Journal of clinical and diagnostic research

Association of Methylene Tetrahydrofolate Reductase Polymorphism with BMD and Homocysteine in Premenopausal North Indian Women

Background and Aim:Osteoporosis (OP) is a common nutrigen omic disease associated with various genetic components. Observational studies have indicated that mildly elevated homocysteine was a strong risk factor for osteoporotic fractures. Yet there is no clear biologic mechanism for an effect of homo cysteine on bone.The aim of this study was to investigate the association of MTHFR C677T and A1298C polymorphisms, and to verify the association of these polymorphisms with bone mineral density and homocysteine in premenopausal women of northern India. Material and Methods:We included 402 north Indian patients with altered BMD, both Osteopenic (OPN) and Osteoporosis, and normal controls. Genotype identification for MTHFR C677T and A1298C polymorphisms were analyzed by PCR RFLP method,correlated with Bone Mineral Density (BMD), Homocysteine (Hcy), Folate and Vitamin B12. Results:The study groups did not differ in terms of age, weight and body mass indices. Prevalence of Genotype frequencies (GFs) for MTHFRC677T OP were (n: 402): CC 361 (89.8%), CT 25 (6.22%), TT 16 (3.98%) and that for MTHFR A1298C were (n: 402) AA 353(87.81%), AC 29(7.21%), CC 20(4.98%). Folate was significantly lower in the OP group than those in both the other groups, while there was no significant difference in Hcy in the OP group relative to OPN, as compared to controls. Conclusion:The GFs for MTHFR C677T and A1298C poly morphisms were not different between both groups. In conclusion, polymorphism of the MTHFR 677T is associated with small differences in BMD with folate levels. Further, more investigations should be done in larger studies for other epigenetic pathways, that may increase the risk of Osteoporosis.

The Volume of the Caudal Space and Sacral Canal in Human Sacrum

Adil Asghar, Shagufta Naaz

Introduction: Caudal block is now- a –days a commonly used procedure for pain management and regional anaesthesia. The optimum volume of drugs required to reach the appropriate level is needed. Material and Methods: For this, we studied seventy-two human sacra and measured morphometrics like height of canal and transverse diameter. We utilized these measurements for volume estimation of sacral canal and caudal space by forming a simple mathematical formula for volume half-cone. Results: We observed that mean volumes of sacral canal and caudal space were 38.26 cm3 (23.76-62.78 cm3) and 14.25cm3 (6.67-24 cm3) respectively.Volumes of sacral canal and caudal space had higher values in males than in females. Conclusion: So, finally, it was concluded that volume of caudal space could be easily calculated this way and it was as reliable as MRI.

Anatomical Variations of Anterior Communicating Artery

Introduction: The Circle of Willis is a vascular network formed at the base of skull in the interpeduncular fossa. Its anterior part is formed by the anterior cerebral artery, from either side. Anterior communicating artery connects the right and left anterior cerebral arteries. Posteriorly, the basilar artery divides into right and left posterior cerebral arteries and each joins to ipsilateral internal carotid artery through a posterior communicating artery. Anterior communicating artery, an important component of circle of Willis, acts as collateral channel to stabilize blood flow. In the present study, anatomical variations in the anterior communicating artery were noted. Material and Methods: One hundred apparently normal formalin fixed brain specimens were collected from human cadavers. Normal anatomical pattern and variations of anterior communicating artery were studied. The anterior communicating arteries were then coloured, photographed, numbered and the abnormalities, if any, were noted. Result: Thity eight variant anterior communicating arteries were noted. The most common variation observed in the anterior communicating artery was its duplication in 10 subjects, followed by its absence in 8 subjects. Some variations like plexus formation, median artery were found in adults, because of persistence of embryonic pattern. Conclusion: Knowledge on variations in the anterior communicating artery is of clinical significance, as it is one of the components of circle of Willis which stabilizes cerebral blood flow when principle conduits fail.

A Unilateral Rectus Sternalis Muscle: Rare But Normal Anatomical Variant of Anterior Chest Wall Musculature

Priyanka Katara, Sangita Chauhan, Rajesh Arora, Pankaj Saini

Introduction: Rectus Sternalis muscle, an uncommon anatomical variant of the chest wall musculature, is regularly present in lower animals and is occasionally detected in humans. Lack of acquaintance of the clinicians with this muscle variant may cause negative changes in prognosis of patient. The anatomical and embryological details of Rectus Sternalis muscle in this article may help clinicians in interventional procedures, in prevention of diagnostic errors and in avoiding complications during any surgery which is done in the pectoral region. Material and Methods: This was a cadaveric study which was conducted as a pilot study, to know the baseline information about the incidence of Rectus Sternalis muscle among cadavers in Indian region. During a period of three years, 30 properly embalmed cadavers of Indian origin were dissected in dissection hall of Anatomy Department, S.M.S. Medical College (Jaipur, Rajasthan) during routine dissections, which is a part of medical education. Dissections of pectoral regions of these 30 cadavers were performed, to know the presence of Rectus Sternalis muscle. Observation and result: Rectus Sternalis muscle was found only in one cadaver, as a vertical strip of muscle in the anterior chest wall musculature. It was present unilaterally at right-side in anterior chest wall, superficial to pectoralis major muscle. Present study provides the initial estimates towards baseline information about the incidence of Rectus Sternalis, which was 3.3% among the cadavers of Indian origin in this study. Conclusion: Rectus Sternalis is a rare but a normal anatomical variant in the anterior chest wall musculature and knowledge on it is important, for interventional and diagnostic procedures which are related to this region.

The Foramen Ovale Morphometry of Sphenoid Bone in South Indian Population

Background: The foramen ovale is an oval opening in the greater wing of sphenoid bone transmitting the mandibular nerve as its major content. It serves as an important landmark for neurosurgeons in certain procedures as to gain access to trigeminal nerve. Therefore, its topographic position in relation to adjacent bony landmarks provides useful tool during these procedures. Aim: To analyse the morphometric measurements of the foramen ovale among South Indian population. Material and Methods: Morphometric analysis was carried out on 104 foramina ovalia of 52 dry human skulls from South India. Following dimensions of foramen ovale were measured: antero-posterior length, transverse width, distance (d1) from tubercle of root of zygoma to the centre of the foramen (CF) and distance (d2) from the midline of the base of the skull to CF. Results: The mean antero-posterior length was 7.0±2.17mm on right side and 6.8±1.40mm on left side, mean transverse width was 5.0±0.42mm and 4.70±0.91mm on right and left side respectively. Mean d1 was 32.58±1.72mm on right side and 32.75±1.76mm on left side. Mean d2 was 25.83±1.26mm on right side and 25.08±1.31mm on left side. Conclusion: Regional variations in the morphometric measures may be useful in neurosurgical procedures like administration of anaesthesia involving the mandibular nerve.

Sex Determination of Human Mandible Using Metrical Parameters

Vinay G., Mangala Gowri S.R., Anbalagan J.

Introduction: Determination of sex from an unknown human bone is an important role in forensic and anthropology field. The mandible is the largest and hardest facial bone, that commonly resist post mortem damage and forms an important source of information about sexual dimorphism. Aim: To determine the sex of unknown human adult mandible using metrical parameters. Material and Methods: A random collection of 250 dry, complete, undamaged human adult mandibles of South Indian population were subjected to metrical parameters like Bigonial breadth, Bicondylar breadth and Mandibular length using Mandibulometer and Vernier caliper. Statistical Analysis Used: The data’s were expressed as Mean ± SD and then analyzed by t-test by using SPSS software. Discriminating point and limiting points were also calculated. Results: The mandibular length, bigonial breadth and bicondylar breadth showed significant statistical gender difference. Conclusion: The present study revealed that the sex of human mandible can be assessed by using metrical parameters as an additional tool to establish the identity of a person.

Establishment of Normative data for Monaural Recordings of Auditory Brainstem Response and its Application in Screening Patients with Hearing Loss: A Cohort Study

Shivaji Chalak, Anita Kale, V K Deshpande, D A Biswas

Objectives: To establish normative data required for recording Auditory Brainstem Response (ABR) using monaural stimulations in children with normal hearing. Methods: This study was conducted on 40 apparently healthy children. Database was collected after assessing with otological questionnaire, otoscopic examination and audiometric evaluation. Brainstem Evoked Response Audiometry (BERA) was used as a tool for establishment of normative data. ABR recordings by monaural presentation were obtained by following the standard test protocol given by Hall. Results: ABR parameters like Absolute latencies, amplitudes, amplitude ratios, Inter- peak latencies and thresholds were assessed for their normative values which are required to establish a baseline data. The Interaural latency difference was less than 0.2 ms (milliseconds) and was found to be normal limit. Mean values of absolute latencies for left ear were1.66 ms 3.68 ms and 5.64 ms respectively and for right ear these were 1.66 ms, 3.65 ms and 5.59 ms respectively. Mean values for amplitude of wave I and V for left ear were 0.32 uV and 0.41 uV respectively. For right values were 0.31 uV and 0.36 uV respectively. Mean values of amplitude ratio (V/I) for left and right ears were 1.81 and 1.74 respectively. Mean values of interpeak latencies of wave I-III, III-V, I-V were 2.02 ms, 2.02 ms and 3.92 ms respectively for left ear and for right ear values were 2.04 ms, 1.98 ms and 4.03 ms respectively. Mean values for left and right ear hearing threshold was 25.25 dBnHL. Conclusion: ABR parameters shows variation in values depending upon age, myelination process, maturation of auditory pathway, environmental factors, laboratory setup etc. Hence it is concluded that each laboratory should have its own normative data which can be used as a baseline data for screening of patients with hearing loss

The Study of Diagnostic Efficacy of Nerve Conduction Study Parameters in Cervical Radiculopathy

Sachin Pawar, Aditi Kashikar, Vinod Shende, Satish Waghmare

Background: Cervical Radiculopathy (CR) is a neurologic condition characterised by dysfunction of a cervical spinal nerve, the roots of the nerve, or both. Diagnostic criteria for CR are not well defined, and no universally accepted criteria for its diagnosis have been established. Clinical examination, radiological imaging and electrophysiologic evaluation are the different modalities to diagnose CR. The incidence of Cervical Spondylosis and related conditions is increasing in the present scenario and the use of radiologic examination is time consuming and uneconomical for the common Indian setup. Thus, there is a definite need to establish a cost effective, reliable, and accurate means for establishing the diagnosis of cervical radiculopathy. Electrodiagnostic tests are the closest to fulfill these criteria. Aim: To evaluate diagnostic utility of various motor and sensory nerve conduction study parameters in cervical radiculopathy. Setting and Design: It was a cross-sectional study conducted on 100 subjects of age > 40 years. Material and Methods: The consecutive patients clinically diagnosed to have cervical radiculopathy, referred from department of Orthopaedics were prospectively recruited for the motor and sensory nerve conduction study using RMS EMG EP Mark-II. Parameters studied were Compound Muscle Action Potential (CMAP), Distal Motor Latency (DML) and Conduction Velocity (CV) for motor nerves and Sensory Nerve Action Potential (SNAP) and CV for sensory nerves. Statistical Analysis: Study observations and results were analysed to find the Specificity, Sensitivity, Positive Predictive Value and Negative Predictive Value using SPSS 16.0. Results: Among various motor nerve conduction parameters CMAP was found to be more sensitive with high positive predicative value. CV was found to have greater specificity and DML had least negative predictive value. Sensory nerve conduction parameters were found to have less sensitivity but higher specificity as compared to motor parameters. Conclusion: Nerve conduction studies are useful supportive diagnostic tool for suspected cervical radiculopathy as they are found to have reliable sensitivity and specific

Role of Reactive Oxygen Species and Antioxidants in Atopic Dermatitis

N. Sivaranjani, S. Venkata Rao, G. Rajeev

Background: In humans, oxidative stress is involved in many diseases such as atherosclerosis, Parkinson’s disease, heart failure, myocardial infarction, Alzheimer’s disease, Fragile X syndrome and chronic fatigue syndrome. Atopic dermatitis (AD), also known as atopic eczema, is a non-contagious, relapsing inflammatory skin disease which is characterized by eczema and pruritus. The skin reacts abnormally to irritants, food and environmental allergens and it becomes very itchy, which leads to scratching, redness and flaky skin. Very little study has been done to find out the relationship between oxidative stress and Atopic dermatitis. Aim: The aim of our work was to evaluate the status of oxidative stress in patients of Atopic dermatitis in comparison with healthy control subjects. Material and Methods: Twenty five patients of known Atopic dermatitis and 25 normal healthy controls of same age group were included in the study. Estimations of oxidants like Malondialdehyde (MDA), enzymatic antioxidants like Superoxide dismutase (SOD), Catalase, Glutathione peroxidase (GPX) and non-enzymatic antioxidants like reduced Glutathione (GSH), Vitamin A, Vitamin E and Vitamin C were done to assess the oxidative stress. Results: Atopic dermatitis patients were more prone to damage caused by Reactive Oxygen Species (ROS) or Oxidants, than controls, which was evident from an increase of Malondialdehyde and a decrease of enzymatic and non enzymatic Antioxidants. Conclusion: Antioxidants may possibly be beneficial in the treatment of Atopic dermatitis, which must be substantiated by further studies.

Serum 25(OH) D in Diabetes Mellitus Type 2: Relation to Glycaemic Control

Dhia J. Al-Timimi, Ardawan F. Ali

Introduction:There is increasing evidence on association between vitamin D insufficiency and diabetes, but the impact of vitamin D status on glycaemic status and vice versa, has not been well reported. Our aim was to investigate the level of 25-hydroxyvitamin D(25(OH)D) and the prevalence of vitamin D abnormalities in patients with diabetes mellitus (DM) type2 and in those without diabetes; and to ascertain the impact of 25(OH)D levels on glycaemic control and vice versa. Material and Methods:Serum 25(OH) D was determined in 337 Kurd patients with DM type2 and in 146 patients without DM type2. Its correlation with the marker of glycaemic control (HbA1c) as well as with anthropometric parameters (age, gender, and body mass index), diabetes duration, and serum blood glucose was examined. Discussion:The mean±SD values for serum 25hydroxy (OH) D levels of diabetic patients was 25.6±12.6 ng/ml and those forthe controls was34.1±14.7 ng/ml (p<0.01). The prevalence of vitamin D insufficiency was significantly higher among diabetic patients than among the controls (53.7% vs. 29.4%, p<0.001). This finding was still true even after the means of serum 25 (OH) D levels were adjusted to those of severe vitamin D deficiency (4.4% vs. 0.68%).Patients with poor glycaemic control had a higher prevalence of low vitamin D status (90%) than those with sufficient vitamin D levels (76%). As compared to diabetics with a good and fair glycaemic control, diabetics with a poor glycaemic control exhibited lower 25(OH)D levels (p<0.01) and a higher prevalence of low vitamin D status (89% vs. 4% and 7%) respectively. Patients with a diabetes duration of more than 5 years also had a higher prevalence of low vitamin D status as compared to vitamin D sufficient group (51% vs. 40%). A statistically negative significant correlation between serum 25 (OH) D levels and HbA1c % was found in diabetic patients (r=0.238, p<0.01). Conclusion:A low vitamin D status is present in two thirds of patients with DM type 2, particularly among diabetics with poor glycaemic control and among those with longer diabetes durations. This may reflect the additive effect of glycaemic control on vitamin D status.

Cardiovascular Disease Risk in Schizophrenia Patients: A Case Control Study

Kedar B. Joshi, Anup Nillawar, A.P. Thorat

Background: The Schizophrenia patients are at higher risk for cardiovascular morbidity and mortality. The aim of this case-control study is to measure Cardiovascular Disease (CVD) risk parameters in patient group and compare it with normal population. Methodology: We recruited 45 cases of Schizophrenia diagnosed by diagnostic and statistical manual of mental disorders (DSM-IV) criteria and 41 healthy controls from general population. The body mass index, metabolic syndrome parameters, lipid parameters and high sensitive C-reactive protein were measured in both groups. Metabolic syndrome and dyslipidemia prevalence were assessed based on National Cholesterol Education Programme (NCEP) Adult Treatment Panel III (ATP III) guidelines. Results: The Schizophrenia subjects showed statistically significant high waist circumference, increased triglycerides and decreased HDL cholesterol values. The subjects also showed statistically significant increased hs-CRP values. The prevalence of metabolic syndrome and laboratory dyslipidemia were 28.8% and 51.1% respectively, which were higher compared to control group. Conclusion: The Schizophrenia subjects are at higher risk for cardiovascular disease events due to high prevalence of metabolic syndrome and dyslipidemia. These patients should be regularly monitored for CVD risk factors and timely referred to physician for further management.

Prevalence of Methicillin Resistant Staphylococcus aureus Carriage amongst Health Care Workers of Critical Care Units in Kasturba Medical College Hospital, Mangalore, India

Background: Outbreaks and prevalence of Methicillin resistant Staphylococcus aureus (MRSA) Nosocomial Infection (NI) among various populations have been well reported in literature, particularly those from developed countries. There is a paucity of information on carriage of MRSA in developing nations, including the carriage by critical healthcare givers who are potential transmitters. Aim and Objectives: Present study was aimed at establishing the carriage rate of MRSA among healthcare workers in the critical care units of Kasturba Medical College Hospital, Mangalore, India and at formulating an MRSA control policy, based on the outcomes. Material and Methods: We screened 200 healthcare workers in the critical care units of the Kasturba Medical College Hospital, Mangalore, India, for MRSA and vancomycin susceptibility of the isolates. Swabs taken from both anterior nares were transported, inoculated onto mannitol salt agar (MSA) and incubated aerobically at 37°C for 18-24 hours. Gram positive cocci in clusters, with positive catalase, coagulase and DNAse tests, were identified as S.aureus. Further categorization of S.aureus into MRSA was done by using cefoxitin disc diffusion method. Sensitivity to vancomycin was tested by vancomycin disc diffusion and vancomycin agar screen plating. Results: The number of strains of S. aureus which was isolated from our 200 participants was 35, with a rate of 17.5% of the 35 isolates of S. aureus, 5 (14.3%) were MRSA. None of the S. aureus strains were vancomycin resistant. Conclusion: MRSA carriage among healthcare workers who were involved in the management of critically ill patients at Kasturba Medical College hospital, Mangalore, India was 2.5%, which is comfortably low. The existing infection control policy in our hospital seems to be effective and the same should be maintained.

Comparison of Clinical and Gram Stain Diagnosis Methods of Bacterial Vaginosis Among Pregnant Women in Ethiopia

Zemenu Mengistie, Yimtubezinash Woldeamanuel,Daniel Asrat, Mahlet Yigeremu

Background:Bacterial Vaginosis (BV) is characterized by an increased thin homogenous white vaginal discharge accompanied by fishy odour and increased vaginal pH. It is associated with different gynecologic and poor obstetric outcome. Bacterial vaginosis can be easily diagnosed by combination of two Amsel’s criteria. Objective:The aim of this study was to evaluate the accuracy of Amsel’s criteria individually or in combination of two for the clinical diagnosis of bacterial vaginosis among pregnant women in Ethiopia. Material and Methods:In this cross sectional study 252 pregnant women were screened for bacterial vaginosis. Vaginal swabs were collected for pH determination, saline wet mount microscopic examination to detect clue cells, KOH preparation for whiff test and Gram-stain evaluation of vaginal flora for diagnosis of bacterial vaginosis by Nugent scoring system. Accuracy of clinical diagnosis using individual and two of Amsel’s criteria was evaluated. Results:The prevalence of BV was 18.3% by Amsel’s two of three criteria and 19.4% Gram by Nugent’s methods. Comparing with Nugent scoring methods, the clinical diagnosis by Amsel’s criteria had sensitivity of 85.7%, specificity of 98%. The most sensitive and specific individual Amsel’s criterion was clue cells. Amsel’s criteria with the lowest sensitivity and specificity were whiff test and vaginal pH respectively. Combination of clue cells with vaginal pH test were the highest in sensitive while whiff test with clue cells were the highest in specificity than the other combined two Amsel’s criteria. Conclusion: Amsel’s criteria diagnosis of bacterial vaginosis can be simplified by using a combination of the two criteria, vaginal pH and clue cells, in settings where time or Gram staining is not available.

Phenotypic Characterization and Antibiogram of CSF Isolates in Acute Bacterial Meningitis

Syamal Modi, Amit Kumar Anand

Context: Acute bacterial meningitis (ABM) is a medical emergency, which warrants an early diagnosis and an aggressive therapy. Despite the availability of potent newer antibiotics, the mortality rate caused by acute bacterial meningitis remains significantly high in India and in other developing countries, which ranges from 16 - 32%. There is a need of a periodic review of bacterial meningitis worldwide, since the pathogens which are responsible for the infection may vary with time, geography and the age of the patient. Aim: To study the bacterial profiles and antimicrobial susceptibility patterns of the CSF isolates which were obtained from patients of acute bacterial meningitis in our area. Settings and Design: Two hundred and fifty two clinically diagnosed cases of acute bacterial meningitis, who were admitted to the wards of a tertiary medical centre in Patna, during the period from August 2011 to December 2012, were included in this study. Material and Methods: Two hundred and fifty two CSF samples from many patients of ABM were processed for cell counts, biochemical analysis, gram staining, culture, antigen detection by latex agglutination test (LAT) and antibiotic susceptibility tests, as per the standard techniques. Results: In this study, 62.3% patients were males and 37.7% were females The most common age group of presentation was 12-60 years (80.2%). Gram stained smears were positive in 162 (64.3%) samples, while culture yielded positive growth in 200 (79.4%) patients. Streptococcus pneumoniae was the most common pathogen which was isolated in 120 (60%) culture positive cases. Cell counts showed the predominance of neutrophils in all cases with ABM. High protein and low sugar levels correlated well with the features of ABM. All gram positive isolates were sensitive to vancomycin. All the gram negative isolates were sensitive to imipenem. Twenty two (8.7%) patients expired during the course of study. Deaths were caused by N.meningitidis in 9 (40.9%) cases, by S.pneumoniae in 3 (13.6%) cases and by H.influenzea in 1 (4.5%) case. In the remaining 9 (40.9%) mortality cases, the organism could not be identified. Conclusion: Simple, rapid, inexpensive tests like gram staining remain significant means for diagnosis of ABM in developing countries. LAT for pneumococcal antigen should be performed first, since Streptococcus pneumoniae remains the major aetiological agent of ABM, both in adults and children. The final diagnosis of ABM depends upon a comprehensive analysis of CSF smears, cultures, LAT, cytological, biochemical and clinical findings of the cases, and a single test or parameter cannot be used to decide the course of management in the patients. However, empirical therapy is advocated, considering the potentially high rate of mortality in these patients.

Determination of Baseline Widal Titres Amongst Apparently Healthy Blood Donors in Ahmednagar, Maharashtra, India

Background:Enteric fever is endemic in all parts of India. The Widal agglutination test is widely used for its diagnosis. But the interpretation of Widal test depends upon the baseline titre which is prevalent amongst healthy individuals in a particular geographical area. Aim:Present study was undertaken to establish the normal baseline titre in apparently healthy blood donors and also to determine cutoff values for the Widal test. Material and Methods:One hundred and three (103) sera were tested by the Widal tube agglutination test from January 2012 to February 2013. Results:Eighty four (81.55%) sera were positive for agglutinins (titre=1:20) and the remaining 19 were negative. 31.64% sera were positive for agglutinins of ‘O’ antigen of Salmonellatyphi(TO) at a titre of 1:40, 33.87% sera were positive for ‘H’ antigen of Salmonellatyphi (TH) at a titre of 1:40 and 38.46% and 36.84% sera were positive for ‘H’ antigen of Salmonella paratyphia (AH) and Salmonella paratyphi B (BH) respectively, both at a titre of 1:80. Conclusion:Therefore, the baseline titre for TO and TH was noted to be 1:40 and that for AH and BH was noted to be 1:80 and therefore, the cutoff level for TO and TH was = 1:80 and that for AH and BH was = 1:160.

Clinico-Microbiological Profile of Chronic Pulmonary Aspergillosis from a Tertiary Care Centre in Southern India

Kiran Chawla, Kranthi Kosaraju, Sridevi Rayasam, Chiranjay Mukhopadhyay

Background:Pulmonary aspergillosis is commonly seen in immunocompromised individuals. A significant rise has been seen in these cases in the past decade, owing to growing number of patients with impaired immune status. Aim:This study includes the detailed clinical and microbiological profiles of all the culture positive cases of pulmonary aspergillosis, detected in three years, from Jan 2008–Dec 2010, at our tertiary care centre. Methods:A hospital based observational and retrospective study was conducted to study the clinico-microbiological characteristics of patients with pulmonary aspergillosis. Respiratory specimens which showed repeated isolation of Aspergillus were included in the study. Demographic details, clinical findings and predisposing factors were noted down for all the patients. Treatment of patients with antifungal agents and their responses to treatment were also documented. Results:There were 22 patients with male to female ratio of 1.2:1 and mean age of 52.5 years. The most common underlying lung disease was presence of bronchial asthma in 27.3% (6/22) cases. Many patients (40.9%; 9/22) were on steroid treatment. Cough with expectoration was the most common symptom observed in 72.7% (16/22) cases. Microbiologically, microscopy showed positivity for the presence of gram positive, acutely branched, fungal hyphae, suggestive of Aspergillus , in all the cases. Aspergillus fumigatus was the predominant species that was isolated in 40.9% (9/22) cases. All the diagnosed patients were given either oral itraconazole or intravenous amphotericin B. A clinical improvement was observed in 72.5% (16/22) cases, but 27.3% (6/22) patients died. Conclusion:Pulmonary aspergillosis presents with non-specific clinical and radiological findings. An early suspicion and diagnosis is essential, especially in patients with underlying lung disease, to prevent dissemination and invasion.

Circulating Serotypes and Trends in Antibiotic Resistance of Invasive Streptococcus Pneumoniae from Children under Five in Bangalore

Ravi Kumar K.L., Feroze Ganaie, Vandana Ashok

Random Amplified Polymorphic DNA (RAPD) Typing of Multidrug Resistant Enterococcus Faecium Urinary Isolates from a Tertiary Care Centre, North India

Tuhina Banerjee,

Background: Enterococci, though they are a part of commensal flora, are becoming increasingly important as nosocomial pathogens, due to their inherited and acquired resistances to several antimicrobial agents. In this context, Enterococcus faecium (E.faecium) requires a special mention due to its characteristic of Multidrug Resistance (MDR) and its ability to disseminate. Aim: This study was undertaken to phenotypically characterize and determine clonal relatedness amongst the indoor isolates of Enterococcus faecium (E. faecium) which were isolated from patients with urinary tract infections (UTIs). Settings and design: This study was carried out prospectively in a tertiary care university hospital and in Department of Microbiology, Varanasi, India. Material and Methods: Urine samples were collected from patients who were admitted in different departments of the hospital with a clinical diagnosis of UTIs and they were processed for a period of one year. Enterococcal species were identified by doing extensive biochemical tests. Anti–microbial susceptibility testing was done by disc diffusion and agar dilution methods. Molecular typing of the isolates was done by Random Amplified Polymorphic DNA (RAPD) typing method. Results: A total of 48 enterococcal urinary isolates were identified in indoor patients, among which a majority (46, 95.83%) were E.faecium isolates. These isolates exhibited high resistance to fluoroquinolones (91.3%) and to ampicillin (60.86%) in particular. Two isolates were found to be resistant to vancomycin on screen agar. RAPD typing showed two major clusters, one of which had ten strains of 100% similarity, all of which were isolated from a common source. Conclusion: This study showed dissemination of multidrug resistant E. faecium isolates within the hospital. Being a quick and cost effective method, RAPD typing can be used to show clonal relatedness and to trace possible sources of organisms for epidemiological purposes

Comparsion of Salmonella typhi and Paratyphi A Occurrence in a Tertiary Care Hospital

Background: Enteric fever is an important public health problem in many underdeveloped and developing countries. In India, though Salmonella enterica serotype Typhi remains the predominant Salmonella species causing enteric fever, isolation of Salmonella enterica serotype Paratyphi A is increasing. It occurs in all age groups and more common in summer season affecting mainly children. Aims: To find out the isolation rate of Salmonella typhi and paratyphi A with reference to age, sex and seasonal variation attending a tertiary care hospital. Material and Methods: A descriptive study was done on the Salmonella species isolated from blood cultures for 5 years. Data was collected regarding basic information like age, sex, different months and years. Results: A total of 292 Salmonellae species were included in the study during the period of 5 years. Out of 292 isolates of Salmonellae, 160 were S. typhi and 132 were S. paratyphi A. Both salmonella species showed male preponderance in all age groups. Salmonella typhi and paratyphi A were highest in the age group 11 – 20 years followed by 21 – 30 years. Highest number of cases were isolated from July – September (123 cases) followed by October – December (81 cases). Conclusion: Occurrence of S. typhi and paratyphi A are increasing which may be due to the improved diagnostics techniques or increased drug resistance. School going children and adolescents in our study were higher, requiring education classes.

Molecular Characterization of Uropathogenic Escherichia coli : Nalidixic Acid and Ciprofloxacin Resistance, Virulent Factors and Phylogenetic Background

Shreya Basu, Sandip Kumar Mukherjee, Avijit Hazra, Mandira Mukherjee

Analysis of Expression and Localization of TLR-2 by Immunofluorescent Technique in Healthy and Inflammed Oral Tissues

Introduction: Toll-like receptors (TLRs) are an important component of immune system. Among them, TLR-2 plays a dominant role in the oral tissues in initiating inflammation in chronic periodontitis. Not many studies have been done on quantitative expression of TLR-2 by using immunofluorescent techniques (IFT) in oral tissues. In this study, the expression and localisation of TLR-2 were detected in gingival tissues of chronic periodontitis patients and healthy individuals. Material and Methods: Immuno Fluorescent Technique (IFT) was used for the expression and localization of TLR-2 in gingival tissue samples from 25 chronic periodontitis patients and from 25 healthy controls. Haematoxylin and Eosin staining was also done for all the samples to determine the histological characteristics of the gingival tissue samples. Result: Both healthy and periodontitis gingival tissues expressed TLR-2. We found that the expression level of TLR-2 was higher in all the periodontitis patients than in healthy individuals. We also found out that the expression of TLR-2 was higher in the epithelial cells than in the connective tissue cells. Conclusion: These data suggest a definite involvement of TLR-2 in initiating an inflammatory response in periodontal tissues. More studies are required to define the mechanisms and expression levels of TLR-2 in oral health and diseases.

blaKPC gene Detection in Clinical Isolates of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital

Priyadarshini Shanmugam, Jeya Meenakshisundaram, Perumal Jayaraman

Introduction: Carbapenem resistance among Enterobacteriaceae, especially in Klebsiella pneumoniae and Escherichia coli, is an emerging problem worldwide. A common mechanism of carbapenem resistance is the production of class-A, Klebsiella pneumoniae carbapenemase (KPC). Aims and Objectives: The present study focused on determining the antibiotic resistance pattern and prevalence of bla KPC gene coding for KPC in carbapenem resistant Enterobacteriaceae. Methodology: Forty six carbapenem resistant isolates belonging to the family Enterobacteriaceae were tested for antibiotic sensitivity pattern. Modified Hodge Test (MHT) and PCR for bla KPC gene detection were performed on these isolates. Of these, 22 were Klebsiella pneumoniae, 21 were Escherichia coli, 2 were Citrobacter species and 1 was Proteus mirabilis Results: Forty three (93.4%) out of the 46 isolates were resistant to Meropenem, 34 (73.9%) were resistant to Imipenem and 30 (65.2%) were resistant to both Imipenem and Meropenem. Modified Hodge Test was positive in 38 (82.6%) out of 46 isolates and blaKPC gene was detected in 31 (67.4%) isolates. bla KPC gene was detected in 28 out of the 38 MHT positive isolates.

Method Validation for Analysis of Simvastatin in Human Plasma Using Liquid Chromatography Tandem Mass Spectrometry (LC-MS-MS)

Khaled M. Alakhali

Introduction:The Liquid Chromatography Tandem Mass Spectrometry (LC-MS-MS) for determination simvastatin in human plasma has been developed after extraction by by ethyl acetate and hexane (90/10%, v/v) using lovastatin as internal standard. Material and Methods:The mobile phase consisting of mixture of acetonitrile and water (75/25%, v/v) 500µL/min by separated the solutes on a C18 column. Discussion:The lower limit of quantitation of 0.25 ng/mL was achieved when the calibration curve was linear from 0.25-50 ng/mL. The entire run time for analysis was only 6 min. The quantitation in the selective reaction monitoring (SRM) in positive ion mode, the daughter ions m/z 325 for simvastatin and m/z 285 for lovastatin were used. The Parent ions in positive ion mode were m/z 441.3 for simvastatin and m/z 405.1 for lovastatin. The intra-day coefficients of variation were less than 14% while the inter-day coefficients of variation were less than 10%. Conclusion:The LC-MS-MS detection is sensitive due to its capability to eliminate interferences from endogenous components.

Anti-nociceptive Effect of Entada Phaseoloides Seeds Formulation after Topical Application in Arthritic Wistar Rats

Jayshree Shriram Dawane, Vijaya Anil Pandit, Bhagyashree D. Rajopadhye

Objectives: To study the effect of topical application of different formulations of Entada phaseoloides seeds for analgesic activity in arthritic wistar rats. Material and Methods: EP (Entada Phaseoloides) seeds were powdered after removing the shell. Paste was prepared by adding water and ointment with polyethylene glycol (PEG 400) & Carbowax 3350. 32 Wister rats of either sex weighing 150-200 gms were divided into four groups ,Gr-I vehicle, Gr-II EP paste, Gr-III EP Ointment, Gr-IV Diclofenac Sodium Ointment. For induction of arthritis 0.1ml Complete Freund’s Adjuvant (CFA) was given by intra-articular injection in left knee joint. Drug treatment was started on the same day by topical application in all groups respectively. Pain threshold for referred pain was measured on Randall Selitto analgesymeter before and after drug treatment. Results: At 0 hours pain threshold of animals from all the groups was approximately similar. Pain threshold in control group was statistically significantly decreased at 72 hours. In comparison with control there was significant (p<0.001) increase in the pain threshold in the EP treated groups after 72 hours. Conclusion: Both the formulations of EP have analgesic activity comparable to Diclofenac sodium.

Prophylactic Antibiotics and Wound Infection

Introduction:Surgical site infections account for 14%-25% of all nosocomial infections. The main aims of this study were to audit the use of prophylactic antibiotic, to quantify the rate of postoperative wound infection, and to identify risk factors for its occurrence in general surgery. Methodology:A cross-sectional study was conducted in the General Surgery Department in Khartoum Teaching Hospital– Sudan. All Adult patients (age > 18 years) admitted during March 1 st to 31 st October 2010 were recruited. Multivariable logistic analysis was done to identify wound infection risk factors. Prescriptions were audited against predetermined criteria. Results:A total of 540 patients were recruited; (females73.7% of total ). The performed surgical procedures were 547. The rate of wound infection was 10.9%. Multivariable logistic analysis showed that; ASA score > 3; ( p = <0.001), wound class ( p = 0.001), and laparoscopic surgical technique; ( p = 0.002) were signifi - cantly associated with prevalence of wound infection. Surgical prophylaxis was unnecessarily given to 311 (97.5%) of 319 patients for whom it was not recommended. Prophylaxis was recommended for 221 patients; of them 218 (98.6 %) were given preoperative dose in the operating rooms. Evaluation of prescriptions for those patients showed that; spectrum of antibiotic was adequate for 160 (73.4%) patients, 143 (65.6%) were given accurate doses, only 4 (1.8%) had the first preoperative dose/s in proper time window, and for 186 (85.3%) of them prophylaxis was extended post-operatively. Only 36 (6.7%) prescriptions were found to be complying with the stated criteria. Conclusion:The rate of wound infection was high and pro - phylactic antibiotics were irrationally used. Multiple interventions are needed to correct the situation.

A Study on Factors Affecting Low Back Pain and Safety and Efficacy of NSAIDs in Acute Low Back Pain in a Tertiary Care Hospital of Western Nepal

Srijana Bhattarai, Himal Paudel Chhetri, Kadir Alam, Pabin Thapa

Introduction: Low back pain is characterized by a range of symptoms which include pain, muscle tension or stiffness, and is localized between the shoulder blades and the folds of the buttocks, with or without spreading to the legs. Non-Steroidal Anti Inflammatory Drugs (NSAIDs) are the drugs of choice which provide an analgesic effect for acute low back pain. Aim: To study the factors affecting low back pain, efficacy and safety of different non-steroidal anti-inflammatory drugs (aceclofenac, diclofenac, naproxen and nimesulide) in low back pain. Methodology: Data collection form and numeric pain rating scale were used as study tools for studying patients’ demographies and severities of pain respectively. Patients prescribed with aceclofenac 100 mg , diclofenac 100 mg, naproxen 500 mg and nimesulide 100 mg for acute low back pain at Orthopaedics Outpatients Department of Manipal Teaching Hospital, Nepal, were enrolled in this study. The decrease in pain scores was recorded on 5th and 10th days of follow-up and pain scores were calculated. Descriptive statistics and Kruskal Wallis non parametric test were used for analysis. Results: Among 150 patients, 67.3% were females (n=101). Low back pain was more prevalent (24.7%) in age-group of 59-68 years and a positive correlation was seen. Similarly, low back pain was found to be high among people involved in agriculture, heavy weight lifters and non smokers. The decrease in average pain scores was more in the patients treated with aceclofenac (4.83 ± 0.537), followed by that in those who were treated with naproxen (4.13 ± 0.067) and diclofenac (3.84 ± 0.086). The decrease in pain scores was found to be lowest among patients who were treated with nimesulide (2.11 ± 0.148). Nimesulide presented more number of side-effects than the comparative drugs. Conclusion: Different factors affect low back pain, such as age, gender, personal habit, posture, occupation, weight lifting. Aceclofenac showed greater decrease in pain scores with lesser number of side-effects.

Causality, Severity and Preventability Assessment of Adverse Cutaneous Drug Reaction: A Prospective Observational Study in a Tertiary Care Hospital

Padmavathi S., Manimekalai K., Ambujam S.

Introduction: The number of subjects involved in a clinical trial are limited, whose findings cannot be extrapolated to the entire population.Due to the emergence of newer molecules the pattern of Adverse Cutaneous Drug Reaction(ACDR) also changes frequently. The need for this study is for early diagnosis, to reduce the morbidity and mortality due to ACDR and to ensure safety of the patients. Material and Methods: Forty one subjects with the diagnosis of ACDR were included in the study for a period of 12 months(Jan 2009- Dec 2009). The informations such as patient demographic details, drug history, associated comorbid conditions and pattern of the skin reaction were noted. Assessment was done for causality, severity and preventability using separate valid scales. Results: The most common ACDR was fixed drug eruption (43.9%) and the most common causative drug for the same was surprisingly found to be paracetamol. Antimicrobials were the most common causative drug group and two significant associated risk factors were multiple drug intake and history of allergy. Among the total reactions 78% were of probable category and 59% were of moderate level severity reaction. Out of which 12% of the cases were definitely preventable.

Comparison of Routine Fixation of Tissues with Rapid Tissue Fixation

Meenakshi Tripathi, Rani Bansal, Mamta Gupta, Vinay Bharat

Introduction: Conventional formalin-fixed, paraffin-embedded tissue provides superior cellular morphology and long-term storage. Problems with formalin fixation comprise delay of fixation and variations in the duration of fixation. Microwave assisted tissue fixation removes the use of noxious and potentially toxic formalin that decreases the turnaround time and creates a personnel friendly workflow. Material and Methods: The present study was conducted over a period of two years. One hundred and forty paired tissue sections were taken including both neoplastic and non-neoplastic tissues. One of the paired tissues was fixed in formalin and the other was fixed by using microwave irradiation in phosphate buffered saline. Both were then processed by conventional method. Each slide was examined and rated for the adequacy of fixation by two pathologists in a blinded fashion using 7 parameters: Cellular outline, cytoplasmic detail, nuclear detail, erythrocyte integrity, lymphocyte appearance, overall morphology and overall staining. Results: Statistical analysis showed that sections obtained from microwave fixed tissues were comparable to that of routinely fixed tissue. The p-values of all parameters were not significant except for the overall morphology for which p-value was significant owing to loss of tissue in some cases. Conclusion: Microwave irradiation substantially shortened the time from specimen reception to diagnosis (turnaround time) and allowed same-day tissue processing and diagnosis of specimens without compromising the overall quality of the histologic section.

Clinicopathological Spectrum of Endometrial Changes in Peri-menopausal and Post-menopausal Abnormal Uterine Bleeding: A 2 Years Study

Background: Abnormal uterine bleeding is the Common presenting complaint in Gynaecology Outpatient Department in all age groups. It is due to the anovulatory cycles which are commonly seen in adolescent and peri-menopausal women. Abnormal uterine bleeding is caused by wide variety of organic or non-organic causes. Histopathological examination of endometrial sample remains the gold standard for diagnosis of endometrial pathology. Aim: To study the clinicopathological spectrum of endometrium in abnormal uterine bleeding in peri-menopausal and post-menopausal age groups. Material and Methods: The study included prospective analysis of 119 cases of endometrial samples in patients of abnormal uterine bleeding above 40 years of age. The specimens were routinely processed and H&E stained slides were studied. Patients were categorized into peri-menopausal (40-49 years) and post-menopausal (> 50 years) age group. Results: A total of 119 specimens of endometrium were analyzed.Maximum number (73.94%) of cases were from peri-menopausal age group. The most common presenting complaint was menorrhagia (48.86%) followed by post-menopausal bleeding (26.05%). In peri-menopausal age group proliferative endometrium (35.22%) was the predominant histopathological pattern followed by endometrial hyperplasia (23.86%). Atrophic endometrium (25.80%) was the most frequent finding followed by endometrial hyperplasia (19.35%) in post-menopausal age group. Three cases of endometrial carcinoma were reported in post-menopausal age group only. Conclusion: A thorough histopathological work up and clinical correlation is mandatory in cases of abnormal uterine bleeding above the age of 40 years to find out organic lesions. Careful screening can detect early cancer of endometrium which has excellent prognosis and it will help in further management.

Utility of Fine Needle Aspiration Cytology in the Evaluation of Breast Lesions

Background:Fine Needle Aspiration Cytology (FNAC) is a simple, minimally invasive, cost effective, outpatient based and a rapid diagnostic method for breast lesions. The aim of the present study was to correlate cytological findings with histopathological findings and to determine the accuracy of FNAC in the diagnosis of breast lesions. Material and Methods:A total of 222 breast aspirates were studied. Histo-cytopathological correlations were obtained in 91 cases. All the aspirates were stained with Haematoxylin and Eosin (H andE) stain. Results:Among 222 patients, 217 were females and 5 were males. Benign breast lesions were found in 144 cases (64.87%); among which fibroadenoma (30.18%) was the commonest lesion which was observed. Malignancy was observed in 69 cases (31.08%); among them, ductal carcinoma was the predominant lesion (29.28%) which was seen. Histopathological confirmations were obtained in 90 cases out of 91 cases in which histo- cytopathological corrections were possible. All 45 malignant aspirates were confirmed by histopathology. Benign reports were confirmed in 45 out of 46 cases by doing histological examinations; except one case which was diagnosed as malignant by studying its histopathology. Sensitivity and specificity of FNAC in breast lesions were reported to be 97.82% and 100% respectively, with 100% positive predictive value and 97.85% negative predictive value. Diagnostic accuracy of FNAC in the present study was found to be 98.90%. Conclusion:It is important to remember that a negative FNAC of a breast lesion does not preclude the diagnosis of a carcinoma, particularly in presence of a clinical suspicion of malignancy and/ or an abnormal mammogram.

NESTROFT - A Valuable, Cost Effective Screening Test for Beta Thalassemia Trait in North Indian Punjabi Population

Background and Objectives: Beta-thalassemia continues to be a cause of significant burden to the society, particularly in the poorer developing countries. The objective of the present study was to evaluate the validity of “NESTROFT” (Naked Eye Single Tube Red Cell Osmotic Fragility Test) as a useful screening tool in the diagnosis of beta thalassemia trait. Material and Methods: The present study was conducted on 150 subjects in the department of haematology in a tertiary health care center in north Indian state of Punjab. In group I, 111 cases diagnosed as microcytic hypochromic anaemia were selected. In group II, 39 individuals (the family members of known cases of beta thalassemia major) were selected. Complete haemogram, NESTROFT and HbA2 levels by electrophoresis were done and the results were tabulated and analyzed statistically. Results: Of the 111 cases in group I, 20 (18%) gave positive results with NESTROFT while 91 cases (82%) tested negative. In group II, out of 39 cases, 30 (76.92%) tested positive with NESTROFT while 9 gave a negative result. In group I, out of 20 NESTROFT positive cases, only 3 had HbA2 levels more than 3.5%. In group II, all the 30 NESTROFT positive cases had HbA2 levels more than 3.5%. The test showed a sensitivity of 100%, specificity of 85.47%, a positive predictive value of 66% and a negative predictive value of 100%. Conclusion: Thus, NESTROFT is a valuable, cost-effective screening test for beta thalassemia trait and appears to be a valid test in rural setting with financial constraints.

A Cross-sectional Study of Clinical, Histopathological and Direct Immunofluorescence Spectrum of Vesiculobullous Disorders

Arundhathi S., Ragunatha S., Mahadeva K.C.

Background: Accurate diagnosis of vesiculobullous lesions of skin requires evaluation of clinical, histopathologic and immunofluorescence findings. Methods: A cross-sectional study of 68 patients to evaluate the clinical, histopathological and direct immunofluorescence (DIF) features in the diagnosis of cutaneous vesiculobullous disorders. The patients with vesiculobullous lesions were subjected to clinical examination regarding socio-demographic and clinical data. Two biopsy specimens were taken, one from intact vesicle for histopathological study and another from perilesional normal looking skin or oral mucosa for DIF. Results: Vesiculobullous lesions constituted 22.08% of total number of skin biopsies. The most common clinical diagnosis was pemphigus vulgaris (PV) in 36 cases, followed by bullous pemphigoid (BP) in 8 cases, pemphigus foliaceous (PF) in 6 cases, and dermatitis herpetiformis (DH) in 4 cases. Characteristic histopathological features were present in 26 cases of PV, 9 cases of BP and 4 cases of PF, and 17.7% showed non- specific changes. DIF was positive in 24 cases of PV, 9 cases of BP and 3 cases of PF, and negative in 34.92% of cases. Conclusion: Clinical, histopathological and DIF features together or in combination help in the final diagnosis of vesiculobullous disorders. Individually, none of these methods are diagnostic in each and every case.

Prevalence and Factors Influencing Perinatal Mortality in Rural Mysore, India

Hugara Siddalingappa, Narayana Murthy.M.R, Praveen Kulkarni, Ashok.N.C

Background: With decreasing Infant Mortality Rate, Perinatal Mortality is gaining importance as it takes into consideration most of the factors influencing child birth and its survival, mortality during this period is a better indicator of quality of Maternal and Child Health services. Objectives: To estimate the Prevalence of perinatal mortality and its associated risk factors. Methodology: Cross sectional community based study was carried out in rural field practice area catering 26,700 population. All births during 2010 among permanent residents of this area were included. House to house survey was conducted to collect details regarding Antenatal, intra-natal and post-natal history by interviewing mother using a pre-tested questionnaire. Hospital records were also referred when available. Results: Nine perinatal deaths had occurred out of 314 births in a span of one year with a perinatal, early neonatal mortality rates of 28.93, 19.29 per 1000 live births respectively and still birth rate of 9.55 per 100 total births. Higher Perinatal Mortality Rate(PNMR) was observed in mothers who got married before 18 years, conceived during teenage, having anaemia, delivered at home, normal vaginal deliveries and having suffered by intra-partal and placental complications. Male babies, babies fed with prelacteal feeds, born out of intra-uterine complications, having low birth weight, had delayed first cry, premature births and twin births showed higher risk for mortality. Conclusion: The prevalence of perinatal mortality in the present study was 28.93 per 1000 live births. Even though this was well below the national and state values indicating improved quality of Maternal and Child Health care, it also gives way for relooking into strategies for further bringing down the perinatal deaths.

Consumer’s Perception on Design and Layout of Consumer Medical Information Leaflets on Obesity and Lipid Lowering Drugs

Elizabeth M. Mathew, Kingston Rajiah, Krishana Kumar Sharma

Background: Printed education materials are often used to augment healthcare professional’s verbal information to consumers so it serves as an important component of symptom management. They also enhance the teaching process and can be used by consumers as a home reference. Objective: This study was aimed to interpret consumers’ perception on Consumer Medical Information Leaflets (CMILs) on obesity and lipid lowering drugs, on design and layout using the standard method such as Baker Able Leaflet Design (BALD). Material and Methods: Convenience sampling was done. The study was conducted over a period of 3 years in community pharmacy settings in Tamil Nadu, India. The Consumer Medical Information Leaflets (CMILs) were randomly collected from different community pharmacies. Total of 19 CMILs which are commonly used by the consumers were collected and CMILs were assessed using BALD assessment tool Results: According to BALD assessment (46.28%) leaflets were rated as ‘above standard’ and (53.72) leaflets were rated as ‘standard or poor’ in layout and design since their scores were less than 25. This shows that this issue may be important from the patient’s perspective, which may discourage patient from actually reading the CMILs. Conclusion: In India, generally CMILs are continued to be prepared in English and with higher proportion of consumers with English illiteracy. CMILs, which are prepared without taking consideration of reading level of consumers and proper layout and design, may not achieve the intended purpose. This is an important aspect that any company has to reckon while preparing leaflets and at least in some major local languages in which CMILs have to be prepared.

A Study of Knowledge, Attitude and Practices on Immunization of Children in Urban Slums of Bijapur City, Karnataka, India

M.M. Angadi, Arun Pulikkottil Jose, Rekha Udgiri, K.A. Masali, Vijaya Sorganvi

Background: The immunization coverage is not uniform in India. In Karnataka, except for Uttar Kannada District (very high immunization coverage of 95%) and 14 districts that have shown a better immunization coverage (>85% coverage), the remaining 15 districts (including Bijapur District) have poor coverage. The United Nations Children’s Fund (UNICEF) 2002 report on Bijapur district shows that only a little over one fourth of the children were fully immunized (25.8%). The state’s fully vaccinated figure was more than two and a half times higher than that of the district. In this prevailing scenario, it becomes the need of the hour to find factors which influence routine immunization in Bijapur district, which will help the planners in implementing the immunization programme in a better way, to achieve >85% coverage. Objectives: To determine the knowledge, attitude and practices of respondents among guardians of children aged 12-23 months with respect to immunization. Material and Methods: A community based, cross-sectional study was conducted in the urban slums of Bijapur city, India. Out of the 20 enlisted slums, 7 slums were chosen by using convenience sampling. House to house survey was done. After obtaining oral consents, information regarding knowledge, attitude and practices was collected by using a semi-structured proforma. Results: A total of 155 mothers/ responsible guardians of children in the age group of 12 to 23 months were included in the study. Children of 54 out of 155 respondents (34.84%) were fully immunized, 97 (62.58%) were partially immunized and 4 (2.58%) were unimmunized. The main reason for partial and non-immunization was found to be lack of information. Conclusion: Immunization coverage in the urban slums of Bijapur is still way short of the 85% coverage mark. A lack of information and motivation among the parents is the main reason for this dismal scenario, that needs to be rectified at the earliest.

Significance of Serum L-fucose Glycoprotein as Cancer Biomarker in Head and Neck Malignancies without Distant Metastas

Rathan Shetty K.S., Satheesh Kumar Bhandary, Arunava Kali

Background:Head and neck neoplasia is a major form of cancer in India, accounting for 30% of all cancers which occur in males and 11% of cancers which occur in females. Elevated serum L-fucose glycoprotein levels have been reported to be associated with neoplastic conditions involving various sites. Therefore, monitoring serum/tissue L-fucose glycoprotein levels could be a promising approach for the early diagnosis and prognosis of head neck cancers. Aim:This study was carried out to determine the significance of serum L-fucose levels in head and neck malignancies. Settings and Design: This comparative study was carried out at a tertiary care hospital in South India. Material and Methods:Serum L-fucose glycoprotein levels were estimated in 50 patients with histopathologically confirmed head and neck malignancies and they were compared with those of 50 age- and sex-matched healthy controls. Statistical Analysis used: Student’s t-test was used to compare L-fucose glycoprotein levels in study and control groups. Results:Most common site of the primary tumour in the current study was oral cavity, followed by larynx, hypopharynx and oropharynx respectively. Comparison of glycoprotein L-fucose in two groups showed more than a two-fold rise in serum fucose levels in cases as compared to the those in controls, with mean values of 11.33±7.39 and 4.74±1.55 mg% in cases and controls respectively. There was no relationship between serum fucose levels and age, sex and tumour differentiation. Conclusion:Serum glycoprotein L-fucose levels can be used as an effective biochemical indicator in conjunction with clinical diagnostic procedures in head and neck neoplasia and they may be useful for monitoring recurrences.

Effect of Posterior Sub–Tenon Triamcinolone in Macular Edema Due to Non–Ischemic Vein Occlusions

Murali Mohan Gurram

Purpose: To study the efficacy and safety of Posterior Sub-Tenon Triamcinolone acetonide (PSTT) in the treatment of macular edema in retinal vein occlusions. The efficacy is studied by anatomical and visual improvements. Background: Macular edema is the most common cause of visual loss in retinal vein occlusions. Many treatments have been advocated including laser, PSTT etc. The most recent trend is the usage of intravitreal Anti-VEGF (Vascular Endothelial Growth Factor) agents and steroids. Intravitreal injections have more complications. Methods: This study was a prospective interventional case series. 24 eyes of 24 patients (13 male and 11 female) with recent onset non-ischemic RVO (Retinal Vein Occlusion) underwent Posterior Sub-Tenon Triamcinolone (PSTT). Of the 24 eyes treated, 18 eyes were of BRVO (Branch Retinal Vein Occlusion) and 6 were CRVO (Central Retinal Vein Occlusion). All the eyes received 40 mg of Triamcinolone Acetonide (TA) in 1ml through posterior sub-tenon route. All the eyes were examined at baseline and after four weeks of being injected with TA. Changes in the best corrected visual acuity {letters of ETDRS (Early Treatment Diabetic Retinopathy Study) chart} and Central Macular Thickness (CMT) were studied. A gain of more than 5 letters was considered as effective. The eyes were examined for raised IOP (Intra-Ocular Pressure) and other complications. Results: Out of the 24 eyes 19 (79%) showed an improvement of more than 5 letters after a month of treatment. All the patients exhibited a certain degree of decrease in CMT. The mean BCVA increased from 30.08±10.16 to 40.21±8.93 (p<0.05). The mean CMT decreased from 575.08±131.55 to 282.08±163.99 (p<0.05). Out of them 3 eyes developed raised IOP of more than >21mmHg, which was controlled with medication. There were no other complications observed in any of the patients. Conclusion: PSTT is an effective modality of treatment with minimal complications for macular edema associated with Non-Ischemic RVO with minimal complications. In view of the more severe complications associated with intravitreal injections, PSTT can be used as the first line of treatment before contemplating intravitreal injections. Multicenter randomised trials with longer periods of follow–up are needed to evaluate the long term safety and efficacy of this treatment. Furthermore, comparative studies are required to compare it with intravitreal Anti–VEGF or TA.

Conjunctival Autograft in Primary and Recurrent Pterygium: A Study

Kavita Mallikarjun Salagar, Kalyanappa Gurlingappa Biradar

Aim: Investigate the efficiency of limbal conjunctival autograft in primary and recurrent pterygium. (2) To report the incidence of recurrence after primary and recurrent pterygium surgery using limbal conjunctival autograft. Material and Methods: It is a prospective study conducted at Department of Ophthalmology, Basaveshwar Teaching and General Hospital, Gulbarga Karnataka, India for a period of 1 year (2007 to 2008) 100 patients were operated of which 6 were recurrent pterygium and the remaining were fleshy pterygium. All patients were in age group 20 to 60 and above. Results: In this study 7% cases were in age group 20 to 30 years, 22% 31 to 40 years, 30% 41 to 50 years, 24% 51 to 60 years and 17% 60 and above. (2) Depending on occupation high incidence is seen in outdoor patients i.e., 80%, indoor 20%. (3) Depending on location, 50% nasal, 30% temporal, bilateral 20%. (4) Laterality – Right eye 52%, left eye 38%, bilateral 10%. (5) Recurrence – More common in younger patients < 40 age 6 patients developed recurrence. Conclusion: Autogenous conjunctival grafting is a safe, uncomplicated, quick procedure and does not involve loss of tissue and prevents recurrence of pterygium. It also reduces the risk of granuloma formation, scleral thinning and necrosis.

Quantitative Micro-albuminuria Assessment from ‘Random Voided Urinary Albumin: Creatinine Ratio’ Versus ‘24 hours Urinary Albumin Concentration’ for Screening of Diabetic Nephropathy

Aims: This study aims at assessing the predictive value of random urine A:C ratio as a screening method for Micro-albuminuria assessment in DM patients as compared to 24 hours urine albumin. Settings and design: A cross sectional observational study was conducted at a tertiary care centre. One hundred ninty three patients diagnosed with DM were enrolled in the study but 14 participants didn’t turn up with 24 hours urine sample. Thus, 179 people actually participated in the study. Material and Methods: All DM patients who attended Out Patient Departments (OPDs) and In Patient Departments (IPDs) of Medicine, Surgery and Orthopaedics, were enrolled. Proper history about development and duration of DM was taken from the patients. Examination in the form of height and weight measurement to know Body Mass Index (BMI), the Waist: Hip Ratio (W:H ratio) calculated from waist and hip circumference and blood pressure measurement was done. Fasting blood sugar was measured in the study group. [Urine analysis was done for urinary albumin and urinary creatinine]. Two urine samples were collected from each participant; one, 24 hours sample and the other random urine sample. 24 hours urine samples were used to measure urinary albumin concentration while urinary albumin to creatinine ratio was measured from random urine sample. Statistical analysis used: SPSS 17. results: Twenty four hours RUA:C ratio has very good sensitivity and specificity of Sensitivity and specificity of 84.9% and 95.8% respectively,which makes it a better alternative to 24 hours UAC. Negative and positive predictive values of RUA:C ratio method are 0.93 and 0.090 respectively with false negative and false positive rates, 15.1% and 4.2 % respectively. Conclusion: Twenty four hours UAC is considered gold standard for screening of Micro-albuminuria but is cumbersome to collect 24 hours urine sample especially in OPD setup and in female patients. This leads to loss of compliance thereby preventing early diagnosis of diabetic nephropathy. This problem is more impracticable in hilly regions of India. By using random urine sample for screening of Micro-albuminuria in the form of RUA: C in random urine sample that correlates well with 24 hours UAC in 24 hours urine sample,is easier and more practical in Indian scenario especially in diabetics residing in hills.

Study of Bone Mineral Density in Patients with Ankylosing Spondylitis

Introduction: Ankylosing spondylitis (AS) is an inflammatory rheumatic disease characterized by spine and sacroiliac joint involvement that mainly affects young male subjects. Bone Mineral Density (BMD) loss occurs in AS disease course. Bone loss in AS appears to be multifactorial and perhaps involves different mechanisms at different stages of disease. The disease typically affects young males and is associated with progressive functional impairment, increased work disability and decreased quality of life. Osteoporosis is frequent in AS and there is a close association of bone mineral density, bone metabolism and inflammatory activity. Osteoporosis is frequently associated with AS and BMD decreased predominantly in patients with active disease. Aims & Objectives: The aim of the present study was to study bone mineral density in cases of Ankylosing Spondylitis (AS) in comparison to age and sex matched controls. Material and Methods: The present study was conducted on 100 established cases of AS based on modified New York criteria and 150 controls healthy, age, race, socio-economic matched controls patients. The results were statistically analyzed. Results: Hundred cases of AS were subjected to undergo BMD by Dual Energy X-ray Absorption (DEXA) scan of different age groups in cases 35.19± 8.23(min age 23- max age 67years) and controls 33.27±5.22(min age 22years - max age 44years) with height observed in cases is 169.67±6-87 and controls 170.99±7.16 with weight varied in cases 65.63±10.27 and controls 70.14±10.67. Conclusion: Osteoporosis is a significant complication in ankylosing spondylitis and needs to be monitored and managed at the earliest. Significant osteoporosis can occur even in early disease. Osteoporosis of spine is much more prevalent than femur.BMD spine is still the most important site to define osteoporosis in ankylosing spondylitis. Rise in BMD in LS spine with duration, is not exclusive for subjects with radiologically evident syndesmophytes. Statistically, presence of syndesmophytes did not affect estimation of osteoporosis of spine.

Comparison of Mean Platelet Volume in Type 2 Diabetics on Insulin Therapy and on Oral Hypoglycaemic Agents

Pradeep V. Vernekar, Kuladeepa Ananda Vaidya

Introduction: Increased mean platelet volume is a known risk factor for various acute vascular complications, which is commonly associated with patients with diabetes mellitus. This study was aimed to investigate the association of Mean Platelet Volume (MPV) with Type 2 Diabetes Mellitus (DM) and to know the difference of MPV in patients on oral hypoglycaemic drugs and insulin therapy. Material and Methods: A total of 150 patients were selected and allocated to three Groups of 50 each, referred to as DM Group on insulin therapy, DM Group on oral hypoglycaemic therapy and non-DM Group (Negative control Group). Investigations like fasting blood glucose, HB A1c and MPV were performed. Difference between the means of age, MPV were calculated by analysis of variance (ANOVA) by using Tukey’s Honestly Significant Difference (HSD) test. p-value and Confidence intervals were also calculated (p<0.05). Result: The outcome of study has shown that values of MPV are increased in patients with Type 2 DM, and are significantly higher in those patients on oral hypoglycaemic therapy than patients on insulin therapy. Conclusion: MPV is a simple and cost-effective tool which can be explored for predicting the possibility of acute vascular events in patients suffering from diabetes mellitus. Values of MPV are increased in patients with uncontrolled Type 2 DM, and are significantly higher in diabetic patients treated with oral hypoglycaemic therapy than in those patients on insulin therapy. Early initiation of insulin treatment in confirmed cases of Type 2 diabetics not only helps in controlling blood glucose level but also helps in keeping MPV low and thereby preventing possibility of impending acute vascular events.

Congenital Clubfoot in Children After Walking Age: Management and Evaluation of 41 Feet with the Dimeglio Score

Zoltan Derzsi, Horea Gozar, Simona Gurzu, Radu Prisca, Ors Nagy

Introduction: Congenital Clubfoot (CC) is one of the most frequent orthopedic lesions in patients younger than 10-15 years. The surgical correction is more difficult in children over 1.5 years, compared to newborns, due to advanced osteoarticular development and higher rigidity of the foot. The aim of this study was to report the results of our experience regarding the combined orthopedic-surgical treatment of CC and the follow-up prognostic value of Dimeglio score in children aged between 1.5 to 12 years. Material and Methods: From June 2009 and May 2012, 31 consecutive patients with CC, aged between 1.5 to 12 years, underwent surgical treatment. To assess the results, pre-operative and post-operative Dimeglio scores, at 6 months after surgery, were compared in each of the cases. An adapted Ponseti-Mitchelle orthosis-bar was used for aftercare. Results: The mean age of patients enrolled in this study was 4.32±2.04 years old. From the 31 patients, 10 had bilateral deformity; surgical intervention was performed for a total of 41 feet. Independently by the age of patients, between pre-operative and post-operative evaluation, the Dimeglio score regressed from a mean of 11.70±7.43 (ranged between 4 and 18) to 3.80±0.96 (ranged between 0 and 12). Unfavorable outcome was observed in 5 feet; the success correction rate was 85.37%. Conclusion: This study reveals that CC can also be treated in older children by using a proper orthopedic, surgical and post-operative management. The Dimeglio score is useful, easy to use and relevant also in children over 1.5 years.

Peak Expiratory Flow Rate In Healthy Rural School Going Children (5-16 Years) of Bellur Region For Construction of Nomogram

Manjunath CB, Kotinatot SC, Manjunatha Babu

Background: Peak Expiratory Flow Rate (PEFR) recording is an essential measure in the management and evaluation of asthmatic children.It is helpful in monitoring disease progression and response to treatment. The PEFR can be measured by a simple instrument—peak expiratory flow meter. Aims and Objectives: To construct nomogram of PEFR in healthy rural school going children from Mandya district of Karnataka state, India and to use these nomograms for comparison with that of children with obstructive lung diseases for this region. Material and Methods: The study was conducted on Healthy rural school going children, both boys and girls between the age group of 5-16 years. For the determination of PEFR we used Mini Wright Peak Flow Meter. At three time measurement, the highest value of PEFR was recorded. Formula for prediction of PEFR was estimated by linear regression analysis after the correlation of PEFR with age and height for both boys and girls. Results: PEFR was measured in 1028 children aged 5 to 16 years by using Wright’s mini peak flow meter. Prediction equations were derived for PEFR with height in boys and girls. Normograms were plotted based on the observed values of PEFR in the study population. Significant linear correlation was seen of PEFR with height in boys (p<0.001, r=0.7624) and in girls (p<0.001, r=0.8825). Prediction equation for PEFR are -317.43 + 4.40 x height (cm) in boys and – 321.21 + 4.25 x height (cm) in girls. Conclusion: Reference values of PEFR are affected by regional, environmental and anthropometric factors. Hence, it is necessary to have regional reference values for children. Among different factors affecting PEFR, height correlates better with PEFR than weight and sex. Hence nomograms constructed can be used for this region

Stress Distribution in Implant Retained Finger Prosthesis: A Finite Element Study

Pokpong Amornvit, Dinesh Rokaya, Konrawee Keawcharoen, Nimit Thongpulsawasdi

Background: Finger amputation may result from congenital cause, trauma, infection and tumours. The finger amputation may be rehabilitated with dental implant-retained finger prosthesis. The success of implant-retained finger prosthesis is determined by the implant loading. The type of the force is a determining factor in implant loading. Objective: To evaluate stress distributions in finger bone when the loading force is applied along the long axis of the implant using finite element analysis. Method: The finite element models were created. The finger bone model containing cortical bone and cancellous bone was constructed by using radiograph. Astra Tech Osseo Speed bone level implant of 4.5 mm diameter and 14 mm length was selected. The force was applied to the top of the abutment along the long axis of the implant. Results: Finite element analysis indicated that the maximum stress was located at the head of abutment screw. The minimum stress was located in the apical third of the implant fixture. The weakest point was calculated by safety factor which is located in the spongy bone at apical third of the fixtures. Finally, 4.9 times yield stress of spongy bone was needed for the deformation of the spongy bone. Conclusion: Finite element study showed that when the force was applied along the long axis of the implant, the maximum stress was located around the neck of the implant and the cortex bone received more stress than cancellous bone. So, to achieve long term success, the designers of implant systems must confront biomaterial and biomechanical problems including in vivo forces on implants, load transmission to the interface and interfacial tissue response.

ICD Versus VATS as Primary Treatment in Fibrinopurulent Stage of Empyema Thoracis

Nandeesh M., B.J. Sharathchandra, P.B. Thrishuli

Background and Objectives:Empyema thoracis is a condition in which pus collects in the pleural cavity. The optimal treatment of Empyema thoracis especially in the fibrinopurulent phase (Stage II) remains controversial. While the Inter Costal Drainage (ICD) is less invasive and cheap, it is not clearly proved that it is better than the Video Assisted Thoracoscopic Surgery (VATS) in terms of conversion into thoracotomy, morbidity and duration of hospital stay. No large randomized trial is available for comparing the two treatment strategies in the condition. Methodology:This study was a prospective comparative study of ICD insertion versus VATS as primary intervention in the fibrinopurulent stage of Empyema thoracis, which was conducted over a period of 2 years (Dec 2008 to Nov 2010), in a tertiarry care Medical College Hospital. With an incidence of around 5-10% and a considerable burden in our hospital, the study was taken up to compare the efficacy of ICD versus VATS, in terms of morbidity and cost effectiveness and to identify the optimal way of managing the condition. The study included a total of 40 patients with each group consisting of 20 patients. Sampling:Purposive sampling technique. The Statistical Methods Used:Descriptive statistics, Freque - ncies, Crosstabs, Independent sample t-test. Results:It was found that VATS was better than the conventional ICD insertion in terms of the variables like mean duration of hospital stay (p<0.05), mean duration of the chest tube in situ (p<0.05), mean cost of the treatment (p<0.05), complications (p<0.05) and failure rate (p<0.05) which were statistically significant. Conclusion:Our study concluded that Video Assisted Thor - acoscopic Surgery is better than conventional ICD tube insertion as a primary mode of treatment in the fibrinopurulent stage of Empyema thoracis.

Prevalence and Severity of Erectile Dysfunction as Assessed by IIEF-5 in North Indian Type 2 Diabetic Males and Its Correlation with Variables

Arvind Goyal, Parminder Singh, Ashish Ahuja

Introduction: The aim of this study was to assess the severity of the erectile (ED) dysfunction among type 2 diabetic men. For subjective information patients were asked to fill up the IIEF questionnaire. This study was also done to correlate ED with other variables like age, obesity, duration of diabetes, degree of diabetic control and complications of diabetes. Neuropathy was assessed objectively by using the Vibration Perception Threshold (VPT). Material and Methods: This study was conducted on 348 patients. Age range of these subjects was 25 years to 75 years. All patients underwent routine clinical examinations which included recording of duration of diabetes, type of diabetes, Body Mass Index, previous HbA1c tests and VPT measurement. Results and Conclusion: In the present study, it was observed that there was a significant association of ED with age, duration of diabetes, glycemic control and BMI. In fact, VPT emerged as a strong predictor of ED. We conclude that adding objectivity of VPT measurement improves the subjective predictive value of IIEF-5.

Comparative Study of Oral and Vaginal Misoprostol for Induction of Labour, Maternal and Foetal Outcome

Kambhampati Komala, Meherlatha Reddy, Iqbal Jehan Quadri, Suneetha B., Ramya V.

Background:Misoprostol is a new promising agent for cervical ripening and induction of labour .The ideal dose, route and frequency of administration of misoprostol are still under investigation. Although, vaginal application of misoprostol has been validated as a reasonable mean of induction, there is a patient resistance to digital examination and there is a risk of ascending infection. For this reason, oral administration of misoprostol for cervical ripening and labour induction has been tried. Aims and Objectives:To compare 50µg of oral misoprostol versus 25µg of intravaginal misoprostol for induction of labour at term and maternal, foetal outcomes. Methods:200 women who were at term, with indication for induction of labour and Bishop scores of = 5 were randomly assigned to receive misoprostol 50µg or 25µg intravaginal, every 4-6 hours, for a maximum of 5 doses. In either group, pregnant females with inadequate uterine contractions despite being given maximum 5 doses of misoprostol, were augmented using oxytocin. The primary outcome measure was time-interval from induction to vaginal delivery and vaginal delivery rate within 24 hours. Results:The median induction to vaginal delivery time in oral group (12.92h) and vaginal group (14.04 h) was not significant. Oral misoprostol resulted in more number of vaginal deliveries as compared to vaginal misoprostol (94% as compared to 86%), which was not significant. There was a significantly higher incidence of uterine tachysystole in the vaginal group, as compared to oral group. There were no significant differences between the groups with respect to oxytocin augmentation, caesarean section rate, analgesic requirement and neonatal outcome. Conclusion:Oral misoprostol is as efficacious as vaginal misoprostol because of shorter induction delivery interval, lower caesarean section rates, and lower incidence of failed induction rates. Lower incidence of foetal distress and easy intake are observed if the drug is administered orally .

Seroepidemiology of Toxoplasma Gondii Infection in Women with First Trimester Spontaneous Miscarriage in Qena Governorate, Egypt

Introduction: To determine seroprevalence and risks factors for T. gondii in women with early miscarriage, Sera of 76 women were analyzed infection by indirect enzyme linked immunosorbent assay (ELISA). Seropositive cases were further examined histopathologically for evidence of Toxoplasma gondii organisms. Material and Methods: Demographic data were obtained from participants to gather information on risk factors. Result and Discussion: Of 76 women with spontaneous abortion screened for Toxoplasma-specific IgG and IgM antibodies with ELISA, 35 were IgG seropositive, of which, 14 samples were IgM seropositive. Therefore, seropositivity rates of 46.1% (95% CI: 35.1%, 57.3%), and 18.4% (95% CI: 10.89%, 28.32%) for IgG and IgM, respectively were found. These indicate that, 27.6 % (21 cases) of studied women (IgG+/IgM-) were immune to toxoplasmosis and 53.94 %(41 cases) were susceptible to primary infection (IgG-/IgM-). Mean while acute toxoplasmosis (IgG+/ IgM+) was 18.4 %( 14 cases) with one case (1.3%) confirmed for recent infection as she had Tachyzoites on histopathology study. On the basis of multivariate logistic regression, living in a rural area was found to be the only independent predictor of toxoplasmosis (OR=3.800, CI= 1.100-10.813, p=0.034). Conclusion: The seroprevalence of T. gondii infection in women with first trimester abortion in Qena governorate of Egypt is high. Pregnant women living in rural area are at a higher risk for acquiring infection during pregnancy. Antenatal screening of pregnant women and educational program about risks for Toxoplasmosis in rural areas is needed.

Fetal Outcome in Meconium Stained Deliveries

Rajlaxmi Mundhra, Manika Agarwal

Objective: To evaluate the foetal outcome in Meconium Stained Amniotic Fluid (MSAF). Material and Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynaecology, North Eastern Indira Gandhi Regional Institute of Health And Medical Sciences, Shillong, India, over a period of eighteen months, from January 2010 to June 2011. A total of 355 pregnant women who had completed more than 37 weeks of gestation, with singleton pregnancies and cephalic presentations were included in this study. One hundred and sixty five cases with MSAF, were thus selected and they were compared with 190 randomly selected controls. Results: Among 165 cases, 27.88 % of the cases had regular visits to the Institute at least 3 times previously, 72.12% cases had no previous visit at all. Primigravidas accounted for a majority of cases and approximately 50% cases had gestational ages of more than 40 weeks Pregnancies complicated with pregnancy induced hypertension had statistically significant higher rates of meconium staining among cases (16.97%), as compared to those among controls (7.89%). 21.81% cases had foetal heart rate abnormalities, as were detected by electronic foetal monitoring and presence of foetal bradycardia was statistically higher in cases compared to that in controls. Casearean section rates were nearly double in cases (49.09%). Neonatal outcome was poor in terms of low Apgar score at birth, birth asphyxia, Meconium Aspiration Syndrome (MAS) and increased neonatal admission among cases as compared to that among controls. Conclusion: Meconium stained amniotic fluid is really worrisome from both, obstetrician’s and paediatrician’s points of view, as it increases the caesarean rates, causes birth asphyxia, MAS and increases neonatal intensive care unit admiss

Maternal and Perinatal Outcome in Teenage Vs. Vicenarian Primigravidae - A Clinical Study

Indranil Dutta, Prashant Joshi

Objectives: The aim of this study was to evaluate the maternal and foetal outcomes and complications in teenage primigravida as compared to those in primigravidae who were aged 20-29 years. Methods: Eighty teenage and one hundred sixty adult primigravidae were taken up for the study. Study duration was 24 months, from November 2010 to October 2012, at Rural Medical Research Centre in southern India. During this period, all cases were included in the study, irrespective of their booking statuses. For every teenage primigravidae, two subsequent adult primigravidae were correspondingly studied. Patients with major skeletal deformities such as kyphoscoliosis, polio, pelvic fractures, diabetes mellitus, renal disorders, morbid obesity were excluded. All cases of molar pregnancies and primigravidas who were admitted for abortions were also excluded. Results: 38.75% of teenage primigravidae were unbooked as compared to 6.9% of adults. 68.75% of teenage primigravidae were anaemic as compared to 33.75% of adults. Antenatal complications like anaemia, hypertensive disorders of pregnancy, oligohydroamnios, hypothyroid were significantly more in teenagers (68.8%) as compared to those which were seen in adults(18.1%). 25% of teenagers had preterm births as compared to 5% adults who has preterm births. 43.75% of teenagers had Lower Segment Caesarean Section (LSCS) as compared to 20% adults who had LSCS. Indication was foetal distress in a majority of teenagers (68.5%). 29.2% of teenagers had low birth weight children as compared to 16.6% adults who had such children. 31.7% of teenage neonates required NICU admissions as compared to 12.27% neonates of adult mothers. Interpretation and Conclusion: It can be interpreted that teenage primigravidae had a significant number of complications in pregnancy, leading cause being anaemia, more preterm incidences and higher rates of LSCS, followed by higher number of NICU admissions. Since teenage pregnancy is a multifaceted problem, it demands multidimensional solutions. Teenage pregnancies are more common in populations with low socio-economic statuses, due to lack of education, awareness of complications of teenage pregnancies, and various other factors. Hence, awareness should be created and various programmes should be taken up, to educate mainly the poor in our rural setup. As early marriages cannot be prevented in our culture, so, possibly creating awareness on late conceptions is of utmost importance.

Risk Assessment for Psychological Disorders in Postmenopausal Women

Introduction: Psychological symptoms are common & bothersome in post menopausal women. Hence, screening these women for risk factors for psychological disorders is an important measure to improve their health. Objective: To study the risk assessment for psychological disorders in postmenopausal women. Material & Methods: This was a prospective and observational study conducted in the Department of Obstetrics and Gynecology of a North Indian tertiary care hospital. It included a cross-section of 200 postmenopausal women attending gynecology OPD and menopausal clinic. Result: Psychological symptoms were present in 32% postmenopausal women while sleep disturbance and decreased concentration were reported by nearly 34%. Irritability, nervousness and depression were the presenting complaints in 31.5%, 28.5% and 23.5% women respectively. Mild depression was present in 41.5%, whereas 3% women suffered from clinical (moderate to severe) depression. Depression was significantly associated with vasomotor symptoms (p=0.000), past history of depression (p=0.048) and psychosocial stressors (p=0.000). Conclusion: Women during postmenopausal years are at increased risk of psychological disorders; hence assessment of mental health and address of related issues should be an integral part of comprehensive evaluation of these women.

Risk for Recurrence of Pre-eclampsia in the Subsequent Pregnancy

Tarakeswari Surapaneni, Vidyavati Patil Bada, C. Praveen Kumar Nirmalan

Background: Pre-eclampsia (PE) is the commonest type of pregnancy induced hypertension and it affects nearly 5% of pregnant women. Besides short term morbidity and mortality that are associated with pregnancy, PE is associated with long term morbidity in women. There is a lack of information on the risk of recurrence of PE in pregnant Asian Indian women. Aim: To determine the rates and risk factors which were associated with recurrence of PE in the subsequent pregnancies of women with PE in index pregnancies. Settings and Design: A retrospective, observational study done at a single tertiary care centre in southern India. Material and Methods: The study included pregnant women with PE, who delivered at the study institute in 2008 and received care for their subsequent pregnancies at the study institute. Hypertension in pregnancy was categorized, based on the criteria of the International Society for the Study of Hypertension in Pregnancy. Point estimates and the 95% confidence intervals around point estimates of rates of recurrence of PE and associations of potential clinical and laboratory parameters with recurrence were determined by using bivariate analysis, logistic regression models and area under Receiver Operator Characteristic (ROC) curves. Results: The study included 82 pregnant women with PE in their index pregnancies. Twenty two (26.83%, 95% CI: 17.03, 36.62) of these 82 women developed recurrence of PE in their subsequent pregnancies. Recurrence of PE was significantly higher (OR 3.94, 95% CI: 1.05, 14.80, p=0.04) among women who were nulliparous in their index pregnancies. Recurrence of PE was not significantly associated with clinical factors or laboratory parameters in the index pregnancies. Conclusion: Nearly one in four of pregnant women with PE developed recurrences in their subsequent pregnancies, although a large proportion of pregnant women with PE (63.38% to 82.97%) in their index pregnancies were normotensive in their subsequent pregnancies.

"Are Medical Students Inclined to do Research?”

Background: Medical research at undergraduate level has been given poor importance in developing countries including India. Less incentives, poor resources, lack of benefits has all been the reason for curbing the research interests of the students. Objective: This research was done to understand if medical students perceived research to be important at an undergraduate level, to understand the reasons for doing research and the benefits obtained from research. Study Design: Cross sectional study. Material and Methods: Questionnaires were distributed to medical students studying in second, third, fourth and fifth years in the MBBS course at an undergraduate medical conference and a medical college. Questions were so designed to verify student’s ideas on research, their research involvement and their reasons for conducting research. The answers were tabulated, data analyzed and statistics were made based on their answers. Statistical Analysis: Frequency and percentage. Results: Out of the given sample, it was seen that though only 20.9% of the students had credited publications, 81.7% of the students admitted to research being essential to understanding and changing their perception of medicine. Only 38.3% of the sample found research to be cumbersome. 24.3% of the students were involved in research purely for the purpose of acquiring knowledge, 18.3% were pursuing interest in the field and a meager 1.7% were doing research to improve their curriculum vitae. Conclusion : These results are in conformance with other studies from elsewhere that shows decreased Indian medical student’s engagement in researches, compared to those from developed countries, but on par with those from the developing countries.

Problem Based Learning (PBL) - An Effective Approach to Improve Learning Outcomes in Medical Teaching

Bajaj Preeti, Ahuja Ashish, Gosavi Shriram

Introduction: As the “Science of Medicine” is getting advanced day-by-day, need for better pedagogies & learning techniques are imperative. Problem Based Learning (PBL) is an effective way of delivering medical education in a coherent, integrated & focused manner. It has several advantages over conventional and age-old teaching methods of routine. It is based on principles of adult learning theory, including student’s motivation, encouragement to set goals, think critically about decision making in day-to-day operations. Above all these, it stimulates challenge acceptance and learning curiosity among students and creates pragmatic educational program. Aim and objectives: To measure the effectiveness of the “Problem Based Learning” as compared to conventional theory/didactic lectures based learning. Material and Methods: The study was conducted on 72 medical students from Dayanand Medical College & Hospital, Ludhiana. Two modules of problem based sessions designed and delivered. Pre & Post-test score’s scientific statistical analysis was done. Student feed-back received based on questionnaire in the five-point Likert scale format. Results: Significant improvement in overall performance observed. Feedback revealed majority agreement that “Problem-based learning” helped them create interest (88.8 %), better understanding (86%) & promotes self-directed subject learning (91.6 %). Substantial improvement in the post-test scores clearly reveals acceptance of PBL over conventional learning. Conclusion: PBL ensures better practical learning, ability to create interest, subject understanding. It is a modern-day educational strategy, an effective tool to objectively improve the knowledge acquisition in Medical Teaching.

“Anaesthesia and Anaesthesiologists: How Famous are We among the General Population?”- A Survey

Uma B.R., Anitha Hanji S.

Introduction: Anaesthesia and anaesthesiologist from the very beginning has obtained “Behind the screen” role. This is of great concern as the field of Anaesthesiology has expanded its services to various specialities like intensive care, post-operative pain management, labour analgesia, accident and trauma management, casualty etc. The general public still do not consider us as true doctors. Material and Methods: A survey was done among 200 surgical patients in a tertiary care hospital attached to teaching institution by providing a questionnaire with 15 questions. Results: 26% did not know that anaesthesia exists as separate speciality, 54% felt anaesthesiologists were somebody in the OT, 40% were under the impression that their job was over ones patient was put to sleep. The mode of gathering information about anaesthesia played an important role. 52.5% patients had gathered their information from other people, 30% from surgeon and only 17.5% from the media (both print and electronic). Conclusion: This study portrays the ignorance among the general population regarding the important role played by anaesthesiologists. This ignorance may partly be attributed to the anaesthesiologist as we are very casual when it comes to spending quality time with patients in the peri-operative period and educating them about our role and our speciality.

Do Professional Practices among Malaysian Private Healthcare Providers Differ? A Comparative Study using Simulated Patients

Alamin Hassan M. A. Alabid, Mohamed Izham Mohamed Ibrahim, Mohamed Azmi Hassali

Background: Malaysia, a South East Asian country, legally permits general medical practitioners in private clinics to dispense medicines. This possibly can dilute the pharmacist role in the provision of healthcare and pharmaceutical care and deprive patients to benefit from these services. Objective: This study explored, assessed and compared the current status of medicines labeling, patient’s counseling, and symptomatic diagnosis by general practitioners and community pharmacists. Material and Methods: This study used trained Simulated Patients (SP), who participated in a scenario of common cold symptoms at private clinics and community pharmacies. SPs explored medication labeling, patients counseling and symptomatic diagnosis undertaken by general practitioners and community pharmacists. Later, study authors assessed and compared these practices. The study was conducted during June 2011 in Penang, Malaysia. Results: The study used descriptive statistics and Fisher-exact test to analyze data. Regarding patients counseling standard, among 100 visits by simulated patients, 64 (64%) from community pharmacists provided information about the medicine name, its indication, dosage and route of administration versus 17 (42.5%) general practitioners during 40 visits (p=0.024). Concerning adherence to labeling standard, for instance, only in one pharmacy visit, (1%) the pharmacist wrote the name of the patient on the medication label versus in 32 (80%) of doctors’ visits, the doctors adhered to this labeling standard (p<0.001). In all doctors’ visits (n=40, 100%), SPs were asked about symptoms, whereas in 87 (87%) CPs’ visits, pharmacists fulfilled this counseling standard (p=0.02). Conclusion: Although pharmacists showed less compliance to medicine labeling and symptomatic diagnosis compared to doctors, their counseling of patients was better. Separation will definitely contribute to more concentration of each provider on his/her roles and improve and direct the experiences and skills towards being more patient oriented.

Anti-mutagenicity Effects of Vitamin E on Oncology and Non-oncology Hospital Nurses by Ames Assay

Majid Rezaei-Basiri, Hassan Rezazadeh, Iraj Aswadi-Kermani Mahmud Ghazi-Khansari

Introduction:The aim of this study is to determine the anti- mutagenic effects of Vitamin E among nurses of oncology and non-oncology hospitals exposed to chemotherapy drugs. Several studies have demonstrated that nurses occupationally exposes to cytostatic drugs. Material and Methods:A total of 138 female nurses from oncology and non-oncology hospitals participated in the study. All urine samples of nurses before and after Vitamin E consumption (200 mg/day) were evaluated by Ames Salmonella typhimorium mutagenicity test using histidine negative of tester strain TA100 with and without S-9mix. In all steps the collected urine samples extracts were prepared using amberlit XAD-2 resins and examined for mutagenicity activity. The data of Ames assay were analyzed with Anova one way and t-test statistical. Results:In the present study 25% of oncology nursing staff excrete carcinogenic compounds in their urine and oral consumption of Vitamin E for two weeks showed significant anti-mutagenic effects. Discussion:It was appeared that the urinary mutagenic activity will decrease by receiving Vitamin E. However, after Vitamin E consumption there was significantly depletion of urinary mutagenic activity in urine extracts among the exposed nursing personnel. Conclusion:We conclude that mild effects of Vitamin E against poor safety and significant adverse events among nurses handling cytotoxic drugs. There is, therefore, a need to improve the safety of the work environment, make available protective equipment, develop standard practice guidelines for oncology nurses and higher therapeutic doses of Vitamin E may be a promising compound for reducing mutagenic effects of anti- neoplastic drugs among oncology hospital nurses.

Calcium Sulfate as Bone Graft Substitute in the Treatment of Osseous Bone Defects, A Prospective Study.

Yashavantha Kumar C, Nalini K B, Jagdish Menon, Dilip Kumar Patro, Banerji B H

Background: Calcium sulfate belongs to synthetic ceramic group of bone graft substitutes having an osteoconductive property. Calcium sulfate is an easily available, economic bone graft substitute. It is a bio-inert material which over a period of weeks get resorbed and fibrovascular tissue takes its place which eventually allows neovascularisation and bone formation within the area. Use of calcium sulfate as a bone graft substitutes avoids the complications and morbidity associated with autograft like infection, second surgery, and finite amount of graft. Material and Methods: A total of 15 patients with benign bone lesions and chronic osteomyelitis were operated and the osseous defects were filled with calcium sulfate which was comprehensively sterilized .Patients were followed with serial radiographs at six week intervals. Calcium sulfate resorption and new bone formation was studied. Results: Thirteen cases out of 15 showed calcium sulphate resorption and new bone incorporation. Calcaium sulphate resorption occurred at an average of 14.5 weeks (range,13-18weeks) whereas new bone incorporation occurred at an average of 6months ( range,5-7months). Thirteen patients out of these 15 cases returned to full activities of daily living. One patient had pathological fracture at the osseous defect postoperatively. One patient with GCT of distal end of tibia had recurrence of tumor and had to undergo second surgery. Conclusion: Although autogenous bone graft is the gold standard for bone grafting, it has limitations like finite amount, additional surgery and donor site morbidity. Calcium sulphate is safe, efficient and easily available bone graft substitute in the treatment of osseous defects. Most common complication encountered was aseptic serous discharge. Functional results were favorable in most of the cases.

Longitudinal Disease Detection Rates for the Evaluation of Disease Detection Technologies with Application in High-Risk Breast Cancer Screening

Jacob Levman

Context: This study presents a longitudinal simulation of disease screening at a variety of different test sensitivities. Aims: It is demonstrated that the difference between the performance of high quality tests and poor quality tests are relatively small in terms of the commonly used longitudinally measured disease detection rate. Statistical Analysis: This simulation study is focused on the screening of patients at high-risk for breast cancer and thus used plausible rates of new cases of disease and initial disease prevalence for this population. Results and Conclusions: The effects of varying the rate at which the disease enters the population and the initial disease prevalence is also discussed and was determined to not affect this study’s conclusions regarding the inappropriateness of the use of the longitudinally measured disease detection rate for the evaluation of screening technologies.

The Effect of Perceived Stress and Family Functioning on People with Type 2 Diabetes Mellitus

Bhagyashree Bhandary, Satheesh Rao, Sanal T.S

Background: Various studies have suggested that support from a patient’s family can facilitate his/her recovery from a physical illness and improve the ability of the patient to deal with consequences of Type 2 Diabetes. Stress is considered to play a major role in influencing Type 2 Diabetes Mellitus. Aim: To determine the roles of Perceived Stress and Family functioning on behaviours of individuals with Type 2 Diabetes Mellitus. Material and Methods: The present study included 250 Diabetics as per the WHO criteria and 250 non-Diabetics. Questionnaires were given to them to obtain data. Results: Stress was found to be high among Diabetics (22.17%) as compared to that in Non-Diabetics (16.92%). Family assessment showed a significant difference among its subscales when it was compared between Diabetics and Non-Diabetics. Conclusion: Perceived stress influences Type 2 Diabetes Mellitus. Role played by the Family is significant in managing Diabetes.

Echocardiography Guided Therapy for Myocarditis after Scorpion Sting Envenomation

Objective: This study was to evaluate echocardiographic findings and its usefulness in clinical management of patients with scorpion sting envenomation. Material and Methods: A total of 84 consecutive patients were prospectively studied. The data included demographics, at the time of presentation to the hospital, the clinical features, echocardiographic findings, admission to intensive care unit, use of inotropic medication, time to discharge, and mortality. Results: Out of 84 patients studied 60 patients (71.4%) had echocardiographic evidence of myocarditis (LVEF <50%). Majority of patients had LVEF <40% (50 patients, 83.3%). Severe LV dysfunction (LVEF <30%) was noted in 20 patients (33.3%). No patient had significant valvular regurgitation. RV dysfunction was noted in half of the patients who had LV dysfunction. RV dysfunction was not seen in isolation. Twenty four patients without evidence of myocarditis on echocardiography were observed in general wards and were discharged in 24 to 48 hours of admission. Ten patients with mild LV dysfunction (LVEF 50-40%) and 20 patients with moderate LV dysfunction were observed in high dependency units with regular monitoring for 24 to 48 hours. Only 3 patients were put on inotropics support and others could be discharged in 72 to 96 hours. All the patients with severe LV dysfunction and moderate LV dysfunction with significant RV dysfunction were admitted in intensive care unit irrespective of symptoms (Total 30 patients). These patients were put on inotropics support. Among severe LV dysfunction group, 4 patients required ventilator support and 2 (2.3%) patients died with refractory shock and multi-organ failure. Tachycardia, muffled and or gallop heart sounds and hypertension didn’t predict presence of LV dysfunction. Persistent hypotension requiring inotropics support was a marker of severe LV dysfunction. Conclusion: Echocardiography is a useful tool in emergency to assess LV function in patients with scorpion sting envenomation. It can guide therapy by identifying patients with severe LV dysfunction.

Study of Operated Patients of Lateral Internal Anal Sphincterotomy for Chronic Anal Fissure

Harshad Shankarlal Patel, Jagdish Chavda, Jayesh Parikh , Nehal Naik

Introduction: Anal fissure causes significant morbidity in the population. It is proposed that elevated sphincter pressures may cause ischaemia of the anal lining and this may be responsible for the pain of anal fissures and their failure to heal. When pharmacologic therapy fails or fissures recur frequently, lateral internal sphincterotomy is the surgical treatment of choice. Material and Methods:Retrospective analysis was done of admitted and operated patients of anal fissure by lateral anal internal sphincterotomy either by open or closed technique between April 2010 and November 2011 in Gujarat Medical Education & Research Society Medical College, Sola, Ahmedabad, India. The follow up data of all patients was evaluated for pain relief, recurrence, wound infection, incontinence to flatus or stool or both for a period of up to 6 months. Results: Wound infection rate was 10.3% in open method and 4.2% in closed method. Incontinence to flatus was 8.3% in closed method and 3.4% in open method. This was temporary and controlled within a 1 week. Incontinence to stool was 3.4% in open method which was temporary and controlled within 2 weeks while none in closed method. None of the patients in either group had come with recurrence within 6 months follow-up. Conclusion: Lateral anal internal sphincterotomy is safe regarding long term incontinence and effective regarding recurrence.

Morphometric Analysis of Superior Articular Facets of Atlas Vertebra and Its Clinical Applications in Ergonomics of Atlanto-Occipital Joints

ManjunathV. Motagi, Vallabhajosyula Ranganath

Aim:The classic variants in superior articular facets of atlas such as, variability in shape, presence of notch, constrictions, partial or complete separation of facets, and presence of pressure facets, have been reported to a limited extent in relation to ergonomics of cranio-vertebral joint. Objective:The objectives of the present study were to report the analyzed morphological features and metrical values of superior articular facets of the atlas. The morphological features which were included in this study were variability in shapes, constrictions and partial or complete separation of facets. The metrical measure included the surface area measurement of the facets. Material and Methods:This study was carried out on 50 (100 sides) dry atlas vertebrae from the Department of Anatomy, St John’s Medical College, Bangalore, India. The superior articular facets were studied for the shape and symmetry, constrictions and partial or complete separation of facets. The surface area of the facets were measured by using Image J (Image processing and analysis in JAVA) tool, that was primarily designed to measure and analyze different metrics. Results:The mean surface area on the right side was 157.3 ± 29.02, and on the left side, it was 158.5 ± 24.85. Oval, irregular, kidney and figure of eight shapes were observed either on both sides or on one side. Bilateral constrictions of facets were seen in 58 % of vertebrae. Bilateral, complete separations of facets were seen in 30% of vertebrae Conclusion:The observations of the present study are important to understand the ergonomics of the cranio-vertebral joint and they are helpful for academicians, neuro-surgeons, clinicians and radiologists in day to day clinical practice.

Quantitative Application of Sigma Metrics in Medical Biochemistry

Sunil Kumar Nanda, Lopamudra Ray

Introduction:Laboratory errors are result of a poorly designed quality system in the laboratory. Six Sigma is an error reduction methodology that has been successfully applied at Motorola and General Electric. Sigma (s) is the mathematical symbol for standard deviation (SD). Sigma methodology can be applied wherever an outcome of a process has to be measured. A poor outcome is counted as an error or defect. This is quantified as defects per million (DPM). A six sigma process is one in which 99.999666% of the products manufactured are statistically expected to be free of defects. Six sigma concentrates, on regulating a process to 6 SDs, represents 3.4 DPM (defects per million) opportunities. It can be inferred that as sigma increases, the consistency and steadiness of the test improves, thereby reducing the operating costs. We aimed to gauge performance of our laboratory parameters by sigma metrics. Objectives:Evaluation of sigma metrics in interpretation of parameter performance in clinical biochemistry. Material and Methods:The six month internal QC (October 2012 to march 2013) and EQAS (external quality assurance scheme) were extracted for the parameters-Glucose, Urea, Creatinine, Total Bilirubin, Total Protein, Albumin, Uric acid, Total Cholesterol, Triglycerides, Chloride, SGOT, SGPT and ALP. Coefficient of variance (CV) were calculated from internal QC for these parameters. Percentage bias for these parameters was calculated from the EQAS. Total allowable errors were followed as per Clinical Laboratory Improvement Amendments (CLIA) guidelines. Sigma metrics were calculated from CV, percentage bias and total allowable error for the above mentioned parameters. Results:For parameters - Total bilirubin, uric acid, SGOT, SGPT and ALP, the sigma values were found to be more than 6. For parameters – glucose, Creatinine, triglycerides, urea, the sigma values were found to be between 3 to 6. For parameters – total protein, albumin, cholesterol and chloride, the sigma values were found to be less than 3. Conclusion:ALP was the best performer when it was gauzed on the sigma scale, with a sigma metrics value of 8.4 and chloride had the least sigma metrics value of 1.4.

A Study on the Bacteriological Profile and Antibiogram of Bacteremia in Children Below 10 Years in a Tertiary Care Hospital in Bangalore, India

Devendra Kumar Tiwari, Saroj Golia, Sangeetha K.T., Vasudha C.L.

Introduction: Blood stream infections are very common in the pediatric age group. Patients with bacteremia may have either a transient bacteremia that may be rapidly and permanently cleared by a patient’s host defenses with no major consequences, or persistent bacteremia which can be self-limited without development of focal infection or sequelae, or may progress to a more serious fatal infection or toxic symptoms. Objectives: The aim of our study is to analyze the hospital data on bacteremia in children less than 10 years with special reference to male and female cases, the pathogens involved, and the antibiotic susceptibility patterns. Methods: Over a one year period samples were collected from 128 children who included all newborn babies and children admitted with fever and suspected of having sepsis. Blood was collected depending upon age groups with aseptic precaution and incubated at 37oC for 10 days. Subcultures were made on blood agar and MacConkey agar plates. Organisms were identified and antibiotic sensitivity test of the isolates were performed. Results: Out of 128 suspected cases, 32 (25%) was culture positive. Male to female ratio is 1.28:1.0. Klebsiella species (43.75%) was the most common organism isolated followed by Staphylococcus aureus (18.75%). Prevalence of gram negative organism was 71.87%. Most of the gram negative organisms showed maximum resistance to ampicillin and the gram positive organisms to penicillin. In this study three gram negative organisms were extended-spectrum beta lactamases (ESBLs) producers and one Pseudomonas aeruginosa was metallo-beta lactamase (MBL) producer. 33.33% of staphylococcus aureus was Methicillin resistant Staphylococcus aureus (MRSA) strains. Interpretation and Conclusion: This study showed a 25% prevalence rate of bacteremia among children with an increasing prevalence in the age group of 5-10 years and also an observed decline in susceptibility of the pathogens to common antibiotics which ultimately stresses on the need for continuous screening and surveillance for antibiotic resistance in the pediatric care unit and calls for increased efforts to ensure more rational use of these drugs.

Prevalence of Goitre in School Children of Chamarajanagar District, Karnataka, India

Syed Yunus Zama, Mansoor Ahmed, Vadiraja N.

Introduction:Iodine is an essential micronutrient. A daily consumption of 100-150 micrograms of iodine is recommended for normal human growth and development. Rationale:Iodine Deficiency Disorders (IDD) can be easily prevented. Simplest, most effective and inexpensive preventive method is consumption of iodated salt. Objectives:To find out the prevalence of Goitre among school children in Chamarajanagar district, India, and to estimate iodine in salt samples. Methodology:A cross-sectional study in the age group of 6-12 years using PPS systematic sampling method. A total of 3757 children were selected for the study. Clinical examination of the thyroid was done and salt samples were collected for Iodine estimation. Data was analyzed by using appropriate statistical tests. Results:The overall prevalence of Goitre was found to be 7.74% in Chamarajanagar district, India. It was higher in female children compared to male children. The difference was more evident in Grade II cases where 64.47% cases were females and 35.53% cases were males and it showed an increasing trend with age (Class1-4.8%, Class 6-10.9%, Class 7–17.6%). Conclusion:It was observed that IDD is endemic in the district with a prevalence of 7.74% among children of 6-12 years. Analysis of salt samples suggested that 28.42% samples had Iodine less than 15ppm.

A Comparative Study to Evaluate the Efficacy and Safety of Acyclovir and Famciclovir in the Management of Herpes Zoster

Background: Over the years, acyclovir has been the oral antiviral agent approved for the treatment of patients with acute herpes zoster,Its effectiveness in lessening the acute signs and symptoms of herpes zoster has been established but the effects on post herpetic neuralgia are less clear cut. Famciclovir is a new member of guanine nucleoside family of drugs. It is a well absorbed oral form of penciclovir with longer half life. This was a open comparative randomized study carried out to compare the safety and efficacy of famciclovir administered at 250mg thrice daily with acyclovir 800mg five times daily for the treatment of acute uncomplicated herpes zoster in immunocompetent individuals aged above 40 years. AIM: To assess the clinical profile of Herpes zoster, compare the efficacy and safety of acyclovir and famciclovir in the treatment of herpes zoster and to describe the effectiveness of acyclovir and famciclovir preventing post herpetic neuralgia. Methods: A total of 100 newly zoster were randomized in 1:1 ratio into acyclovir and famciclovir groups after inclusion criteria were satisfied.Treatment was initiated within 72 hrs of onset of symptoms and was continued for 7 days and evaluated at the end of each week up to six weeks period for full crusting of the lesions, complete healing of the lesion and loss of acute pain. Results: It was observed that famciclovir was as effective as acyclovir with no significant difference in time taken for full crusting, complete healing of lesions or loss of acute pain. Famciclovir was well tolerated with a better safety profile comparable to that of acyclovir. Constipation, headache, nausea and vomiting were the most commonly reported adverse effects, but constipation was considered to have a possible relationship to treatment. Conclusion: In conclusion, oral famciclovir administered three times daily for 7 days during acute zoster infection is as effective as acyclovir, administered 800mg five times daily.In addition it offers significant benefit by providing a well tolerated, cost effective, convenient dosage regime and accelerated rate of lesion resolution and a reduced duration of PHN.

Socio-demographic Determinants of Compliance among Type 2 Diabetic Patients in Abha, Saudi Arabia

Mohammad Abdul Salam, Aesha Farheen Siddiqui

Background and Objectives: Saudi Arabia has one of the highest prevalence of diabetes. This study was conducted with the following objectives: (1) To study the socio-demographic profile of diabetic patients in Abha. (2) To find the sociodemographic determinants of compliance among diabetic patients in Abha. Material and Methods: A self administered questionnaire which had detailed the socio-demographic features and various aspects of compliance was used on a random sample of registered diabetics at two primary health care centres of Abha. Results: Most of the patients (70.4 percent) were between 40- 60 years age. Most of the patients were men (about 60 percent) and Saudis. Majority of patients did not have a university education. Young patients (age<40) were more compliant with all aspects of management, except medication (23.8 percent). Women were significantly more compliant with exercise (49.7 percent), while men were significantly more compliant with follow up (81.1 percent). Saudi patients were significantly compliant with medication (79.2 percent), while non Saudis were compliant with exercise (62.9 percent). All single patients were diet compliant. Smokers were significantly less compliant with exercise. Patients with normal BMI were significantly more compliant with diet and exercise. Conclusion: Patients were found to be generally less compliant towards the regimen. Socio-demographic factors which were significantly associated with non compliance were age, gender, nationality, educational status, marital status, smoking status and BMI.

An 8 Years Retrospective Study of Breast Cancer Incidence in Ilam Province, Western Iran

Introduction: Breast cancer is the most common cancer (27% of all cancers) and common cause of death (16%) which occurs due to cancers among women, either in developed or developing countries. The current study aimed to assess incidence of breast cancer in west of Iran (Ilam province). Methods: During a cross-sectional study, all documented records of patients who were referred to the health centre of Ilam province in a period of 8 years (2002-2009) were investigated and 82 files which were related to breast cancer were identified. Patients’ data were entered into SPSS, version 16 and using X2, t-test and descriptive statistics, they were analyzed. Results: Totally, 82 confirmed breast cancer cases were diagnosed between 2002-2009 and this figure accounted for 21.4% of all cancers in Ilam province. The mean age with standard deviation (SD) of patients was 47.4 ± 14.5 years and the disease was most frequent in the age group of 30-40 years (38.3%). The highest incidence rate was seen in 2006- 2007 and the lowest rate was seen in 2002-2003. The most prevalent morphologic pattern of breast caner (86.2%) was invasive ductal carcinoma (IDC). There was a 23% incidence rate for breast cancer, with a significant increase in its incidence rate during 2002-2009. Conclusions: Due to diagnosis of the disease in its advanced stages, and also involvement of low age groups and young population in the country, screening programs such as self examination, examination by doctors and mammography should be started in the lower age groups, in ages which are lower than 30 years.

Female Sexual Dysfunction: Prevalence and Risk Factors

Molouk Jaafarpour, Ali Khani, Javaher Khajavikhan, Zeinab Suhrabi

Background and Aim: Sexual dysfunction adversely affects quality of life, self esteem and interpersonal relationships and it may often be responsible for psychopathological disturbances. The purpose of this study was to explore the prevalence and associated risk factors for Female Sexual Dysfunction (FSD) in women with Kurdish culture from western Iran . Material and Methods: This was a cross-sectional descriptive survey which included 400 women aged 18–50 years old, married, from Ilam-IR, who were interviewed as per the Iranian version of Female Sexual Function Index (FSFI). The subjects were randomly selected from 4 primary health centres. Results: According to the findings, 185 (46.2%) women reported FSD. Prevalence of FSD increased with age, from 22% in women aged <20 years to 75.7% in women aged 40-50 years. FSD was detected as a desire problem in 45.3% of women, an arousal problem in 37.5%, a lubrication problem in 41.2%, an orgasm problem in 42.0%, a satisfaction problem in 44.5% and a pain problem in 42.5%. The educational level was inversely correlated with the risk of FSD (OR: 1.54 ,95% CI: 1.09-2.13). Patients with FSD were significantly more likely to be older than 40 years (OR: 2.23, 95% CI: 1.12-2.68), who had sexual intercourse fewer than 3 times a week (OR:1.85, 95% CI: 1.23-1.99), who had been married for 10 years or more (OR:1.76, 95% CI: 1.04-1.97), who had 3 children or more (OR: 1.48, 95% CI: 0.97-1.24), who had husbands aged 40 years or more (OR: 2.11, 95% CI: 1.35-2.37) and who were unemployed (OR: 1.34, 95% CI: 1.06-1.63). No significant differences were detected in smoking history, residences and contraception methods used (p>0.05). Conclusion: FSD needs to be recognized as a significant public health problem in Kurd women. Further research, particularly studies on awareness and competency of physicians in the management of FSD, is required.

Incresed Non-Enzymatic Glycation of Plasma Proteins and Hemoglobin in Non-Diabetic Patients with Acute Myocardial Infarction (MI)

V. Parthibane, N. Selvaraj, V. Sathiyapriya, Zachariah Bobby, Medha Rajappa

Background: Glycation is known to play a key role in complications of many pathophysiological processes. The present study was carried out to assess whether there are abnormalities of non-enzymatic glycation of proteins and hemoglobin in acute Myocardial Infarction (MI) patients. Methods: Eighteen acute Myocardial Infarction (MI) patients and 20 healthy controls were enrolled for the present study. Fasting plasma glucose, fructosamine, glycated hemoglobin were evaluated. Results: A significant rise in the mean values of fructosamine and glycated hemoglobin was found in acute myocardial patients when compared with controls. When Pearson’s correlation analysis was performed, no significant correlation was found between fasting plasma glucose with either fructosamine or glycated hemoglobin levels. Conclusion: This data suggests an increased glycation of both plasma proteins and glycated hemoglobin in acute myocardial patients, which might be independent of prevailing glucose concentration.

A Drug Utilization Study of Psychotropic Drugs Prescribed in the Psychiatry Outpatient Department of a Tertiary Care Hospital

Background:Psychiatric disorders are one of the major causes of morbidity. Development of newer drugs like SSRIs and atypical antipsychotics has altered the treatment paradigms. Various factors like cost of drugs, local paradigms, etc. play a role in the selection of drug therapy and hence, affect the outcome. Keeping this in mind, we conducted a study to delineate the various drugs used in psychiatric disorders, to find discrepancies, if any, between the actual and the ideal prescribing pattern of psychotropic drugs and to conduct a cost analysis. Material and Methods:After our institutional ethics committee approved, a retrospective cross sectional drug utilization study of 600 pre scriptions was undertaken. Preparation of the protocol and conduct of the study was as per the WHO – DUS and the STROBE guidelines. Results:Drug use indicators – In 600 prescriptions, 1074 (88.25%) were psychotropic drugs. The utilization from the National and WHO EML was 100% and 90%, respectively. Average number of psychotropic drugs per prescription was 1.79 ± 1.02 (SD). 22.5% of the prescriptions contained psychotropic FDCs. 76.01% of drugs were prescribed by generic name. Percentage of psychotropic drugs prescribed from the hospital drug schedule and psychotropic drugs actually dispensed from the hospital drug store were 73.1% and 62.3%, respectively. Drug utilization pattern in different psychiatric disorders – Most commonly prescribed drugs for schizophrenia, bipolar disorders, depression and anxiety disorders were trifluoperazine + trihexiphenydyl (63.9%), carbamazepine (17.2%), amitriptyline (34.9%), and diazepam (23.8%), respectively. The least commonly prescribed drugs were levosulpiride (1.7%), lithium (1.3%), bupropion (4.7%) and clozapine (1.9%), respectively. The PDD/ DDD ratio of three drugs – haloperidol, pimozide and amitriptyline – was equal to one. The cost borne by the hospital was 116, i.e., 65.2% of the total cost. The cost index of clozapine was 11.2. Conclusion:Overall, the principles of rational prescribing were followed. The hospital drug schedule should include more SSRIs. The practice of using 1 st generation/ typical anti–psychotics as the first line was as per current recommendations. Anti– cholinergics should be used only in selected cases of patients on anti–psychotics. The use of diazepam should be curtailed and it should be used for short term only.

Legal Awareness and Responsibilities of Nursing Staff in Administration of Patient Care in A Trust Hospital

Hemant Kumar, Gokhale, Kalpana Jain, D.R. Mathur

Introduction: The enactment of various legal provisions like Consumer Protection Act, Right to Information Act and standardization of procedures and practices have brought nursing care under legal ambit. Needless to say, the level of legal awareness amidst nursing staff in India is abysmally low. Present study was undertaken to assess the level of legal awareness and responsibilities of nursing staff in administration of patient care at a trust hospital. Methods: An open ended questionnaire was prepared to assess the level of legal awareness among the nursing staff. The GNM and ANM nursing staff deployed at the nursing home and general wards only were randomly screened and specialty nurses were exempted. Results: The knowledge on various legal provisions, as was applicable to nursing, across all categories of nurses which were under review, was found to be poor. The nursing staff had poor knowledge on patients’ rights and also on their legal obligations towards patients. The GNM nurses fared better than ANM nurses. However, 46.67 % of nurses were found to be aware about cases of omission or commission. Conclusion: This study substantiated the fact that nurses had poor knowledge on the law that governed their profession and that in days to come, it would become increasingly difficult for them to avoid law suits which were prepared against them, unless remedial actions were take

Comparison of Ultrasonography and Fine Needle Aspiration Cytology in the Diagnosis of Malignant Breast Lesions

Introduction: Breast cancer is the most common cancer of women worldwide and usually presents as lump in the breast. Ultrasonography and Fine Needle Aspiration Cytology (FNAC) are two investigational tools often used to differentiate malignant breast lump from benign one. Aims and Objects: To find out and compare the sensitivity, specificity and predictive values of ultrasonography and FNAC in diagnosing malignant breast lump. Material and Methods: Patients who presented with clinically palpable breast lump at the department of Surgery, RIMS, India, from September, 2010 to August, 2012, were included. Recurrent lumps, breast abscess and cystic breast lumps were excluded. All the patients underwent Ultrasonographic evaluation using 7.5 MHz probe (©SIEMENS, Sonoline Versa Plus) at the department of Radiodiagnosis, RIMS and FNAC at the department of Pathology, RIMS. All the patients underwent excision of the lumps and tissues were sent for Histopathological examination. Sensitivity, specificity and predictive values of ultrasonography and FNAC were calculated taking Histopathological result as the gold standard. Values were compared. Results: Sixty patients with 62 breast lumps (40 benign and 22 malignant) were included. FNAC reported 42 lumps as benign and 19 as malignant and was indeterminate in 1 case. Ultrasonography reported 36 cases as benign, 18 as malignant and 6 as indeterminate; it failed to detect breast lump in 2 cases. Sensitivity, specificity, positive and negative predictive values of ultrasonography and FNAC in diagnosing malignant breast lump were respectively 94.74%, 100%, 100%, 97.22% and 90.48%, 100%, 100%, 95.24%. Conclusion: Ultrasonography and FNAC are 100% specific in diagnosing malignant breast lesion. Although Ultrasonography appears more sensitive than FNAC, the percentage of indeterminate report is higher with Ultrasonography.

Outcome of Surgery for Benign Prostatic Hyperplasia-Is It Predictable?

Aim: The study was done to evaluate the pre-operative and intra operative factors which influence the post-operative outcome in patients undergoing surgery for Benign Prostatic Hyperplasia (BPH). Setting and design: It was carried out prospectively at a university college hospital in northern India. Materials & Methods: The study was carried out prospectively in 31 patients who underwent surgery for BPH (TURP – 50, Open Prostatectomy – 10). Various pre-operative and intra-operative parameters were studied by means of a detailed history and examination, IPS score, urodynamic evaluation & cystoscopic examination. Their effect on post-operative outcome was evaluated by measuring changes in IPSS, maximum and average flow rates, and fall in PSA values. Statistical analysis: Repeated measure ANNOVA was applied to calculate the significance of preoperative factors on post operative outcome (IPSS, Q max and Q av). Results: All parameters studied in the patients improved significantly following surgery. Patients who had pre-operative urinary retention and catheter at the time of surgery had significant improvement in both subjective (IPSS ,p=.oo4) and objective (maximum & average flow rates p=.04) parameters studied. Patients with larger prostrate had a significantly better maximum flow rate (p=.03) and IPSS at 3 months post-operatively. Similarly, patients with larger bladder capacity (more than 150 ml), better compliance (more than 6 ml per cm of water) and lower post-voidal residue (less than 60ml) had better post-operative outcome. Conclusion: Patients with pre-operative urinary retention, shorter duration of bladder catheterization, lower post voidal residue, high IPSS score, larger prostrate, larger bladder capacity and compliance had a significantly better outcome following surgery for BPH as assessed by various parameters studied

A Clinical and Epidemiological Study of Psoriasis and its Association with Various Biochemical Parameters in Newly Diagnosed Cases

Background:There has been a lot of recent search on consideration of psoriasis as a systemic disease, with researchers being of the view that dermatological manifestations represent only a part of the spectrum. Although, there have been plenty of studies from the west reporting an association of psoriasis with the metabolic syndrome, there are no large-scale Indian studies evaluating Asian patients. The present study is an endeavour in this regard. Aim:To investigate the prevalence of metabolic syndrome in Indian patients with newly diagnosed psoriasis at the onset of the disease. Methods:The study is a prospective clinical case control study, with 100 patients of psoriasis and 100 age-matched healthy controls. 5ml plain venous blood after overnight fasting was obtained by venepuncture. Plasma glucose was tested by glucose oxidase method. Serum cholesterol and triglycerides was estimated by enzymatic method. Metabolic syndrome was diagnosed by the presence of three or more criterion of the National Cholestrol Education Programme’s Adult Panel ? (ATP ?). The statistical software SAS 9.2 and SPSS 15.0 was used for the analysis of the data. Results:Metabolic syndrome was diagnosed in 8 out of 100 cases and 9 out of 100 controls (p-value: 0.811). We did not find any association of psoriasis with metabolic syndrome in our study. The age of onset of the disease, the duration of the disease and the severity of the disease activity were also not found to be associated with the likelihood of developing metabolic syndrome. Conclusion:Our study refuted any association of psoriasis with metabolic syndrome at the onset of disease activity in Indian patients. The plenty of reports from west approving such an association can be explained by increased risk factors like smoking, alcohol consumption, obesity and stress levels. Further, most such studies have been conducted with patients on treatment, while ours is the first study on newly diagnosed patients prior to the initiation of any therapy.

Immunohistochemical Detection of p16INK4a in Leukoplakia and Oral Squamous Cell Carcinoma

Introduction: Over-expression of p16INK4a has been reported in tissues of oral squamous cell carcinoma (SCC) associated with Human Papillomaviruses (HPVs). Immunohistochemical (IHC) detection of p16INK4a is an easy technique than molecular detection of HPVs, hence we investigated the presence of this protein in the most common pre-malignant and malignant oral lesions i.e. leukoplakia and SCC respectively. Material and Methods: We performed IHC detection of p16INK4a in sections of paraffin embedded formalin fixed tissues of leukoplakia with or without dysplasia (n= 21) and SCC lesions (n= 69) and correlated with various patterns of p16INK4a positivity with respect to histological diagnosis. Results: In the present study, 71% cases of oral SCC cases were positive for p16INK4a, of which the most common pattern was diffuse nuclear and cytoplasmic staining. Among the cases with leukoplakia, 57.1% were positive for overexpression of p16INK4a, wherein diffuse and sporadic pattern was observed among 23.8 percent each. Conclusion: In the present study, significant number of oral SCC cases observed overexpressing p16INK4a . However HPV DNA detection based studies are needed to validate the utility of IHC detection of p16INK4a as a surrogate marker for HPV associated oral SCC.

Surgical Management of Tibial Plateau Fractures – A Clinical Study

Background: Advance in mechanization and acceleration of travel have been accompanied by increase in number and severity of fractures and those of tibial plateau are no exception. Being one of the major weight bearing joints of the body, fractures around it are of paramount importance. The study was aimed to identify the role of surgical treatment of tibial plateau fractures, its functional outcome and complications. Methods: Thirty-two cases of tibial plateau fractures treated by various modalities were studied from Jan 2004 to Dec 2005 at Bapuji Hospital and Chigateri General Hospital, Davangere and followed for minimum period of 6 months. Results: The selected patients evaluated thoroughly: clinically and radiologically, were taken for surgery, after the relevant lab investigations. The indicated fractures were treated as per the SCHATZKER’S types accordingly with CRIF, with percutaneous cannulated cancellous screws, ORIF with buttress plate with or without bone grafting, external fixator. Early range of motion started soon after the surgery. No weight bearing upto 6-8 weeks. The full weight bearing deferred until 12 weeks or complete fracture union. Immobilization in insecurily fixed fractures continued for 3-6 weeks by POP cast. The knee range of motion was excellent to very good, gait and weight bearing after complete union was satisfactory. redepression in 1 case, malunion in 2 cases, knee stiffness in 3, wound dehiscence in 2 cases and non-union in none of our cases. Conclusion: Surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, fascilitate early motion and reducing post-traumatic OA and hence to achieve optimal knee function.

Pigmented Basal Cell Carcinoma in Marjolin’s Ulcer

Marjolin’s ulcer is a carcinoma that develops in chronic benign ulcers or scars. It was first found to be associated with chronic osteomyelitis. Squamous cell carcinoma is the most common cancer which is being noted in Marjolin’s ulcer. Suspicion of such lesions should be raised in chronic wounds which demonstrate characteristic changes. Diagnosis is made by doing a biopsy and it is treated by wide local excision. We are reporting here a case of 65–year–old female who presented with a growth in a long standing scar over her back. Scar was caused by an incision and drainage for an abscess performed 30 years back. On biopsy, features of pigmented variety of Basal Cell Carcinoma (BCC) were seen. Though occurrence of basal cell carcinoma in Marjolin’s ulcer is known, pigmented variety is yet to be reported. The rare varieties like pigmented type of basal cell carcinoma in Marjolin’s ulcer, must be borne in mind by histopathologists.

Glucose 6 Phosphate Dehydrogenase Deficiency Unmasked by Diabetic Ketoacidosis: An Underrated Phenomenon

Ayushi Agarwal, Deepak Nayak M., Asha Patil, Chethan Manohar

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked disease responsible for moderate to severe hemolytic anaemia. Despite being the most common erythrocyte enzyme disorder, it is often overlooked in the regular diagnostic parlance. A 40-year-old male patient admitted to the casualty with an acutely exacerbated diabetic ketoacidosis, showed features of hemolytic anaemia on peripheral smear examination. Crucially, the spherocytes and bite cells suggested a possibility of G6PD deficiency. This was substantiated by an increased reticulocyte count (6.8%) and a reduced quantitative G6PD enzyme assay (7.2%). There was no significant family or prior medical/ drug history. Interestingly, the hemolytic features were evidenced when blood glucose levels were returning to normal values. The insulin mediated NADPH loss may have resulted in an increased erythrocyte oxidant sensitivity and a loss of sulfhydryl group availability; causing hemolysis to manifest. G6PD deficiency is conventionally affiliated with drug induced oxidative stress. But an association with a diabetes mellitus is seldom reported. This case is being presented as it highlights the lesser known complication of diabetic crisis such as hemolysis secondary to a G6PD deficiency

Leukostasis in an Adult with AML Presenting as Multiple High Attenuation Brain Masses on CT

Abdulaziz Ahmad AlGharras , Alexander Mamourian, Thomas Coyne, Suyash Mohan

Acute myeloid leukemia (AML) is a hematologic malignancy that can present with central nervous system (CNS) symptoms. Neurological symptoms may result from the local accumulation of malignant cells in or near the brain (chloroma), infection, hemorrhage, or infarcts from leukostasis. Leukostasisis a syndrome that can include brain infarction due hyperviscosity of blood with vascular occlusion but CNS involvement is rarely encountered in adults. We report an unusual case of leukostasis in an adult who presented with multiple high attenuation intracranial masses on CT. While initially thought to represent chloromasthey proved to be hemorrhagic infarcts secondary toleukostasis on open brain biopsy. This condition is under-reported in the radiology literature and only rarely biopsy proven. We review in this paper the pathological, CT, and MRfindings of leukostasis in order to increase awareness of this uncommon entity and facilitate diagnosis.

Ovarian Hyperstimulation Syndrome (OHSS) Presented as Massive Hydrothorax

Pradip kumar Saha, Poonam Goel, Rimpy Tandon

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of controlled ovarian stimulation. Although considered uncommon, the severe form is potentially fatal. Patient can present with varied clinical presentation like pain abdomen, abdominal distension or tachypnea. Diagnosis is made by careful history, examination and investigation. Treatment is conservative and supportive care. Here, we have presented a case of severe OHSS which was missed initially, as the doctor who had first seen probably was not aware of this disease.

Late Postpartum HELLP Syndrome 60 Hours after Delivery Associated with Mild Pre-eclampsia

Bulent Cakmak, Muhammet Toprak, Mehmet Can Nacar, Ahmet Karatas

The purpose of this report is to present a case of mild Pre-eclampsia which was complicated with postpartum HELLP syndrome. A 25-years-old pregnant woman with mild Pre-eclampsia at 36 weeks of gestation was admitted to our clinic with uterine contractions. A caesarean section was performed, due to her previous caesarean section history. Postpartum period was uneventful until the 2nd day after the caesarean section. Epigastric pain, nausea and vomiting appeared two days after her delivery. In evaluation of the case, laboratory findings which were associated with HELLP syndrome were found to include haemolysis, elevated liver enzymes and low platelet counts. The general condition and laboratory findings of the case returned to normal with supportive and steroid treatment after 3 days. It should be noted that HELLP syndrome can develop in the postpartum period. Therefore, caution should be exercised in patients with pre-eclampsia, for the development of the postpartum HELLP syndrome

A Case of Heterotopic Pregnancy with Tubal Rupture

Shraddha K Shetty, Anil K Shetty

Heterotopic Pregnancy (HP) is the simultaneous development of an intra-uterine pregnancy and ectopic pregnancy. In natural cycle, it is a very rare event. With the increasing popularity of ovulation induction performed during assisted reproductive techniques, its incidence has significantly increased. However, diagnosis is often delayed because of its rarity and difficulty. Heterotopic pregnancy is an important differential diagnosis to consider in patients with intra-uterine pregnancies presenting with acute abdominal pain and hemoperitoneum. Here we are reporting a case of heterotopic pregnancy in a 26-year-old woman presented with symptoms and signs of ruptured tubal pregnancy with live intra-uterine gestation at 8 weeks of amenorrhea.

Anaesthetic Management of a Neonate with Right Sided Congenital Diaphragmatic Hernia

Lavanya Kaparti, Padmaja R.

Neonates who are born with CDH suffer from sub-stantial morbidity and mortality. Modalities of treatment are said to influence outcome, apart from pre-natal and post-natal factors. Reports from developed countries have described improved survival with High Frequency Oscillatory Ventilation (HFOV), Extra Corporeal Membrane Oxygenation (ECMO) and inhaled Nitric Oxide (NO). Many centres in developing countries lack these neonatal advanced care facilities and outcome is expected to be different. In this case, we have focused on anaesthetic management of RCDH in a 5–day–old neonate, by using conventional ventilation.

Anaesthetic Management of a Child with Neurofibromatosis Type 2 for Multiple Tumour Decompressions

Neurofibromatosis type 2 is a genetic disorder with autosomal dominant pattern. It can manifest as intracranial, spinal, ocular and cutaneous lesions. The lesions can extend to all the systems. We present an anaesthetic management of a paediatric patient with neurofibromatosis 2 for multiple spinal and thoracic tumour decompression.

Isolated Absent of Coronary Sinus: Two Cases Report

Mustafa Yolcu, Serdar Turkmen, Alper Sertcelik, Canan Yolcu, Talant Batyraliev

Coronary sinus (CS) is the venous drainage system of the heart. Absence of the coronary sinus or atresia of ostium of the CS are rarely seen cardiac malformations. Congenital absence of CS usually is found together with other cardiac malformations, however, isolated congenital absence of CS is very rare. Multiple coronary-cameral fistulous connections, through which the blood drains into one of the cardiac chambers, are commonly seen in patients with CS abnormalities. Herein we present a case two cases of total absence of CS with a venous system draining directly into the left ventricle through Thebesian veins.

Familial Facial disfigurement in Multiple Familial Trichoepithelioma

Usha Kataria, Deepti Agarwal, Dinesh Chhillar

Trichoepithelioma is an uncommon, benign hamartomatous tumor of the pilosebaceous follicle. Presenting as multiple papules and nodules on face and neck, they pose a significant cosmetic problem in affected individuals. Familial involvement of this dermatosis occurs in an autosomal dominant pattern, the locus being located on chromosome 9p21, which causes multiple facial lesions in family members and their kins. Here, we report a case of multiple familial trichoepithelioma causing considerable disfigurement of the face.

Pigmented Basal Cell Carcinoma: A Clinical Variant, Report of Two Cases

Deepadarshan K., Mallikarjun M., Noshin N. Abdu

Basal cell carcinoma is the most common malignant tumour of skin, comprising 80% of non-melanoma cancers. Intermittent exposure to ultraviolet radiation is an important risk factor. Pigmented basal cell carcinoma is a clinical and histological variant of basal cell carcinoma that exhibits increased pigmentation. It is a very rare variant, although its frequency can reach upto 6% of total basal cell carcinomas in Hispanics. Herein, we are reporting 2 cases of pigmented basal cell carcinoma.

Giant Subcutaneous Synovial Sarcoma: An Interesting Case

A 45-year-old lady presented to us with a large subcutaneous swelling on her left side of back of 1 year duration. Local examination revealed a 13×12 cm spherical swelling on the left lower paraspinal region. Magnetic resonance imaging of lumbosacral spine revealed a 13×12 cm mass having solid and cystic components with internal septations in the subcutaneous tissue of left posterior paraspinal area. The mass was hetrogenously hyperintense on T 2 weighted images suggestive of synovial sarcoma. Wide local excision of the lump was carried out followed by closure of the defect with a lateral intercostal artery based rotational flap. The histopathology of the excised tumor revealed synovial sarcoma that stained positive for cytokeratin and epithelial membrane antigen. This case highlights an unusually large subcutaneous synovial sarcoma present in para-spinal area

Carcinoma Stomach: Unwanted Chemotherapeutic Success: A Case Vignette

A 45-years-old male, chronic smoker and occasional alcoholic, from Tamenlong district of Manipur was admitted to the department of Surgery, RIMS, Imphal on 19th August, 2011. He was diagnosed as a case of poorly differentiated adenocarcinoma of the stomach located at incissura along the lesser curvature. CT scan of abdomen had revealed para-aortic, aorto-caval and celiac lymphadenopathy. Patient had undergone 5 cycles of neo-adjuvant chemotherapy consisting of 3 weekly course of Oxaloplatin 80mg(D1) + epirubicin 200mg (D1) + Capicitabine 2000mg(D1-D14). After 1 month of chemotherapy, patient then underwent subtotal gastrectomy (modified D2 resection) without any significant peri-operative complication. Surprisingly, the final histopathological report of the resected specimen didn’t reveal any evidence of malignancy in any sections. Role of chemotherapy in gastric cancers has been an adjunct to surgery and the optimal drugs regimen has not been elucidated so far. Till now, very few cases of carcinoma stomach which show pathological complete response have been reported. Our case is such a rare case of pathological complete response following neoadjuvant chemotherapy.

Ossicular Injury Caused by A Knitting Needle

Amritpal Singh, Maninder Kaur

Ossicular chain injury is a complication of trauma caused to temporal bone, but rarely, it can also occur due to direct trauma caused to ossicular chain by a penetrating injury. Patients usually suffering from conductive hearing loss and vertigo, although a facial nerve injury is also a possibility. We are describing here a case of young male who presented with a penetrating trauma to the left ear, caused by a metallic knitting needle, that resulted in ossicular chain disruption. The patient suffered from severe vertigo and conductive hearing loss. He was advised complete bed rest and vertin for controlling vertigo, after which he recovered. Computed tomography is the investigation of choice for detecting and characterizing such injuries, for proper management of patients. Penetrating middle ear trauma differs from blunt trauma, as the mechanism of injury is distinct. The injury is usually isolated and an urgent repair may be needed. Hearing results after an immediate or a delayed ossiculoplasty are apparently satisfying, although late cases are assumed to be associated with adhesions or fibrosis.

Acute Retention of Urine, Tubercular Prostatitis: A Rare Case

Prasad Mylarappa, H.C. Srikantaiah

Prostate tuberculosis is a very rare condition and only few isolated cases have been reported in the literature in immunocompetent individuals. We, report a case of a 58-year-old man, who presented to us with features of lower urinary tract symptoms. On evaluation, prostatomegaly was found which was treated conservatively. Due to failed conservative treatment, transuretheral resection of prostate was performed. Histopathological examination along with Polymerase chain reaction and Ziehl-Neelsen staining confirmed tubercular prostatitis. He received nine months course of antitubercular treatment with good response.

Ischaemic fasciitis: A Very Rare entity with Unusual Presentation

Jyotsna Wader, Neha Gajbi, Sujata Kumbhar

We are reporting a case of ischaemic fasciitis which occurred in a 55-year-old female with no debilitating or long bed ridden history. She presented with a large swelling over left gluteal region. On evaluation, swelling was found to be of size, 5x5 cm, slightly tender and with induration. The operative findings led to a probable diagnosis of a calcified lesion, due to its hard consistency. However, the microscopic picture was typical of ischaemic fasciitis, because of its characteristic central necrosis, vascular and atypical fibroblastic proliferations. Also seen was presence of foreign body giant cell reactions, inflammatory cells and extravasated RBCs. Ischaemic fasciitis is a very rare pseudo sarcomatous proliferation of atypical fibroblasts, which has been described to be located over bony protuberances and said to develop most often in immobile elderly or debilitated patients. Recognition of this distinct entity as a reactive process, mostly associated with debilitation is rare in occurrence.

Soft Tissue Giant Cell Tumour of Low Malignant Potential: A Rare Tumour at a Rare Site

Amoolya Bhat, Geethamani V., Vijaya C.

“Soft tissue giant cell tumour of low malignant potential” is considered as the soft tissue counterpart of osteoclastoma of the bone. It is a primary soft tissue tumour which is classified under the category of fibrohistiocytic tumours of intermediate malignancy. Seventy percent of the tumours involve the extremities and only about seven percent of them arise in head and neck region. They are composed of nodules of histiocytes in a vascular stroma, with multinucleated osteoclast-like giant cells positive for vimentin, smooth muscle actin (SMA), CD68 and Tarterate Resistant Acid Phosphatase (TRAP). We are presenting a case of a 75-year-old man who had a nodule on the ala of the nose. Histopathology showed a histiocytic lesion.Benign fibrous histiocytoma, plexiform fibrohistiocytic tumour, solitary reticulohistiocytoma and histioid leprosy were ruled out by using special stains and immunostains. Expression of smooth muscle actin and CD68 confirmed the diagnosis of a soft tissue giant cell tumour with a low malignant potential.

Spontaneous Hepatocellular Adenoma in Paediatric Age Group – Case Report

Rajalakshmi Vaithianathan,Philipchandran, G.Selvambigai, P.Jayaganesh

Hepatocellular adenoma (Hca) is a rare, benign, liver cell tumour. Hca is most frequently seen in women with a history of oral contraceptive use. Hca is also reported in children with glycogen storage disorders, galactosaemia, Hurler’s syndrome, severe immune deficiency states, diabetes mellitus, sex hormone disturbances, Fanconis anaemia, in those who are on androgen therapy and also in seizure disorder patients who are on carbamazepine therapy. Usually, Hca arises typically in a clinical setting of hormonal or metabolic abnormalities which stimulate hepatocyte proliferation. Though it is rare, a few cases of spontaneous Hca have been reported in children and also in adults, which were not associated with any of the known risk factors which are associated with Hca. Hca has to be differentiated from focal nodular hyperplasia, hepatocellular carcinoma and hepatoblastoma. The histological features and the assessment of cell proliferation by using immuno histochemistry, help in confirming the diagnosis of Hca. In a few cases of Hca, malignant transformations have been reported. Hence, a careful search for malignant transformations is necessary. In this report, we have documented two cases of spontaneous Hca which occurred in two normal children.

Eccrine Porocarcinoma: A Case Report

Sharathkumar H.K., Hemalatha A.L., Deepthi B. Ramesh, Ankita Soni, Revathi V.

Eccrine porocarcinoma is an extremely rare malignancy of the eccrine sweat gland. It is believed to arise from the intra-epithelial portion of eccrine sweat glands. It can either arise de novo or it can develop in a long standing eccrine poroma. It often occurs in the elderly, with the mean age of occurrence being 67 years. The tumour favours extremities, particularly the legs and feet. The propensity to form multiple cutaneous metastases is an unusual feature of eccrine porocarcinoma. It is also associated with visceral metastasis, resulting in death. An early diagnosis and prompt treatment are thus essential, owing to the aggressive behaviour of the tumour. Keeping in view its rarity of occurrence, we are hereby presenting a case of eccrine porocarcinoma which occurred in a 55–year–old female.

A Unique Branching Pattern of the Axillary Artery: A Case Report

During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in the arm gave anterior circumflex humeral artery at the surgical neck of humerus, which terminated in the cubital fossa by dividing into radial and ulnar arteries. The superficial brachial artery gave two profunda brachii arteries, both of which passed through spiral groove, along with radial nerve and three muscular branches, to brachialis muscle. This variation is very rare. As per our knowledge, we did not find any literature which explained variations which were similar to this. The normal and abnormal anatomy of the axillary region has practical importance among vascular radiologists and surgeons and it should be known for making an accurate diagnostic interpretation.

Capillary Haemangioma of The Right Elbow and Forearm in New Born Child

Arun Kumar S Bilodi, Sabita Singh, David A Ebenezer, Parineeta Suman, Ramkumar M

Here we are reporting a case of capillary haemangioma in a new born female child born to non consanguineous parents. Capillary Haemangioma is a very common angiomatous lesion that occurs in infancy or in childhood. It may occur either superficially in the skin or at a deeper level. At the deeper level, intramuscularly or very rarely within the osseous tissue. On examination, child had a well-defined nonpulsatile swelling over the upper one-third of the right forearm on the flexor aspect very near the elbow. Skin was stretched and shinny with haemorrhagic spots and pale yellow border all round. There was a painful limitation of movement in the right elbow. All the peripheral pulses were normal, except the right radial pulse which was feeble. This study has profound embryological, as well as, clinical importance. Hence, it has been studied and reported.

Accessory Superficial Ulnar Artery: A Case Report

Shweta Solan

Undisplayed Bicarbonate ion Concentration in Arterial Blood Gas Analysis

Aditya Balakrishna Sathe, Manjiri Shashank Bhalkar

Blood bicarbonate ion concentration (BcHCO3-) is a vital parameter in the management of acid base disorders. In an arterial blood gas (ABG) analyzer, the BcHCO3- is calculated from the values of pH and pCO2. We received four samples in a span of one year, from December 2011 to November 2012 for arterial blood gas analysis, in which the BcHCO3- was not displayed by the blood gas analyzer. Based on the information available in literature, the formula for calculating the BcHCO3- from pH and pCO2 was obtained and BcHCO3- was calculated in all four samples mentioned above. An attempt was made to establish a clinical correlation between laboratory and clinical data of these patients. All these values of BcHCO3- were above the maximum display limit of our blood gas analyzer, which was 60 mmol/L and hence, they were not displayed. All four patients had chronic respiratory disease and they were taking furosemide and / or dexamethasone. High values of BcHCO3- , sometimes falling beyond the display range of the ABG analyzer, could be observed in patients of chronic respiratory disease, treated with drugs like furosemide and dexamethasone, that result in bicarbonate retention.

Community Acquired Bacteremia by Sphingomonas paucimobilis:Two Rare Case Reports

Shyamasree Nandy, Mridu Dudeja, Ayan kumar Das, Rachna Tiwari

S.paucimobilis has a diverse nutritional substrate spectrum and found in both environmental and hospital settings. Sphingomonas paucimobilis is rarely isolated from clinical specimen. This low virulence organism since has been reported to cause a variety of diseases since 1979. It has been reported to be associated with both community acquired and nosocomial diseases including bacteremia, catheter related sepsis, diarrhoeal diseases, peritonitis, meningitis, cutaneous infections, endopthalmitis, visceral infections , urinary tract infections etc. We report two cases of community acquired primary bacteremia by Sphingomonas paucimobilis. One of the patients was 55-year-old female who had gallbladder carcinoma and the other was a 2-year-old healthy male who had no history of any underlying disease. Both got admission in hospital with complaints of pyrexia. Blood culture yielded S.paucimobilis which was found to be sensitive to quinolones, chloramphenicol, carbapenems, aminoglycosides and beta lactams except penicillin and amoxicillin.

Mycobacterium fortuitum Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis (CAPD): A Case Report

Jyoti Sangwan, Sumit Lathwal, Satish Kumar, Deepak Juyal

Mycobacterium fortuitum, an environmental organism, is capable of producing a variety of clinical infections such as cutaneous infections, abscesses and nosocomial infections. Rarely, it has been a documented as a cause of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD). Continuous Ambulatory Peritoneal dialysis (CAPD) is one of the treatment options which are used for patients with end-stage renal disease (ESRD). Although peritonitis rates have declined in parallel with advances in peritoneal dialysis (PD) technology, peritonitis remains a leading complication of CAPD and it is the major cause for transfer to other methods of dialysis. We are reporting a case of M. fortuitum peritonitis in a patient who was undergoing CAPD, which was successfully treated. This case emphasizes the importance of mycobacterial cultures in patients with CAPD-associated peritonitis, whose routine cultures may yield no organisms.

Transitional Cell Carcinoma: A Case Report with Clinical, Histological and Cytological Findings

Papillary carcinoma of the uterine cervix with features reminiscent of Transitional Cell Carcinoma (TCC) of urothelial origin, is a poorly recognized subtype of cervical carcinoma. This tumour has a propensity for late metastasis and local recurrence, in spite of the fact that histologically it could be misinterpreted as CIN grade III with a papillary configuration or as a squamous cell papilloma. This tumour occurs mainly in post-menopausal females, it is potentially aggressive and it presents at a more advanced stage. Here, we are presenting a case of a 65-year-old female who presented with post-menopausal bleeding and pelvic pain, and underwent hysterectomy for pyometra. The cervix showed a focus of papillary transitional carcinoma.

Myxoid Leiomyoma of Cervix

Leiomyoma, a benign smooth muscle tumour of uterus, is the most common pelvic tumour which occurs in women of reproductive age group. Uterine leiomyomas are frequently seen in women who are older than 30 years of age and they are very rarely seen in women who are below the age of 18 years. They tend to regress after menopause. Incidence is 4% in women who are below 30 years of age. However , lifetime risk of fibroids in women who are over the age of 45 years is more than 60%, with an incidence which is higher in blacks than in whites Cervical leiomyomas constitute 1-2% of the total leiomyoma cases and they rarely occur. There are three types of cervical leiomyomas, namely; interstitial, supravaginal, and polypoidal. Supravaginal leiomyoma is the commonest type. Large cervical fibroids present with abdominal masses, incarcerated procidentia, uterine inversion, cervical malignancy, etc. The prevalence of fibroids during pregnancy, irrespective of site, has been reported to be 1-4%. Degeneration in leiomyomas have been described in 65% of the cases. Myxoid leiomyoma is characterized by absence of mito tic activity and the presence of myogenic phenotype. The higher end of prevalence for a myxoid degeneration has been reported in upto 50% of all degenerations in uterus, but myxoid leiomyoma has been rarely described in cervix. Cause of a myxoid change in pregnancy is unknown.

Desmoplastic Small Round Cell Tumour in a Young Woman with Widespread Metastasis and Peritoneal Caking

Vidya Monappa, Sudha S. Bhat, Manna Valiathan

Desmoplastic Small Round Cell Tumour (DSRCT) is a rare, highly aggressive, mesenchymal tumour that arises from the peritoneal cavity. It is commonly seen in adolescent and young adult males and its occurrence in females is uncommon. We are reporting here a rare case of DSRCT in a young woman, which clinically masqueraded as an ovarian malignancy, with metastasis to liver, lung, spleen and peritoneum. The cytologic findings, Histomorphological and immunohistochemical features have been discussed, with a brief review of literature.

Rare Retro–Orbital Intraconal Occurrence Of Benign Schwannoma – A Case Report

A.L. Hemalatha, Vani D, Giripunja M, Bharathi M, Geetanjali S

Schwannomas otherwise referred to as neurilemmomas are benign, slowly progressing, encapsulated tumors arising from Schwann cells in the peripheral nerve sheath. They may grow along any peripheral or cranial nerve. Amongst the cranial nerve schwannomas, the eigth cranial nerve is the commonest site. But orbit is a rare site for their occurrence. Solitary orbital schwannomas account for 1% of orbital neoplasms. Orbital schwannomas arise from 3th, 4th, 6th cranial nerves and ciliary ganglion. Since complications like optic nerve compression and atrophy are likely to occur, early diagnosis is imperative for appropriate management. The present case deals with the rare occurrence of a retro-orbital, intraconal schwannoma in a 23-year-old lady who was clinically and radiologically diagnosed to have a retro-orbital cavernous hemangioma. The variable presentation and location of this tumor can certainly make the diagnosis difficult which may be confirmed only by histopathological examination as in the present case. Our patient underwent a successful complete surgical excision before any complications could ensue.

Solitary Fibrous Tumour of the Kidney: Case Report with Review of the Literature

Solitary Fibrous Tumour (SFT) is an unusual spindle cell tumour that usually occurs in the pleura, but has recently also been reported to be extra-pleural in origin. A renal presentation is very rare. Upto 90% of the tumours have benign characteristics. It is difficult to differentiate it from renal cell carcinoma by using imaging techniques. A definitive diagnosis can be made by doing a detailed pathological examination, which includes immunohistochemistry. We are reporting a case of a large solitary fibrous tumour of the kidney which here occurred in a 70-years-old male. Histological examination of the resected specimen confirmed the diagnosis, by revealing strongly positive reactions of the neoplastic cells for CD34, bcl-2, vimentin and negativity for Epithelial Membrane Antigen (EMA), Smooth Muscle Actin (SMA), S-100 protein and Ki-67. The patient suffered a cardiac arrest and died on the seventh day after his surgery.

Extragastrointestinal Stromal Tumour of The Abdominal Wall - A Case Report

A. Sathish Selva Kumar, R. Padmini, G. Veena, N. Murugesan

Stromal tumours occurring in areas other than the GastroIntestinal Tract (GIT) are known as Extra GastroIntestinal Stromal Tumours (EGISTs). They usually arise in the mesentery, omentum or retroperitoneum, while EGISTs which occur in the abdominal wall are very rare. Both gastrointestinal stromal tumours (GISTs) and EGISTs are histologically and immunophenotypically similar. We are reporting a case of EGIST, which occurred in the anterior abdominal wall in a twenty five-year-old female patient. The tumour was present in the right loin and imaging studies suggested that it was a desmoid tumour. It was surgically excised by doing an abdominal wall mesh repair. The histological examinations revealed a tumour with spindle cell morphology, with <2 mitoses per 50 High Power Field (HPF) and no necrosis, with tumour free margins. Immunohistochemistry was strongly positive for CD117 and Smooth Muscle Actin (SMA), while it was negative for Beta-catenin and S100. The patient is well post operatively and is on close follow up. EGISTs should be considered in the differential diagnosis of mesenchymal tumours which occur in the abdominal wall, inspite of their rarity, as the high risk patients may need Imatinib chemotherapy.

Acute Exacerbation of Chronic Rhinosinusitis (AECRS) with Orbital Complications in an Atrophic Rhinitis Patient: A Mere Co-incidence?

Mainak Dutta, Soumya Ghatak

Recurrent Acute Exacerbations of Chronic Rhinosinusitis (AECRS) in a setting of atrophic rhinitis are perplexing clinical situations. While either may act as the primary factor, repeated inflammation in a vessel-poor atrophied tissue is unusual. Progressive mucosal degeneration, vascularity and the effect of bacterial colonization are the factors suggested to play an important role for the pathobiogenesis of the co-existence of the two diseases. Through presentation of a case, a brief attempt has been made here to explore the temporal relationship between rhinosinusitis and atrophic rhinitis, in the process, other noteworthy features of the patient have also been highlighted.

An Interesting Case of Relapsing Polychondritis in A Young Girl

Shibani V Anchan, Santosh S Garag, Arunkumar J S, K C Prasad, Poorvi V Sharma

Relapsing polychondritis is an acute, recurrent and progressive inflammation and degeneration of cartilage and connective tissue including that within the tracheobronchial tree affecting men and women equally and usually in the middle age. Serious airway manifestations occur in at least half of these patients. We present to you an interesting case report of a 20-year-old female who presented with exertional breathlessness. Imaging revealed diffuse calcification of pinna and tracheobronchial tree. Based on the characteristic clinical features and imaging studies a diagnosis of relapsing polychondritis was attained.

Systemic Sclerosis Presenting with Simultaneous Retinal Vasculitis in One Eye and Optic Neuritis in the other along with Severe Immune Haemolytic Anaemia

Avijit Moulick, Biswanath Sharma Sarkar, Anirban Jana, Pradipta Guha, Anjan Das

Systemic Sclerosis (SSc) is a connective tissue disorder which involves multiple systems in a chronic progressive manner. Micro–angiopathic haemolytic anaemia is a distinguished feature of “scleroderma renal crisis”, which is manifested by severe hypertension, a rapidly progressing renal dysfunction and hyperreninaemia and is seen in patients with an early, diffuse form of the disease. A nervous system involvement is rare, though entrapment neuropathies have been reported. Who presented with a sequential loss of vision in both eyes; due to retinal vasculitis in right eye and optic nerve demyelination in the left eye. She also had severe Coombs’ negative haemolytic anaemia in absence of any renal dysfunction or hypertension. Both the ophthalmologic and the haematologic manifestations are very rare and both responded well to oral prednisolone therapy.

Polymicrobial Endocarditis in Intravenous Heroin and Fentanyl Abuse

Raman Mehrzad, Marcus Sublette, Michael Barza,

Infective endocarditis is a life threatening condition with a high mortality rate. Intravenous Drug Abusers (IVDA) are more likely to acquire endocarditis. Most of the cases of infective endocarditis are caused by a single pathogen; cases of polymicrobial endocarditis are rare and they are associated with a reported mortality rate of more than 30%. Only 21 cases of N. sicca endocarditis have been described in the literature since 1918, and only 15 reported cases of endo carditis which involved Actinomyces species have been reported since 1939. We are reporting a case of a 49-year-old male with intravenous heroin and fentanyl abuse, who presented with infective endocarditis caused by Neisseria sicca/subflava(N. sicca) , Actinomyces , Streptococcus mitis , and Haemophilus parainfluenzae, complicated by septic emboli to the lungs and skin, ARDS , splenic infarct and immunocomplex mediated proliferative glomerulonephritis.

Ileosigmoid knot – A Surgeon´s Nightmare

Ileosigmoid knot, also known as compound volvulus, is an unusual and a rare cause of intestinal obstruction. We are reporting a case of ileosigmoid knot in a 30-year-old male, who presented with lower abdominal pain. On examination, there was tenderness in the suprapubic area and later, the patient developed features of peritonitis. Exploratory laparotomy revealed a large volume of haemorrhagic fluid with gangrenous sigmoid colon, distended and gangrenous ileum twisted round the base of the sigmoid loop. Gangrenous portion of the ileum and sigmoid colon was resected and end to end anastomosis with Hartmann’s procedure was done.

A Rare Content in Inguinal Hernial Sac, Masquerading as Scrotal Tumour

Sri Vengadesh Gopal, Ashley Solomon

Some of the commonly performed operations can become difficult due to unusual findings which are seen during surgery. One such sort of operation is hernia repair. Decision making during such situations could be challenging, even for experienced surgeons. We are reporting here a rare case of a terminal ileal intussusception in inguinal hernial sac, which presented as a scrotal tumour. A 45–year–old man presented with an uncomplicated left inguinoscrotal swelling of 4 years duration. He had a large non–transilluminant hydrocoele (20x 10cm) with a partially reducible inguinal hernia, with another scrotal mass mimicking a scrotal tumour. Sonographic evaluation showed a complex scrotal mass with bowel loops in the sac. On surgical exploration, a terminal ileal intussusception mass was noted in the sac, which required ileocaecal resection by laparotomy. This case report is an unusual presentation of a common disease. Surgeons should be aware of these unusual contents in hernial sac, for better decision making and management during hernia operations.

Ileo-ileal Intussusception in an Adult Caused by Vanek’s Tumour: A Rare Case Report

Bhavuray Teli, Madhu CP, Sudhir S, Shreeharsha MV

Adult intussusception is relatively rare in patients with bowel obstructions. Adult invagination is mostly caused by benign tumours. Intussusceptions caused by inflammatory fibroid polyps (IFPs) are uncommon. IFPs are rare, localized, non-neoplastic lesions originating in the submucosa of the gastrointestinal tract. We are reporting a rare case of intestinal obstruction caused by an ileo-ileal intussusception, caused by an IFP, a rare but peculiar and always benign tumour

Voglibose: An Alpha Glucosidase Inhibitor

Ajay S. Dabhi, Nikita R. Bhatt, Mohit J. Shah

Diabetes Mellitus (DM) is a morbid disease worldwide, with increasing incidence as time passes. It has macro-vascular and micro-vascular complications. The main cause of these complications is poorly controlled postprandial hyperglycaemia. Alpha glucosidase inhibitors, namely acarbose, voglibose and miglitol, are available for therapy. Voglibose is well tolerated and effective in comparable doses among these drugs. This article highlights the important features of voglibose.

Piceatannol: A Potential Futuristic Natural Stilbene as Fetal Haemoglobin Inducer

Aayush Kukreja, Samarth Tandon, Amit Mishra, Archana Tiwari

Beta thalassaemia is an autosomal recessive inherited blood disorder which results in abnormal formation of Haemoglobin molecule and ineffective erythropoiesis. Patients need to be dependent on habitual blood transfusion and on unaffordable exorbitant therapies for contin - ued existence. It has been hypothesized that if the level of foetal Haemoglobin increases, it compensates the need of adult Haemoglobin and hence, ameliorates clinical symptoms associated with beta thalassaemia major. Illation from previous studies has proved that reactiva - tion of foetal Haemoglobin with the aid of natural compounds is a better alternative therapy for patients of beta thalassaemia because of its cost effectiveness and occurrence in natural eatables. Piceatannol, a naturally occurring stilbene, is less studied compound in comparison to resveratrol, but it shows a wide range of biological activities. This article has mainly focused on piceatannol and its application as a foetal Haemoglobin inducer in future.

An In vitro SEM Study on the Effect of Bleaching Gel Enriched with Novamin on Whitening of Teeth and Dentinal Tubule Occlusion

Gaurangi Kakodkar, Anuj Lavania, Ida De Noronha De Ataide

Introduction: Tooth whitening products enjoy substantial popularity. However, tooth hypersensitivity is invariably an undesirable consequence. Desensitizing toothpastes may be used for alleviating the symptoms. NovaMin, as an active ingredient in many dentifrices, has been shown to deliver significant therapeutic desensitising benefits. Aim: To study the effect of NovaMin desensitising toothpaste mixed with 15% carbamide peroxide on tooth bleaching and tubule occlusion. Material and Methods: This study was carried out in vitro, on extracted premolars which were bleached, using the above mentioned mixture and shade change was evaluated. They were then sectioned to be observed under a scanning Electron Microscope. The number of completely and partially blocked tubules as well as open tubules were counted for each specimen. Statistical analysis for shade change was done by using paired t-test. Mean and Standard deviation were calculated for the tubule counts and they were analyzed statistically. Conclusion: The results of this study indicated that the addition of NovaMin to 15% Carbamide peroxide occluded the dentinal tubules and that it did not affect the bleaching procedure. They also emphasized its clinical relevance in a dual advantage of desensitizing and bleaching with a single paste system.

Oral Rinse as a Simpler Approach to Exfoliative Cytology: A Comparative Study

Shaila Mulki, Pushparaj Shetty, Prakash Pai

Background:Oral rinse is a novel method that can be used to detect dysplasia in potentially malignant disorders and malignant oral lesions in resource challenged areas. A study was undertaken to compare the quality of the normal smears prepared with the oral rinse and that of the wooden tongue spatula. Material and Methods: One hundred five normal subjects were selected for the study. Two smears were prepared from clinically normal mucosa using an oral rinse and further two smears were scraped from clinically normal buccal mucosa using a wooden spatula. Statistical Analysis: The smears were graded for cell yield, dispersion and cellular clarity on a three-point scale by two observers. The results were analyzed using Mann Whitney non parametric test. Results: The Oral rinse was found to be significantly more efficient than the wooden spatula, in terms of cell yield (p<0.0001), cell dispersion (p =.0052) and cellular detail (p<0.0001). Conclusion: The study showed that the Oral rinse is an effective method for use in exfoliative cytology of normal oral mucosa.

Dentascan – Is the Investment Worth the Hype ???

Monali A. Shah, Sneha S. Shah, Deepak Dave

Background:Open Bone Measurement (OBM) and Bone Sounding (BS) are most reliable but invasive clinical methods for Alveolar Bone Level (ABL) assessment, causing discomfort to the patient. Routinely, IOPAs & OPGs are the commonest radiographic techniques used, which tend to underestimate bone loss and obscure buccal/lingual defects. Novel technique like dentascan (CBCT) eliminates this limitation by giving images in 3 planes – sagittal, coronal and axial. Aim:To compare & correlate non-invasive 3D radiographic technique of Dentascan with BS & OBM, and IOPA and OPG, in assessing the ABL. Settings and Design:Cross-sectional diagnostic study. Material and Methods:Two hundred and five sites were subjected to clinical and radiographic diagnostic techniques. Relative distance between the alveolar bone crest and reference wire was measured. All the measurements were compared and tested against the OBM. Statistical Analysis:Student’s t-test, ANOVA, Pearson correlation coefficient. Results:There is statistically significant difference between dentascan and OBM, only BS showed agreement with OBM (p< 0.05). Dentascan weakly correlated with OBM & BS lingually.Rest all techniques showed statistically significant difference between them ( p = 0.00). Conclusion:Within the limitations of this study, only BS seems to be comparable with OBM with no superior result of Dentascan over the conventional techniques, except for lingual measurements.

Ponticulus Posticus on the Posterior Arch of Atlas, Prevalence Analysis in Symptomatic and Asymptomatic Patients of Gulbarga Population

Aims and Objectives: To investigate the prevalence and morphological features of Ponticulus Posticus (PP) in symptomatic and asymptomatic patients of Gulbarga population, to substantiate whether ponticulus posticus was the possible cause of chronic tension-type headaches and migraine. Material and Methods: Five hundred patients were investigated with digital lateral cephalograms for the presence and type of ponticulus posticus. All the patients in whom ponticulus posticus was present in either partial or complete form were further studied for symptoms like chronic tension type headache, orofacial pain or diagnosed migraine. Results: Among the sample of 500 cases, partial ponticulus posticus was found in 302 patients (60%) [ Males 48% and Females 52%]. Complete variant was found in 40 cases (8%) [Males 65% and females 35% both, who were in the age group of 16-45 years], with a mean age of 28 years and SD 27.76 ±10.74. In partial PP, 42 patients (14%) were found to be symptomatic. In complete form, 32 patients (78%) were found to be symptomatic. Symptoms were mainly in the form of migraine or chronic type of headache. Conclusion: According to our study, partial form of PP was found to be more prevalent as compared to complete form in Gulbarga population and complete form of ponticulus posticus can be considered as possible cause for chronic tension type headache, orofacial pain and migraine.

Palatal Lipoma: A Case Report

Sreenivasulu Pattipati, M. Naveen Kumar, Ramadevi, B. Praveen Kumar

Intraoral lipomas are benign mesenchymal neoplasms that originate in mature adipose cells with differential diagnosis of other soft tissue lesions. Lipoma, rarely, occurs in the oral cavity, and it corresponds to less than 4.4%, of all benign oral soft tissue tumors. Here, we are reporting a case of lipoma that occurred in the hard palate, which is extremely rare.

Impact of School Based Oral Health Education Programmes in India:A Systematic Review

The teaching of Oral Health Education aims at preventing the dental disease and promoting dental health at early stages. Schools are powerful places to shape the health, education and well-being of our children. The objective of this study was to determine the impact of school dental health education programmes conducted in various parts of India. A systematic review from available literature was carried out. The study examined papers relating to oral health interventions which were published between 1992 and 2012. Ten articles were selected and included in the review. All the studies were found to contain the required information on the outcomes of school dental health programmes in India. Different methods were used to deliver oral health education. All the studies reported significant improvement in oral hygiene of school children after imparting dental health education. In some studies, school teachers were also trained to impart oral health education. Decreased level of awareness was found in children coming from low income families. Longer duration studies are needed to improve the results. School dental education programmes should be more focused on north-eastern Indian population

Bar and Sleeve Attachment: A Report of Two Cases

Yogesh Rao, Pankaj Yadav, Mariette D’Souza, Jagjeet Singh, Anurag Jain

Patients with the anterior defects either due to trauma, congenital or pathological can be treated with conventional removable or fixed partial denture. The lost soft tissue structures are not replaced by the conventional treatment option. Andrews bridge is combination of both removable and fixed partial denture and fulfills all the requirements like phonetics, hygiene, aesthetics and comfort. This article describes the bar and sleeve attachment as the best treatment option in these types of defects and restores the patients satisfaction.

Anterior Maxillary Intrusion and Retraction with Corticotomy-Facilitated Orthodontic Treatment and Burstone Three Piece Intrusive Arch

An adult patient with proclination and spacing was performed orthodontic treatment combined with corticotomy and the burstone three piece intrusive arch who desired a shortened treatment period. The patient had Angle’s Class I malocclusion with flaring of the maxillary and mandibular incisors. Pre adjusted edgewise appliance (MBT prescription) was fixed to the maxillary and mandibular teeth. Then corticotomy was performed on the cortical bone of the buccal sides in the maxillary anterior regions. Intrusion and retraction initiated immediately after the corticotomy. The intrusive arch was adjusted once in every 2 weeks. The total treatment time for intrusion was 5 months. Cephalometric superimpositions showed no anchorage loss, and panoramic radiographs showed neither significant reduction in the crestal bone height nor marked apical root resorption. A corticotomy-facilitated orthodontic treatment shortened treatment period without any anchorage loss or adverse effects.

Supporting the Drive to Thrive in Cleft Lip and Palate Infant- A Case Report

Thabitha Rani S, Manjula M, Sreelakshmi N, Rajendra Reddy E, Rajesh A

In infants with cleft lip and palate, failure to thrive (FTT) condition has largely been attributed to early feeding difficulties. Presurgical Nasoalveolar Molding (PNAM) forms an integral part of treatment modality for cleft infants in such conditions, by providing a myriad of benefits. It balances several aspects of treatment such as growth, aesthetics and function in cleft infants and also provides psychological reassurance to the parents. This clinical report describes the presurgical management of an infant with complete unilateral cleft lip and palate who was in failure to thrive condition.

Carisolv- An Innovative Method of Caries Removal

Vartika Kathuria, Anil V. Ankola, Mamata Hebbal, Monica Mocherla

The use of minimal invasive dentistry and attention to patient comfort is of utmost importance especially for the school children and anxious and uncooperative patients. This demanded the newer patient friendly technique in dentistry amongst which is the Chemo mechanical caries removal (CMCR). CMCR involves the selective caries removal of carious dentine. As only the carious dentine is removed the painful removal of sound dentine is avoided and the anxiety due to the vibration of the handpiece is also reduced thus it appears to be more comfortable to the patient. CMCR although more prolonged procedure, is effective in caries removal. Thus CMCR is an effective alternate method for caries removal; it is more conservative and appears to be more comfortable for the patients.

Assessment of TMJ Disorders Using Ultrasonography as a Diagnostic Tool: A Review

Hansa Kundu, P. Basavaraj, Sowmya Kote, Ashish Singla, Shilpi Singh

Temporomandibular disorders affect nearly 10-70% of population. Hence, a proper diagnosis of temporomandibular disorders using appropriate diagnostic aids is required. Thus, the purpose of this review was to check the use of ultrasonography as a diagnostic aid in the detection of TMJ disorders.A literature review was performed in Pub Med Central and Cochrane library using Mesh Terms – ‘ultrasonography’ and ‘TMJ disorders’. Out of the total 113 titles appeared, 38 were related to the research question. Further search criteria were applied to the articles, out of which 11 articles fulfilled the criteria and were selected for the review. Two articles which were hand searched were also included. Sensitivity of ultrasonography in detecting TMJ disorders in a majority of articles ranged from 41%-90% in disc displacement, when MRI was taken as the gold standard. In case of TMJ Effusion and Condylar effusion, sensitivities ranged from 20-80% and 83% respectively. It was also seen that sensitivity increased with increase in frequency of transducer. In the available literature, it was found that ultrasonography was an acceptable diagnostic tool for detection of disc displacement, condylar erosion and articular effusion.

Can Accidental Local Application of A Drug Cause Discolouration of Permanent Teeth?

Manoj Kumar Hans, Ajay Nagpal, Shashit Shetty, Rinki Hans

Thorough knowledge on the aetiology of tooth staining is of importance to dental surgeons, in order to enable a correct diagnosis to be made when examining a discoloured dentition and it allows the dental practitioner to explain to the patient the exact nature of the condition. Tetracyclines are a group of drugs which can discolour teeth permanently. One such case of discolouration of adult teeth caused by administration of tetracycline (oxytetracycline) has been reported here and it has been discussed in detail.

Spirulina and Pentoxyfilline – A Novel Approach for Treatment of Oral Submucous Fibrosis

Background: Oral submucous fibrosis is a habit associated insidious precancerous condition of the oral cavity commonly found in Asian countries. Many treatment modalities have been attempted in treating the condition apart from steroids which have been the main stay. Hence the present study was designed to assess the efficacy of spirulina and pentoxyfilline and also to compare them in oral submucous fibrosis. Material and Methods: Fourty Patients with clinico-histological diagnosis of oral sub mucous fibrosis were selected and divided into two groups with 20 in each group by simple randomization method. Group I received Pentoxyfilline and Group II Spirulina for period of 3 months. The efficacy was assessed by parameters like mouth opening, burning sensation and tongue protrusion using vernier caliper, visual analog scale and a metric scale respectively along with the side effects. Results: Student’s t-test was applied to obtain the results. Both Pentoxyfilline and Spirulina groups showed statistically significant results (p=0.000) in all the three parameters namely mouth opening, burning sensation and tongue protrusion. On comparing both the drugs statistically insignificant results were obtained for mouth opening (p=0.35) and tongue protrusion (p=0.25) but statistically significant difference was seen in subjective parameter i.e burning sensation (p=0.04). Side effects like bloating of stomach, nausea and gastritis were noted in the pentoxyfilline group in contrast to Spirulina group. Conclusion: Newer drugs Pentoxyfilline and Spirulina showed promising results in treatment of Oral sub mucous fibrosis. Spirulina was used for the first time for treatment of Oral submucous fibrosis (OSMF) and it proved to be superior than pentoxyfilline as no side effects were observed. Also it was superior in reducing burning sensation and hence can be advised in OSMF patients suffering from severe subjective symptoms.

Effects of Simulated Microwave Disinfection on the Mechanical Properties of Three Different Types of Denture Base Resins

Statement of problem:Disinfection of prostheses with chemical solutions has deleterious effects on dentures. The appropriate power setting of microwave for disinfection, without affecting denture base properties, is a controversy. Purpose:To evaluate and compare the effect of simulated microwave disinfection at a recommended power setting on the mechanical properties of three denture base heat polymerized acrylic resins. Material and Methods:Ninety rectangular specimens of each acrylic resin of 65mm × 10mm × 3 mm dimensions were divided into three groups. Group A (Trevalon), Group B (Trevalon- HI), Group C (Ivocap). In each group, thirty specimens were divided into three subgroups with ten specimens in each and they were submitted to MicroVickers hardness, flexural strength, and impact strength tests. In each subgroup, five specimens were tested before the simulated microwave disinfection and they served as the control group. The remaining five were tested after simulated microwave disinfection and they were considered as the experimental group. Simulated microwave disinfection was done in a domestic microwave oven at 650 W for 5 minutes. Results:The data were analyzed using One-way ANOVA and t-test. The mechanical properties of the three denture base resins were not altered after simulated microwave disinfection, as compared to those of the controls. Conclusion:Microwave irradiation at 650 W for 5 min did not affect the mechanical properties of the three denture base resins. Domestic microwave oven, at the prescribed setting, can be used as an alternative method of disinfection for complete dentures without affecting their properties.

Immunohistochemical Ex-pression of p16 in Carcinoma Ex-pleomorphic Adenoma (undifferentiated and Adenocarcinoma Types)

Objective: This study was aimed at characterizing alterations in the immunohistochemical expression of p16 in carcinoma ex-pleomorphic adenomas. Study Design: A selected series of 27 cases of carcinoma ex-pleomorphic adenomas were examined. Results: The results showed that p16 expression in non tumour duct cells was strongly positive nuclear staining in 23 (85%) cases out of 27 cases, that 3 (11.1%) had moderate staining, and that 1 (3.7%) had weak staining. p16 expression in carcinoma ex-pleomorphic adenomas was indicated as a negative nuclear staining in 22 (81.4%) cases out of 27cases, and 5 (18.5%) cases expressed moderate staining. Conclusion: This study suggests that alteration of p16 expression is detected in carcinoma ex-pleomorphic adenomas. p16 has a role in development of carcinoma ex-pleomorphic adenomas.

An in Vitro Spectrophotometric Analysis of the Penetration of Bleaching Agent into the Pulp Chamber of Intact and Restored Teeth

Aim: To investigate the pulp chamber penetration of bleaching agent in intact teeth and teeth following restorative procedure. Methodology: Sixty extracted human incisors were selected and divided into 6 Groups. Four Groups were restored with hybrid composite resin and resin modified glass ionomer cement respectively, while 2 Groups were left intact. The Groups were then immersed in the treatment agents for 60 mins at 37°C. The optical density of the resultant blue solution obtained by adding leucocrystal violet and horseradish peroxidise to the acetate buffer solution present in the pulp chamber was measured spectrophotometrically and the data thus obtained was statistically analysed using ANOVA and paired t-test. Results: The amount of pulpal peroxide penetration in restored teeth was significantly higher than intact teeth (p< 0.001). the control Group showed no peroxide penetration. Groups restored with resin modified glass ionomer cement showed higher pulpal peroxide levels than Groups restored with hybrid composites, though the difference was not statistically significant (p = 0.52). Conclusion: Peroxide readily penetrates into the pulp through intact and restored teeth, with restored teeth showing higher pulpal peroxide levels than intact teeth. Teeth restored with resin modified glass ionomer cement showed higher pulpal peroxide level than teeth restored with composite resins.

A Comparative Study of Dermatoglyphics in Individuals with Normal Occlusions and Malocclusions

Boggula Rama Mohan Reddy, Singaraju Gowri Sankar, Roy E.T., Supraja Govulla

Introduction: Dermatoglyphics is the study on edpidermal ridges on the palmar and plantar surfaces of the feet and hand. Embryological development of orodental structures and these dermal patterns occur during the same period. The environmentally influenced genetic predisposition is found in different types of malocclusions. This malocclusion should also exhibit different dermal patterns which are unique for each class. Aim of the Study: The present study was conducted to compare the Dermatoglyphics parameters of individuals with normal occlusions and various classes of malocclusions. Methodology: The participants were divided into four groups; Group 1: class I ideal; Group 2: class I malocclusionl; Group 3: class II Div 1 and Div 2; Group IV: class III. The finger and palmar prints were obtained and they were analyzed for each type of pattern. The Total Finger Fridge Count (TFRC), a-b ridge count and the angle “atd” (angle formed by connecting lines from digital triradius ‘a’ to the axial triradius and from this triradius to the digital triradius ‘d’) were associated with particular groups. Results: The data was entered and analyzed by using Students t-test and ANOVA. Conclusion: Particular predictive occurrence of patterns was not found to be associated with each group. However, some of the finger patterns, such as increase in twinned loops in class II malocclusions and absence of radial loops in class III malocclusions were found to be statistically significant (p<0.001). The parameters associated with palmar prints had no statistical significance. Further studies with more samples in each group should be carried out.

Assessment of Blood Glucose Using Gingival Crevicular Blood in Diabetic and Non-Diabetic Patients: A Chair Side Method

Harmanpreet Kaur, Bhawanpreet Singh, Anshu Sharma

Aim: Diabetes mellitus is undiagnosed in approximately half of the patients actually suffering from the disease. The prevalence of diabetes mellitus is nearly twice in patients with periodontitis as compared to periodontally healthy subjects.In addition, the prevalence of Diabetes mellitus is more than twice as high as in patients with periodontitis when compared to periodontally healthy subjects. The purpose of the present study was to evaluate whether blood oozing from gingival crevice during routine periodontal examination can be used for determining glucose levels. Material and Methods: In the present study 50 patients(25 diabetic and 25 non-diabetic) with chronic periodontitis were selected and were divided into two groups i.e. Group I and Group II, respectively. Blood glucose measurements were made using gingival crevicular blood, finger stick blood using glucose self-monitoring device (FinetestTM ; Infopia Co.Ltd;Korea) and at the same time intra venous blood was collected for measurement in a laboratory glucose analyzer. Each laboratory measurement was corrected from a serum glucose value to a whole blood glucose value by a function of the patient’s haematocrit. Results: The patient’s blood glucose values ranged from 83.6 to 483mg/dl in diabetic patients(Group I) and 70-218 mg/dl in non-diabetic individuals (Group II) to 83.6 to 483mg/dl. The comparison between gingival crevicular blood, finger-prick blood and corrected intra venous blood showed a very strong correlation with an r value of 0.99(P level< 0.001). Conclusion: The data from this study has shown that gingival crevicular blood collected during diagnostic periodontal examination can be an excellent source of blood for glucometric analysis.

Effectiveness of Cryogen Tetrfluoroethane on Elimination of Gingival Epithelium and its Clinical Application in Gingival Depigmentation–Histological Findings and Case Series

Santhosh Kumar, G. Subraya Bhat, K. Mahalinga Bhat

Objective: To histologically assess and clinically co-relate the effectiveness of cryogen Tetrafluoroethane (TFE) for gingival depigmentation procedure. Material and Methods: Twelve patients having unaesthetic gingival melanin pigmentation were included in the study. Gingival tissues of eight patients having gingival melanin pigmentation undergoing gingivoplasty or gingivectomy for crownlengthening were exposed to the cryogen and this was used for the histological examination. Gingivectomies were done after 8, 24, 96 hours and after a week of application of tetrafluoroethane. Four fair skinned patients complaining of unaesthetic gingival hyperpigmentation underwent gingival depigmentation using Tetrafluoroethane cryogen. Results: Histologically after 96 hours of application of cryogen there was complete loss of retepegs and epithelial detachment from the corium was evident. Complete re – epithelialisation was noted after a week and was clinically correlated. Conclusion: We therefore, concluded that histologically tetrafluoroethane can effectively destroy gingival epithelium without causing damage to the connective tissue and clinically the color of the gingiva had more pleasing appearance 6 months postoperatively. Hence the cryogen can be used safely for depigmentation procedure.

Aesthetic Rehabilitation of Discoloured Nonvital Anterior tooth with Carbamide Peroxide Bleaching: Case Series

Gautam P. Badole, Manjusha M. Warhadpande, Rakesh N. Bahadure, Shital G. Badole

Discolouration of teeth, especially the anteriores, can result in considerably cosmetic impairment in person. Combine effects of intrinsic and extrinsic colour determines the appearance of teeth. Whitening of teeth with bleaching is a more conservative therapeutic method than full crowns, veneers or composite restorations which is more invasive and expensive. Among bleaching techniques, in office bleaching with carbamide peroxide provide superior aesthetic result in short period of time with no adverse effects. This paper presents case series of tooth discolouration in non-vital tooth which was successfully bleached using 35 % carbamide peroxide. After 1 year follow up the prognosis was good with no reversal of tooth discolouration. This case report allows the better understanding of the concept of nonvital tooth bleaching with carbamide peroxide which gives a non-invasive alternative for aesthetic purpose in preserving the natural tooth structure.

Supplemental Mandibular Mesiodens: A Diagnostic Challenge

Manjunath Naganahalli, Ad arsh Honnappa, Nallan CSK Chaitanya

Developmental anomalies affecting the number of teeth are occasionally encountered clinically. The incidence of supernumerary teeth is approximately 1–3%. Among these are the maxillary anterior teeth, the maxillary molars, and the maxillo-mandubular premolars, in terms of descending order of occurrence. Supernumeraries occur rarely in the mandibular anterior teeth region. They may be either supplemental or rudimentary. We are reporting case of a supplemental type of supernumerary tooth in the mandibular anterior region and steps which were followed to distinguish supernumerary tooth from the normal series.

Giant Cell Fibroma: A Case Report with Immunohistochemical Markers

Samson Jimson, Sudha Jimson

Giant cell fibroma may mimic fibroma of the gingiva, but have distinctive histopathological difference. Immunohistochemical markers are required to diagnose GCF. It may occur at any age but most often in the third decade of life. It may be often asymptomatic but may not be esthetic if present in the anterior region of the jaw. Surgical excision should be performed, and the prognosis is good. However long term follow-up is required to check for any recurrence. The most common gingival enlargements like fibroma and granuloma may be mistaken for GCF. We present a case report with histopathological markers used to diagnose GCF.

Multidisciplinary Approach for Restoring Function and Esthetics in a Patient with Amelogenesis Imperfecta: A Clinical Report

Vaibhav D. Kamble, Rambhau D. Parkhedkar

Amelogenesis Imperfecta (AI) is a genetically determined and enamel mineralization defect reported, depicted as “Hereditary brown teeth.” AI is characterized as a clinical entity and its clinical manifestations, histological appearance, and genetic pattern are characterized by their heterogeneity. The need for prosthodontic management of this group of patients varies. Some patients need oral hygiene instructions only, whereas others need extensive dental treatment that includes composite restorations, metal ceramic crowns, all ceramic crowns, porcelain veneers. A 20-year-old male patient presented with sensitive, discoloured, and mutilated teeth, with a decreased vertical dimension of occlusion. The 4-year recall examination revealed no pathology associated with the full mouth rehabilitation, and the patient’s aesthetic and functional expectations were satisfied. The rehabilitation included all-ceramic crowns on anterior teeth and metal-ceramic crowns on posterior teeth following endodontic treatment and a crown-lengthening procedure for eliminating tooth sensitivity, improving the aesthetics and occlusion, and for restoring function.

Fixed Dentulous Appliance to Replace Primary Upper Anterior Edentulous Span

Paul Chalakkal, Ramisetty Sabitha Devi, G. Vijay Srinivas, Pammi Venkataramana

This article discusses about a fixed dentulous appliance that was constructed to replace the primary upper anterior edentulous span in a four year old girl. It constituted a design, whereby the maxillary primary second molars were used to support the appliance through bands and a wire that contained an acrylic flange bearing trimmed acrylic teeth, anteriorly. The appliance was functionally and aesthetically compliant.

HIV Associated Intra–oral Burkitt´s Lymphoma: A Case Report

Soujanya Pinisetti, Govind Raj Kumar Nalabolu, Chowdary UVR, Durg a Prasad Tadi

Immunodeficiency associated Burkitt’s lymphoma is the most common in patients with HIV/AIDS. It accounts for 30-40% of Non–Hodgkin’s lymphomas and may be the first sign of underlying immunosuppression. This report illustrates a case of Burkitt’s lymphoma of maxillary alveolar ridge, which was the first manifestation in an HIV positive patient, with a brief discussion on clinicopathologic features, aetiopathogenesis and treatment.

Intraoral Lipoma: A Rare Case Report and Review of Literature

Benign soft tissue neoplasms commonly occur in oral cavity. Lipoma is one such benign tumour which rarely occurs in the oral mucosa. About 20% of lipomas occur in the head and neck region among which oral lipomas comprise only 1-4% of all lipomas. They slowly enlarge and they are known to grow to large sizes, thus causing mastication and speech difficulties. Usually, the lesion consists of a well circumscribed, lobulated mass of mature fat cells. Oral lipomas are usually asymptomatic, but in some situations, the covering mucosa becomes ulcerated and it presents difficulties in diagnosis. Here with, the present paper reports a rare case of intaoral lipoma in a 53-year-old female patient.

Mandibular Aneurysmal Bone Cyst Associated with Cemento–Ossifying Fibroma – A Case Report

Bhavani S.N., A. Rajesh, Narendranatha Reddy.P., Firoz Kamal

Aneurysmal bone cyst is an uncommon bone lesion which rarely occurs in craniofacial region. Among all the cystic lesions occurring in the jaws, aneurysmal bone cyst is infrequent and it more commonly occurs in the mandible. Most of the cases occur in the first two decades of life, with no gender predilection. Here, we are presenting a case of an aneurysmal bone cyst which occurred in the mandible of a twelve year old female patient.

Amyloidosis of the Tongue-Report of A Rare Case

Suresh Babb uri, Ramya B, Subramanyam RV, Aparna V, Gautam Srivastava

Amyloid involvement of the tongue is almost always secondary to systemic amyloidosis. Isolated amyloidosis of the tongue is relatively rare and it accounts for less than 9% of all types of amyloidosis. We are presenting a case of a 54–year–old male patient who complained of an enlarged tongue and bilateral multiple swellings on the lateral borders of the tongue, which had been there since one year. Bilaterally symmetrical, violaceous, purpuric patches interspersed with nodules were seen surrounding the eyes. Histopathologically, the lesion exhibited homogenous eosinophilic amyloid-like material. Special staining with Congo red showed amyloid material as peach red colour under light microscopy and as apple green birefringence under polarized light. Based on these observations, a definitive diagnosis of amyloidosis of tongue was made. Amyloidosis of tongue is uncommon and its features resemble those of a benign tumour. A battery of tests is necessary to differentiate localized amyloidosis from its systemic forms.

A Case of Chronic Abdominal Pain

Kannan R, Senthil Kumar Aiyappan, Upasana Ranga, Rajendran K

Fine Needle Aspiration Cytology of Cysticercosis

Jitendra Singh Nigam, Ankit Sharma

Endodontic Treatment of a Maxillary Second Molar with Two Separate Palatal Roots: A Case Report

Bonny Paul, Kavita Dube

Awareness of Dental Treatment Protocol for Pregnant Women and Lactating Mother’s in General Dental Practitioners of Davangere District, Karnataka, India

Shruthi K. Patil, Mohankumar K.P.

Obesity and Overweight Management in Malaysia and Singapore: Progress on Right Track

Rohit Kumar Verma, Grace Chua, Sheba Rani David