Out of 100 patients 65 were males and 35 females. Mean age of the population was 50.08 ± 6.32 years. Overall incidence of LVDD was 41%. Grade 1 LVDD was most common. Mean HbA1C level of LVDD group was found higher as compared to those without LVDD. Conclusion: LVDD is very common at the time of diagnosis of type 2 DM even in normotensive patients independent of confounding effect of hypertension, ischemia and BMI. HbA1C and age, were found to be strong indicators of LVDD in newly diagnosed cases of Type 2 DM.

Clinical and Laboratory Potential Predictors of Blood Culture Positivity in Under Five Children with Clinically Severe Pneumonia - Khartoum -Sudan

Background: Blood culture is necessary for appropriate management of clinically severe pneumonia in children under five years of age. However, in limited resource countries it might be unduly costly and waste of valuable time because of the high negative culture rate. Objectives: This study aims to identify clinical and laboratory parameters that potentially predict a positive blood culture in cases of severe pneumonia. Materials and Methods: A hospital based study, enrolled 189 cases satisfying the WHO definition of severe pneumonia. Age, gender, clinical history, physical examination, temperature, complete blood count, C-reactive protein, blood culture and Chest X Ray for all the patients were recorded. Results: Forty one patients had positive blood culture giving a prevalence of 21.7%. All variables were used in a dichotomous manner. White Blood Count (WBC) more than 20 000, very high C-reactive protein (C-RP =8mg/L) and Temperature more than 40oC, had a positive predictive value of 46.1%, 44.3% and 40.0% respectively for a positive culture as well as a Negative Predictive Value of 91.1%, 91.6% and 91.7% respectively. The WBC more than 20 000 and temperature above 40oC had a significant association with a positive blood culture. Their adjusted Odds Ratios were 3.9 (95% CI: 1.4-10.90) and 3.1 (95% CI: 1.2-8.4) respectively. This was not the case for C-RP (Odds Ratio=2.2, 95% CI: 0.7-2.2) or positive Chest X Ray (Odds Ratio=1.5, 95% CI: 0.6-3.6). Conclusion and Recommendation: Temperature of more than 40oC, Very high C-RP and WBC of more than 20 000 are good indicators of a potential positive blood culture. It is therefore recommended that further research be undertaken to refine these predictors as screening tools before resorting to blood culture. It is also recommended that antibiotic treatment may be initiated on the basis of the high temperature and WBC, while waiting for the culture results.

Pattern of Cancers Treated with Radiotherapy in Uduth Sokoto: A New Center Experience

Usman M. Aliyu, Abdulgafar O. Jimoh, Abdulmajeed Yunusa, Moh’d Umar

Background: Cancer is a leading public health problem worldwide. In many developing countries, cancer tends to present in predominantly advanced stages, to a certain extent due to lack of comprehensive screening and poor access to efficient management. This study was carried out to describe the pattern of cancers managed in the Department of Radiotherapy and Oncology in Usmanu Danfodiyo University Teaching Hospital Sokoto, North-western Nigeria. Materials and Methods: This was a cross-sectional descriptive study involving patients with malignancies that attended the new Oncology Department of the Usman Danfodiyo University Teaching Hospital Sokoto, North-West Nigeria for the period of one year (June 2013 – May 2014). The data was analyzed using SPSS (versions 20). Result: A total of 210 patients with complete records met the criteria for the study. Majority 162 (77.1%) were females with a mean age of 45.68±12.4 years. The male patients were 48 (22.9%) with mean age 46.27±16.5. The spectrum of malignant lesions observed were cancer of the cervix 77 (36.67%), breast cancer 74 (35.24%), nasopharyngeal cancer 20 (9.52%), cancer of the larynx 18 (8.57%) and rectal cancer 14 (6.67%). Late presentation was most common with 6 (3%), 101 (49.8%) and 58 (28.6%) patients presenting at stage I, III and IV, respectively. Conclusion: The study demonstrates that Cancer of the cervix is the leading malignancy in the study population.

Role of Arthroscopy in the Treatment of Osteoarthritis of Knee

Background: A variety of procedures have been described for treatment of the osteoarthritic knee. Comprehensive Arthroscopic treatment regime has definite role in treating patients with knee Osteoarthritis. Aim: To evaluate the role of arthroscopy in functional and subjective outcomes of patient with moderate to severe osteoarthritis of knee. Materials and Methods: Between October 2011 to September 2013, 30 patients were treated with an arthroscopic regimen. Patients with primary osteoarthritis who fulfilled clinical and radiographic classification criteria of American College of Rheumatology for osteoarthritis were included. All patients were followed for 18 months. All patients were subjected to comprehensive arthroscopic treatment. Results: Overall, mean age was 59 years, with 17 females and 13 males. According to Kellgren Lawrence scale, 17 patients had grade 2 osteoarthritis, 10 had grade 3 osteoarthritis and 3 patients had grade 4. The average preoperative Lysholm score was 38.8. According to Outerbridge grading of chondral surface lesions, 14 patients were in grade-1, 5 in grade-2, 8 in grade-3 and 3 patients were in grade-4. The average 18 months postoperative Lysholm score was 83.3 (range 60- 96). 73.33% patients showed good/ excellent outcome. 80% of patients with chondral and meniscal lesions showed excellent/good outcome. Conclusion: This arthroscopic treatment regimen can improve function and activity levels in patients with moderate to severe osteoarthritis. Patients with meniscal and chondral pathology will be benefited more by arthroscopic treatment.

A Hospital-based Study to Determine Causes of Diffuse Hair Loss in Women

Shashikant Malkud

Background: Diffuse hair loss is a common complaint encountered by dermatologists in their daily clinical practice. Hair loss in women is a distressing condition. Various underlying factors individually or in combination contribute to the pathogenesis. Objectives: To determine causes of diffuse hair loss in women and to find the association between probable causes and relevant laboratory parameters, wherever applicable. Materials and Methods: One hundred and eighty women with diffuse hair loss were included in the study. Detailed history and clinical examination including hair pull test and hair microscopy were done in all study subjects. Specific laboratory investigations for determining iron deficiency anaemia, thyroid dysfunction and parasitic infestation were done. Results: Among 180 patients, 116 (64.44%) had telogen effluvium, 28 (15.55%) had CTE, 21 (11.66%) had FPHL and 1 (0.55%) had AE. Fourteen patients (7.77%) had more than one aetiological diagnosis of diffuse hair loss. TE was the commonest type of diffuse hair loss. Incidence of TE and FPHL were highest in the age group of 21-30 years, whereas CTE in 30-40 years. Psychological stress and iron deficiency anaemia were the most common underlying aetiological factors for TE, which is statistically significant (p<0.05). Out of 130 patients with TE, more than one aetiological factor was recorded in 10 cases whereas in 32 cases probable aetiological factors could not be elicited from history. Most cases of CTE were idiopathic. No significant relationship was observed between CTE, haemoglobin level and serum ferritin level. Out of 35 patients with FPHL, low haemoglobin level was observed in 6/20 (30%) and low serum ferritin level in 14/17 (82.35%). Conclusion: Diffuse hair loss is a multifactorial condition. A detailed history, thorough clinical examination and appropriate investigations help to identify the causative factors and treat them accordingly.

Validity of Moyers Mixed Dentition Analysis and a New Proposed Regression Equation as a Predictor of Width of Unerupted Canine and Premolars in Children

Introduction: The Moyer’s mixed dentition analysis forms an essential part of diagnostic procedures to determine adequacy of the space available for the erupting permanent teeth. However, its reliability among different racial groups has been questioned. Objectives: The objectives of this study were to test the reliability of Moyer’s method and to produce new regression equation for Bangalore population for predicting the mesiodistal diameters of the unerupted permanent canines and premolars. Materials and Methods: Data was collected from study models of 400 randomly selected Bangalore subjects aged 13 to 16 years with fully erupted, intact dentitions and no significant malocclusion. The mesiodistal widths of the incisors, canines and premolars of both arches were measured. This data was then utilized to predict the mesiodistal widths of canines and premolars and further compared with Moyer’s table. Conclusion: It was found that 50% is more applicable to boys and 75% to girls. The canine premolar segment in both arches is statistically larger in men than in women (p<0.05). New regression equation was formulated, the accuracy of which needs to be evaluated further in a larger sample.

Amphotericin B Resistant Apophysomyces elegans Causing Rhino-oculo-Cerebral Mucormycosis in an Immunocompetent Host

Debasis Biswas, Aarti Kotwal, Barnali Kakati, Sohaib Ahmad

Mucormycosis, an angioinvasive infection is caused by the ubiquitous filamentous fungi of the order Mucorales and class Mucormycetes. Reports of this disease are on the rise over the past few decades. Rhino-oculo-Cerebral presentation associated with uncontrolled diabetes is the predominant characteristic of this entity. We report here a case of rhinooculocerebral mucormycosis (ROCM) due to Apophysomyces elegans (A. elegans) in a 45-year-old diabetic lady with background illness of hypothyroidism and polyradiculoneuropathy. Though this condition is usually managed with surgical debridement of the affected tissue and medical therapy with Amphotericin B, the isolate recovered in our case was found to be resistant to Amphotericin B.

Invitro Anti-mycotic Activity of Hydro Alcoholic Extracts of Some Indian Medicinal Plants against Fluconazole Resistant Candida albicans

Saranya V., Malathi N., Malaisamy M., Chamundeeswari D.

Background: Candidiasis is one of the most common opportunistic infections caused by Candida albicans. Fluconazole is the drug of choice for prevention and management of this condition. However, the emergence of fluconazole resistant candidal strains has become a major concern. Many herbs like fenugreek, cinnamon, papaya, oregano, garlic are rich in phytochemical constituents known to express antimycotic activity. With the available information, the present research study was carried out to assess the invitro anti-mycotic activity of hydro alcoholic extracts of Trigonella foenum-graecum seeds, Cinnamomum verum bark and Carica papaya leaves and seeds against fluconazole resistant Candida albicans Materials and Methods: Hydro alcoholic extracts of Trigonella foenum-graecum (seeds), Cinnamomum verum (bark), Carica papaya CO.2 strain (male and female leaves) and Carica papaya CO.2 strain (seeds) were prepared by maceration. The anti-mycotic activity of the prepared extracts against Candida albicans was assessed by agar well diffusion method. Three independent experiments were performed in triplicates and the mean and standard deviation were calculated. Minimum inhibitory concentration was determined. Results: The results of the present study revealed that all the extracts exhibited anti-mycotic activity in a dose dependent manner and minimum inhibitory concentration of all the extracts was found to be 15.62 µg/ml. Conclusion: The results of the present study shed light on the fact that plant extracts could be used not only as an alternate drug for management of fluconazole resistant candidiasis but also explored further for oral cancer prevention as a therapeutic adjunct.

Is ‘Pure’ Dhat Syndrome a Stable Diagnostic Entity? A Naturalistic Long Term Follow Up Study from a Tertiary Care Centre

Moideen Sameer, Vikas Menon, Ramamurthy Chandrasekaran

Background: Very little is known about the long term diagnostic stability of Dhat (semen loss) syndrome owing to a dearth of follow up studies on this condition. Aim: The aim of the study was to assess the diagnostic stability and naturalistic long term outcomes in a group of pure Dhat syndrome cases. Materials and Methods: The study was carried out in the outpatient psychiatry department of a tertiary care hospital in South India, using a retrospective cohort design. Forty one cases of ‘pure’ Dhat syndrome (with no other concurrent diagnosis) were selected by a chart review of patients attending the outpatient Psychiatry department. Out of this initial cohort, follow up interviews were held for 36 patients. Direct clinical interviews were held with all participants to assess change in diagnosis. Those who no longer qualified for Dhat syndrome were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to generate other diagnoses. For analysis, the patients were divided into two groups – those who positively endorsed symptoms of Dhat syndrome at follow up (DSP group) and those who no longer did (DSN group). These groups were compared using chi-square test for categorical variables and student t-test for continuous variables to look for significant differences. Frequencies and percentages were used to depict socio-demographic data and the follow up diagnoses. Statistical Analysis: Data was analysed using SPSS for Windows, Version 16.0 (Chicago, SPSS Inc.) Results: The mean duration of follow up was 6±3.5 years. Nearly two-thirds of the sample no longer fulfilled criteria for Dhat syndrome in follow up. The most common revisional diagnosis in these patients was somatoform disorders. Age, marital status and literacy distinguished the two groups. About a quarter of the sample (26.07%) was in complete remission. Conclusion: Even the purest variety of Dhat syndrome is not a stable diagnosis in the majority of patients. The condition may be better conceptualized as a subtype of somatoform disorder with culturally determined explanation for somatic symptoms. Clinicians should look at explanations of semen loss as fluid cultural idioms of distress rather than as a standalone diagnostic entity.

A Comparative Evaluation of the Amount of Fluoride Release and Re-Release after Recharging from Aesthetic Restorative Materials: An in vitro Study

Ruchika Bansal, Tajinder Bansal

Aim: To measure the amount of fluoride released and re released after recharging from various restorative materials: Conventional Glass Ionomer Cement (Fuji II), Light Cure Resin Modified GIC (Fuji II LC), Giomer (Beautifil II), Compomer (Dyract). Materials and Methods: Fifteen cylindrical specimens were prepared from each material. The specimens were immersed in 20 ml of deionized water. The amount of released fluoride was measured during the 1st day, 7th day and on the day15 by using specific fluoride electrode and an ion-analyser. After 15 days each material was divided into three Sub Groups of five samples each. Sub Group A served as control, Sub Group B was exposed to 2% NaF solution, Sub Group C to 1000ppm F toothpaste. The amount of fluoride re-released was measured during the 1st day, 7th day and on the day15 by using specific fluoride electrode and an ion-analyser. The results were statistically analysed using analysis of variance (one-way ANOVA) and Tukey Kramer multiple comparison tests (p=0.05). Results: Independent of the observation time period of the study the Conventional GIC released the highest amount of fluoride followed by RMGIC, Giomer and Compomer. The initial burst effect was seen with GIC'S but not with Giomer and Compomer. After topical fluoride application fluoride re release was highest in Sub Group B and GIC had a greater recharging ability followed by RMGIC, Giomer and Compomer. The fluoride re release was greatest on 1st day followed by rapid return to near exposure levels. Conclusion: From the study it was concluded that, the initial Fluoride release was highest from Conventional GIC followed by Resin Modified GIC, Giomer and Compomer. The Fluoride re release was high when recharging with professional regime (2% NaF) as compared to home regime (Toothpaste). Conventional GIC had a greater recharging ability followed by Resin Modified GIC, Giomer and Compomer.

Comparative Evaluation of Three Different Obturating Techniques Lateral Compaction, Thermafil and Calamus for Filling Area and Voids Using Cone Beam Computed Tomography: An Invitro study

Ruchi Gupta, Anil Dhingra, Nidhi R Panwar

Introduction: The success of root canal treatment depends upon the proper sealing of root canal system. Improper apical seal leads to the microleakage which can be prevented by proper obturation technique. Aim: To compare the quality of three different root canal obturation techniques: lateral compaction, Thermafil and Calamus by using cone beam computed tomography. Materials and Methods: A total of 30 central incisors were selected. Biomechanical preparation was done by Reciproc file no 25. Teeth were divided into 3 groups of 10 teeth each according to the obturation technique i.e. Calamus, Thermafil and lateral compaction. Cone beam computed tomography was used to measure filling area and voids at coronal, middle and apical third of the root canal after obturation by different techniques. Data was statistically analysed by One-Way Anova and multiple comparison of Tukey HSD tests. Result: The maximum amount of obturating material was observed in Calamus group followed by Thermafil and lateral compaction. Minimum voids were seen in obturation by Calamus technique. Conclusion: Within the limitations of this study, it can be concluded that Calamus may be a good obturation technique.

Anatomical Variations of Upper Segmental Renal Artery and Clinical Significance

Gyan Prakash Mishra, Shobha Bhatnagar, Brijendra Singh

Introduction: Classically each kidney is supplied by a single renal artery. In its course renal artery divides into anterior and posterior division, both of these division further divide into segmental arteries that are apical, upper, middle, lower and posterior. Segmental arteries are representing an end artery and they form independent renal segments. In their course they are closely related with collecting system. So, a thorough in depth knowledge of the variations in segmental arteries is a basic requirement for surgeons. Aim: To observe and investigate the anatomical variations in arterial pattern of upper segmental renal artery and its relations with collecting system of ducts in human kidneys. Materials and Methods: Fifty human kidneys of both sexes were observed and studied by corrosion cast method. Different colour coded cast material (butyl butyrate) like red for artery and black for collecting ducts were used. 20% solution of butyl butyrate in acetone was injected into renal artery and ureter of the kidneys. After polymerization (24 hours) these kidneys were kept immersed in a bath of concentrated KOH solution at 500C for 24-48 hours for corrosion to obtain the endocasts. These endocasts were cleaned and washed under running tap water and photographed. Results: In present study upper segmental artery was found in 49 (98%) kidneys. It was absent in 1 (2%) kidney. We observed four types of variations in arterial pattern of upper segmental artery namely Upper Segmental Artery Type-1 (USAT1), Upper Segmental Artery Type-2 (USAT2), Upper Segmental Artery Type-3 (USAT3), Upper Segmental Artery Type-4 (USAT4) and they were found in 20 (40%), 14 (28%), 10 (20%), 5 (10%) kidneys respectively. We also observed two different variations in the anatomical relations between upper segmental artery and collecting system namely Upper Segmental Artery Group -1 (USAG1) and Upper Segmental Artery Group-2 (USAG2). USAG1 was found in 40 (80%) kidneys and USAG2 in 9 (18%) kidneys respectively. Conclusion: Anatomical knowledge of these variations is very important and useful for the uro-surgeons for best outcome and minimal complications in and during nephrectomies, removal of calculi, surgery of renal tumors or other various intrarenal surgeries.

A Comparative Study of Histopathology of Astrocytomas with Intraoperative Cytology with Special Reference to MIB-1 Labelling Index

Deepti Sukheeja, Shashi Singhvi, Naresh N. Rai, Manojit Midya

Background: Although radiological imaging and surgical techniques have substantially improved, assessment of prognosis by grading astrocytoma has been challenging task for pathologists. We have tried to assess these tumours intraoperatively for rapid diagnosis. Also MIB-1Labelling index (MIB-1 LI) was done to study their proliferative activity. Aims: To compare and grade squash smear technique with histopathology to study its utility in diagnosis of astrocytomas. Further, to study correlation of various grades with their MIB-1 labelling index. Setting and Designs: This study was carried out in the Department of Pathology, SMS Medical College, Jaipur over a period of one year. Materials and Methods: Forty five cases of radiologically suspected astrocytomas were submitted for intraoperative cytology and later for histopathology. Two techniques were compared for ability to diagnose as well as grade the tumour. Also, MIB-1 LI were performed in biopsy tissue. Histopathological and immunological grades were compared. Results: Out of 45 cases 44(97.7%) correctly diagnosed by squash smear technique. Further significant differences seen in values of MIB-1 LI of high-grade and low-grade astrocytomas. A progressive increase in the MIB-1 LI was observed with increasing grades. In grade I astrocytoma MIB-1 LI was <0.05%. In grade II astrocytoma it varied from 0.8-2.6% except in one case where it was 3.2% who presented with a recurrent mass. In grade III, MIB-1 LI was 3.5% to 7.5%. In grade IV was 10-20%. Conclusion: Intraoperative cytology is fairly accurate and useful in intraoperative consultation. Also, MIB-1 LI can be a useful adjunct for grading particularly in small biopsies.

High Incidence of Stress Fractures in Military Cadets During Training: A Point of Concern

Introduction: Stress fractures occur due to repetitive cumulative micro trauma on the bone over a period of time.Stress fractures in military cadets is a rising cause of concern. It increases morbidity,long periods of absence from training and economic losses. Aim: The purpose of this prospective study was to determine the incidence and distribution of stress fracture (SFs) in Border Security Forces (BSF) cadets in Bangalore during their basic training tenure. Materials and Methods: A detailed analysis of history and physical assessment was performed of those presenting with symptoms of pain, swelling or deformity. These cadets then underwent radiographic imaging for the evaluation of symptoms. All cadets with clinical and radiological diagnosis of SFs were appropriately managed and followed up every two weeks till the time of union. Results: Three hundred BSF candidates had clinical and radiological signs of SF with an overall incidence rate of 15%. The average age of the patients with SFs was 23 years (range 20-26).The incidence of SFs was highest during their physical training exercises and reached maximum at 12 weeks of the training schedule. Overall, the most common sites of bone injuries were the tibia (87.66%), fibula (7.8%), and metatarsals (2%).There were 5 femur fractures including one bilateral femur(1.67%) and two neck of femur (0.67%). Three tibia, three femur shaft and two neck femur fractures were operated and rest treated conservatively. All fractures healed in an average period of seven weeks. All cadets returned to their full activity in an average period of nine weeks. Conclusion: The study provides evidence that SF among BSF cadets occur frequently during their training period with undoubtedly high incidence rate which is probably underrated in Indian setting. To prevent stress fractures, modifiable causes and risk factors must be identified and a proactive approach which can help the cadets withstand intense physical activity should be adopted.

The Effect of Various Finish Line Configurations on the Marginal Seal and Occlusal Discrepancy of Cast Full Crowns After Cementation - An In-vitro Study

Vaishali Nemane, Ravikumar Akulwar, Suresh Meshram

Background: The marginal fit of crowns is of clinical importance. It is found that marginal and occlusal discrepancies are commonly increased following cementation. The resistance of cementing materials is a factor that prevents cast restorations from being correctly seated. Different finish lines behave differently in facilitating the escape of the cement. When the escape path of the cement decreases, the crown fails to seat further. Materials and Methods: This study was planned with an aim to evaluate the effect of various finish lines on the marginal seal and occlusal seat of full crown preparations. Six stainless steel metal dies were machined to simulate molar crown preparations. The diameter was 10 mm and height was 6mm. The occlusal surface was kept flat and a small circular dimple was machined for reorientation of the wax pattern and metal copings, margins of various designs were machined accurately. The margins prepared were Group A- 900C shoulder, Group B- Rounded shoulder, Group C- 45 degree sloped shoulder, Group D- Chamfer, Group E- Long chamfer, Group F- Feather edge. Full cast metal crowns of base metal alloy were fabricated over the metal dies. Zinc phosphate luting cement was used for the cementation. After twenty four hours, the cemented crown and die assembly were embedded in clear acrylic resin so as to hold the assembly together while sectioning. Twenty four hours later, all the samples were sectioned sagitally. The sectioned halves were focused under a stereomicroscope and the cement spaces were measured to the nearest micron. The cement thickness was measured at two points on the occlusal surface and one at each margin. Results: Significant differences were observed in the occlusal seat and marginal seal of all the finish line configurations. The rounded shoulder had the best occlusal seat, followed by 900C shoulder. The occlusal seat and marginal seal afforded by the shoulder finish lines were similar whereas there was a vast difference in the seating and sealing of long chamfer and feather edged preparations. They showed the worst occlusal seat. Conclusion: It was found that the finish lines like shoulder preparations which exhibit poor sealing prior to complete cementation allow good seating whereas margins which seal earlier do not allow escape of cement and hence do not seat completely.

Analysis of Human Papilloma Virus 16/18 DNA and its Correlation with p16 Expression in Oral Cavity Squamous Cell Carcinoma in North-Eastern India: A Chromogenic in-situ Hybridization Based Study

Background: The incidence of head and neck squamous cell carcinoma (HNSCC) is quite high in North Eastern India. Apart from the traditional risk factors like tobacco and alcohol consumption, human papilloma virus (HPV) is now considered an established causative agent. These HPV related tumour have a clinico-pathological profile that is quite divergent from conventional non-HPV related tumours. Association of HPV in oral cancers has not been explored in north-east India. Materials and Methods: Thirty-one patients with oral cavity squamous cell carcinoma (OSCC) on treatment from October 2010 to January 2013 were included in the study. Patients who received neo-adjuvant chemotherapy were excluded. HPV 16/18 DNA was evaluated using Chromogenic in-situ Hybridization (CISH). Presence of nuclear signals was taken as positive HPV expression. p16 was evaluated using immunohistochemistry and was considered positive if = 80% of the tumour cells showed strong and diffuse nuclear/cytoplasmic immunostaining. The results were analysed using Fisher exact test and confidence interval was calculated where required. Results: The study group age ranged from 30 to 80 years (median age- 54.2 years). The most common site was gum, with well differentiated squamous cell carcinoma being the most common histology. HPV 16/18 DNA was positive in 29% (95% CI: 13.03% - 44.97%) cases and had a clear tendency towards statistical significance with non-smoker cases (p=0.05), lymph node metastasis (p=0.05) and a significant correlation with p16 overexpression (p=0.04). There was no significant correlation with other clinico-pathological parameters. Conclusion: HPV 16/18 is associated with OSCC, commonly seen among non-smokers and may be related to nodal metastasis. So, HPV may be used as a prognostic factor in OSCC and p16 may be considered as a surrogate marker for HPV.

A Noble, Easy and Conceptual Radiographic Analysis to Assess the Type of Tooth Movement (Molar Distalization)

Abhishek Bansal, Anaveri Thimmappa Prakash, Deepthi, Atri Naik

Context and Aim: Bodily tooth movement is desirable in the field of Orthodontics and so is with molar distalization. Till date there is no such analysis available which could gauge and quantify the molar distalization and the type of tooth movement achieved, therefore one was required. Materials and Methods: An OPG and Lateral cephalogram was used taking Inter orbitale plane and FH plane respectively as reference lines and the analysis was devised to measure the amount and type of tooth movement achieved in distalization of molar. Conclusion: This analysis is a noble, easy and conceptual analysis to assess the type of tooth movement achieved during molar distalization and other molar movements using Lateral cephalogram and orthopantomogram.

Is There a Critical Period for Amblyopia Therapy? Results of a Study on Older Anisometropic Amblyopes

Taskin Khan

Purpose: Amblyopia, a common cause of low vision, is rarely treated in adults. Improvement in vision has been seen beyond the critical period at times. Hence, this study was taken up to study the effect of minimal occlusion therapy (2-4 hours/day) in anisometropic amblyopic patients in the age group of 12-30 years. Materials and Methods: The study is a prospective, randomized case series of anisometropic amblyopia patients aged 12-30 years who reported in the outpatient department of Hakeem Abdul Hameed Centenary Hospital, New Delhi, from December 2011 to November 2013. Thorough ocular examination and cycloplegic refraction was done to rule out other ocular disease. Anisometropic Amblyopia was diagnosed only after four weeks of spectacle wear. The selected patients were then advised occlusion therapy of 2-4 hours per day of better eye with stress on near visual task. Videogames, computers, mobile phone gaming and colouring in especially designed patterns were used as vision training aids. The outcome measure selected was best corrected visual acuity (BCVA) achieved that remained stable for three consecutive months of occlusion. Results: Sixty one patients of anisometropic amblyopia were included in the study (32 males and 29 females) aged 12-30 years (mean age 17 years). Mean BCVA at the start of treatment was 20/125 (0.8 log MAR units) and 20/32 (0.2 log MAR units) at the end of the treatment. Thirty three patients (54%) out of 61 had BCVA of 20/20, while 58 patients (95%) had = 20/40 BCVA, 01(1.6%) had 20/50 and 02 (3.27%) had 20/80 BCVA at the end of therapy. The results were statistically significant (p- value <0.0001) with a 95% confidence interval. Conclusion: This study clearly proves that there is no critical period for the treatment in older (12-30 years) anisometropic amblyope. Even 2-4 hours per day of occlusion of better eye with vision training thorough near visual task of amblyopic eye is effective. However, counseling and patient compliance is important for successful outcome of therapy.

Prediabetes Awareness and Practice Among Indian Doctors– A Cross–sectional Study

Asha Basavareddy, Ashwitha Shruti Dass, Sarala Narayana

Introduction: Prediabetes is an intermediate state between diabetes and normoglycaemia, where the glucose levels are higher than normal but not significant to be diagnosed as diabetes mellitus. Guidelines from various associations suggest different types of management in this situation. Objective: To assess knowledge and attitude of the doctors regarding prediabetes using questionnaire. Materials and Methods: A cross-sectional questionnaire based study was conducted to assess the knowledge, attitude and practice among doctors regarding prediabetes treatment. One hundred twenty two (of 150) filled questionnaires were received from general practitioners, post graduates (PGs), physicians and super specialists in and around Kolar and Bangalore. Data was analysed using descriptive statistics and expressed as percentage. Results: A total of 81.3% responded to the questionnaire, of which 14 were general practitioners (MBBS), 48 PGs in General Medicine, 46 physicians (MD General Medicine), and 14 super specialists (DM). Knowledge response was 85.7% (definition – 100%, prevalence – 50.8%, approved drug- 45.2%, progression- 86.2%). Screening for prediabetes was done by 71% of the general practitioners and physicians, but specialists would screen all. 100% general practitioners, 97.9% post graduates, 91.3% of physicians and 64.2 % specialist preferred diet and exercise and rest of them opted for oral antidiabetic drug (OAD) along with diet and exercise, but none of the doctors considered OAD alone for prediabetes. Among OADs metformin (77.45%) was the most preferred followed by voglibose (20.6%) and sitagliptin (1.9%). Conclusion: All doctors had awareness of prediabetes and most of them would regularly screen and treat prediabetes. Majority considered diet and exercise as first modality of treatment. The OAD opted commonly was metformin.

Effectiveness of CoQ10 Oral Supplements as an Adjunct to Scaling and Root Planing in Improving Periodontal Health

Introduction: Deficiency of CoQ 10 was found in human inflamed gingiva and has been found to be responsible for periodontal destruction. Aim: To evaluate the effectiveness of CoQ 10 supplementation as an adjunct to scaling and rootplaning in reducing gingival inflammation and periodontal pocket depth. Materials and Methods: The study was a randomized, double-blind, controlled, parallel group design clinical trial. Thirty subjects with plaque induced gingival inflammation and having atleast three nonadjacent interproximal sites with a probing pocket depth = 5mm were included in the study. The subjects were randomly divided into two groups. The test group (n=15) in which patients were given oral CoQ10 supplements after scaling and root planing and the control group (n=15) in which patients were given an oral placebo after scaling and rootplaning. The plaque index, gingival index and probing depth were recorded at baseline, 1 month and 3 months. Statistical analysis done by using Student’s paired t-test for intragroup comparison and unpaired t-test for inter-group comparison. Results: Both the groups showed marked reduction of afore mentioned periodontal parameters at one month and three months when compared to baseline. Though there was no significant difference in plaque index and probing pocket depth between the two groups at any given time period, test group showed significant difference in gingival inflammation at one month and three months when compared to control group. Conclusion: In the present study use of Coenzyme Q10 oral supplements as an adjunct to scaling and root planing showed significant reduction in gingival inflammation when compared to scaling and rootplaning alone.

Coronal/Hemicoronal Approach – A Gateway to Craniomaxillofacial Region

Susmitha Rajmohan, David Tauro, Bhupesh Bagulkar, Anuj Vyas

Aims: The coronal incision with its various modifications provides the most versatile approach to various areas in the craniomaxillofacial region coupled with excellent exposure. The aesthetic advantage of a hidden scar in the hairline, accounts for its continued popularity. The aim of this study was to review the surgical anatomy, technique and problems of post-operative morbidity pertinent to coronal approach in various clinical situations such as craniofacial trauma, tumour resections and reconstructive craniofacial procedures. Materials and Methods: In this study, ten patients who presented to Oral and maxillofacial surgery department with various craniofacial problems requiring the use of coronal and hemicoronal approach for treatment were evaluated over a period of two years. Five patients needed coronal approach and another five underwent the surgical procedures through hemicoronal approach. This was an observational study. Results: It was observed that a well-planned and carefully designed coronal/hemicoronal incision with strict adherence to surgical principles posed minimal complication during surgery as well as post-operatively. None of the patients developed infection or heamatoma in the postoperative period. Sensory nerve deficits along the distribution of supraorbital nerve was observed in four patients of bicoronal approach and three patients of hemicoronal approach which completely resolved at the end of six months. Motor nerve weakness was observed in four patients in immediate postoperative period which gradually improved. But it persisted in one patient even after six months who had pathology of temporo-orbital region. All the patients had transient alopecia along the line of incision which improved at the end of six months. No other significant disadvantages or complications were noted. Conclusion: This approach offers widest accessibility and visibility to the entire upper and middle one third of the face in less than twenty minutes as observed in our study. The postoperative complications are minimal, minor and outweigh the advantages for surgical treatment in any given clinical situation as observed in this study. This proves the brilliance of coronal approach in solving an array of surgical problems pertinent to craniomaxillofacial region with superior aesthetic outcomes. Abbreviations: ZMC-Zygomatico maxillary complex, NOE-Nasoethmoidal complex, LF-Lefort, ORIF-open reduction internal fixation.

Morbidity Among Tribal Under-Five Children of Tea Garden Areas in a Block of Darjeeling District, West Bengal: A Cross-Sectional Study

Kaushik Ishore, Sharmistha Bhattacherjee, Dilip Kumar Das

Background: In the developing world, more than half of infant and childhood mortality is related to childhood diseases particularly- acute respiratory infections (ARI) and diarrhoea. The situation is worse among underprivileged population such as tribals and people living in tea garden areas. Aim: To identify the morbidity pattern and the associated factors among tribal, under five, children living in tea garden areas of Darjeeling district. Materials and Methods: A cross-sectional study was conducted in three randomly chosen tea garden areas of a block in Darjeeling District, West Bengal, India from September 2013-February 2014. The collected data was analysed using SPSS software and binary logistic regression was applied to test association between morbidity and other epidemiological correlates. Results: Morbidity was noted among 74 out of 192 children studied. Major causes of morbidity were- diarrhoea (26%), acute respiratory infections (24.5%) and fever (16.7%). Proportion of underweight children according to their age was 64.4%. Morbidity status was found statistically significant with some factors, like- religion, socio-economic status, immunization status and number of siblings. Conclusion: There is high prevalence of diarrhoea and ARI associated morbidity in this part of the country.

A Comparison of Efficacy of Segmental Epidural Block versus Spinal Anaesthesia for Percutaneous Nephrolithotomy

Introduction: Percutaneous nephrolithotomy (PCNL) is done under general anaesthesia in most of the centres. Associated complications and cost are higher for general anaesthesia than for regional anaesthesia. Present study is designed to compare the efficacy of epidural block versus spinal anaesthesia with regards to intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, Postoperative complications and patient satisfaction in patients undergoing PCNL. Materials and Methods: After taking Ethical Committee clearance, patients were randomly allocated into 2 groups using table of randomization (n= 40 each) Group E- Epidural block, Group S- Spinal block. Various parameters like intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, postoperative complications and patient satisfaction were studied in these groups. Statistical Analysis: Quantitative data was analysed using unpaired t-test and qualitative data was analysed using chi-square test. Results: Twenty four times in Epidural as compared to fifteen times in spinal anaesthesia two or more attempts required. Mean time (min) required to achieve the block of anaesthesia in group E and group S was 15.45±2.8 and 8.52±2.62 min respectively. Mean arterial pressure (MAP) at 5 min, 10 min and 15 min were significantly lower in spinal group as compared to epidural group. After 30 minutes, differences were not significant but still MAP was lower in spinal group. After 30 minutes difference in heart rate between two groups was statistically significant and higher rate recorded in spinal group till the end of 3 hours. Postoperative VAS score was significantly higher in spinal group and 4 hours onwards difference was highly significant. Postoperative Nausea Vomiting (PONV) Score was significantly higher in spinal group as compared to epidural group. Conclusion: For PCNL, segmental epidural block is better than spinal anaesthesia in terms of haemodynamic stability, postoperative analgesia, patient satisfaction and reduced incidence of PONV. Epidural anaesthesia is difficult to execute and takes longer time to act as compared to spinal block which limits its use.

An Audit of VDRL Testing from an STI Clinic in India: Analysing the Present Scenario with Focus on Estimating and Optimizing the Turnaround Time

Bhanu Mehra, Preena Bhalla, Deepti Rawat, Shikhar Saxena

Background: Timeliness of reporting is of utmost importance to limit the spread of syphilis. The present analysis was undertaken to evaluate the turnaround time of syphilis testing (mainly Venereal disease research laboratory /VDRL test) in a sexually transmitted infections (STI) clinic in India; to find out the possible reasons for delay; to describe the trends of clinical indications for syphilis testing from an STI clinic; to assess the frequency of a positive syphilis serology among STI clinic attendees; and to analyse the follow-up rates of VDRL report collection. Materials and Methods: Two hundred consecutive VDRL requests received at the serology laboratory of a tertiary care health facility from the STI clinic of the linked hospital were prospectively analysed to evaluate the above parameters. Results: For the 200 requests audited, the mean absolute turnaround time of VDRL test was 7.46±2.81 days. The mean duration of the pre-laboratory, laboratory and post laboratory phases was 0, 4.69±2.13 and 2.77±2.51 days respectively. The interval from specimen receipt to performance of tests (mean duration=4.25±1.96 days) was the major reason for long VDRL turnaround time. The common indications for syphilis testing in STI clinic attendees were lower abdominal pain (33%),vaginal discharge (26.5%) and genital ulcer disease (9%); and the follow-up rate for report collection was 71%. Conclusion: Our study highlights the strong need to shift to alternative testing methods, mainly rapid point of care procedures for serodiagnosis of syphilis in order to circumvent the problems of long turnaround time and low patient follow-up rates.

Management of Chronic Periodontitis Using Subgingival Irrigation of Ozonized Water: A Clinical and Microbiological Study

Introduction: Adjunctive use of professional subgingival irrigation with scaling and root planing (SRP) has been found to be beneficial in eradicating the residual microorganisms in the pocket. Objective: To evaluate the effect of ozonized water subgingival irrigation on microbiologic parameters and clinical parameters namely Gingival index, probing pocket depth, and clinical attachment level. Materials and Methods: Thirty chronic periodontitis patients with probing pocket depth =6mm on at least one tooth on contra lateral sides of opposite arches were included in the study. The test sites were subjected to ozonized water subgingival irrigation with subgingival irrigation device fitted with a modified subgingival tip. Control sites were subjected to scaling and root planing only. The following clinical parameters were recorded initially and after 4 weeks at the test sites and control sites. Plaque Index, Gingival Index, probing pocket depth, clinical attachment level. Microbiologic sampling was done for the test at the baseline, after scaling, immediately after ozonized water subgingival irrigation and after 4 weeks. In control sites microbiologic sampling was done at the baseline, after scaling and after 4 weeks. The following observations were made after 4 weeks. The results were statistically analysed using independent t-test and paired t-test. Result: Test sites showed a greater reduction in pocket depth and gain in clinical attachment compared to control sites. The total anaerobic counts were significantly reduced by ozonized water subgingival irrigation along with SRP compared to SRP alone. Conclusion: Ozonized water subgingival irrigation can improve the clinical and microbiological parameters in patients with chronic periodontitis when used as an adjunct to scaling and root planing.

Correlation between Six Minute Walk Test and Spirometry in Chronic Pulmonary Disease

Mitali Bharat Agrawal, Nilkanth Tukaram Awad

Introduction: Six minute walk test (6MWT), is an exercise test, used as a clinical indicator of the functional capacity, in patients with cardiopulmonary diseases. The present study assessed the correlation of six minute walk test with pulmonary function variables, in patients with chronic pulmonary diseases, in local population. Aims & Objectives: The objectives were to study correlation of different spirometry variables with variables of six minute walk test like percent predicted 6 minute walk distance (% Predicted 6MWD) as per Enright et al., formula and Indian reference equation, pre and post exercise pO2 and pCO2 and exercise desaturation. Materials and Methods: All consecutive patients with confirmed diagnosis of chronic pulmonary diseases were included from January 2013 to June 2014 in tertiary care institute. 6MWT was performed as per the ATS guidelines. Among 130 patients 108 were also subjected to arterial blood gases pre and post test. Spirometry was performed as per ATS guidelines. Percent (%) predicted 6MWD was calculated. Correlation between spirometry and 6MWT was assessed. Results: One hundred and thirty patients with chronic pulmonary disease were taken. Out of them there was 102 patients with obstructive airway disease and 58 patients with interstitial lung disease. FEV1 significantly correlated with %predicted 6MWD &; with basal pO2 and pCO2 and with post exercise pCO2 and pO2. FVC also correlated with %predicted 6MWD, with basal pO2 and pCO2 and post exercise pO2. FEV1/FVC correlated only with post exercise pCO2 while MVV correlated with %predicted 6MWD and only basal pCO2. Exercise desaturation correlated only with FVC. Percent predicted 6MWD also correlated with basal pO2 & post exercise pO2. Conclusion: Thus significant correlation found between 6MWT & spirometry variables (FEV1, FVC, MVV & FEV1/FVC).

Direct Immunofluorescence in Oral Lichen Planus

Waranun Buajeeb, Nis Okuma, Supanee Thanakun, Titikarn Laothumthut

Introduction: Oral lichen planus (OLP) is a common immune-mediated oral mucosal disease. Diagnosis of OLP depends mainly on both clinical and histopathological features. Direct immunofluorescence (DIF) is a useful investigation method to distinguish between similar lesions and to confirm diagnosis in cases of uncharacterized features. Aim: The purpose of this study was to evaluate the prevalence and pattern of DIF in a group of Thai patients with OLP. Materials and Methods: Records of clinically and histologically diagnosed OLP patients attending the Oral Medicine Clinic, Faculty of Dentistry, Mahidol University, Bangkok, Thailand were consecutively reviewed for DIF results. The DIF patterns in these patients were analysed. Results: There were 82 atrophic and/or erosive OLP patients with a mean age of 51.6 years. Male to female ratio was 1:5. Of these, 82.9% showed positive DIF. Buccal mucosa was superior to the gingiva and palate in terms of sensitivity for DIF. All specimens except one (98.5%) demonstrated deposition of fibrinogen at the basement membrane zone (BMZ) in a shaggy pattern. The most common DIF pattern was shaggy fibrinogen at BMZ with IgM deposition on the colloid bodies (CB) (35.3%) followed by shaggy fibrinogen along BMZ (27.9%). Conclusion: The prevalence of positive DIF in Thai OLP patients was 82.9%. The most common finding was shaggy fibrinogen at BMZ. The typical pattern was shaggy fibrinogen along BMZ with or without positive IgM at CB. DIF pattern could be evaluated for the diagnosis of OLP lacking clinical and/or histopathological characteristic features.

Comparative Analysis of Urinary Total Proteins by Bicinchoninic Acid and Pyrogallol Red Molybdate Methods

Padma Yalamati, Aparna Varma Bhongir, Madhulatha Karra, Sashidhar Rao Beedu

Background: The concentration of total proteins in urine is a good index of renal function, but its determination is found to be unreliable. The pyrogallol red molybdate (PRM) method for urine total proteins is being widely used in most of the hospitals because of its high sensitivity, better precision and its practicability. Bicinchoninic acid method (BCA) is also used for protein estimation and there have been no studies comparing this method with the PRM method in human urine samples. BCA method overestimates the urinary protein concentration in the presence of interfering substances. After removing the interfering substances present in the human urine samples the results of BCA method were compared with the PRM method. Aim: The purpose of the study is to identify whether the results of urine total proteins by BCA method are comparable to PRM method and can be used as an alternative to the PRM method. S etting and Design: This is a cross-sectional study done on fresh urine specimens from the hospital laboratory, covering a wide range of protein concentrations. Material and Methods: Fresh urine specimens covering a wide range of protein concentrations (urine dipstick: nil, trace, 1+, 2+ and = 3+) of 36 patients were analysed by both the methods. Statistical Analysis: Imprecision was determined by repeated analysis study and Inaccuracy was assessed by comparing the results of the patient’s urine samples by both the methods using correlation plots, Bland and Altman, and Passing and Bablok regression analyses. Results: The coefficient of variation and mean (SD) for the BCA method were 4.6% and 799.1 (882.5) mg/L and for the PRM method were 5.1% and 802.1 (911.9) mg/L. The Pearson correlation coefficient, r was 0.93 (p < 0.0001). Method agreement studies showed no significant constant and proportional bias between both the methods. Conclusion: In urine which is subjected to removal of interfering substances, the BCA results are comparable to PRM method.

Shoulder Tip Pain After Cesarean Section

Tayfur Cift, Emin Ustunyurt, Canan Yilmaz, Fatma Olmez, Birsen Basar

Aim: The aim of this study was to investigate the frequency of postoperative shoulder tip pain (STP) after cesarean section and compare spinal and general anaesthesia with respect to STP. Materials and Methods: Three hundred patients who underwent cesarean section were randomly assigned to either spinal anaesthesia group (Group SA, n=143) or general anaesthesia group (Group GA, n=157). Postoperative STP was assessed at 8 hours and 24 hours after operation by Visual Analogue Scale of Pain (VAS). Results: There were no statistically significant difference between the groups in terms of demographic data, operative findings, and clinical outcomes. The overall incidence of STP in study population was 35.7%. The incidence of STP in group SA (26.6%) was lower than that in group GA (43.9%)(p=0.005). Moreover VAS scores for STP at 6 hours and 24 hours were significantly lower in Group SA (p=0.001 and p<0.001, respectively). Conclusion: Shoulder tip pain is a common complaint after cesarean section, which is more prevalent in general anaesthesia.

Evaluation of LAMP Assay Using Phenotypic Tests and Conventional PCR for Detection of nuc and mecA genes Among Clinical Isolates of Staphylococcus spp

Introduction: The purpose of this study is to develop a nuc and mecA gene specific Loop-mediated isothermal Amplification (LAMP) assay for rapid identification and detection of methicillin resistant Staphylococcus aureus among clinical isolates. Materials and Methods: A total of 100 (70 from pus and 30 from blood), clinical isolates of Staphylococcus spp were screened for the nuc gene to differentiate between S.aureus and Coagulase negative Staphylococci (CONS) by a nuc gene specific LAMP assay. The isolates were also screened for the presence of the mec Agene by the mecA specific LAMP assay. The results were compared with the phenotypic identification and methicillin resistance by Vitek-2 system (bioMérieux, Marcy l’Etoile, France) and conventional PCR. Results: Among 100 Staphylococcus isolates, there were 82 (82%) Staphylococcus aureus isolates and 18 (18%) coagulase negative Staphylococcus as detected by the Vitek 2, conventional PCR and the LAMP assay using the nuc gene. The mecA gene was detected by the LAMP assay in 56(56%) isolates (44 Methicillin resistant Staphylococcus aureus (MRSA) and 12 Methicillin resistant coagulase negative Staphylococcus (MRCONS), which were also identified by the Vitek 2 and conventional PCR as methicillin resistant. The results of the LAMP assay were available within 90min as compared to the Vitek 2 results (18- 24hours) and conventional PCR (3-4 hours). Conclusion: The present study proved that LAMP assay can be used for the simultaneous differentiation of Staphylococcal spp and detection of methicillin resistance.

Evaluation of Dietary Choices, Preferences, Knowledge and Related Practices Among Pregnant Women Living in An Indian Setting

Ajantha, Awnish K Singh, Bhavya Malhotra, Surapaneni Krishna Mohan, Ashish Joshi

Introduction: Healthy and nutritious diet is very essential component of Antenatal care along with clinical advice. The objective of this study was to understand the dietary choices, preferences, knowledge and related practices among pregnant women living in an Indian setting. Materials and Methods: Hundred pregnant women were enrolled in this cross-sectional study. Information about Socio-demographic profile, food item price and approach during inflation, nutrition related knowledge, attitude and practices and 24 hour dietary recall was acquired. Results: Majority of the participants (87%) reported regular antenatal care visits and intake of iron and folic acid tablets. Eighty two percent of the participants were acquainted with standardized marks on food items and 64% of them reported checking of these marks before purchasing. Thirty two percent of the participants did not know about balanced diet. Fifty eight percent of the participants felled in fair category of dietary recall final scores. Conclusion: There is still vast room for improvement of the nutritional status of pregnant women as none of the participants were able to achieve excellent status on 24 hour food record scoring sheet.

Serum Osteocalcin as a Diagnostic Biomarker for Primary Osteoporosis in Women

Sudhir Singh, Dharmendra Kumar, Atil Kumar Lal

Introduction: Osteoporosis, a major health problem in elderly population, especially in post-menopausal females, is diagnosed basically on clinical suspicion and bone mineral density measurement. Dual energy x-ray absorptiometry (DEXA) scan though a gold standard of diagnosis becomes unfit for screening purpose due to its prohibitive cost, unportability and lack of availability of machine. Aim: To assess the diagnostic potential of serum osteocalcin levels in primary osteoporosis. Materials and Methods: In a case-control study, 82 post-menopausal females, between 40-70 years, were subjected to measurements of bone mineral density and serum osteocalcin levels. Based on the results of DEXA scan they were divided into two: a) Control group and B) Case group. Case group was further subdivided as Osteopenia and Osteoporosis depending on their t-scores. Correlation between different BMD grades and the levels of serum osteocalcin were analysed statistically. Results: A negative correlation was found between serum osteocalcin levels and BMD grading. Significant association of age and years since menopause (YSM) was found with serum osteocalcin levels and BMD. No association of BMI and serum osteocalcin was observed with BMD. Statistically significant difference between values of serum osteocalcin in postmenopausal non-osteoporotic women, post-menopausal women with low bone mass (osteopenia) and post-menopausal women with osteoporosis were seen. Conclusion: Serum osteocalcin level measurement can be used for screening purpose in post-menopausal patients. Subjects can be further assessed by DEXA scan to, if indicated.

Prevalence of Osteosclerosis Among Patients Visiting Dental Institute in Rural Area of Western India

Background: Idiopathic osteosclerosis (IO) is a benign lesion of unknown aetiology and is not attributed to any dysplastic, inflammatory, neoplasia, or systemic disorder. Aims and Objectives: To assess the prevalence and distribution of IO according to its location and to patients’ age and gender, among rural population of western India. Materials and Methods: Seven hundred and fifty patients were examined for the presence of IO in the jaw bone. After a thorough clinical examination, radiographic examination was done using OPG. Age specified by WHO were used 5, 12, 15, 35-44 and 65-74. The data collected was than tabulated and subjected to descriptive statistics and chi square test. Results: Among the total study population 89 (11.8%) were found to be suffering from IO out of which 27 (7.2%) were males and 62 (16.53%) were females. The maximum number of IO cases cases was seen among the age group of 35-44 y, 33 (22.0%) and minimum in 5 y 9 (6%) Conclusion: IO is higher among the females as compared to males and mostly seen among the 3rd and 4th decade individuals.

Knowledge and Awareness of Teledentistry among Dental Professionals – A Cross Sectional Study

Background: The use of technology in the form of smart phones and other electronic media in day to day life has become an integral part of life today. Technology today is seeing a paradigm shift towards better inter-professional communications which can help doctors, patients and the masses as a whole. Putting these technological advancements to good use evolves as a major milestone in medicine/ dentistry in the form of telemedicine/teledentistry. Aim: The present study was aimed at knowing the knowledge and awareness of teledentistry among dental professionals of a dental college in India. Settings and Design: The study was conducted in a dental college in India and was circulated among dental professionals. Materials and Methods: A questionnaire was prepared to assess the knowledge and awareness of teledentistry and was circulated among dental professionals in a dental college. The data thus collected was statistically analysed and results obtained. Statistical analysis: The data collected was statistically analysed using SPSS software. Results: A total of 406 persons responded to the questionnaire. In the present study it was found that the knowledge and awareness about teledentistry was very low among post graduates (7.23%) and interns (9.38%) when compared to I & II BDS while most of them agreed that teledentistry is a practice of dentistry through various media options with limited application in dentistry without a legal issue. Conclusion: In the present study, it was apparent that most of the respondents were lacking adequate knowledge and awareness on teledentistry. Hence, there is an immense need to create awareness among dental professionals on teledentistry as the future lies in technological advancement. Tele dentistry can mark the beginning of a new era in dentistry. This can be achieved by conducting CDE programs and awareness campaigns/programs which helps in various levels.

Pattern of Use of Antibiotics Following Snake Bite in a Tertiary Care Hospital

Dhanya Sasidharan Palappallil

Introduction: There are several conflicting recommendations on the use of antibiotics in snakebite victims. This study aimed to identify the pattern of antibiotics used following snake envenomation in a tertiary care hospital of Kerala. Materials and Methods: Retrospective review of case records from January to August 2011 was done and all the cases filed as snakebite were reviewed and details entered in a structured performa. Data was analysed using SPSS 16 and results were expressed mainly using descriptive statistics. Results: Three hundred and thirteen cases were evaluated with mean age 37.58± 14.54 year and 51.1% were males. Out of total, 94.6% received antibiotics of which 88.85% were oral, 8.1% parenteral and 3.04% both. There were total 454 prescriptions of antibiotics. In all seven different types of antibiotics were prescribed alone or in combination of which Ampicillin (205) was the commonest followed by Cloxacillin (194). The mean antibiotic usage was 1.46±0.716 per patient and the mean duration of antibiotic use was 3.16±1.446 days. In patients with no envenomation the mainly prescribed antibiotic was Cloxacillin (126). Intravenous antibiotics like Piperacillin plus Tazobactam were given only in patients with either local or systemic envenomation. Conclusion: The main pattern of use of antibiotics following snakebite envenomation is Ampicillin alone or in combination empirically, Cloxacillin prophylatically and Piperacillin with Tazobactam for severe established infections. The choice of antibiotics is based on the clinician’s discretion. Since the study setting is in a developing country the prophylactic use of antibiotics may be justified weighing the concerns of secondary infections.

Peer Teaching to Foster Learning in Physiology

Introduction: Peer teaching is an effective tool to promote learning and retention of knowledge. By preparing to teach, students are encouraged to construct their own learning program, so that they can explain effectively to fellow learners. Peer teaching is introduced in present study to foster learning and pedagogical skills amongst first year medical under-graduates in physiology with a Hypothesis that teaching is linked to learning on part of the teacher. Materials and Methods: Non-randomized, Interventional study, with mixed methods design. Cases experienced peer teaching whereas controls underwent tutorials for four consecutive classes. Quantitative Evaluation was done through pre/post test score analysis for Class average normalized gain and tests of significance, difference in average score in surprise class test after one month and percentage of responses in closed ended items of feedback questionnaire. Qualitative Evaluation was done through categorization of open ended items and coding of reflective statements. Results: The average pre and post test score was statistically significant within cases (p = 0.01) and controls (p = 0.023).The average post test scores was more for cases though not statistically significant. The class average normalized gain (g) for Tutorials was 49% and for peer teaching 53%. Surprise test had average scoring of 36 marks (out of 50) for controls and 41 marks for cases. Analysed section wise, the average score was better for Long answer question (LAQ) in cases. Section wise analysis suggested that through peer teaching, retention was better for descriptive answers as LAQ has better average score in cases. Feedback responses were predominantly positive for efficacy of peer teaching as a learning method. The reflective statements were sorted into reflection in action, reflection on action, claiming evidence, describing experience, and recognizing discrepancies. Conclusion: Teaching can stimulate further learning as it involves interplay of three processes: metacognitive awareness; deliberate practice, and self-explanation. Coupled with immediate feedback and reflective exercises, learning can be measurably enhanced along with improved teaching skills.

Membrane Sweeping for Vaginal Birth after Caesarean Section and its Outcome -A Comparative Study

V. Ramya, Seetesh Ghose, P. Pallavee

Introduction: Sweeping of membrane is a method of induction of labour. This is used to avoid prolonged labour. However, there is paucity of data about the use of this method for induction of labour and reducing prolonged labour in pregnancy with previous caesarean section. This study is an effort to find the effect of membrane sweeping in previous caesarean section. Objective: To initiate labour in previous LSCS patients by membrane sweeping and maternal outcome. Study setting: This prospective randomised control study was conducted in Mahatma Gandhi Medical College and Research Institute, Puducherry between January 2011 to June 2012. Materials and Methods: Seventy five women were randomly assigned to membrane sweeping and seventy five to control. In study group serial membrane sweeping was done once weekly from 39 weeks of gestation until the onset of labour up to 41weeks of gestation. In control group, no intervention up to 41 weeks of gestation. All the cases were monitored by biophysical profile. Outcome measures: The primary outcomes measured were number of patients who had onset of labour. The secondary outcome included the successful vaginal delivery, number of membrane sweeping to initiate labour, sweeping to delivery interval and amount of oxytocin required. R esults: The onset of labour in study group was 61.3% similar in control group 64% with p 0.736. The mean interval from sweeping to labour onset was 50.15±8 hours. The rate of VBAC was 17.3% in study group in compared to 18.7% in control group and LSCS was 82.7% in study group in compared to 81.3% in control group respectively. The mean gestation age at delivery 40±0.56 weeks for study group compared with 39.92±0.55 weeks for control group. Conclusion: Although membrane sweeping is an easy way of inducing labour, present study failed to demonstrate its beneficial effect on obstetrical outcome.

Analysis of Antibiotic Resistance Genes and its Associated SCCmec Types among Nasal Carriage of Methicillin Resistant Coagulase Negative Staphylococci from Community Settings, Chennai, Southern India

Objective: The study was designed to find the distribution of SCCmec types and the various antibiotic resistance genes amongst MR-CoNS isolates from asymptomatic individuals. Materials and Methods: A total of 145 nasal swabs were collected from asymptomatic healthy individuals from community settings. Identification and speciation of CoNS were done by standard biochemical methods. Screening of methicillin resistance (mecA gene) and detection of various antibiotic resistant genes were done using multiplex PCR method. SCCmec types (I - V) were determined using multiplex PCR. Results: 50 (44.6%) isolates were found to be methicillin resistant both by cefoxitin method and multiplex PCR. S. epidermidis (40%) was the predominant species followed by S. haemolyticus (28%), S. hominis (20%) and S. warneri (12%). Highest resistance was shown for cotrimoxazole (26%), followed by ciprofloxacin (24%), tetracycline (20%), erythromycin (18%), fusidic acid (10%) and mupirocin (6%). Among SCCmec types, 44 isolates showed single type, including type I (30%), type IV (24%), type II (18%), type V (14%) and type III (2%). 6 isolates showed two types, III+IV (n= 2), II+V (n=2), IV+V (n=1) and type I+V (n=1). Conclusion: In conclusion, to the best of our knowledge, this is the first study in India to study the distribution of antibiotic resistant genes and SCCmec types among MR-CoNS from community settings. This study highlights high prevalence of MR-CoNS in community and its role in harbouring genetically diverse SCCmec elements as antibiotic resistance determinant.

Assessment of Critical Care Provider’s Application of Preventive Measures for Ventilator-Associated Pneumonia in Intensive Care Units

Background: The implementation of guidelines for the prevention of Ventilator-associated pneumonia has been shown to have a significant effect in reducing the incidence of VAP. Objective: The aim of the present study was to evaluate the implementation of the preventive strategies for VAP in ICUs of university hospitals of Sari, Iran. Materials and Methods: This cross-sectional study was carried out in 600 beds/day in the ICUs of university hospitals of Sari from April to June 2012. Sampling was done by availability technique in patients receiving mechanical ventilation in the ICU. The implementation of the preventive measures was assessed by a standard checklist with previously approved validity and reliability. Results: The percentage of implementing each of the measures was as follows: sterile suction, 88.44%; semi-recumbent position, 76.8%; oral hygiene, 58.45%; using heat and moisture exchanges (HMEs), 58%; controlling cuff pressure, 46.8%; hand hygiene, 32.8%; using anti-coagulants, 26.8% and physiotherapy, 25.5%. Closed suction system, continuous drainage of subglottic secretions and kinetic beds were not used at all. Conclusion: The overall mean percentage of implementing preventive measures was low and required designing integrated guidelines by considering the conditions of the ICUs in each country, as well as educating and encouraging the staffs to use the recommended guidelines.

The Incidence of Allergic Disorders in First Degree Relatives of Neonates with Transient Tachypnea of Neonate

Mojgan Safari, Behnaz Basiri, Mehdi Ghaeeni

Background: The role of maternal allergic disorders to increase the risk of Transient Tachypnea of Neonate (TTN) in neonates remained unclear. We determined the incidence of allergic disorders in first degree relatives of neonates suffered from TTN to clear role of these allergic disorders to predispose TTN in neonates. Materials and Methods: In a cross-sectional study carried out at Fatemieh hospital between September 2010 and September 2011, all consecutive neonates with the diagnosis of TTN were included into the study. Those neonates were not treated after 5 days of hospitalization were excluded. Baseline information with regard to the history of allergic diseases among first degree relatives of neonates were charted from family members using a structured questionnaire at enrolment by interviewing and examination if required. Results: The two groups were matched for baseline data including neonate gender, birth weight, and type of delivery. In the TTN group, one of first degree relatives (2.9%) suffered from bronchial asthma and two of them (5.7) had atopic dermatitis. In total, allergic diseases was revealed in 8.6% of first degree relatives of neonates with TTN. Besides, none of the first degree relatives of neonates in healthy neonates group experienced bronchial asthma or atopic dermatitis. Allergic rhinitis was not also found in the relatives of the two study neonates groups. Comparing incidence of allergic diseases in first degree relatives of neonates in TTN and healthy groups showed no significant difference (8.6% in TTN group versus 0.0% in healthy group, p = 0.076). Conclusion: Our study showed that the incidence of allergic disorders in first degree relatives of neonates suffered from TTN is higher than healthy newborns, but these differences are not statistically significant.

The Use of Ice Pack for Pain Associated with Arterial Punctures

Mohammadreza Bastami, Arman Azadi, Masoud Mayel

Background: Arterial punctures for monitoring respiratory problems are one of the most painful procedures in hospitalized patients. The knowledge regarding non-pharmacologic methods of pain management, including cold application is limited. Objective: This aim of this study was to determine if the application of ice pack before the procedure would decrease the pain perception of patients during the arterial puncture. Materials and Methods: This experimental study was undertaken among patients admitted to emergency ward in a public educational center affiliated to Ilam University of Medical Sciences, Ilam/Iran. Sixty-one eligible subjects were randomly assigned to two groups. The treatment group (n=31) received ice pack before arterial puncture, whereas the control group (n=30) received no intervention for pain management. Pain immediately and 5 minute after the arterial puncture were scored on a visual analog scale (VAS) from 0 to 10. Results: The mean of pain score immediately after the arterial puncture were 3.12 (1.68) and 4.6 (1.56) for treatment and control group, respectively (p<0. 001). The mean pain score 5 minute after the punctures were 1.9 (1.51) for treatment group and 2.53 (1.85) for control group. This difference was not statistically significant. The mean of heart rate during the procedure were 75.45 (9.76) beats/min for the treatment subjects and 75.46 (9.36) beats/min for the control group (p>0.05). Patients with previous arterial puncture reported higher pain intensity. Conclusion: Cold pack is a simple, non-invasive and inexpensive technique for pain management before the arterial puncture. However, there is a need for further research regarding this topic.

Association Between Harmful Oral Habits and Sign and Symptoms of Temporomandibular Joint Disorders Among Adolescents

Context: Temporomandibular disorder (TDM) is defined as a heterogenous group of psychophysiological disorders commonly characterised by orofacial pain, chewing dysfunction or both. Various Epidemiological studies had shown occurrence of TMD in all age groups including children. Also research had shown that non nutritional oral habits to be associated with TMD. Aim: Present study aimed to find whether harmful oral habits are associated with sign and symptoms of TMD among adolescents in Greater Noida. Setting and Design: Schools in Gautam Buddha district and descriptive study. Materials and Methods: Cross sectional study was carried out among 240 adolescents (10 – 19 years) studying in schools of Greater Noida. Study population were selected by random sampling to whom screening questionnaires recommended by American Academy of Orofacial Pain (AAOP) were distributed. Patient history and clinical examination was used to determine harmful oral habits. Data analysis was done in SPSS version 21 and Chi-square test was applied. Results: Sixty one participants (25.4%) displayed no sign and symptoms of TMD, 34 (14.2%) responded affirmatively to atleast one item on the questionnaire and 108(46%) gave at least three affirmative responses. Headache, Neckpain and Toothache were most frequent reported sign and symptoms of TMD (46.2%). There was statistically significant association between gender and sign and symptoms of TMD on three items of the questionnaire (p < 0.05). Nail Biting (45.8%), Biting Lips/objects (37%) were most common habits among the study group. There was statistically significant association between Nail Biting (p = 0.001), Lip Biting/ object biting (p=0.001), Grinding of teeth (p = 0.01) and sign and symptoms of TMD. Conclusion: A statistically significant association was found between nail biting, lip/ object biting and grinding of teeth with signs and/or symptoms of TMD. Thus there is need for preventive dental treatment and community dental education so that young adults realize importance of early diagnosis and treatment of TMJ disorders.

Comparing Utility of Anthropometric Indices Based on Gender Differences in Predicting Dyslipidaemia in Healthy Adults

Introduction: Anthropometry is a simple reliable method for quantifying body proportions by measuring body length, weight and circumferences. Aim: Our intention in this study was to compare sensitivities and positive predictive values of waist circumference (WC), waist-hip ratio (WHR), waist-height ratio (WHtR) and body mass index (BMI) in identifying healthy subjects, males and females separately for identifying obesity associated dyslipidemia. Materials and Methods: We analysed randomly selected 100 healthy subjects (males:58%, females:42%) between 25 and 60 years of age attending tertiary health care center in South India, after obtaining informed consent and Institutional Ethical Clearance. WC, WHR, WHtR and BMI of all the enrolled subjects were measured and estimated. Their fasting serum lipid profile was assessed. Subjects were divided based on their gender and each group was then categorized as obese and non-obese using anthropometric parameters and their individual serum lipid profile values depending on the cut off standards as per WHO and ATP III guidelines and compared. Data obtained was statistically analysed. Results: Mean values of WC, WHR, WHtR and BMI were highly significant (p<0.000) in obese in both males (97.43 ± 6.21cm, 0.96 ± 0.04, 0.61 ± 0.05, 27.72 ± 2.45kg/m2) and females (91.82 ± 5.18cm, 0.92 ± 0.06, 0.60 ± 0.04, 27.70 + 3.44kg/m2) when considered separately compared to non-obese males (82.27 ± 5.33cm, 0.83 ± 0.033, 0.51 ± 0.03, 22.80 ± 2.11kg/m2) and females (71.68 ± 7.33cm, 0.78 ± 0.03, 0.48 ± 0.03, 21.82 ± 1.98kg/m2 respectively). WC was more sensitive for predicting the altered lipid profile (85%) in females and WHR (65%) in males. WHR showed higher ability to correctly predict the occurrence of dyslipidemia in the obese males (90% positive predictive value) and WHtR in females (92%). Conclusion: The present study inferred that WC, WHR are more sensitive while WHR and WHtR have a higher positive predictive value than BMI in identifying dyslipidemia in healthy males and females.

Awareness, Attitude and Barriers Towards Evidence Based Dental Practice Amongst Practicing Dentists of Bhopal City

Introduction: Evidence based dental practice is said to be the recent best approach to provide treatments or interventions, methodically proven to be safe and sound, efficient and cost effective. So, for providing quality dental care, clinical expertise, research evidence and patient’s preferences all should be given equal importance. Aim: To assess the awareness, attitude & barriers of evidence-based dental practice (EBDP) amongst dentists of Bhopal city. Materials and Methods: The target population of this cross-sectional study involves dentists of Bhopal city. Two hundred fifty private dentists of Bhopal were selected using convenience sampling technique. Data was collected using a self-administered questionnaire containing 15 questions for assessing Knowledge, attitude, practice & barriers in Evidence based practice. Chi-square, t-test & one-way ANOVA were applied for data analysis and p<0.05 was considered statistically significant. Results: The study revealed that dental practitioners had low knowledge about evidence based dental practices but they showed positive attitude towards adopting it in their future practice. There exist certain barriers in practice of evidence based dentistry. Conclusion: Including evidence based dental practice teaching in dental curriculum may prove to be a significant step in effective and efficient dental care delivery to the patients. Barriers in evidence based practice needs to be identified & eliminated.

The Evaluation of Head and Craniocervical Posture among Patients with and without Temporomandibular Joint Disorders- A Comparative Study

Shweta Channavir Saddu, Sujatha Dyasanoor, Nidhin J Valappila, Beena Varma Ravi

Introduction: Temporomandibular disorders (TMD) are the most common non-dental cause of orofacial pain with a multifactorial aetiology. Aim: To evaluate the head and craniocervical posture between individuals with and without TMD and its sub types by photographic and radiographic method. Materials and Methods: Thirty four TMD patients diagnosed according to Research Diagnostic Criteria for TMD’s (RDC/TMD) and were divided into 2 groups: Group I (muscle disorder), Group II (disc displacement). Control group comprised of 34 age and sex matched subjects without TMD. Lateral view photographs were taken and the head posture angle was measured. Craniocervical posture was assessed on lateral skull radiograph with two angles (Craniocervical Angle, Cervical Curvature Angle) and two distances (Suboccipital Space, Atlas-Axis Distance). To compare the results, t-test was used with significance level of 0.05. Results: Head posture showed no statistical significant difference (p > 0.05) between Group I, II and control group in both photographic and radiographic methods. The cervical curvature angle showed significant difference (p = 0.045) in Group I only. Atlas-Axis Distance was statistically significant in Group II (p = 0.001). Conclusion: The present study confirmed that there is a negative association of head posture and TMD whereas, cervical lordosis was present in Group I only.

Use of Curcumin Mouthrinse in Radio-Chemotherapy Induced Oral Mucositis Patients: A Pilot Study

Introduction: Oral Mucositis is a complex and distinct pathobiologic entity resulting in injuries in mucosa that is a common complication in cancer patients undergoing chemotherapy (CT) and radiation therapy (RT). Phytochemicals, such as Curcumin, turmeric extract, has attracted great attention for its therapeutic benefits in clinical oncology due to its chemopreventive, antitumoral, chemosensibilizing and radiosensibilizing activities against various types of cancers and the complications associated with their management. Aim: To evaluate the efficacy and safety of curcumin mouthwash in the management of Oral Mucositis in cancer patients undergoing radio-chemotherapy. Materials and Methods: The research group consisted of 20 adult cancer patients undergoing radio-chemotherapy at the Regional Oncology Centre, who were evaluated for signs and symptoms of oral mucositis and then randomly divided into two groups. Standard preventive oral care i.e. chlorhexidine mouthwash 0.2% was given to one group while the other group was provided with freshly prepared curcumin mouthwash; each to be used thrice daily. Oral mucositis was assessed at days 0, 10 and 20. The World Health Organization (WHO) scale, the Oral Mucositis Assessment Scale (OMAS), and a Numerical Rating Scale (NRS; patient reporting scale of 0-10) were used. Adverse events were tracked. Statistical Analysis: Descriptive statistics, Independent sample t-test and repeated measure ANOVA test were performed. Results: Statistically significant difference was found in the NRS (p=0.000), Erythema (p=0.050), ulceration (p=0.000) and WHO scores (p=0.003) between the two groups. Conclusion: Curcumin was found to be better than chlorhexidine mouth wash in terms of rapid wound healing and better patient compliance in management of radio-chemotherapy induced oral mucositis. No oral or systemic complications were reported.

Study on Surgical Management of Post Burn Hand Deformities

Context: Functionality of the hands is the major determinants of the quality of life in burns survivors. If contractures or scarring affect the dominant hand, as they do on most occasions, the vocation and there by the economic status of the patient suffer. Aim: The aim of this study is to evaluate the different surgical procedures for resurfacing after release of post-burn hand contractures in terms of functional recovery and aesthetic outcome. S ettings and Design: It’s a prospective, non-randomised study of 50 patients admitted and undergoing surgical reconstructive procedures for post burn hand contractures in our plastic surgery department. Materials and Methods: Resurfacing procedures were done according to type of contracture with individualisation for each case. All cases were followed up with physiotherapy and splinting advices. Functional and aesthetic outcome and recurrence of contracture for each procedure was noted at 6 months. Results: Forty seven percent of the cases were reconstructed with skin grafting, 30% cases with Z plasties and 23% with flap coverage. Split thickness skin grafts (STSG) and full thickness graft (FTSG) reconstructed cases had good recovery of joint mobility in 43% and 75% of cases respectively. Reconstructive procedures were aesthetically acceptable to the patients in 63%, 75% and 94% of STSG, FTSG and Z plasty cases respectively. Recurrence was seen in 17% of STSG done cases. Conclusion: Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z plasties with proper planning gives maximum length gain with no donor morbidity as other procedures. Postoperative physiotherapy and splinting is must for better outcome in all cases.

Pubertal Timing and Demographic Predictors of Adolescents in Southwest Nigeria

Background: Changes in the timing of puberty have been an area of research interest in developed countries because of its associated health and psychosocial problems. Adolescents in Africa are no exception as they are reaching adulthood today much earlier than before. This changing trend may have a major influence on adolescents’ sexual behaviour. Aim: This study determined the timing of puberty and demographic predictors among the adolescents in southwest Nigeria. Materials and Methods: The study was a cross-sectional study. Using Modified Sexual Maturity Scale (MSMS) of pubertal assessment, data were collected from 1000 respondents from rural and urban areas of Osun state, Nigeria. Data were collected using pre-tested Assisted Self Completion Questionnaires (ASCQ). The rate of pubertal development was based on age group and current pubertal stage. Data were analysed using SPSS version 16. Chi-square and logistic regression analyses were done to identify significant demographic predictors. Statistical significance was at 5% level. Results: The overall mean age of the respondents was 14.22±2.47 years. The mean age for males was 14.19±2.38 years and 14.25±2.57 years for females. A total of 52.9% of the respondents were males and 47.1% were females. Higher proportions of the females, 41.6% were already in late puberty stages compared to their male counterparts where 21.9% were at this stage. With regards to this rate of pubertal development, more males, 14.2% significantly had late rate of pubertal development than the females 5.1%. The significant demographic predictors was socio-economic class in females only. Conclusion: From this study, the timing of puberty was early for females and socio-economic class is an important demographic predictor for pubertal development. This study was however limited because intrinsic factors such as genetic makeup and nutritional status which could affect the finding were not be excluded.

Assessment of Tooth Wear Among Glass Factory Workers: WHO 2013 Oral Health Survey

Background: Glass factory workers are often exposed to the hazardous environment that leads to deleterious oral health and subsequently, general health. We planned to determine the effects of the particulates present in the milieu on the tooth wear among workers. Aim: To assess tooth wear among glass factory workers in Jaipur, Rajasthan, India. Settings and Design: A descriptive cross-sectional survey was conducted among 936 glass workers in Jaipur, Rajasthan, India from January-June 2014. Materials and Methods: A survey proforma was designed for tooth wear evaluation with the help of WHO Oral Health Assessment form 2013 (for adults). Information regarding oral health practices, adverse habits and dietary habits, demographic details was gathered and clinical parameters were recorded. Statistical Analysis: The Chi–square test, t–test, One-way Analysis of Variance and a Stepwise multiple linear regression analysis. Results: The most prevalent form of erosion was enamel erosion (589, 62.93%) with few subjects of deeper dentinal erosion and the difference was statistically significant (p=0.001). Dental erosion was found to be higher among males compared to females. Years of experience and educational status were identified as best predictors for dental erosion. Conclusion: It was concluded that there was considerable evidence of dental erosion found among the factory workers. Due to ignorance on social, cultural and health aspects, professional approach with regular dental care services for detection of early symptoms and planning of preventive strategies is warranted.

Use of Clinical UV Chamber to Disinfect Dental Impressions: A Comparative Study

Himanshu Aeran, Sakshi Sharma, Varun Kumar, Neelu Gupta

Introduction: Dental impressions are potential source of infection in a prosthodontic practice. Risk of transmission of infection through saliva, blood etc is considered as hazard for both dentist as well as dental auxiliary staff. A number of methods are currently employed for disinfecting the impressions which are technique sensitive and time consuming. This study focuses on disinfecting impression using dental UV chamber which is commonly employed for storing sterilized instruments. Aim: The aim of this invitro study was to evaluate the use of clinical UV chamber to disinfect various impression materials at different time intervals and its comparison with 2% glutaraldehyde using standard immersion technique. Materials and Methods: Total sample size of 180 specimens was taken from three different impression materials. The impressions were made from 30 dentulous subjects. A total of ten impressions were made for each impression material i.e. alginate, addition silicone and polyether impression material. Six punch samples were taken from each impression. Out of 6 punch sample, one was kept as control, second was disinfected by immersing in freshly prepared 2% glutaraldehyde solution for 10 minutes and remaining four were exposed to UV rays for 3 minutes, 6 minutes, 10 minutes and 15 minutes using dental UV chamber. Amount of disinfection achieved was evaluated by counting the colonies over the culture plates with the help of digital colony. Results: The results showed that the mean CFUs for alginate were found to be i.e. 11797.40 ± 5989.73 (mean ± SD). The mean CFUs for addition silicone impression material was found 7095.40 with a standard deviation of 4268.83 and the mean CFUs for polyether impression material was found to be 2168.92 ± 1676 (mean ± SD). Conclusion: For alginate and addition silicone impression material, disinfection was achieved on exposure to UV rays for a period of 10 minutes. However, for polyether impression material 3 minutes of exposure to UV rays was sufficient to cause complete disinfection.

Morphological Study of Soft Palate by Using Computed Tomography–A Prospective Study

Chandramani Bhagwan More, Nairita Saha, Ritika Vijayvargiya

Background: Soft palate is an important part of oro-nasopharyngeal apparatus. The morphometric assessment of soft palate is well-performed on computed tomography (CT). Aim: To evaluate the morphology of soft palate in healthy individuals by using Computed tomography. Materials and Methods: The study was conducted on 300 healthy voluntary participants who were subjected to CT scan (sagittal view) of head and neck region. The measurements of antero-posterior and supero-inferior length of soft palate were performed by using Syngo CT 2009E software. Statistical Analysis: The statistical analysis was performed by using SPSS software version 16 and test applied were one-way ANOVA, independent t-test, chi-square and Karl Pearson’s corelation coefficient. Results: The participant’s age ranged from 18-80 years with mean of 39.51±14.64. The study had equal number of males (n=150) and females (n=150). Out of six shapes of soft palate, Butt type (38.7%) was the commonest. The morphology of soft palate in different age groups was statistically not significant (p>0.05). The total mean of antero-posterior length (30.31±3.39 mm) of soft palate was more than supero-inferior length (10.72±1.71 mm). The mean of antero-posterior length in males (30.69±3.42 mm) was more than females (29.92±3.32 mm); which was statistically significant (p<0.05). The mean of supero-inferior length in males (10.67±1.78 mm) was less than females (10.78+1.64 mm), which was statistically not significant (p>0.05). Conclusion: CT scan is an important diagnostic aid for studying the accurate morphology of soft palate.

Evaluation of Hi-Tec Implant Restoration in Mandibular First Molar Region- A Prospective Clinical Study

Background and Aims: Missing teeth lead to loss of structural balance, inefficient function, poor aesthetics and psychological effects on human beings, which needs restoration for normal contour, function and aesthetics. Several natural or synthetic substitutes are being used for replacement of missing tooth since centuries. Implants are the latest modality of replacement. So, the study was aimed to assess clinical success rate of Hi-Tec implant; which is economical and new in market. Results of the study will help clinician for appropriate implant selection. Materials and Methods: The study included 10 patients from 19 to 31 years and needed restoration of missing mandibular first molar. Restoration had done using Hi Tec Single-tooth implants with metal-ceramic single crown prosthesis after three months of osseointegration. The implants were evaluated clinically (bleeding on probing, probing depth, implant mobility- periotest) and radiographically (marginal bone loss and peri-implant radiolucency) for six years. The observers were blinded for the duration of the study to prevent bias. Results: All the patients had uneventful post-surgical healing. No bleeding on probing, Implant mobility, peri-implant radiolucency with minimal marginal bone loss and constant probing depths were observed well within the normal range during follow-up periods. Conclusion: Two stage single-tooth Hi Tec implant restoration can be used as a successful treatment modality for replacing mandibular first molar in an economic way. However, these results were obtained after 6 years of follow up with a smaller sample size, so long term multi center studies with a larger sample size is recommended for the predictability of success rate conclusively.

Primary Hydatid Cyst of the Diaphragm Mimicking Diaphragmatic Tumour: A Case Report

Vinay Kumar Doddaballapur Prasanna Kumar, Shama Shetty, Rajat Saxena

Echinococcus commonly affects the liver and the lung, but several organs can be affected by this disease. The isolated primary diaphragmatic hydatid cyst, not associated with liver or lung, is very rare. We report a case of hydatid cyst in a 55-year-old male, located in the abdominal side of the left hemidiaphragm which mimicked a hypovascular diaphragmatic tumour and exophytic splenic cyst. In our case the diagnosis was confirmed only with histopathological examination done after surgical excision of the cyst. The aim of this work lies in the fact that knowledge of this clinical entity especially in endemic areas as in India will enable radiologists to guide the clinicians in proper diagnosis and adequate pre-operative planning.

Proboscis Lateralis : A Rare Bilateral Case in Association with Holoprosencephaly

Vasavi Kolluru, Sendhil Coumary

Proboscis lateralis is a very rare congenital craniofacial malformation characterized by a trunk like tubular appendage arising commonly from roof of the orbit near medial canthus. It may be seen as an isolated defect with sporadic occurrence or it may be associated with a spectrum of anomalies. It is usually unilateral and very few bilateral cases of proboscis lateralis have been reported in the literature worldwide. Alobar holoprosencephaly is commonly associated with a single central proboscis and cyclopia. Here we report an unusual case of a bilateral proboscis lateralis seen in association with holoprosencephaly.

Unruptured Noncoronary Sinus of Valsalva Aneurysm Associated with Atrial Septal Defect (ASD)

Kartik Mittal, Divyesh Dadhania, Amit Kumar Dey, Rohit Gadewar, Priya Hira

Sinus of Valsalva aneurysms are rare cardiac anomalies. Incidence of this anomaly is higher in Asian population with male preponderance. Our case highlights a rare association between unruptured sinus of Valsalva aneurysm and atrial septal defect (ASD). Rarely diagnosis of sinus of Valsalva aneurysm is missed on two dimensional echocardiography. Multi slice CT scan is done to confirm echocardiographic findings and to detect any missed complications, other cardiac abnormalities and anatomy for a precise surgical approach.

Anatomical Description and Clinical Relevance of a Rare Variation in the Mesenteric Arterial Arcade Pattern

Ranjeeta Hansdak, Rohini Pakhiddey, Avinash Thakur, Vandana Mehta, Gayatri Rath

Solitary vascular variations of the mesenteric arteries are extremely rare and have been seldom reported in the past. The aim of this study is to emphasize the anatomical and clinical relevance of one such rare variation of inferior mesenteric artery (IMA). The current case anomaly was incidentally observed while guiding the undergraduate medical students in the dissection of the mesenteric region of the abdomen in an Indian cadaver. An Accessory left colic artery was seen to be branching off from the Inferior Mesenteric artery and further dividing into two transverse branches which took part in the formation of arterial arc for the perfusion of the transverse and the descending colon. Awareness of such aberrant branches of Inferior Mesenteric artery helps in optimal selection of the mode of treatment or operative planning. Additionally, this knowledge minimizes possible iatrogenic injuries resulting from surgeries. Moreover, surgical anatomy of anomalous branches of Inferior Mesenteric artery is extremely essential for planning and successfully executing reconstructive procedures using these branches as pedicles for the transposed part of the colon.

Dermatofibrosarcoma Protuberans of Lumbar Region with Metastasis to Lung: A Rare Presentation

Anil Khurana, Vijay Kumar J, Paramjeet Kaur, Ashok K Chauhan, Gajender Singh

Dermatofibrosarcoma protuberans (DFSP) is a cutaneous slow growing soft tissue sarcoma associated with a high local recurrence rate. Common site of presentation is trunk followed by proximal extremity and head and neck region. A case of recurrent DFSP of left lumbar region with metastasis in lung in a 50-year-old woman presented here. Absence of symptoms often leads to a delay in diagnosis. DFSP is often mistaken for other skin conditions, particularly in its early stages.

A 16-Year-old Boy with Combined Volatile and Alcohol Dependence: A Case Report

Soumya Sachdeva, Raghu Gandhi, Pankaj Verma, Arshdeep Kaur, Rohit Kapoor

Substance abuse has been defined as the use of chemical substances for non medical purposes in order to achieve alterations in psychological functioning. The substances commonly abused in India include nicotine, alcohol, cannabis and opioids. However, the use of solvents and propellants is also on the rise as these are inexpensive, legally available household, industrial, office and automobile products; which are more commonly available to children and adolescents. We hereby describe a 16-year-old boy with combined volatile and alcohol abuse; who presented with increasing ataxia, visual and hearing disturbances.

Intracystic Papillary Carcinoma in Male Breast with High Nuclear Grade: A Case Report

Abdulaziz Ajlan M. Al Salloom

Intracystic papillary carcinoma (IPC) in men is an extremely rare disease that accounts for less than 1% of all malignancies with only a few case presentations published so far. This report presents a case of 53-year-old male, who presented a painless swelling of his left breast. The left breast mass was 6 cm maximally and was found to be non-invasive IPC. The tumour is consistently positive for GCDFP-15, ER or PR and negative for HER-2. It consists of predominantly fibrovascular stromal lined by monotonous epithelial cells retaining intermediate to high histological grade with a high nuclear cytoplasmic ratio. In addition, increased numbers of mitotic figures were also seen. Chest X-ray, liver ultrasound and bone centigram showed no evidence of distant metastases. In short, this is the first case report from Saudi Arabia of a male having IPC, with increased number of mitotic figures and high nuclear grades.

Catamenial Pain in Umbilical Hernia with Spontaneous Reduction: An Unusual Presentation of a Rare Entity

Divya Pandey, Ritu Sharma, Sudha Salhan

Spontaneous umbilical endometriosis occurring in absence of any previous abdominal or uterine surgery is extremely atypical. Its association with umbilical hernia is very rare and hernia getting spontaneously resolved has not been reported in literature so far. Here we report a case of a patient with spontaneous umbilical endometriosis associated with umbilical hernia which led to spontaneous hernia reduction. This was also associated with multiple uterine fibromyoma and bilateral ovarian endometrioma which were simultaneously treated by total abdominal hysterectomy with bilateral salpingo-oopherectomy along with surgical excision of the endometriotic tissue and repair of the abdominal wall defect. To the best of our knowledge, this is the first described case of spontaneous umbilical hernia reduction due to development of endometriosis.

Hepatoid Adenocarcinoma of the Gall Bladder-A Rare Variant

Nalli. R. Sumitra Devi, R. Sathyalakshmi, J. Devi, S. Marylilly

Hepatoid adenocarcinoma is a rare variant of extra hepatic adenocarcinoma, consisting of foci of both adenomatous and hepatocellular differentiation with morphological and functional resemblance to hepatocellular carcinoma and hence correct diagnosis is a challenge. The most frequent site is stomach. We present this case of hepatoid carcinoma of the gallbladder for its rarity and difficulty in diagnosis which on histology showed papillae, sheets and trabaculae of polygonal cells with eosinophilic cytoplasm and vesicular nuclei with prominent nucleoli with adjacent foci showing high grade dysplasia.

Metaplastic Carcinoma of Breast with Extensive Chondroid Differentiation: A Case Report with Review of Literature

Metaplastic carcinoma of breast (MBC) is a rare and aggressive type of invasive breast cancer. As it encompasses a variety of distinct histopathologic designations, diagnostic challenges abound. We present a case report of metaplastic carcinoma with extensive chondroid differentiation. This case merits presentation because of its rarity and difficulty to diagnose, especially if the tumour is composed mainly of sarcomatous elements. Standard chemotherapy regimes are ineffective against MBC. The prognosis of MBC is poor in comparison to classical invasive breast cancer. Data focusing on MBC is limited due to its rare incidence.

Concurrent Lactating Adenoma and Infiltrating Ductal Carcinoma: A Case Report

Harendra Kumar, Ap Arna Narasimha, Bhaskaran, Divya Rani M.N.

A lactating adenoma is a benign tumour which usually occurs in younger women who are either pregnant or breast feeding. In some instances these lactating adenomas can occur simultaneously with breast carcinoma, so they have to be carefully evaluated. We report an unusual case of simultaneous occurrence of a lactating adenoma and infiltrating ductal carcinoma occurring in a 25-year-old lactating mother.

Intra-Arterial Angiolymphoid Hyperplasia with Eosinophilia: A Rare Case Report of Peripheral Medium Sized Muscular Artery Involvement

Ashima Amin, T. Umashankar, Chryselle Olive Dsouza

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon benign vasoproliferative disease with distinct clinical and histopathological features. The most common clinical presentation is dermal and subcutaneous painless nodules in the head and neck region. The involvement of medium sized peripheral muscular artery is uncommon. It predominantly affects Caucasian adults during the third and fourth decades, but is also known to occur in Asians and it very rarely occurs in children. We here by present a case of intravascular ALHE in a 46-year-old female presenting with subcutaneous forearm nodule clinically diagnosed as ulnar artery thrombosis.

Bilateral Cystic Lymphangioma of Ovary Associated with Chylous Ascites

Intraabdominal cystic lymphangiomas are rare and are located in retroperitoneum, mesentery, omentum and other visceral organs. Lymphangiomas of the ovary are rare and are usually unilateral. Cases with bilateral cystic lymphangiomas of the ovary are reported very rarely in literature. We report a rare case of bilateral cystic lymphangioma of ovary associated with chylous ascites in a 35-year-old lady who presented with complaints of severe dysmenorrhoea and oligomenorrhoea since 6 months with history of chyluria for the past 3 years.

Paroxysmal Nocturnal Haemoglobinuria Masquerading as Malaria: A Case Report

Archana Dambal, Naren V Nimbal, Shanmukh T Kalsad, K Pramod, M P Madhavaranga

Paroxysmal Nocturnal Haemoglobinuria (PNH) is a rare type of acquired Haemolytic anaemia that is described as a triad of acquired intravascular Haemolysis, venous thrombosis and anaemia with pancytopenia sometimes due to bone marrow failure. However the classical triad may not be observed at once and fever due to leucocytopenia may confuse the clinical picture. Since this is a rare disease, other epidemiologically common causes may be attributed to the illness. We report a case of PNH with a rare association of malaria due to Falciparum and Vivax species which was undiagnosed for 6 years in a young man.

Atrial Fibrillation Due to Over The Counter Stimulant Drugs in A Young Adult

Braghadheeswar Thyagarajan, Sayee Sundar Alagusundaramoorthy, Abhinav Agrawal

The usage of over the counter stimulant drugs and energy drinks is increasing on a day to day basis for various purposes including work, sports and leisure among individuals in all age groups. Multiple formulations are available in the market including pills, liquid capsules and drinks in various flavours. Many of them contain excessively high doses of caffeine along with a variety of stimulant compounds that have multiple effects in different parts of the human body. The consumption of such high amounts of caffeine itself has shown to have caused cardiac arrhythmias in healthy individuals and when it is mixed with a number of stimulant compounds can be associated with a number of adverse effects in the human body. However, the awareness of such life threatening complications associated with these energy drinks does not exist among people who consume it on a day to day basis. We report a case of 25-year-old Caucasian male with no significant past medical history for cardiac diseases, no risk factors for atrial fibrillation, non smoker, occasional alcohol drinker who presents with new onset atrial fibrillation with rapid ventricular response due to the consumption of over the counter stimulant energy capsule which had high doses of caffeine.

Ethionamide: Unusual Cause of Hypothyroidism

Multidrug-Resistant tuberculosis (MDR TB) is major health hazard to the people living in developing countries. As incidence rate of MDR TB has gone up, its therapy has become crucial. MDR TB therapy is known to cause multiple adverse effects however the data related to them is minimal. Hypothyroidism is one of the important adverse effects which usually manifests with vague symptoms and is frequently missed. We present a case of 24-year-old woman who was diagnosed to have MDR TB and started on ethionamide based regimen for same. After 6 months of therapy the patient had clinical symptoms suggestive of hypothyroidism, laboratory investigations confirmed it. As ethionamide is an integral component of MDR TB therapy it was continued and thyroxine replacement therapy was given with which she improved. Hypothyroidism completely resolved after 2 months of stoppage of MDR TB therapy suggesting the reversible aetiology of ethionamide.

Clear Cell Hidradenoma of the Ear Lobule: An Unusual Site of Presentation

The origin of hidradenoma was from the eccrine sweat glands, generally found in the head, face, and upper extremity regions. This lesion has not been reported to be large enough to present in the ear lobule. Hence, its description in the otolaryngology literature is extremely rare. The rarity of this neoplasm and failure to identify its morphologic features may lead to misdiagnosis. We present a benign clear cell hidradenoma of the right ear lobule in a 45-year adult male. We encountered a tumour measuring 4 cm in diameter. Mass shows ulcerated surface, bleeds on touch and remained a diagnostic dilemma till an excision biopsy was carried out and a histopathological report confirmed that it was a hidradenoma of clear cell variant. The aim of presenting this case report was interesting in the fact that it has added clear cell hidradenoma in the final diagnosis, in an uncommon site of presentation.

Intrauterine Fetal Death in Gunshot Injury to the Gravid Uterus: Forensic Perspective

Yogender Singh Bansal, Senthil Kumar, Murali G Rao

Assault on pregnant women is not a rare event; however forensic analysis of gunshot injuries among the same group requires a greater deliberation. This is the report of a 38-week-old fetus which succumbed following gunshot injuries to the mother while the latter survived. The uniqueness of fetal injuries in the form of avulsed wound with complete detachment of anus is of great forensic interest. Such unusual wound pattern could have been the result of a blast wave effect created due to the high velocity projectile affecting the fluid filled uterine cavity.

Ganglioneuroblastoma of Skull Base

Neuroblastic tumours are common in childhood and adrenal glands are the most common site. Head and neck ganglioneuroblastomas are extremely rare and nose is a very uncommon site for a ganglioneuroblastoma. The management of this primitive sympathogonic tumour may vary depending on the age of the patient and stage of the tumour. We present a middle-aged man with a ganglioneuroblastoma of skull base, management of this tumour and a review of literature.

Tubercular Nodular Episcleritis: A Case Report

Sankalp Yadav, Gautam Rawal

Tuberculosis (TB) is an infectious disease caused by the acid-fast bacillus Mycobacterium tuberculosis and is an important cause of death worldwide. Tuberculosis most commonly affects the lungs, but has many extrapulmonary manifestations as well, including intraocular involvement. Tubercular nodular episcleritis is a very rare presentation and no such case in an adult male has been reported in the literature. Herein, we present the very first case of tubercular nodular episcleritis in a 30-year-old Indian male.

PNET of the Abdominal Wall: A Rare Presentation

Srikanth Soma, Sunil Kumar Shetty, Shriram Bhat

Primitive neuroectodermal tumours (PNETs) are a malignant group of neoplasms and are neuroectodermal in origin. In most large series published to date, peripheral primitive neuroectodermal tumours usually present in the second decade of life, with a slight male preponderance. Those which occurs peripherally resemble soft tissue sarcomas. Peripheral PNET is rare in presentation and of which only few cases involving the soft tissues of the abdominal wall have been reported. We present a case affecting a young female who presented to us with a progressively enlarging swelling involving the anterior abdominal wall. She underwent wide excision followed by adjuvant therapy based on final histopathology report.

Purple Urine Bag Syndrome

Purple urine bag syndrome (PUBS) is a rare disorder seen in elderly persons, wherein the urinary bag and the tubing turn in to purple colour. It is usually seen in patients who are on urinary catheters for a long time. Purple coloured urine occurs due to the accumulation of indigo and indirubin, which are the end products of tryptophan metabolism due to the action of sulfatases and phosphatases formed by bacteria like Providencia, Citrobacter, Enterobacter, Klebsiella etc. We present this interesting phenomenon of purple urine in a young male who was on prolonged urinary catheterization. The urine culture was positive for Providencia and constipation was an added risk factor for the purple urine. The urinary catheter and tubing was changed along with a course of antibiotics which lead to the normalization of the urine colour.

Verrucous Carcinoma with Oral Submucous Fibrosis: A Rare Case with Brief Review

Khot Komal, Siddharth B Deshmukh, Anjum Deshmukh

Oral verrucous carcinoma (VC) is a variant of well differentiated oral squamous cell carcinoma (OSCC) characterized by exophytic over growth. Oral submucous fibrosis (OSMF) is a potentially malignant disorder associated with chronic betel nut chewing habit. The development of OSCC is seen in one-third of the OSMF patients, but the development of VC is rare in such patients. There are very few cases of OSMF with VC reported in literature. Here, present a rare case of an elderly patient with VC in conjunction with OSMF.

Restoration of Long Standing Traumatized Teeth: A Case Report

Children are uniquely susceptible to craniofacial trauma. Injuries to the teeth occur often as a result of falls and sport activities. The pulp often gets infected after dental trauma resulting in to numerous complications. The authors present a case report of successful restoration of traumatized teeth with open apex which were weakened due to long standing infection and internal resorption. Initially antibiotic combination of 3- mix was used to disinfect the root canals. One tooth is treated with conventional endodontic treatment and the other tooth with open apex and perforation is managed by MTA apexification followed by canal reinforcement using glass ionomer cement and fiber reinforced composite post. Core build up is done using light cure composite resin followed by aesthetic crowns. The patient also presented with the peg shaped lateral incisors, which were built to an aesthetic appearance using light cure composite resins.

Large Cervical Paraspinal Haemangioma in Association with Intraosseous Haemangioma: A Rare Case Report

Hanish Bansal, Ashwani Kumar Chaudhary, Anuj Mahajan

Haemangiomas are most commonly found in skin and subcutaneous tissue and are very rare in intramuscular region. Paraspinal musculature has been barely reported as location of intramuscular haemangioma while we could not find any literature reporting haemangioma in cervical paraspinal previously. We report a case of middle aged woman with a large intamuscular haemangioma involving left cervical paraspinal musculature extending from suboccipital region to C5 vertebra and reaching upto left parotid gland along with C6 vertebral body haemangioma.

Bilateral Multifocal Renal Angiomyolipoma Associated with Wunderlich’s Syndrome in A Tuberous Sclerosis Patient

Renal Angiomyolipoma (renal AML) is a benign clonal neoplasm with a incidence of 0.3-3%, occurring as isolated sporadic entity or in association with Tuberous sclerosis (TS) in 80% cases. Multiple, bilateral renal AML are considered diagnostic of Tuberous sclerosis. Wunderlich's syndrome, a urological emergency is a spontaneous nontraumatic bleeding into subcapsular and or peri-renal space and is a life threatening complication of renal AML occurring in 10% cases which has to be timely diagnosed and treated. Here, we present an unusual case of TS with bilateral, multifocal renal AML in a 25-year-old female who presented with Wunderlich's syndrome, which is a rare but life threatening complication that has to be suspected, timely diagnosed and treated. We have discussed the importance of early diagnosis, timely treatment, follow up and education of patient and relatives of the possible complications associated.

Conservative Management of Horizontal Root Fracture – A Case Series

Neha sisodia, MK Manjunath

Root fracture has been defined as a fracture involving dentin, cementum, pulp and periodontal ligament. Depending on the level of the fracture line various treatment modalities may be employed by the clinician to promote healing. The following case reports highlight how changes in technique allow for conservative management of horizontal root fractures at different levels. This approach allows the patient to retain their natural dentition at an affordable cost and provide a viable alternative to the use of more invasive and expensive alternatives. These patients presented with complaints of pain and mobility in upper front tooth region following trauma. Diagnosis was confirmed on the basis of intra-oral periapical radiographs following which non-surgical root canal treatment was performed.

Naphthalene Poisoning following Ingestion of Mothballs: A Case Report

Tanveer Singh Kundra, Vikas Bhutani, Rimple Gupta, Parminder Kaur

Naphthalene is a widely used industrial and household chemical in the form of mothballs. But it has rarely been an agent of poisoning worldwide. We describe a case of ingestional naphthalene poisoning with a good outcome after proper management. A 29-year-old girl ingested 8 mothballs, and presented two days later with haemolysis and methaemoglobinaemia. She was given intravenous methylene blue, N-acetylcysteine and ascorbic acid, besides supportive treatment. Renal replacement therapy in the form of SLED of 8 hours was done on a daily basis. She was discharged after ten days on twice a week outpatient follow-up haemodialysis.

Pathologic Surface Changes in the Submental Flap Used for Intraoral Reconstruction: Report of Two Cases

Amin Rahpeyma, Saeedeh Khajehahmadi

Soft tissue reconstruction is often necessary after pathologic resection of oral squamous cell carcinoma. Although morphologic changes are common after transfer of the flaps to the oral cavity, pathologic changes within the transferred flaps, used for intraoral reconstruction, are rare events. Despite the widespread use of submental flap for oral cavity reconstruction, there are no reports in this respect. In this article, pathologic changes in the surface epithelium of transferred submental flaps are demonstrated with the report of two cases. The occurrence of lichen planus in a submental flap that had been used for reconstruction of lateral tongue border is reported in one case and in another patient, squamous cell carcinoma arising in the transferred de-epithelialized submental flap, used for maxillary and buccal reconstruction, is shown.

Successful Outcome of Twin Gestation with Partial Mole and Co-Existing Live Fetus: A Case Report

Setu Rathod, Reddi Rani, Lopamudra B. John, Sunil Kumar Samal

Sad fetus syndrome comprising of a live twin gestation with a hydatidiform mole is a rare entity. The condition is even rarer when the co-existing live fetus is associated with a partial mole than a complete mole. We report the case of a 24-year-old G2P1L1 at 28 weeks gestation who presented to our casualty in the second stage of labour. She had a previous ultrasound scan at 13 weeks which showed a live fetus with a focal area of multicystic placenta. She delivered an alive preterm male fetus weighing 1.32 kg vaginally. Following expulsion of normal placenta of the live fetus, partial mole was expelled. The fetus was admitted to neonatal ICU and discharged after two weeks. Soon after delivery, ß-hCG (human chorionic gonadotropin) was 1,21,993 mIU/ml which decreased to 30mIU/ml within two weeks. The patient was discharged with advice of regular follow up of ß-hCG reports.

Clinico-Microbiological Investigation of Catheter Associated Urinary Tract Infection by Enterococcus faecalis: vanA Genotype

Prolonged hospitalization and exposure to third generation cephalosporins are reported to facilitate the acquisition and colonization of Vancomycin Resistant Enterococci (VRE). Though VRE is not uncommon in India, urinary tract infection with a vanA genotype is a cause of serious concern as VRE co-exhibit resistance to aminoglycosides. In India, majority of the VRE isolates recovered from hospitalized patients include Enterococcus faecium. We report a case of catheter associated urinary tract infection by an endogenous, multidrug resistant E. faecalis of vanA genotype following prolonged hospitalization, ICU stay, catheterisation and exposure to 3G cephalosporin and metronidazole. The patient responded to linezolid therapy.

Hirayama Disease: Escaping From the Quotidian Imaging

Arjit Agarwal, Shruti Chandak, Pawan Joon

Hirayama disease is a rare type of neurological disease commonly manifesting as brachial monomelic amyotrophy in young males of Asian origin, easily understood as juvenile non-progressive cervical amyotrophy. The first case was reported by Hirayama in 1959. The pathogenesis is attributed towards chronic compression of cervical spinal cord during flexion movements of neck in cases where there is detachment of posterior dura mater. This chronic event, invariably leads to features of cord atrophy along with other MRI features. We report a case of 21-year-old male who presented with atrophy of distal muscles of his right hand and was sent for MRI of cervical spine which revealed prominent posterior epidural venous plexus without significant cord atrophy. Clinico-radiologic profile of the patient leads toward the diagnosis of Hirayama disease which was considered as borderline because of asymmetrical cord atrophy which is a not a routine imaging feature of the entity.

Radiotherapy-Induced Vitiligo in a Patient with Carcinoma Buccal Mucosa: A Case Report

Sunil Choudhary

Vitiligo significantly affects self-esteem and deteriorates the quality of life of affected persons. Radiotherapy has several early and late effects but it is not known to induce vitiligo. This is a case report of a patient suffering from carcinoma buccal mucosa that had developed vitiligo in the radiotherapy portal. To the best of my knowledge this is a one of the first case reports of its kind as this patient had no history of vitiligo but developed it soon after radiotherapy. Since radiotherapy is an essential component of cancer management, the radiation oncologist must be aware of this toxicity of radiotherapy. Choosing the high energy of photon beam may reduce the risk of such toxicities.

Adult Multicystic Nephroma: Case Report and Review of the Literature

Ayse Nur Deger, Erdem Capar, Bercis Imge Ucar, Hakki Deger, Mahir Tayfur

Multicystic nephroma (MCN) is relatively a rare, nongenetic and benign lesion of the kidney which has a bimodal distribution. The congenital form is commonly seen under the age of 2. Adult-onset MCN is more often seen in women, especially in post menopausal females. The aetiopathogenesis of MCN is still unknown. Ovarian-like stroma of the tumour indicates the tumour originates from the mullerian tissue of the kidney. Hormonal theory is suggestive as the stroma of the tumour is positive for estrogen and progesteron. Preoperative diagnosis of MCN is difficult. Surgical approach is recommended both for the histological diagnosis and the treatment of the disease. We here present a 53-year-old female patient with MCN admitted to the urology clinic with left flank pain treated successfully with partial nephrectomy. No recurrence was noted after six months of clinical and radiological follow-up.

A Case of Lower Respiratory Tract Infection with Canine-associated Pasteurella canis in a Patient with Chronic Obstructive Pulmonary Disease

This is the report of lower respiratory tract infection with Pasteurella canis in a chronic obstructive pulmonary disease (COPD) patient with history of casual exposure to cats. Pasteurella species are part of the oral and gastrointestinal flora in the canine animals. These organisms are usually implicated in wound infection following animal bites, but can also be associated with a variety of infections including respiratory tract infections.

H’ Shaped Bilobate Placental Partition: A Rare Placenta Variation

Anomalies of placental growth with respect to its shape have been associated with adverse pregnancy outcomes. A very rare form of ‘H’ bilobate placental partition was observed in a 31-year-old woman presenting at 24 weeks of gestation. This observation was made during a routine obstetrics scan. Sonographic features showed that it was a non-fibroid partition. The placenta featured anterior and posterior portions separated by a large middle, vertical portion. The placenta was antero-posterior semi-circumferential in shape, measuring approximately 16.70 cm in length and 12.48 cm at shorter chorionic plate (minor axis). The middle, vertical part of the placenta partitioned the uterine cavity into two, creating the impression of two separate gestational sacs. The fetus was located in one of these. The patient was eventually delivered through caesarean section at gestational age (GA) of 36 weeks 6 days. The baby had a low birth weight of 1.70 kg. The early detection of this placental anomaly underlines the importance of ultrasonography in obstetrics.

Distinguishing Myasthenia Exacerbation from Severe Preeclampsia: A Diagnostic and Therapeutic Challenge

Pooja Sikka, Bharti Joshi, Neelam Aggarwal, Vanita Suri, Hement Bhagat

Myasthenia gravis is an acquired, autoimmune neuromuscular disorder characterized by voluntary muscle weakness. Pregnant patients may have disease exacerbation, respiratory failure, crisis, adverse drug reaction, surprisingly enough remission at any trimester or postnatal period. Concurrence of myasthenia gravis with severe preeclampsia is a dreadful condition raising diagnostic and management issues. We hereby discuss a case of myasthenic woman who developed severe preeclampsia during pregnancy and presented in last trimester with clinical features mimicking signs of impending eclampsia. Keeping in mind the history of myasthenia gravis, urgent neurology review taken and diagnosis of myasthenic exacerbation was entertained. She responded well to injection neostigmine and in this way inadvertent use of magnesium sulphate was avoided.

Idiopathic Juvenile Osteoporosis: A Case Report

Halenur Altan, Gül Tosun, Yas¸ar S¸en

Idiopathic Juvenile Osteoporosis (IJO) is a very rare disease, self restrictive and shows marked, spontaneous improvement during adolescence. The major clinical features were pain with difficulty walking, growth retardation, oral and dental abnormalities with radiographically porous bone structure. A 13-year-old male referred to paediatric dentistry clinic for toothache. The observations made with extra-intraoral clinic examination that one revealed short and skinny stature, diffuse caries in deciduous teeth, abraded lower incisor, deep bite and dysmorphic appearance in permanent incisor. This report emphasizes the recognized features of IJO as well as describes facio-dental findings that could aid in the diagnosis and management of these patients.

A Survivor of Neonatal Intestinal Mucormycosis

Gastrointestinal mucormycosis (GIM) is a rare opportunistic fungal infection. One third of all patients are children and of these, 50% are infants. The most common clinical mimic is necrotizing enterocolitis (NEC). It has to be differentiated from this entity as the treatment is entirely different. High index of suspicion by the clinicians and the pathologists aids in early diagnosis and immediate treatment. If untreated, it has a frequent fatal outcome. Very few survivors of GIM are found in literature. We report a rare case of a surviving neonate of GIM.

Spontaneous Partial Vanishing Cytomegalovirus Pseudotumour of Colon in an Immunocompetent Patient

Cytomegalovirus (CMV) pseudotumour of the gastrointestinal tract, is a rare benign entity which is treated with antiviral medications and known to resolve spontaneously in a few cases. This is a case report of a 58-year-old man who presented with right lower quadrant abdominal pain. Contrast enhanced computerized tomography of abdomen and pelvis showed apple core lesion involving proximal transverse colon, ceacum, ascending colon, ileoceacal valve and terminal ileum. Synchronous carcinoma of colon was suspected. At laparotomy, there was growth palpable only in the proximal transverse colon. Histological findings of biopsy specimen revealed CMV pseudotumour. CMV pseudo tumour should be included in the differential diagnosis of apple core lesions of the colon even in immunocompetent adults. Endoscopy and biopsy are strongly recommended before surgery in colonic mass lesions to make a definitive diagnosis and to avoid unnecessary surgery.

Surgical Approaches and Management of Panfacial Trauma: A Case Report

Sourav Sharma, Vandana Dhanasekaran

Patients with multiple fractures involving upper third of the face, the mid-face and the lower third are generally referred to as Pan-facial fractures and managing these cases is extremely complicated. Proximity of the maxillofacial region to the important features or senses such as visual function (diplopia),olfaction, respiration (airway management),chewing or mastication (occlusion), deglutition and aesthetics; makes the scenario a little more complex for the surgeon operating in this particular region than the surgeon operating any other part of the body. Inability to directly visualize and reduce all the components of a pan facial injury along with inadequate stability of the fractured bones leads to persistent deformity. It is challenging to follow an established pattern for repairing the pan facial fractures. Each case with this type of fracture is unique and requires skill and expertise of the surgeon to restore the pre-traumatic anatomy and facial aesthetics. Despite all the aggressive treatment, most of the patient’s with pan facial trauma may have some residual deformity which may require another correction surgery later. This article briefs about the management and simple approaches used to reduce and fix a case of pan facial trauma in a 23-year-old male.

Clinical and Genetic Analysis of Fibrodysplasia Ossificans Progressiva: A Case Report and Literature Review

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder characterized by congenital malformation of the great toes and disabling heterotopic ossification in specific anatomic locations with a world wide prevalence of 1 in 2 million population. Nearly 90% of patients with FOP are misdiagnosed and mismanaged. We present a case of a four-year-old boy brought by his parents with the complaints of stiffness of right shoulder, neck and multiple swellings over the upper back noted over the past 4 months. On examination bilateral symmetrical hallux valgus with microdactyly of great toes and multiple bony hard swellings on both the scapulae were noted. Skeletal survey revealed all the classical features of FOP. Mutation of the ACVR1gene on genetic analysis confirmed the diagnosis of FOP. Invasive surgical procedures including biopsy and manipulations for stiff joints were avoided as they strikingly end up in rapid progression of FOP. Congenital hallux valgus with short great toe in a child should be considered as an early diagnostic tool for FOP even before the onset of mass lesions. Genetic analysis for mutation of ACVR1gene is confirmatory. Prevention of injury, medical management of acute painful flare-ups and rehabilitation are the mainstay of treatment.

Six Sesamoid Bones on Both Feet: Report of a Rare Case

SP Boelch, H Jansen, RH Meffert, SP Frey

There is a variation of the total number of distinct bones in the human in the literature. This difference is mainly caused by the variable existence of sesamoid bones. Sesamoid bones at the first MTP are seen regularly. In contrast additional sesamoid bones at the second to fifth MTP are rare. We report a case of additional sesamoid bones at every metatarsophalangeal joint (MTP) of both feet. A 22-year-old female Caucasian presented with weight-dependent pain of the second MTP of the left foot. In the radiographs of both feet additional sesamoid bones at every MTP could be seen. This case reports a very rare variation in human anatomy. A similar case has not been displayed to the academic society and therefore should be acknowledged.

TIVA-A Promising Approach to Anaesthetic Management of Montgomery T-tube Insertion

Ashwini H. Ramaswamy, Madhuri S. Kurdi, Sindhupriya

One of the treatment modalities for tracheal stenosis is tracheal dilatation and stenting using silicone Montgomery T-tube. Various techniques have been reported for this procedure. For safe anaesthetic management, anaesthesiologist must be aware of the surgical procedure, limitations of T-tube, likelihood of compromised airway besides the inherent problems of sharing the airway with surgeons. Total intravenous anaesthesia (TIVA) is a technique which has become very popular and possible now a days for various surgical procedures owing to its advantages. The anaesthetic technique should be based on the provider’s experience and severity of tracheal stenosis. We present here the anaesthetic management using TIVA technique with propofol and atracurium for the insertion of Montgomery T-tube in a case of post intubation tracheal stenosis.

Single Rooted Permanent Premolars and Molars - A Rare Clinical Presentation Confirmed using Cone Beam Computed Tomography

Nadeem Jeddy, T. Radhika, S. Nithya, C. Krithika, Ramachandra Prabakar

The morphology of the root and root canal system plays a significant role in the treatment outcome of endodontic procedures. The necessity of clear and high contrast images for tissues like bone and teeth has made the usage of newer imaging techniques inevitable. This is a rare case report wherein, the permanent posterior dentition of both arches was single rooted. While sporadic cases of single rooted teeth have been reported, it is rare for all the premolars and molars to show such variation. This rare clinical observation has been enhanced by Cone Beam Computed Tomography (CBCT), which provides a clear image with added benefits of 3D (Three Dimensional) image reconstruction, low dosage and rapid scan time.

Primary Peritoneal Hydatid Cyst Presenting as Ovarian Cyst Torsion: A Rare Case Report

Hydatid cyst disease is a zoonotic disease caused by Echinococcus granulosus, E.multilocularis or E.Vogli. The most common primary site is liver (75%) followed by lungs (5-15%) and other organs constitute 10-20%. Peritoneal hydatid cysts are very rare especially primary peritoneal hydatid. Secondary peritoneal hydatid cysts are relatively common, which usually occurs due to rupture of primary hepatic hydatid cyst. We present a rare case of large primary peritoneal hydatid cyst misdiagnosed as torsion of ovarian cyst that underwent Laparotomy with cyst excision and postoperative Albendazole therapy.

Ectopic Male Breast Cancer: A Case Report

Carcinoma of male breast constitutes 1% of total breast malignancy. Carcinoma arising from ectopic breast tissue in male is an extremely rare entity and can be misdiagnosed. Ectopic breast tissue may be supernumerary or aberrant one. Despite morphologic difference, ectopic breast tissue presents characteristics analogous to orthoptic breast in terms of functional and pathologic degeneration. Most of the ectopic breast tissue occurs in thoracic or abdominal portion of milk line. If found in a location outside the milk line, it proves a diagnostic dilemma. We are reporting a case of 60-year-old male who presented with a fixed mass of size 10cm×8cm, in right chest wall infraclavicular area of 6 months duration. Histopathology of the mass revealed invasive duct carcinoma. He had no evidence of malignant or occult primary lesion in the bilateral mammary glands. Due to the paucity of the literature, incidence of ectopic male breast cancer and its management is not well understood. There is high probability of misdiagnosis of this disease. To the best of our knowledge this is the first described case of ectopic male breast cancer in the chest wall, not along the milk line, which is being reported here for documentation.

Primary Squamous Cell Carcinoma of Submandibular Salivary Gland with Sialo-Cutaneous Fistula: A Rare Case Report

Aditya Atul Kulkarni, Sanjiv S. Thakur

Malignant tumours of the submandibular salivary glands are rare entities. Most common malignant tumour of submandibular gland is mucoepidermoid carcinoma. Histological finding of squamous cell carcinoma is very rare in submandibular salivary gland. Metastasis from distant primary squamous malignancy, direct invasion from cutaneous or mucosal squamous carcinoma, squamous component of mucoepidermoid carcinoma or primary squamous cell carcinoma of salivary origin are some of the possible causes. Of these, the latter is distinctly uncommon. Primary squamous malignancy is diagnosed only after ruling out other possible explanations. A positive mucin stain in the tumour or synchronous/ metachronous squamous carcinoma elsewhere excludes the diagnosis of a primary carcinoma. Primary squamous carcinoma is seen most commonly in parotid gland and rarely in submandibular gland. We present a case of primary squamous cell carcinoma of right submandibular salivary gland in a 45-year old-man. This case is presented for the rare entity of primary squamous cell carcinoma in submandibular salivary gland.

Hyperactive Dental Lamina in a 24–Year–old Female – A Case Report and Review of Literature

An extra tooth to the normal formula of teeth sequence in any region of dental arch is regarded as Supernumerary teeth (ST). The reasons are still not clearly known, one of them being dichotomy of tooth bud, but the more accepted reason is the hyperactivity theory. Supernumerary teeth are present more in permanent dentition than in primary dentition and can present as a single entity or multiple, unilaterally or bilaterally, impacted or erupted, in either or both the dental arches. This article discusses the supernumerary teeth in detail with a case discussion of a non-syndromic 24-year-old girl, with six ST (bicuspids) present in all the four quadrants. In the mandible, ST’s showed a classical clustered flower like presentation. The interesting feature in the presented case was the sequential orthopantomographs taken at various ages of the patient that showed continuous development of STs in all four quadrants, thus pointing to the theory of hyperactive dental lamina or atavism. An electronic search was conceded in PubMed, Cochrane Library and google scholar databases, and articles dated between December 1932 and December 2012 were selected to review the occurrence patterns of supernumerary teeth in non-syndromic cases.

An Experimental Study to Evaluate the Effect of Memantine in Animal Models of Anxiety in Swiss Albino Mice

Harish G Bagewadi, Afzal Khan Ak, Rekha M Shivaramegowda

Background: Due to the adverse effects produced by the present conventional medicines for anxiety disorders, research for newer drugs is still desirable. From the literature it is evident that NMDA receptors play a key role in animal models of anxiety. Aim: The present study is done to evaluate the antianxiety effect of memantine in swiss albino mice. Materials and Methods: The experimental study was conducted from November 2014 to January 2015. Animals were divided into four groups. Twelve mice were randomly allotted in each group. Animals in the first group received normal saline as a control 10ml/kg, lorazepam 0.5mg/kg was administered to second group, memantine 3mg/kg as a test drug was given to the third group and memantine 3mg/kg + lorazepam 0.5mg/kg was administered to the fourth group. All the drugs were given for 7 consecutive days by intraperitoneal route. Results: Results were analyzed by one-way ANOVA followed by Post-hoc Tukey’s test. On the 1st day, memantine treated group did not show statistical significant anxiolytic effect in both the behavioural paradigms when compared to control group. On the 8th day, the animals showed significant decrease p<0.001 in step down latency period in shock free zone (185.4±3.87 Vs 278.3±5.49), significant increase p<0.001 in step down errors (6.8±0.78 Vs 1.4±0.19) and significant increase p<0.001 in total time spent in shock zone (32.1±2.22 Vs 5.6±0.6). In open field test, on 8th day the animals treated with memantine when compared to control group, showed significant increase p<0.001 in number of squares crossed (112.7± 2.69 Vs 83.2±2.96), time spent in central square (11.5±1.26 Vs 3.4±0.65), no. of rearings (32.4±2.61 Vs 17±1.81) and significant decrease p<0.001 in freezing time (15.2±1.12 Vs 20.2±2.29). Memantine showed synergistic antianxiety effect when combined with lorazepam. Conclusion: Memantine showed significant anxiolytic effect in open field and passive avoidance response tests which are commonly used experimental models to assess anxiety states in animals.

Economical, Efficient, Simple Device for Controlled Annealing NiTi Archwire

In fixed orthodontic treatment, for the cinch back purpose, there is need of annealing of distal end of NiTi arch wire. During this procedure the area or length to be annealed is difficult to control. This inappropriate heating leads to deleterious effect on property of the wire. To prevent this problem a simple economical and efficient device was prepared that prevents annealing of excessive length of wire and thus prevents the deterioration of wire required for appropriate action.

Ophthalmology Teaching-Learning in Undergraduate Classes: Roadblocks and The Remedies

Kirti Nath Jha

The curriculum needs to run apace with the changing morbidity pattern and social needs. Teaching methodology requires constant evolution. With a static curriculum and teaching methods undergraduate ophthalmology proves difficult for many students. This article briefly analyses the ophthalmology curriculum, highlights the problems of teaching and offers some solutions.

Osteopetrosis – Classic Imaging Findings in the Spine

Jared D. Kirkland, William T. O’Brien

Marjolin’s Ulcer in a Post Burn Scar of the Hand

Selvan Ranganathan, Surya Rao Rao Venkata Mahipathy, Sridharan Murugesan

Marjolin’s ulcer arising from a post burn scar is rare. Here, we present a case of an elderly male with a Marjolin’s ulcer of the hand arising from a post burn scar sustained two decades ago. The patient was not willing for an amputation, so he was managed with a spit skin graft after explaining the possibility of recurrence.

Role of Advanced Diagnostic Imaging in Intracranial Tuberculoma: MR Spectroscopy

Raman Gangadhar Shingade, Suthar Pokhraj Prakashchandr

abstract

An Unusual Presentation of Chronic Lymphocytic Leukaemia

Kavita Paul, Geetika Paul, Harbans Lal Kazal, Nariender Kumar Bairwa

Congenital Fusion of C6 and C7 Vertebra—A Case Report

Vanitha, Chandrika Teli, H. S. Kadlimatti

Accidental Swallowing of Mandibular Partial Denture

Sumeet Jain, Hari Prasad Yadav, Rakesh Shivhare

Comment on “Is It Safe to Provide Abortion Pills Over The Counter? A Study on Outcome Following Self– Medication with Abortion Pills”

Laura J. Frye, Beverly Winikoff

abstract

Unexplained Anterior Uveitis: Viral Causes

Keerti Mundey, Ishfaq Ahmad Sofi, Priya

Waist-Hip Ratio in Patients with Acute Myocardial Infarction

Sevket Balta, Ugur Kucuk, Sait Demirkol, Cengiz Oztur, Mustafa Demir

Correction:2014 Oct: 8(10):). OC13-OC15

Ashraf Direkvand-Moghadam, Ali Delpisheh, Azadeh Direkvand-Moghadam, Effect of Infertility on the Quality of Life, A Cross Sectional Study. (Published in Journal of Clinical and Diagnostic Research. 2014 Oct: 8(10):). OC13-OC15 In this article changes have been done in the Authors name. Names and surname have been placed in correct order for correct citation.

Correction:2015 May: 9(5):). QC01-QC03

Direkvand-Moghadam Ashraf, Delpisheh Ali, Direkvand-Moghadam Azadeh, Effect of Infertility on Sexual Function: A Cross-Sectional Study. (Published in Journal of Clinical and Diagnostic Research. 2015 May: 9(5):). QC01-QC03 In this article changes have been done in the Authors name. Names and surname have been placed in correct order for correct citation.