Journal of clinical and diagnostic research

Primary Localised Amyloidosis of Urethra Presenting as a Penile Stricture

Padmapriya Jaiprakash, Archana Shivmurthy, Manna Valiathan, Arun Chawla

Amyloidosis is characterized by the deposition of fibrillar proteins by either plasma cells or derived from circulating proteins, the former especially involved in pathogenesis of localised amyloidosis. We describe a case of primary localised amyloidosis involving the urethra, in a 54-year-old diabetic patient, presenting with symptoms of stricture. Though a rare cause, in a patient with clinical diagnosis of urethral stricture, one of the differential diagnosis to be ruled out is primary urethral amyloidosis.

Interceptive Treatment of Impacted Maxillary Lateral Incisors- An Outcome of Two Cases

Ali Alqerban

This case report describes the successful interceptive treatment approach for two young patients with impacted permanent lateral incisors. The interceptive orthodontic treatment for impaction usually includes extraction of primary tooth, expansion and space opening with fixed appliance. If all kinds of interceptive treatments fail, the surgical intervention is an option by exposing the impacted tooth, then applying traction force to move the impacted tooth to the normal position. However, surgery is not the first option in growing patients since, there is still a chance for spontaneous eruption of the impacted tooth. In the present report, the patients presented to the orthodontic clinic with complaint of non-erupting front teeth after the loss of deciduous teeth, with the eruption of lateral incisors on the contralateral side. The treatment of both patients consisted of maxillary expansion to create space for permanent left lateral incisor. The teeth erupted spontaneously after the maxillary expansion.

Use of a Locking Compression Plate in the Management of Congenital Pseudarthrosis of the Tibia

Norliyana Mazli, Mohd Yazid Bajuri, Abdul Muhaimin Ali, Srijit Das

Congenital pseudarthrosis of tibia is a rare condition and it is highly associated with neurofibromatosis. The goals of surgery are to restore the tibial alignment, achieve bone union and re-establish the length of the tibia. The treatment includes resection of the pseudarthrosis followed by fixation with external fixation devices to perform callus distraction, intramedullary nail or open reduction and plate fixation in combination with bone graft. We present a case of a 16-year-old male with underlying neurofibromatosis and congenital pseudarthrosis of right distal third of tibia. Patient was treated with excision of the pseudarthrosis followed by reduction and fixation using locking compression plate and bone graft. Radiograph showed union of the tibia at eight months postoperation. Patient had limb length discrepancy of 10 cm and was ambulating with a shoe raised. At two years follow-up, there was no refracture of the tibia. The patient was satisfied with his current functional status and had adapted well. Due to his good functional outcome, he declined to undergo limb lengthening surgery. We thereby concluded that locking compression plate may be considered as a suitable option for the treatment of congenital pseudarthrosis of tibia.

Leiomyomatous Nodule and Ovarian Mucinous Borderline Tumour: A Rare Co-existence

Sadaf Khan, Swati Sharma, Jyothi Shetty

Occurrence of ovarian cystic neoplasms with mural nodules are rare entities, however well established. We report a case of a leiomyomatous mural nodule co-existing with an ovarian mucinous borderline tumour. To the best of our knowledge, this is the first case of a leiomyomatous nodule co-existing with an ovarian mucinous borderline tumour in the English literature and it becomes more interesting owing to the presence of ovarian mucinous neoplasms in both the ovaries which is also a rare phenomenon. Primary leiomyomas of ovary are rare ovarian tumours and must be considered as a possible differential whenever cystic ovarian neoplasms are detected with solid component radiologically, since they have a benign course and a good prognosis.

Primary Myelofibrosis with Mesenteric Extramedullary Haematopoiesis

Saurabh Kumar, Shaloo shaloo, Juhi Chawla, Subha ashok, Shalini Thapar Laroia

Primary myelofibrosis or chronic idiopathic myelofibrosis is a myeloproliferative neoplasm characterized by proliferation of abnormal haematopoietic stem cells in bone marrow resulting in replacement of marrow with fibrotic scar tissue. Extramedullary Haematopoiesis (EMH) as a compensatory phenomenon in myelofibrosis can lead to hepatosplenomegaly with diffuse organ infiltration or focal deposits. Peritoneal involvement of EMH is rare and can present with peritoneal or serosal implants which can mimic malignancy. We present a case of diffuse peritoneal /mesenteric extramedullary haematopoiesis with hepatosplenomegaly as an initial presentation in patient of idiopathic myelofibrosis.

A Rare Translocation in a Paediatric Myelodysplastic Syndrome

Rachana Kiran Koppalkar, Purnima S Rao, I Sandhya, Muktha R Pai

Myelodysplastic Syndromes (MDS) belong to acquired clonal haematologic disorders associated with defective maturation in erythroid, myeloid and megakaryocytic lineages. It rarely affects children and young adults. The common cytogenetic abnormalities in children are monosomy 7, trisomies 8 and 21. Here, authors report a case of MDS in a 15-year-old patient with a rare finding of chromosomal translocation t (6;9) (p23;q34).

Maintaining ‘V-Contour’ of the Neck after Surgery for Neglected Congenital Muscular Torticollis in an Adult (A New Technique)

Osama Neyaz, Abhimanyu Vasudeva, S L Yadav

In Congenital Muscular Torticollis (CMT), also called twisted neck or wryneck, an individual holds his or her head tilted to one side. There is a little consensus on the treatment approach of neglected CMT after skeletal maturity in adults. This case report describes a case of an 18-year-old male who presented with neglected CMT and was successfully managed using a novel surgical technique wherein after releasing the clavicular head of Sternocleidomastoid (SCM), proximal attachment was released while keeping the sternal head intact.

Twain Impaction-A Novel Orthodontic Approach

Primary failure of eruption (PFE) contend one of the varied rationale for etiology of malocclusions with eruption sequence disturbances. In a contemporary world of modernisation and advanced technological innovations. Orthodontics is being revising its literature with new dimensions fortifying the biomechanics with biological considerations. The Poul Gjessing universal spring which is a distinguished and highly efficient spring assured simultaneous three dimensional control of teeth, which being a sculler achievement of many specialists. This seldom case report details a unique in its incidence with ectopically erupted and impacted first premolar interfering the late eruption pathway of canine, leading to twain impaction.

Overjet Reduction with the Use of ELIBA Device: A Case Report

The dental overjet, in subjects with skeletal class II, division I, malocclusion represents one of the difficult problems to resolve for the orthodontist. We describe a case of dental overjet reduction, treated with the Lingual Elevator by Balercia (ELIBA). This orthodontic approach, convenient for patients, can help the orthodontist to solve complex cases of dental overjet.

Takayasu’s Arteritis and Systemic Lupus Erythematosus-A Rare Coexistence

Takayasu arteritis, also known as “pulseless disease” is an inflammatory disease characterized by large caliber artery inflammation. Although tuberculosis and syphilis are known to be associated with Takayasu arteritis, it is rarely found in association with Systemic Lupus Erythematosus (SLE). We report a case of 28-year-old Indian female with SLE, on low dose corticosteroids, she presented with hypertension and developed sudden onset of abdominal pain. She was found to have features suggestive of large vessel vasculitis. The patient was treated with one month of high dose corticosteroids and discharged. She was reviewed, once inflammation subsided and underwent procedure of placement of a self-expandable stent. She had improvement of blood pressure immediate post procedure and reduction of abdominal pain and claudication pain after two weeks of follow up to hospital. Although, SLE is known to involve small and medium-sized arteries, large vessel involvement and features of Takayasu arteritis are extremely rare, clinically.

Role of Cone Beam Computed Tomography in Evaluation of a Large Cystic Lesion

In the management of large radicular cysts, especially on an aesthetic region, it is essential to obtain information by means of three-dimensional images. They provide proper definition of the extension and of the relationship with important anatomical structures. This case report aims to describe the role of the Cone Beam Computed Tomography (CBCT) on diagnosis, endodontic approach, surgical treatment, as well as follow-up of a large radicular cyst. The patient came to the Dental Clinic of the State University of Maringá, showing asymptomatic enlargement in the anterior maxilla. Tooth 11 was non-vital. CBCT presented a cystic lesion, measuring about 20.69×17.18×16.75 mm, in the periapical region of 11, with involvement of the left nasal fossa floor and incisive canal. Based on clinic and tomographic examinations, the provisional diagnosis was radicular cyst. The treatment plan consisted of endodontic treatment of 11 and enucleation of the lesion, under local anaesthesia. Histopathological examination confirmed the diagnosis. The patient was followed-up clinically and radiographically for two years. We concluded that CBCT contributed a lot to the success of this case, as an important tool for proper diagnosis, surgery, endodontic treatment, as well as follow-up.

Hypocellular Acute Myeloid Leukaemia- A Diagnostic Conundrum

Sindhura Lakshmi Koulmane Laxminarayana, Chethan Manohar

Hypocellular acute leukaemia is a rare entity with an incidence of 5-12% of all acute leukaemias. Almost all reported cases are of myeloid lineage. It is defined by bone marrow hypocellularity (less than 20% of cellularity in trephine biopsy) with increase of bone marrow blasts (20% or more) and peripheral blood blastopenia. It is termed as a secondary disease in a pre-existing haematologic disorder or prior cytotoxic or radiation therapy and is often misdiagnosed as Myelodysplastic Syndrome (MDS). In this report, we describe an unusual case of Hypocellular Acute Myeloid Leukaemia (H-AML) without any past haematologic disease or radio/chemotherapy in an elderly male. The diagnosis of H-AML can be difficult and may be confused with Hypocellular MDS (H-MDS) and Aplastic Anaemia (AA). Presence of dysplasia and abnormal localization of immature precursors may not be able to differentiate between H-AML from H-MDS. Strict diagnostic criteria must be followed to arrive at correct diagnosis which includes counting atleast 100 leukocytes on peripheral smear and 500 leukocytes in Bone Marrow Aspirate (BMA).

Radiographically Detectable Dystrophic Calcinosis of the Cheek: A Case Report and Literature Review

Candice Jacinta Antao, Ajit D Dinkar, Manisha Khorate, Nigel R Figueiredo

Dystrophic calcinosis is a condition wherein calcium is deposited in degenerated tissues, often associated with trauma, infection, or inflammation, in the absence of a systemic mineral imbalance. It commonly occurs in cardiac and skeletal muscles; rarely in oral and perioral region. We report a unique case of a 25-year-old healthy male, with dystrophic calcinosis in the subcutaneous tissues of the cheek overlying the right body of the mandible, with history of infection in that region. CT and CBCT examination revealed multiple irregular to curvi-linear shaped radiodense calcified structures, discrete from the mandibular buccal cortex. The calcified structures were surgically removed via extra oral approach without complications. Although soft tissues of the cheek do not frequently contain lesions that include calcifications, dystrophic calcinosis must be considered among the differentials for calcified masses in the oral region, particularly when infection is present. Its preoperative diagnosis poses a challenge in view of differential diagnosis.

Prenatal Diagnosis of Isolated Type 2 Diastematomyelia at 12 Weeks Using 2D Ultrasound with a Normal Intracranial Translucency

Megha Pandove, Akhila Vasudeva, Anjali Mundkur, Pratap Kumar

First-trimester ultrasound provides an opportunity to screen for various foetal abnormalities. Isolated Diastematomyelia is a rare spinal deformity which is infrequently diagnosed during the first-trimester ultrasound. Here, authors report a case of isolated Type 2 Diastematomyelia which was diagnosed in the 12-week ultrasound during a detailed survey of the foetal spine in view of previous neural tube defects.

Fabrication of Silicone Prosthesis for an Amputated Pollex with Kapandji Score 8: A Case Report

Anshulika Singh, Mayank Singh, Saumyendra V Singh, Pooran Chand, Deeksha Arya

Amputations are most commonly seen due to the accidents, congenital malformations and diseases. Regardless of the cause of the loss of the part of the body, an amputation results in aesthetic, physical and psychosocial damage to an individual. An amputation can be surgically treated but in some cases where patient reports to the prosthetist, when the damage is irreversible, it can be treated with prosthetic replacements of the lost part. A prosthetist acts as an important link in helping such patients in regaining the lost confidence by rehabilitation. Prosthetic management of an amputated thumb aims to deliver a well-fitting silicone prosthesis that can mimic the opposite thumb as closely as possible, with good range of movement without dislodgement. This case report presents rehabilitation of the amputated thumb with minimal residual thumb in a conventional way along with restoring the range of movements with evaluation of the range of movement without the use of an extra retentive aid.

Ayurvedic Treatment Protocol for Chronic Pelvic Pain in Endometriosis

Chronic pelvic pain presents as a main symptom in 71%-87% cases with endometriosis, a disease in which the endometrial glands and stroma grow outside the uterine cavity. The management modalities to cope with the long-standing, frustrating pelvic pain are still not reassuring. Ayurveda can provide an effective pain management protocol, though a single correlation of endometriosis cannot be made from the classical background. In the present case, a 44-year-old woman who was suffering from severe chronic pelvic pain since 20 years was managed using a definite Ayurvedic treatment protocol including shodhana (cleansing) procedure for 21 days and shamana (internal medications) for two months. The whole treatment period spanned for a total of nine months including a follow-up of six months. The patient reported a considerable improvement in her condition after the treatment.

Bardet-Biedl Syndrome Late Diagnosis with a Great Disability: A Case Report

Oriana Amata, Enrica Scalisi, Alessandro Conti, Giuseppe Umana, Matteo Cioni

The Bardet-Biedl Syndrome (BSS) is a genetic disease based on autosomal recessive disorder characterised by non-allelic heterogeneity. The prevalence in the European population is only 1 in 160,000 live births. We observed a case of late diagnosis in a patient of 59 years. Different medical specialists, who had seen him before his admission to the hospital, separately treated his different signs and symptoms. The patient was genetically investigated with successfully confirmation of the clinical diagnosis of Bardet-Biedl syndrome was done. This case report underlines the importance of an overview of different clinical signs and symptoms and how different specialties need to collaborate to allow early diagnosis of the diseases.

Osseous Metaplasia in Adenocarcinoma

Phiza Aggarwal, RPS Punia, Robin Kaushik, Manveen Kaur, Deepak Aggarwal

Osseous Metaplasia (OM) or heterotopic ossification is a rare phenomenon with unknown aetiology that is characterised by the formation of mature bone elements in the stroma of different tumours. Awareness of this condition is important to avoid diagnostic confusion with carcinosarcoma and local bone invasions that have different lines of treatment and prognosis. Here, authors report two cases of heterotopic ossification in adenocarcinoma of sigmoid colon and lung and provide salient features that could help to detect the condition.

Sclerosing Extramedullary Haematopoietic Tumour Presenting as Bilateral Gluteal Abscess in a Patient with Chronic Myelogenous Leukaemia

KS Sunil Kumar, N Geetha, L Swetha, Prabu

Sclerosing Extramedullary Haematopoietic Tumours (SEMHT) are found to be associated with Chronic Myeloproliferative Neoplasms most commonly reported in the skin, lacrimal system, orbit, omentum and liver. A 26-year-old male with a known history of Chronic Myelogenous Leukaemia (CML) sought medical attention for non-healing ulcerated lesions on both gluteal regions. Histopathological examination revealed patchy skin ulceration with dermal abscess formation, dense-periadnexal and perivascular extramedullary haematopoietic elements comprising of erythroid progenitors, granulocytes with all stages of maturation and atypical megakaryocytes extending into subcutaneous fat. Immunohistochemistry confirmed the lineage of erythroid progenitors by Glycophorin, granulocyte lineage by Myeloperoxidase and megakaryocytes by CD61 staining. CD34, CD30 and CD15 immunoreactivity were negative. Keeping this differential diagnosis in mind is essential while reporting a sclerotic lesion with extramedullary haematopoietic elements in a clinical setting of Chronic Myeloproliferative Neoplasms to prevent inaccurate diagnosis and unnecessary surgeries.

Foreign Body in Rectum: Case Management and Review of Literature

Mahim Koshariya, Abhishek Shitole, Anshul Siroliya, Mayank Soni, Sheikh Behram

General surgeons not so often encounter rectal foreign body; but its incidence is now increasing. Males are the common victim in both child and adult age group. Management can be challenging for the treating surgeon. Diagnosis can be made on clinical grounds and confirmed by radiological investigations. Various approaches have been described in literature but owing its wide spectrum of presentation and heterogeneity of foreign bodies, no single procedure can be considered as the gold standard. We hereby present a case of rectal foreign body in a young male with a history of assault.

Phantom Pain after Robotic Cystoprostatectomy for Bladder Pain Syndrome

Venkatesh Kumar, Malik Abdul Rouf, Rajesh Taneja

Phantom pain is a syndrome in which a person experiences pain when that part of the body, external or internal, is no more physically present following an accident or operation. There are very few reports of phantom bladder pain. Here, we present a case of a 29-year-old male with phantom pain following three months of robotic cystoprostatectomy for bladder pain syndrome.

Conservative Management of Intraperitoneal Urinary Bladder Perforation with Enterovesical Fistula

Debansu Sarkar, Akash Agrawal, Dilip Kumar Pal

Surgical repair is usually done in intraperitoneal bladder perforation, whereas in genitourinary trauma reports of conservative management exist. We hereby, present a case of an old man with carcinoma prostate having intraperitoneal urinary bladder perforation with enterovesical fistula that was successfully managed non-operatively and conservatively.

Primary Lymphoma of the Soft Tissue: A Pathologist’s Perspective

Madhusmita Jena

Primary lymphoma of the soft tissue is rare accounting for 0.1% of the cases. A case of Non Hodgkin lymphoma of the soft tissue presented as multiple swellings in the upper extremity diagnosed clinically & radiologically as neurofibroma. A Fine Needle Aspiration Cytology (FNAC) performed on the swellings showed cytologic features of a lymphoproliferative lesion which was confirmed subsequently on histopathology and immuno-histochemistry. This case is reported to highlight and recognize this entity at a rare anatomic site and to bring out an awareness among cytopathologists and radiologists of this rare lesion which may avoid errors in diagnosis.

Haemangioma with Multiple Phleboliths-A Rare Case

Haemangiomas and venous malformations are formed due to disturbances during the developmental period of an embryo. Changes in blood flow dynamics within a haemangioma may induce thrombus formation and phleboliths. Inflammation, trauma, debris acting as nidus and vascular lesions have been attributed as principal causes for occurrence of calcifications within the oral mucosa. Occurrence of multiple calcified thrombi (phleboliths) is considered pathognomonic for haemangioma and vascular malformations in the oral and maxillofacial region. We hereby report a rare case of haemangioma associated with multiple phleboliths of the lower lip for seven years. Clinically, it appeared as a smooth circumscribed swelling with mild pain. Excision of lesion was done. Histopathological report showed thin-walled, dilated and congested blood vessels, containing fibrin thrombi in the lumen. Foci of organisation and calcification were seen.

Lingual Schwannoma-A Common Tumour at Uncommon Site in a Paediatric Patient: A Case Report and Review of the Literature

Alka Mary Mathai, K Preetha, S Valsaladevi, C Karthikeyan

Schwannomas are infrequent tumours of oral cavity that are not routinely included in the differential diagnosis of oropharyngeal masses. The tumour presents with non-specific clinical symptoms and is clinically indistinguishable from varied soft tissue neoplasms of the oral cavity. Of the 84 cases of lingual schwannoma reported in English literature in the past 61 years, only 18 cases have been reported in paediatric age group ranging from 1 to 15 years. We, herein, report a rare case of schwannoma of the tongue in a 14-year-old boy, presented as a painless swelling with characteristic Antoni A and Antoni B pattern with Verocay bodies on histopathology. Strongly positive immunohistochemical staining with S 100 protein confirmed the Schwann cell origin.

Biloma Presentation after Six Months of Thoracoabdominal Trauma: A Case Report

Mojtaba Ahmadinejad, Saman Afrasiabi, Izadmehr Ahmadinejad

Perforation of biliary tree will result in accumulation of bile as a collection called biloma. Post-traumatic biloma is diagnosed mostly soon after the trauma happened. We are reporting about a patient with traumatic biloma whose manifestation of symptoms appeared six months after an abdominal blunt trauma. A 65-year-old male reported with the complaint of nausea and abdominal pain since three days. On examination, a rigid abdominal mass was detected in the right upper quadrant, which was increasing in size. The patient had a record of admission in his medical history due to blunt thoracoabdominal trauma, six months ago. On laboratory investigations, there was a rise in the level of alkaline phosphatase. Computed Tomography scanning showed a fluid collection with pressure effect on liver. Emergency operation was performed for drainage and about 2 L of bile was discharged via percutaneous drainage. CT scan performed immediately after operation showed liver in the normal site and decompressed. Following-up, the patient was asymptomatic for one year. Traumatic biloma is a probable diagnosis in patients with abdominal trauma even if there is a long period of time between the incidence of trauma and the appearance of symptoms. Biloma is managed mostly by surgical methods in order to drain and find the leakage but in some cases even a percutaneous drainage can be effective.

Surgical Management of Root Canal Perforation Aided by CBCT Scan

This study describes the surgical management of two Root Canal Perforations (RCP) in maxillary incisors aided by CBCT scans. In the first case, a patient was referred for retreatment due to a history of overfilling. The chief complaint was frequent discomfort and slight oedema in upper front tooth (#9). Periapical radiography showed gutta-percha extruded out of the root canal. CBCT revealed a RCP and more than 1 cm of a gutta-percha cone extruded out of the apex. At follow-up one year after surgical procedure for the removal of the extruded filling material and apicoectomy, bone tissue formation was observed, without clinical symptoms. In the second case, a series of RCP was verified in multiple maxillary incisors of the same patient, who was referred due to a history of unresolved pain. On clinical examination, no abnormalities of the soft tissue were observed. Imaging exams revealed RCP in all maxillary incisors. The patient underwent conventional treatment and follow-up surgical procedures to seal the RCP. One year after surgery, imaging exams demonstrated tissue formation without clinical symptoms. RCP is considered a serious error in operative procedure. Once properly diagnosed, localised and sealed with biomaterial, a favourable prognosis is often achieved. MTA offered a good seal of perforations, with promising results. The use of CBCT in diagnosis allowed better security, correct positioning and improved surgical planning of RCP.

Multiple Osteoma Cutis of the Wrist and Hand

Osteoma cutis is a rare, benign condition characterised by dermal or subcutaneous bone formation that presents as stony hard nodules. The disease is classified into primary and secondary forms. Primary Osteoma Cutis (POC) is not associated with any predisposing conditions, whereas Secondary Osteoma Cutis (SOC) occurs as a result of metabolic conditions that lead to an increase in blood calcium levels. Here, author present a case of a 21-year-old girl having multiple tiny stony hard nodules on the right wrist and hand. Syndromic association was ruled out by obtaining a thorough clinical history, accompanied by physical examination and search for laboratory signs of pseudohypoparathyroidism. This ultimately led to a more accurate diagnosis of isolated primary osteoma cutis, a very rare condition reported in the literature.

Correspondence: Are Automated Blood Pressure Apparatus Reliable? Automated Versus Manual Measurement of Blood Pressure

Himel Mondal, Shaikat Mondal

Role of Magnesium as Analgesic Sparing Adjuvant to Ropivacaine in Thoracic Paravertebral Block for Breast Cancer Surgery: A Prospective, Double-Blinded Randomised Controlled Study

Introduction: Thoracic surgeries are often associated with intractable pain leading to postoperative pulmonary complications. To alleviate this pain in intraoperative and postoperative period, Thoracic Paravertebral Block (TPVB) has been proven as an effective mean. Various adjuvants and their mixtures have been tried to prolong the duration of TPVB. Aim: In this randomised controlled study, we have evaluated the analgesic sparing efficacy of magnesium sulfate; a NMDA receptor antagonist, administered along with ropivacaine for TPVB for breast cancer surgery patients. Materials and Methods: Eighty breast cancer surgery patients, undergoing General Anaesthesia (GA), were randomly divided into group RP and group RM (n=40 each) receiving preoperative TPVB at T3-5 level with 0.5% ropivacaine solution admixture with normal saline and magnesium sulphate, respectively. Intraoperative fentanyl and propofol requirement was compared. Visual Analogue Scale (VAS) was used for postoperative pain assessment. Total dose and mean time to administration of first rescue analgesic paracetamol was noted. Side effects and haemodynamic parameters were also noted. Results: Intraoperative fentanyl (153.86 vs. 138.49 µg), propofol requirement (150.34 vs. 134.23 mg) was significantly less in test (magnesium) group. The requirement of paracetamol was also significantly less (1592.09 vs. 1149.23 mg) and later (8.44 vs. 13.34 hour) in group RM than group RP. Haemodynamics and side effects were comparable among two groups. Conclusion:Magnesium provided better intraoperative as well as postoperative analgesia than placebo when administered with ropivacaine in TPVB prior to breast cancer surgery patients. It also renders a lesser analgesic requirement without major haemodynamic alteration and side effects.

Role of Ultrasonography and Ultrasound Elastography in the Evaluation of Thyroid Nodules

Introduction: Thyroid nodules are frequently encountered with its Incidence is increasing steadily. Most nodules are benign and <5% of nodules are malignant. High-Resolution Ultrasonography (HRUS) is the most sensitive imaging test available for the examination of the thyroid gland to detect thyroid lesions accurately. Ultrasonography (US) is relatively cheap, easily accessible, rapidly performed and has an advantage of no exposure to ionising radiation. Sonoelastography (SE) is a relatively new non-invasive technique for imaging stiffness or elasticity of the tissue by measuring movement or deformation of tissue in response to a small applied pressure. Aim: To assess the diagnostic performance of conventional ultrasonography, colour mapping and strain ratio using SE for characterising thyroid nodules. Materials and Methods: A prospective study was conducted from October 2015 to August 2017 in which 65 patients were examined. All age group patients who were referred for thyroid ultrasonography and detected to have a thyroid nodule which was subsequently confirmed by FNA/histopathology were included in the study. Test of significance was assessed using the chi-square test, p<0.05 was considered significant. Results: FNA/HPE revealed 14 (21.5%) malignant (six papillary carcinomas, three poorly differentiated carcinoma, two anaplastic carcinomas and three follicular carcinomas) and 51 (78.5%) benign nodules. Out of these 14, 13 (92.9%) cases were found in patients above 50 years and only 1 (7.1%) case was found below 50 years. Calculation of strain ratio was done between the thyroid nodule and the surrounding thyroid tissue at the same depth. Significant differences were seen between the strain ratios for the benign and malignant lesions (p<.001). By using ultrasound elastography score malignancy was seen in 81.3% of malignant nodules. Conclusion: Ultrasonography is a cost-effective modality of imaging and also the investigation of choice in thyroid nodules. Elastography has proven to be a good adjunct tool in assisting USG in the diagnosis and differentiation of benign versus malignant nodules.

Trends in Permanent Pacemaker Implantation in Indian Population: A Single Centre Experience

Basant Kumar, Jaya Prakash, Savita Kumari, CN Manjunath

Introduction: More than 20,000 pacemakers are implanted each year in India and the numbers are growing annually. Despite this growing numbers, there is no national registry in India who collects or tracks data of implanted devices. Aim: The present study aimed to provide a small fraction of demographic profile of patients who underwent Permanent Pacemaker (PPM) implantation at our premises, one of the largest tertiary care centres in South-east Asia. Materials and Methods: This was a single centre, retrospective study. Patients who underwent pacemaker implantation between December 1999 and February 2014 were included in this study. The data were extracted from a prospectively maintained database, 1551 patients were included in this study. The data analysis was based on patient’s age, gender, indication of PPM implantation, surgical parameters and modes of pacing and pacing parameters. Data were analysed with SPSS. Results: Of the PPM implantation procedures, 56.8% were performed on males and the mean age of population was 60.1 years. The prime indication for pacemaker implantation was degenerative complete heart block (68.3%) followed by sick sinus syndrome (9.0%). Of the total population, 68.3% patients acquired single chamber PPM and 55.9% patients received VVI pacemakers followed by DDDR pacemakers (20.8%). Conclusion: More number of pacemakers was implanted to male patients than female and there was no major age difference between genders. Degenerative complete heart block was the prime indication for PPM implantation. Single chamber devices were used significantly more than the dual chamber devices.

Comparison of Posterior Short-segment Pedicle Screw Fixation with or without Fusion in Thoracolumbar Burst Fractures

Arvind Bharadwaj, Akshay Rakeshmohan Bhardwaj, Gaurav Mahesh Sharma

Introduction: Treatment of unstable Thoracolumbar vertebra burst fractures has seen a paradigm shift from conservative to surgical modalities with either a short or long-segment posterior fixation with or without fusion. Aim: To assess the functional and radiological outcome in burst fractures of thoracolumbar vertebrae treated with short-segment posterior instrumentation with and without fusion. Materials and Methods: The study was conducted on 31 patients, divided into two groups, with thoracolumbar burst fractures. Patients above18 years of age, with or without neurological deficit, Kyphosis>300, anterior vertebral height loss >50%, spinal canal narrowing >40% were included in the study. Group A (n=15) had patients in which posterior short-segment pedicle screw fixation was done while patients with pedicle screw fixation combined with posterolateral fusion were in Group B (n=16). The final outcome was measured using the Modified Mcnab’s questionnaire, low back outcome scale of Greenough and Fraser and Frankel scoring system at an interval of 3,6 and 12 months were calculated using the Mann-Whitney’s U-test which was not statistically significant (p=0.770). Results: The most common mode of injury was road traffic accident affecting 23 (74.2%) cases. L1, L2 and T12 were the most commonly involved vertebrae. The time duration between the injury and surgery was 12.44±9.6 days in Group A and 8.6±2.7 days in Group B (p=0.1273). Intraoperative blood loss was 468±94.6 mL in Group A and 693±88.3 mL in Group B (p<0.001). The mean surgical time in Group B cases (149.33±4.72 minutes) was more than those in Group A (110.8±4.65 minutes) (p<0.001). The average duration of hospital stay was 27.8±7.33 days in Group A and 24.3±8 days in Group B (p=0.3056). There was a gradual improvement in Frankel scoring, anterior vertebral height and kyphotic angle at last follow-up. The Greenough low back outcome score was 45.25 in Group A and 46.10 in Group B cases which were not significant. As per the modified Mcnab’s questionnaire, 17 (54.83%) had excellent, 10 (32.2%) had good and 4 (12.9%) had the poor functional outcome. Superficial infection and screw loosening were apparent in 3 (9.6%) cases. Conclusion: Posterolateral fusion combined with fixation is not superior to fixation alone in burst thoracolumbar fractures.

Knowledge, Attitude and Practice of Smoking among Pharmacy Students: Findings from a Public University

Introduction: Smoking causes substantial preventable morbidity, mortality and financial burdens. It is the main risk factor for many diseases and a significant cause of death. Smoking prevalence is high internationally and in Malaysia, especially among males. Smoking cessation is essential to reduce tobacco-related morbidity and mortality. Aim: To evaluate knowledge, attitude towards and practice of smoking among pharmacy students in the International Islamic University Malaysia (IIUM). Materials and Methods: A cross-sectional study was conducted using a validated structured self-administered questionnaire among a sample of IIUM pharmacy students (n=251) from November 2012 to December 2012. Descriptive and inferential statistics were used to summarise data and to examine the relationship between variables. Results: A total of 251 IIUM pharmacy students have participated in the survey. The median age of the participants was 21-23 years; 23.9% of them were males and 76.1% were females. The percentage of current smokers and ex-smokers was 0.4%, 0.8%, respectively. About 43% of the respondents had a good knowledge (score >16), more than half of them had a positive attitude (score >17), and about 38.4% had a good practice (score >11). Conclusion: Smoking prevalence among pharmacy students in IIUM is very low. However, conducting training and educational programs to improve knowledge, attitudes and practice of pharmacy students is highly recommended to assist their contribution to smoking cessation interventions in the future.

Role of EEG in Diagnosing Abdominal Epilepsy Patients

Introduction: Abdominal Epilepsy (AE) is an uncommon cause of paroxysmal abdominal pain. It is very challenging to diagnose a case of AE. This entity is less recognised as there is paucity in report and its literature. Aim: To find out AE amongst individual suffering from chronic recurrent abdominal pain with the help of clinical manifestations and Electroencephalography (EEG) changes. Materials and Methods: This was an observational, analytic study done for a period of three years at tertiary care hospital. The cases having recurrent abdominal pain were studied for EEG abnormalities showing sharp wave and spike wave pattern. All the data were analysed and studied by using software SPSS version 2.0. Results: Total of 30 cases of AE was studied for EEG abnormalities. The age range was from 5 to 35 years. The mean age group affected was from 8 to 10 years. The male to female ratio was 1:1.7. The main clinical presentation was pain in abdomen which was observed in all the cases. Other symptoms were nausea, vomiting, diarrhoea, bloating, blurring of vision, confusion, etc. The EEG changes were noted in temporal region in 18(60%) cases, fronto-temporal in three (10.01%) cases, generalised in eight (26.66%) cases. The focal sharp wave and spike wave pattern was recorded in 20 (66.66%) cases, generalised sharp wave and spike wave pattern in 10 (33.33%) cases. Conclusion: The common epileptiform EEG abnormality pattern noted was focal sharp wave and spike wave pattern. Recurrent abdominal pain is usually overlooked and remains undiagnosed. If it is properly investigated with EEG it will be helpful for better management of patients.

Can p63 Alone Resolve the Mystery of Suspicious Lesions in Prostate Biopsies?-A Study of Interobserver Agreement

Hema Kini, Beshwanth V Chowdary, Radha R Pai, Jyoti R Kini

Introduction: Prostatic biopsies more often, present diagnostic dilemma raising the suspicion of malignancy. Small acinar pattern, limited atypical glands and benign mimickers are few pitfalls. Markers like p63, High Molecular Weight Cytokeratin (HMWCK) detect presence/absence of basal cells and p504s, malignant epithelial cells. This study highlights the usefulness of p63 alone in the resolution of suspicious foci. Aim: To ascertain the effectiveness of p63 in resolving doubtful prostatic biopsies. Materials and Methods: Cross-sectional study on 30 prostatic biopsies with suspicious foci from January 2014 to July 2016. Immunohistochemistry with p63, HMWCK and p504s was performed on all the biopsies and final diagnosis was arrived at. The routine paraffin sections and p63 slides were reviewed by two independent pathologists who were blinded to the above diagnosis. Their opinion was analysed against the final diagnosis with SPSS v.23 to calculate sensitivity, specificity and interobserver agreement. Results: The diagnosis achieved by performing three markers were benign in 24 and adenocarcinoma in six cases. Pathologist 1 concurred in 30 (100%) cases and pathologist 2 in 29 (97%). A p63 had (6/6) 100% sensitivity and specificity in diagnosing adenocarcinoma with pathologist 1. With pathologist 2, it had sensitivity of (6/6) 100% and specificity of (23/24) 95.83%. Cohen’s kappa was 0.902 which showed significant agreement. Conclusion: A p63 alone can help the pathologist to arrive at a diagnosis and is highly sensitive and specific. Interobserver agreement is also significant indicating high reproducibility.

Rotational Malalignment after Intramedullary Fixation of Trochanteric Fractures

Introduction: Rotational malalignment after intramedullary fixation of fractures of the shaft of femur and tibia has been assessed by many studies but less frequently after intramedullary fixation of intertrochanteric fractures. Intertrochanteric fractures are managed by closed reduction in a traction table and fixation either by dynamic hip screw or proximal femoral nail under image intensifier. Reduction is checked intraoperatively by antero-posterior and lateral views with image intensifier in which rotational alignment cannot be assessed. Aim: To study the rotational malalignment in the operated limb compared to normal limb by computed tomography (CT). Materials and Methods: A prospective study was conducted on 70 patients at Kasturba Medical College and allied hospitals with intertrochanteric fractures with intramedullary fixation and with normal anatomy on opposite side. Postoperative CT with pelvis and knee was done and compared for rotational alignment. Results: The mean anteversion on the normal side was 13.20. The mean anteversion on the operated side was 15.70. The mean rotational malalignment was 9.70; there was internal rotational deformity in 41 cases (58.6%) and external rotational deformity in 29 cases (41.4%) with Grade III malrotation in 17 (24.3%) cases. Conclusion: Rotational malalignment postoperatively is frequently present and needs to be corrected intraoperatively by improving assessment methods.

Dupuytren’s Contracture: Epidemiological Patterns and Results Following Radical Fasciectomy

Introduction: Dupuytren’s disease is a debilitating condition, affecting the palmar fascia of the hand. Patients develop a flexion contracture and have difficulties in activities of daily living. Treatment is usually surgical, and a wide range of options are available. Aim: To study the epidemiological parameters associated with Dupuytren’s contracture and to study the results following Radical Fasciectomy. Materials and Methods: This was a prospective, interventional, institutional based study conducted at Dr RML Institute of Medical Sciences. A total of 26 patients with Dupuytren’s disease, fulfilling the inclusion criteria, were treated with radical fasciectomy. Epidemiological parameters and postoperative improvement in form of Digitopalmer Distance (DPD), extension lag and Quick DASH scores were recorded. Data was analysed using SPSS version 21 software. Continuous data was analysed by students t-test and categorical data was analysed by chi-square test and p-value less than 0.05 was considered as significant. Results: Mean age of involvement in the present study was 54.82±7.34 years. An 84% (22 patients) of patients were male and 16% (4 patients) female. Bilateral hand involvement was seen in 84.61% and single hand involvement was seen in 15.38%. Dominant hand involvement was seen in 69.23% cases, nondominant hand in 15.38% cases and bilateral hands equally in 15.38% cases. Thenar Band and Commissural Band was noticed in 19% of cases. A total of 27% of all cases were diabetics, and 15% were known smokers. One patient in the entire series was a known epileptic on medications. DPD following surgery at two weeks and three months postoperatively was satisfactory as more than 60% of patients had full closure and more than 90% had a DPD of less than two centimeters. Extension Lag at MCP and PIP joints was found to be satisfactory as full opening at both MCP and PIP joints was found in more than 80% patients postoperatively at two weeks and three months. Conclusion: Outcomes following radical fasciectomy are very encouraging in terms of functional results as well as patient satisfaction. Intensive hand therapy during the first two weeks in the postoperative period gives best functional results.

Surveillance of Swine Flu Influenza H1N1 by Chip Based Real Time PCR Technology from the Clinical Specimens in a Tertiary Care Hospital

J Vijayalakshmi, B Sreekanth Reddy, A Surekha, A Renuka Devi

Introduction: Influenza viruses are one of the most important viruses which have the ability to cause epidemics and pandemics. Swine flu influenza H1N1 pandemic in 2009 has seen an alarming response from all over the world. Since then continuous surveillance is ongoing to find any new swine flu case. Molecular techniques using real time Polymerase Chain Reaction (PCR) technology gained momentum for the identification of these infections. Aim: The study aims to identify the prevalence of swine flu influenza H1N1 cases by using Truenat H1N1 micro PCR system and to understand the clinical and demographical distribution of cases attending the tertiary care hospital. Materials and Methods: This was a prospective study done during the period of Jan 2017 to Dec 2017. All the suspected cases for influenza like illness attending our hospital were included in the study. Only samples from category C patients were subjected to laboratory testing for H1N1. Clinical specimens like nasal or throat or nasopharyngeal swabs were collected by nylon swab and transported in the viral lysis medium. Viral nucleic acid detection was done by Truenat H1N1 micro PCR system (Molbio diagnostics, Bangalore). Results: A total of 205 samples were obtained during the study period. Out of which 15 samples (7.3%) were tested positive for swine flu influenza H1N1 by Truenat H1N1 micro PCR system. Out of these 15 cases five cases died with the case fatality rate of 33.3%. Majority of the samples were from males accounting for 65.3% followed by females 34.7%. Majority of the cases were in the age group of 30-39 year (24.8%) followed by 40-49 year age group (22.9%). Majority of the patients presented with fever (96.5%) followed by cough (75%) and cold (63.9%). Associated comorbid conditions identified were diabetes (18%), chronic kidney disease (5.3%), pre existing lung diseases (6.8%) and pregnancy (2.4%). Conclusion: Early and accurate detection of swine flu cases is the best way to undertake any interventions in the management of any epidemic or pandemic. In order to do so, molecular techniques like Truenat H1N1 chip based real time PCR technology systems will be extremely helpful in countries like India where testing is necessary especially in the peripheral settings.

Genotype Distribution of Human Papillomavirus in Women with Cervical Cancer and Normal Cytology in Malwa Region of Punjab- A Pilot Study

Shilpa Arora, Avnisha, Pragati Grover, Navneet Kaur, Neerja Jindal, Ratika Gupta

Introduction: Human Papillomavirus (HPV), a small circular double stranded DNA virus is the major aetiological agent of cervical precancerous and cancerous lesions. Genital HPV types are divided into high and low risk types, according to their oncogenic potential. The proportion of women infected with HPV varies greatly across populations as is the distribution of HPV genotypes. Aim: The present pilot study was conducted to determine the most frequent genotypes of HPV associated with: a) Histologically proven cases of cervical carcinoma; b) Women with normal cervical cytology. Materials and Methods: The present hospital based cross-sectional study was conducted on 132 women attending Obstetrics and Gynaecology department of a tertiary care hospital. Consecutive cervical brushings were collected from women presenting with any type of cervical lesion and were subjected to cytology, histopathological examination, HPV DNA testing and genotyping by using Sacace real time PCR. Results: Of the 132 women studied between January 2014-October 2014, 50 (37.87%) had histologically proven cervical carcinoma and 82 (62.12%) had normal cytology. In proven cases of cervical carcinoma, HPV infection was found to be associated in 49/50 (98%) and all of them had high risk HPV genotypes. The most common genotypes were 16 (67.34%) and 18 (20.4%). Other genotypes present were 45 and 33. Out of 82 cytological normal women, five showed presence of HPV DNA on RT PCR. While all the five had infection of HPV genotype 18, in one there was presence of both 16 and 18 genotypes. Conclusion: The detection of HPV genotypes 16, 18 along with high risk type 33 and 45 in Malwa region of Punjab confirm the importance of identifying the types of HPV that infects this community to design more effective prevention strategies and thus contribute to fight against cervical cancer.

Analysis of MRI Slices of Hamstring Avulsion Injury using Histogram

Introduction: Hamstring avulsion injury can be defined as improper functioning of the hamstring muscles due to external stress or strain. The detachment of hamstring muscular region from the tendons occurs under severe conditions. Magnetic Resonance Imaging (MRI) is used as a diagnostic tool to study the region of injury. Histogram analysis is a special type of image processing technique used to describe the changes in the gray levels of the images based on the abnormalities. Aim: To analyse the region of Hamstring avulsion injury in MRI slices using histogram. Materials and Methods: Hamstring avulsion injury MRI slices were obtained from an authorised database, Radiopeadia for analysis. Histogram of each slice of the MRI image was determined. Statistical features were derived from the histogram of each slice which was used to identify specific slice of MRI with high intensity avulsion injury. MRI slice with high intensity was determined for further processing and analysis of the injury. For further accurate identification of the high intensity slice in the MRI slices, statistical features of the slice histogram were obtained. These features were used to define the exact high intensity slice. Results: Histograms of 10 slices of an image were compared to obtain the slice with high intensity region. After comparison, slice four described the high intensity which defines the affected region of hamstring muscle. For further detailed study, statistical values were derived from the histogram. These values were significant for all the 10 slices but highly significant for the slice four. Slice four was further analysed to confirm all the details about the nature of the affected region of injury in hamstring muscle. Conclusion: Histogram defines the intensity variations of the pixels which mainly illustrate the nature of abnormalities, injuries or recognition of any region in the human body. Histogram based statistical values were used to analyse the abnormality or injury. These features were used in different ways for diagnosis and analysis of various abnormalities or disorders. Thus, Histogram and statistical features derived from the histogram from the MRI slices of hamstring avulsion injury were compared to identify the slice that possess high intensity region for the identification of the injury and its characteristics.

Determination of Range of Quadriceps Angle by Computed Tomography

Valida Rolin Mendonsa, Winniecia Dkhar, Suresh Sukumar, Arathy Mary John

Introduction: The Quadriceps angle (Q angle) has come to be accepted as an important factor in assessing knee joint function. Various conditions can affect the Q angle such as increased pelvic width, sociological factors, wearing high heels and certain sports postures such as an increase in pronation can lead to increase in Q angle. Therefore, measurement of Q angle is important in the field of Orthopaedics and sports medicine. Aim: To determine the range of Q angle in right and left lower limbs and among genders and the association of Q angle with Tibial Tuberosity–Trochlear Groove (TT-TG) distance, lateralization of pelvis femur length, weight, height, body mass index and waist to hip ratio. Materials and Methods: A total of 70 subjects were selected from patients who have undergone lower limb angiography in Computed Tomography (CT). The sample size was then categorised into 35 males and 35 females. Both legs of the subject were kept extended and in relaxed position. The images were then reconstructed into volume rendering (3D) and the Q angle, femur length and lateralization of pelvis were measured on volume rendering and TT-TG distance was measured on 2-dimensional axial images. The data were statistically analysed using descriptive statistics where mean, standard deviation, and range was used to report the data. ‘Multiple Logistic Regression’ test was used to analyse the association of Q angle with various factors. Results: The mean Q angle in right leg was 11.76±4° and in left leg was14.76±6.45°. The mean of Q angle in right leg of male was 10.4±3.62°, and in females, it was 13.11±4.25° whereas the mean of Q angle in left leg of male was 12.17±4.59° and in females, it was 17.34±7.05°. The association of Q angle with TT-TG distance, lateralization of pelvis femur length, weight, height, body mass index and waist to hip ratio showed no significant association. Conclusion: The range of the Q angle varies in both legs among gender. Though there was no significant association between Q angle and femur length, the major factor contributing to the varying Q angle was femur length compared to other parameters. Therefore, Q angle increases with increases in femur length and the left Q angle is more than that of right Q angle.

Ventilatory Defects in Toll Plaza Workers at Sriperumbudur Toll Plaza, Tamil Nadu, India

VP Sundaravadivel, K Senthil Kumar, Varadharaju, Krishnapriya

Introduction: Highways are the arteries of the nation. As fast as they grow, many toll plazas are installed to collect the taxes, ignoring the health hazards of the toll collectors due to the air pollution caused by the vehicular emissions. Aim: The present study was aimed to carry out dynamic Pulmonary Function Tests (PFT) on the toll personnel using a computerised spirometry and identify any ventilatory defects. Materials and Methods: This observational study was done on 44 subjects comprising of toll collectors, supervisors and security personnel who were continuously exposed to the vehicular traffic. After complete examination and informed consent, the eligible subjects were taken up for PFT and the results were interpreted. The Spirometry test parameters were compared with the predicted values by paired t-test. Statistical significance was indicated by p-value <0.05. Correlation analysis was done to find any relationship between the duration of exposure with spirometry parameters and respiratory rate. Results: The PFT done on the toll personnel, showed significantly reduced FVC, PEFR and increased FEV1 /FVC ratio when compared to the expected values. The study subjects had increased respiratory rate than normal persons. More than 50% of the test subjects had ventilator defects. Conclusion: Air pollution decreases the lung function of the toll personnel. Regular health check-ups with PFT can identify at risk personnel and protective gears can help them in long run.

Molecular Analysis of Dengue Virus Serotypes Circulating in Chennai, Tamil Nadu, India

Introduction: Dengue fever is one of the most important arboviral infections all over the world. Globally, 50% of the human population is at risk of dengue virus infection. Circulation of more than one serotype and virulent genotypes are responsible for major outbreak with high mortality in any geographical region. Aim: To identify the Dengue virus serotypes and genotypes circulating in Chennai, Tamil Nadu, India. Materials and Methods: Dengue serum samples were subjected to Reverse Transcriptase-PCR and representative samples were sequenced, subsequently; Maximum-Likelihood phylogenetic tree was constructed by MEGA 7 software. Results: Out of 140 samples tested, 45 were positive for different serotypes of dengue virus. Among the 45 PCR positives, 12 (26.7%) and 5 (11.1%) samples were positive for Dengue virus-2 and Dengue virus-3 respectively. The remaining 28 (62.2%) samples showed more than one serotype infection. The following combinations of multiple infections were observed in the present study: one sample (2.2%) had mixed infection of Dengue virus-1, 2; seven samples (15.5%) had mixed infection of Dengue virus-2, 3; 10 samples (22.2%) had mixed infection of Dengue virus-1, 2, 3; three samples (6.7%) had mixed infection of Dengue virus-2, 3, 4 and seven samples (15.6%) had mixed infection of all four serotypes. The predominant serotypes were Dengue virus-2 and 3 when multiple serotypes were concerned. Genotyping analysis revealed that Dengue virus-1 sequence belonged to Genotype-I, Dengue virus-2 belonged to GenotypeIV, Dengue virus-3 belonged to Genotype III. Conclusion: In the present study, authors conclude that the circulation of multiple serotypes with a high number of concurrent infections, re-emergence and continuous circulation of genotypes in our region. The burden of dengue viral disease in India is massively under-reported. Hence detailed continuous molecular surveillance studies and stringent control measures are urgently warranted to save lives from dengue-related mortalities.

Comparative Study of Scores for Prediction of Coronary Artery Disease Severity: Evaluation of a Newly Formulated CHA2DS2-VASc-HSLp(a) Score

Bhupendra Kumar Sihag, Dharmendra Jain, Geetha Subramanian

Introduction: The Framingham Risk Score (FRS) and CHA2DS2- VASc scores include risk factors for the development of Coronary Artery Disease (CAD). On review of literature, one study concluded that CHADS2, CHA2DS2-VASc, and especially CHA2DS2-VASc-HS scores could be considered predictive of the risk of severe CAD. CHA2DS2-VASc-HS score was made by adding hyperlipidaemia and smoking to CHA2DS2-VASc score. In developing countries like India, other than hyperlipidemia and smoking, Lipoprotein-(a) is an independent risk factor of CAD and adding Lipoprotein-(a) to CHA2DS2-VASc-HS score could be a better predictor of CAD in Indians. Aim: To formulate a new CHA2DS2-VASc-HSLp(a)) score by including hyperlipidemia, smoking and Lipoprotein-(a) and to compare it with FRS and CHA2DS2-VASc score. Hence to better predict CAD severity especially in developing countries like India. Materials and Methods: A total of 516 consecutive patients who underwent coronary angiography were enrolled in the study. Presence of >50% stenosis in a coronary artery was assessed as significant CAD. This study investigated whether these three scores can be used to predict CAD severity. Statistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS version 16.0) for Windows (SPSS Inc., Chicago, Illinois). Results: Out of 516 patients, 31 had normal coronary angiograms or mild CAD. The remaining 485 patients with coronary stenosis were further classified into single, double and triple vessel disease. The FRS, CHA2DS2-VASc, and CHA2DS2-VASc-HSLp(a) Scores correlated significantly with the number of significant diseased vessels and highest predictive ability was found with CHA2DS2- VASc-HSLp(a) score (r=0.157, r=0.279, and r=0.461, p<0.001, respectively). The diagnostic accuracy and Positive predictive value were 87.2% and 97.7% obtained for CHA2DS2-VAScHSLp(a) score with optimum Lp(a) cut-off =19 mg/dL. In addition, these three scores correlated significantly with the Gensini score and highest predictive ability was found with CHA2DS2- VASc-HSLp(a) score (r=0.194, r=0.459, and r=0.587, p<0.001 respectively). Conclusion: FRS, CHA2DS2-VASc, and especially CHA2DS2- VASc-HSLp(a) scores could be considered predictive of the risk of severe CAD. The CHA2DS2-VASc-HSLp(a) score was found to be the better scoring scheme to predict CAD severity in Indian population.

Comparison of Efficacy of Low Dose (25 mg) with High Dose Diclofenac (50 mg) in Management of Postoperative Pain after Periodontal Flap Surgery: A Randomised Clinical Trial

Introduction: The perception of pain is highly subjective and varies substantially among individuals. Diclofenac is powerful NSAID and is associated with adverse effect, like gastric irritability. Aim: To compare a low dose Diclofenac (25 mg) with Diclofenac (50 mg) in postoperative pain management after periodontal flap surgeries. Materials and Methods: Study included 20 patients with chronic periodontitis (17-55 years), scheduled for open flap debridement surgery on at least two quadrants >1 week apart. Study was being divided into two groups One group received low dose Diclofenac (25 mg Diclofenacand 325 mg paracetamol), BID for three days, whereas the other group received Diclofenac (50 mg Diclofenac and 325 mg paracetamol), BID for three days. The pain assessment of the subjects was carried out by VAS and pain assessment questionnaire. Results: The mean pain scores in both groups were obtained by VAS After comparing those pain scores of both groups by independent t-test and repeated measures of ANOVA test, statistically significant (p<0.05) results were found between both groups at day 1,2 and 3 but less gastric discomfort were observed with Diclofenac 25 mg group. Conclusion: Diclofenac 25 mg can be used efficiently in controlling postoperative pain after open flap debridement, especially in patients with gastric discomfort.

Role of Endoscopic Retrograde Cholangiopancreatography Guided Brush Cytology in Evaluation of Malignant Biliary Tract Strictures: Experience of a Tertiary Care Teaching Centre in Northern India

Introduction: Endoscopic Retrograde CholangioPancreatography (ERCP) is a gold standard procedure for evaluation of biliary tract lesions. There is a need to obtain a timely diagnosis without subjecting patient who harbours benign disease to major surgery. Strictures due to malignancy are one of the common reasons for obstructive jaundice in our set up. ERCP procedure is performed in such cases to relieve the block by stenting or papillotomy. Biliary strictures that are suspected to be malignant but lack a tissue diagnosis, termed indeterminate strictures, often pose a diagnostic dilemma. Pathological confirmation is desirable for deciding further management protocol. Brush cytology proves to be safe and sensitive procedure in diagnosis of biliary tract lesions. Aim: This study aims at evaluating the cytomorphological features of intra/extrahepatic malignant lesions directed by ERCP guided brush cytology and to establish the usefulness of biliary brushings in reaching a diagnosis in cases of malignant strictures presenting with obstructive jaundice. Materials and Methods: The study was a prospective study of one year time period. Cytological material was obtained from 40 cases of malignant strictures presenting with obstructive jaundice, who underwent ERCP for evaluation and treatment. Five cases of benign stricture were assessed to define benign baseline cytomorphology. The smears were prepared and analysed for standard cytological features. Results: Out of 40 malignant cases, smears from eight were classified as benign, five as reactive, five as NOS-suspicious, and 22 as malignant. Benign and reactive smears were considered as negative (13/40), suspicious and malignant smears (27/40) were considered as positive. On follow up 62.5% of the cases (25/40) were diagnosed as Carcinoma Gall bladder, 20% (8/40) as cholangiocarcinoma, 12.5% (5/40) as periampullary carcinoma and 5% (2/40) as pancreatic ductal adenocarcinoma. Detection rate by cytology was 100% in pancreatic ductal adenocarcinoma, 87.5% in cholangiocarcinoma, periampullary carcinoma (80%) and 56% in carcinoma gall bladder involving common bile duct. Overall sensitivity of brush cytology was 67.5%. Cytomorphological features of increased cellularity, loss of polarity, nuclear hyperchromasia, irregular nuclear outline and nucleolar prominence were found consistent with malignancy. Additional features seen in malignant diagnosis were nuclear variability, background atypical cells and multinucleate cells. Conclusion: The present study support that ERCP guided brush cytology is a sensitive method in evaluating cases of malignant biliary tract strictures.

Prevalence of Class I and II Integrons among MDR Enterobacter cloacae Isolates Obtained from Clinical Samples of Children in Kermanshah, Iran

Introduction: Enterobacter species are among one of the key causes of hospital infections. The transfer of drug resistance genes through the integrons promotes the development of antibiotic resistance and the emergence of Multidrug Resistant (MDR) strains. Aim: The aim of this study was to determine the prevalence of class I and II Integrons among MDR Enterobacter cloacae isolates obtained from clinical samples of children in Kermanshah, Iran. Materials and Methods: This descriptive cross-sectional study was done during 11 month period from October 2016 to September 2017, 72 isolates of E.cloacae were collected from children under 15 years of age in Mohammad Kermanshahi Hospital in Kermanshah, Iran. After confirmation of the isolates with biochemical specific tests, their antibiotic susceptibility with disk diffusion was examined. Then the frequency of Class I and II integrons was determined by using their specific primers and by PCR method. Data was analysed by SPSS software version 20 and p-values less than 0.05 were considered statistically significant. Results: The highest and lowest frequency of isolates were in blood samples 29 (40.3%) and CSF 2 (2.8%) respectively. From the 72 isolates of E.cloacae, 54 isolates (75%) were MDR. The highest antibiotic resistance was observed against Ampicillin-clavulanic acid (94.4%) and Cefalexin (69.4%), whereas the lowest antibiotic resistance was to Imipenem (9.7%) and Colistin (6.9%). Genotypically, the frequency of class I integron was 42 (58.3%), but none of the isolates had class II integron. Conclusion: The results of this study demonstrates that E.cloacae isolated from children, in addition to the high frequency of MDR isolates, the prevalence of isolates with integron is expanding. Therefore, keeping with the role of integrons in resistance to different antibiotics, it is necessary to pay greater attention to identify them.

Plasma Neutrophil Elastase and its Endogenous Inhibitors as Differential Inflammatory Markers for Dengue and Pneumonia

Mamatha Kunder, V Lakshmaiah, AV Moideen Kutty

Introduction: Neutrophils play a crucial role in protecting the host against microbial pathogens but they produce proteolytic enzymes such as Neutrophil Elastase (NE), the uncontrolled activity of which can destroy tissue and lead to organ failure. Thus, measurement of circulating levels of NE and its endogenous inhibitors may possibly contribute to diagnosis and management of diseases. Aim: This study was aimed to evaluate the changes in levels of NE, alpha1-Antitrypsin (a1-AT), alpha2-Macroglobulin (a2-MG) as well as elastase in complex with a1-AT (NE-a1-AT complex) in patients with dengue and pneumonia to ascertain if they could be of use as differential inflammatory markers and as adjunct diagnostic parameters in these two distinct disease conditions. Materials and Methods: This was a comparison study including 152 individuals in which 50 were in dengue group, 50 in pneumonia group, and 52 in control group. NE was measured using N-Succinyl-tri-alanine-p-nitroanilide as substrate. a1-AT, a2-MG and NE-a1-AT complex were estimated by Enzyme-Linked Immunosorbent Assay (ELISA). ANOVA, Kruskal-Wallis test and Pearson’s correlation tests were used to analyse the data. The results were expressed as Mean±SD and p-value <0.001 was considered statistically highly significant. Results: The result analysis indicated that the dengue and pneumonia patients had significantly higher elastase activity with significantly reduced a1-AT levels compared to controls. a2-MG level were significantly decreased in dengue while the levels were significantly increased in pneumonia. Conclusion: Significantly elevated levels of NE were observed in patients with dengue and pneumonia. Significantly reduced a1-AT in dengue and significantly increased a2-MG in pneumonia are observations of relevance.

Branching Pattern of Subclavian Artery–A Cadaveric Study

Janani Maheshwari V Vyas, Ramesh Kumar Subramanian, Senthil Kumar Sampath Kumar

Introduction: Several variants in Subclavian Artery (SA) have been reported, yet its branching pattern has not been reappraised in the recent years. Aim: To investigate the subclavian artery and its ramification to understand well its anatomy and surgical significance. Materials and Methods: Thirty-two Subclavian arteries in 16 (8 male and 8 female) adult cadavers were dissected bilaterally and their origin, termination, course and branching pattern were investigated. The study was conducted in Sri Ramachandra Medical College and Research Institute, Porur, Chennai, India, from July 2012 to February 2014. Cadavers showing surgical intervention or any visible abnormalities in the region were excluded. Results: The origin and termination of the Subclavian artery were normal throughout. The branching pattern could be classified into three types: Type I (20 arteries), Type II (11 arteries) and Type III (1 artery). The artery showed normal course in all cases except one with a transfixed course i.e., it perforated the Scalenus anterior muscle. Conclusion: Comparison and analysis of the results with previous works showed that the origin, termination, course and branching pattern of the Subclavian artery exhibited conventionality. This information shall, thereby, contribute to literature and aid anatomists, head and neck surgeons, vascular surgeons and radiologists.

Impact of Maternal Iron and Zinc Status on Foetal Cord Blood Levels: A Pilot Study

Introduction: Trace elements are essential for healthy life particularly in females, especially the pregnant women and their foetuses. Zinc and iron are described as the significant contributors for the proper functioning of human beings. Aim: To assess the association between maternal and neonatal cord blood levels of zinc, iron and Total Iron Binding Capacity (TIBC) and how the maternal status could be a screening tool for neonatal iron deficiency anemia. Materials and Methods: This cross sectional pilot study was carried out in the Labour ward in Cairo University Hospital. Healthy mothers and their neonates were selected (n=51 paired samples). Levels of serum zinc (Zn), iron (Fe) and TIBC in maternal and cord blood samples were estimated. The collected data were coded, tabulated and statistically analysed using IBM SPSS statistics (Statistical Package for Social Sciences) software version 22.0, IBM Corp., Chicago, USA, 2013. Results: There were significant positive correlation between maternal and neonatal zinc (r=0.322, p=0.021), significant positive correlation between maternal and neonatal iron (r=0.312, p=0.026) and significant negative correlation between birth order and neonatal iron (r=-0.511, p<0.001). Maternal serum zinc, iron and TIBC are accounted as key factors that increase neonatal serum zinc, iron and TIBC. Conclusion: This study provides important insight into the impact of maternal zinc, iron and TIBC concentration on their neonatal levels. Therefore there is a specific need for proper, adequate and balanced micronutrients during pregnancy in order to have healthy neonates.

Bone Turnover Markers: An Emerging Tool to Detect Primary Osteoporosis

Mayur Rai, Tirthal Rai, Janice D’Sa, Srinidhi Rai

Introduction: Osteoporosis is a global health problem, asymptomatic and noticed only after a fracture. Ten years after the cessation of ovarian function due to hormonal imbalance, women show an accelerated phase of reduction in bone mass known as primary osteoporosis. Determination of Bone Mineral Density (BMD) and Dual Energy X-Ray Absorptiometry (DEXA) are the gold standard diagnostic approaches for osteoporosis. However, they are costly; hence Bone Turnover Markers (BTMs) have been suggested to detect the risk of osteoporotic fractures. Aim: To assess the potential of BTMs as a diagnostic tool for primary osteoporosis in order to reduce the associated morbidity and mortality. Materials and Methods: This study was conducted on 105 women who were divided into Group I with 35 pre-menopausal women, Group II with 35 post-menopausal women without fractures and Group III with 35 post-menopausal women with wrist, spine or hip fractures. Serum osteocalcin (OC), calcium, phosphate, alkaline phosphatase, total protein, albumin and 24 hour urinary hydroxyproline were estimated. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) Version 16.0. ANOVA test was done to compare variables among the groups. Tukey’s test was applied for intergroup comparison. Student’s t-test was used to compare two groups and correlation studies were done using Pearson’s correlation. Statistical significance was considered as p<0.05. Results: The mean serum OC level in post-menopausal women with fractures was statistically low when compared to the premenopausal and post-menopausal women. The mean urinary hydroxyproline level was statistically higher in post-menopausal women with fractures and a positive correlation of urinary hydroxyproline was seen with age and BMI. The mean OC level was lowest in the spine fractures, when compared to the wrist and hip. Urinary hydroxyproline level had no significant difference among the fracture groups. Conclusion: BTMs can be an inexpensive diagnostic and screening tool for primary osteoporosis. Low serum OC levels and high urinary hydroxyproline levels in post menopausal women could thus predict osteoporosis and its timely intervention could prevent the risk of osteoporotic fractures thereby decreasing the mortality rate.

Osteoporosis at Distal Radius in Otherwise Healthy Adult Patients with Type 2 Diabetes: Does it differ from Routine?

Introduction: Type 2 Diabetes Mellitus (T2DM) affects bone metabolism at axial as well as the appendicular skeleton. Bone loss may vary at different sites. Besides spine and hip, the distal radius is commonly evaluated for osteoporosis in T2DM. The study represents the findings of osteoporosis at distal radius in otherwise healthy T2DM cases. Aim: To study osteoporosis at distal radius in relation to spine and hip in otherwise healthy T2DM cases. Materials and Methods: In this cross-sectional, observational study, adult patients above 50 years of age with T2DM with no other comorbidities or bone disease were assessed. All patients underwent Bone Mineral Density (BMD) evaluation with Dual-Energy X-Ray Absorptiometry scan (DXA) at spine, hip and distal radius. T-score of <-2.5 was considered as osteoporosis. Student’s t-test and Chi-square test were used to detect statistically significant differences in continuous and categorical data. One-way analysis of variance (ANOVA) was used to compare continuous data in more than two groups. Pearson coefficient was determined to study the correlations. The p-value <0.05 was considered statistically significant. Results: In 200 patients studied, osteoporosis at spine, hip and distal radius was found in 33.5%, 13.5% and 90.0% patients, respectively. Body mass index was significantly lower in patients with radial osteoporosis (p=0.048). There was a significant correlation between osteoporosis at the distal radius and osteoporosis at the spine (p<0.0001) and hip (p<0.0001). As osteoporosis was observed in a large number of patients; we further used T-score =-5.0 cut-off and observed osteoporosis in 37.5% patients. There was no difference in prevalence of osteoporosis in different age groups (p=0.510 and p=0.796) and two genders (p=0.203 and p=0.289) using either cut-off values. Vitamin D deficiency did not differ significantly in patients with or without osteoporosis using either cut-off values (p=0.603 and p=0.582). Conclusion: Compared to spine and hip, the prevalence of osteoporosis was higher at distal radius (90.0%) using standard T-score cut-off (=-2.5). Therefore, distal radius site should be evaluated in all cases for osteoporosis in T2DM. Further research is necessary to study whether bone loss occurs early and faster at distal radius compared to other sites.

Molecular Subtypes in Locally Advanced Breast Cancer-Do They Have a Preferential Destination?

Introduction: The patterns of relapse in breast cancer are very much driven by the intrinsic molecular subtypes, which have been studied mainly in early stage breast cancer and have prognostic implications. Aim: To explore the relationship between the different molecular subtypes and their predilection to a distinct distant metastatic site in locally advanced breast cancer. Materials and Methods: This was a retrospective review of the records of 70 women with a histopathological diagnosis of locally advanced breast cancer who received radiation therapy between January 2011 and September 2012. Results: In all the molecular subtypes, the most common site of metastasis is the most common first site of distant relapse as well. In luminal A it is the bone, in luminal B the liver and in triple negative and Human epidermal growth factor receptor 2 (HER2/neu) enriched it is the lung. But, the odds ratio was significant only among luminal A patients. There is no significant difference in disease free survival and overall survival between the molecular subtypes. But, luminal subtypes have a longer median survival (25 months) after the development of metastasis compared to non-luminal subtypes (7 months) with a p-value of 0.056. Conclusion: Different molecular subtypes of locally advanced breast cancer have a preferential distant destination and difference in survival post detection of metastasis. A well-structured prospective study protocol with a longer follow up with a larger number of patients is required before tailor made surveillance protocols can be developed for the various molecular subtypes of locally advanced breast cancer.

A Comparative Histopathologic Analysis of Prostatic Carcinomas by Conventional and 2005 ISUP Modified Gleason Systems

Deborah Dalmeida, T Umashankar, Crysle Saldanha

Introduction: The Gleason system is one of the most widely used systems for grading prostatic carcinomas. With several revisions since its inception, earlier studies have found poor levels of agreement between core biopsy and radical prostatectomy specimens. However, the adoption of the 2005 International Society of Urological Pathology (ISUP) Modified Gleason System has noted not only a better level of agreement between core biopsies and radical prostatectomy specimens but in addition, noted a trend towards upgrading of tumours when compared with the Conventional Gleason system. Aim: The aim of this study is to analyse the implications of 2005 ISUP Modified Gleason System on grading of prostatic carcinomas. Materials and Methods: The study involved histopathologic analysis of 30 needle core biopsy and transurethral resection of prostate specimens which were graded by two independent observers, using the Conventional Gleason System and 2005 ISUP Modified Gleason System. This study was conducted between January 2014 to May 2016. Results: Number of cases with Gleason score 6 reduced by 40% and number of cases with Gleason score 9 and 10 increased by 46.73% and 17% respectively. The overall number of high grade tumours (8-10) increased by 57.03% between reviews. Conclusion: This analysis showed a significant change in scores between the Conventional and 2005 ISUP Modified Gleason Systems. The result is likely due to expansion of the definition of Pattern 4 in the Modified Gleason system and elimination of the 5% threshold for reporting of higher grade tumours.

Relationship between Attachment Style and Body Mass Index of Children using Ex-Post Facto Research Design

Aditya Pareek, Uma Joshi

Introduction: ‘Attachment’ refers to a child’s relationship with and the need for its parent, which sets the base for all future relationship patterns and interactions. Underweight and obesity are recognised as complex problems emerging from genetics, poor nutrition, developmental processes, life experiences and lifestyle. Higher and lower than normal Body Mass Index (BMI) at an early age is associated with many negative health outcomes, concurrent as well as later in life. Few studies place BMI within the framework of the Internal Working Model of attachment theory due to its power in regulating feeding and emotions in caregiver/parents relationships with their children, to the best of authors knowledge none compare the attachment style of the contrast group of obese, normal and underweight children within the Indian setting in the same study. Aim: To investigate the effect of attachment style on BMI of children. Materials and Methods: Information on attachment style (Ricky Finzi-Dottan, 2012) and BMI (Omron model-HBF212) was collected from 217 early adolescents (10-14-year-old, in Grade IV-IX) from three private schools of Jaipur. The sample was divided into three groups as per BMI specifications of Indian Academy of Paediatrics. Further, contrast group comparison of underweight, overweight and normal weight adolescents was identified and computed with the chi-square analysis. Results: Results confirmed that insecure attachment style is associated with higher than normal BMI (overweight/obesity), whereas, children with normal BMI showed secure attachment style. However, no specific trend of attachment style could be identified among children with below normal BMI (underweight). The result was found to be significant (?2 =35.787, df=2, p<0.01). Conclusion: Findings suggest that attachment style with parents/caregiver during the early years are of vital importance in contributing towards shaping the future course of eating, feeding pattern, developmental trajectory leading to a healthy or unhealthy style of life and accumulation of specific experiences, modus operandi to face challenges leading to problems like obesity or overweight.

Analysis of Salivary Protein Profiles and its Viscosity in Early Childhood Caries (A Cross-Sectional Study)

Endang Winiati Bachtiar, Ingetiarani Y Hermawan, Ratna-Farida, Boy M Bachtiar

Introduction: Early Childhood Caries (ECC) affects a significant proportion of the child population worldwide. Salivary proteins contain a host defense system that plays a role in the caries pathogenesis. Aim: To analyse the protein profile and salivary viscosity from ECC and caries-free subjects. Materials and Methods: The number of subjects included in the study was 16 ECC and 16 caries-free. Salivary viscosity was assessed visually and salivary protein profile was analysed using SDS PAGE. Results: The five most prominent protein bands with molecular mass 15 kDa, 25 kDa, 60 kDa, 65 kDa and 95 kDa were found in ECC patients with the frequency of occurrences in order 8, 3, 16, 6, 2 and caries-free subjects 14, 5, 16, 16, 9. The saliva viscosity of ECC patient was higher than the caries-free subjects. Conclusion: In ECC patients, the frequency of occurrences of salivary protein profile 15 kDa, 25 kDa, 65 kDa and 95 kDa were found less than in caries-free subjects. Meanwhile, protein profile 60 kDa has the same frequency of occurrence in ECC and caries-free subjects. Viscosity of ECC patient was higher than the caries-free subject.

Prevalence of Glenohumeral Internal Rotation Deficit and its Association with Scapular Dyskinesia and Rotator Cuff Strength Ratio in Collegiate Athletes Playing Overhead Sports

Prateek Srivastav, Ganesh Balthillaya, Siddharth Bagrecha

Introduction: Glenohumeral Internal Rotation Deficit (GIRD) indicates a 15° or greater loss of internal rotation of the throwing shoulder compared with the non-dominant shoulder. Aim: To estimate the prevalence of GIRD in collegiate overhead sports player and determine whether GIRD is associated with scapular dyskinesia and rotator cuff strength ratio. Materials and Methods: The present study was a Cross-sectional study. A total of 127 collegiate athletes were assessed for passive range of motion, external to internal rotation strength ratio (ER/IR ratio) and scapular dyskinesia for the throwing and non-throwing shoulder. Internal and external rotation of shoulder was measured using an inclinometer with the subject in prone and arm abducted to 90°. Scapular dyskinesia was measured using Lateral Scapula Slide test (LSST) and external to internal rotator strength was measured using a held hand isometric dynamometer. Chi-square test was used to find the association between GIRD and scapular dyskinesia and rotator cuff strength ratio. Results: Prevalence of GIRD (n=37) was found to be 29.1%. GIRD was not found to be associated with Scapular dyskinesia (p=0.237) and ER/IR strength ratio (p=0.411). Conclusion: Prevalence of GIRD in collegiate athletes playing overhead sports was found to be 29.1% and there was no association of GIRD with scapular dyskinesia, rotator cuff strength ratio.

Residual Placental Blood Volume Estimation to Measure the Increase in Neonatal Blood Transfer by Delayed Cord Clamping: A Quasi-Experimental Study

Geetanjali Mahagundappa Katageri, Deepthi Nagaraj

Introduction: Iron deficiency and iron deficiency anaemia are common in newborns and children in India. Iron is essential for the physical, mental and even emotional growth of the child. Breast milk is not rich in iron and is not enough to provide the requisite amount of iron to the baby. Though WHO recommends delayed clamping of the cord in all developing countries, this is rarely a routine practice. Aim: To practically demonstrate the increase in neonatal blood transfer by adopting the practice of delayed cord clamping. Materials and Methods: This was a quasi-experimental study conducted at a tertiary care centre in Bagalkot, Karnataka between July and September 2014. The study was conducted in two phases, with the first phase not attempting any change of existing practices. Halfway through the study, the birth attendants were asked to change the timing of clamping whenever possible, to after stoppage of cord pulsations. Maternal characteristics were recorded. Timings of the various events during labour were noted. Residual placental blood volume was estimated in all cases by allowing the cut end of the cord to bleed. The results were analysed using t-test. Results: A total of 172 deliveries occurred during the period of observation, out of which 117 fulfilled the inclusion criteria. There were no significant differences in the maternal characteristics in the two groups (early cord clamping versus delayed cord clamping). There was an average difference of 44 mL in the residual placental blood volume (more in the early clamping group), which was statistically significant. The babies in the delayed clamping group had a higher average birth weight, which was also statistically significant. Unexpected complications interfering with a prior decision of delayed cord clamping were relatively few. Conclusion: Delayed cord clamping significantly increases the volume of blood transferred to the baby. Adopting this practice routinely, as recommended, requires minimal extra efforts on the part of the birth attendants, and should be stressed on.

Ultrasound Elastography in Differentiating Benign and Malignant Thyroid Lesions and its Correlation with Fine Needle Aspiration Cytology or Biopsy Results

Introduction: Ultrasound Elastography is a newly developed, non-invasive imaging technique that can be used as an adjunct in assessment of the thyroid lesions. Aim: To evaluate the diagnostic performance of ultrasound elastography in characterising thyroid lesions as benign/malignant and to correlate with FNAC/biopsy results. Materials and Methods: A hospital based prospective diagnostic study on ultrasound elastography was done on 88 pathologically proven thyroid lesions in 86 patients of 20 years or above of age on SIEMENS ACUSON S 2000 machine. Elasticity Imaging (EI) scores and Shear Wave Velocity (SWV) values were assessed and the findings were correlated with FNAC or Biopsy results. Receiver Operating Characteristic (ROC) curve analysis was done to find sensitivity and specificity values. Areas under ROC curves, best cut-off values and 95% confidence intervals were calculated. Results: Out of 88 lesions, 15 lesions were malignant and 73 lesions were benign on FNAC or biopsy. On EI, 5 lesions had score of 1, 58 lesions had score of 2, 13 lesions had score of 3, 10 lesions had score of 4 and 2 lesions had score of 5. The optimal cut-off point for SWV values was 2.87 m/s. The mean SWVs were 2.17±0.84 m/s for benign and 6.17±2.72 m/s for malignant lesions and was statistically significant (p<0.001). The sensitivity and specificity were 93.3%, and 84.9% for EI scores and 86.7% and 94.5% respectively for SWV values. Conclusion: Ultrasound Thyroid Elastography (Shear > Strain) has high potential to satisfactorily differentiate benign from malignant lesions, thereby reducing the need of unnecessary invasive FNAC/biopsy procedures.

Consistency of Fractional Anisotropy Values Using Different Combinations of b-Value and Time of Echo (TE) in Diffusion Tensor Imaging of Normal Brain White Matter

Rahul P Kotian, K Prakashini, Sreekumaran Nair, M Satish Babu

Introduction: Fractional Anisotropy (FA) values are considered as a solid concrete index for determining white matter integrity in ageing and neurodegenerative diseases. FA is more comparable and reliable parameter than individual diffusivity parameters. A b-value and Time of Echo (TE) significantly affect the reproducibility and accuracy of Diffusion Tensor Imaging (DTI) derived indices at 1.5 Tesla (T) MRI machines in grey and white matter. Hence, no fixed b-value and TE protocol combination is recommended in literature to obtain consistent FA values, as it is a relatively new imaging technique. Aim: To check the consistency of FA values using different combinations of b-value and TE in DTI of normal brain white matter and to establish a standardised protocol for calculating FA values in different regions of normal brain white matter of the corpus callosum, centrum semiovale and pons. Materials and Methods: A cross-sectional study of 23 healthy participants without neurological abnormalities using 1.5 T MRI, DTI of brain white matter was performed. FA values were measured at the corpus callosum, centrum semiovale and pons using fiber track analysis in six different combinations of b-value and TE. Results: The FA values with least coefficient of variation was found with a b-value of 1000 s/mm2 and TE 100 ms. Conclusion: The current study established a standardised protocol for calculating FA values in different regions of normal brain white matter of the corpus callosum, centrum semiovale and pons.

Does Treatment of Fistula-in-Ano by Ligation of Intersphincteric Fistula Tract Offer any Advantage over Standard Fistulectomy or Fistulotomy?

Pallavi V Ayyar, Satish B Dharap

Introduction: Standard surgical treatment of trans-sphincteric fistulae by fistulectomy or fistulotomy has a morbidity of leaving a large perianal wound which needs prolonged care and has risk of incontinence and recurrence. Ligation of Intersphincteric Fistula Tract (LIFT) technique for fistula-in-ano has been reported to have less morbidity and recurrence. Aim: To assess if the use of LIFT technique for the treatment of trans-sphincteric fistulae offers any advantage over standard fistulectomy or fistulotomy technique. Materials and Methods: The prospective comparative study was carried out at Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India, after obtaining approval from the Institutional Ethics Committee. Sixty patients of trans-sphincteric fistula of cryptoglandular origin undergoing either LIFT or fistulectomy/fistulotomy were included and prospectively observed for operative time, postoperative pain, hospital stay, time taken for wound healing, incontinence and early recurrence (within three months of the operation). Statistical analysis was done by unpaired t-test and chi-square test using SAS® software. Results: Patients operated by LIFT showed significantly shorter operative time (mean of 32.50 minutes vs. 40.17 minutes) and hospital stay (mean of 1.64 days vs. 2.53 days), decreased severity of pain and faster wound healing (mean 5.74 weeks vs. 6.89 weeks) compared to patients undergoing fistulectomy/fistulotomy. Though more patients had recurrence in the LIFT group (five patients in LIFT vs. three patients in fistulotomy/fistulectomy) this difference was not statistically significant. There was no incidence of incontinence (temporary or permanent) in patients of LIFT while three patients of fistulectomy had temporary flatus incontinence. Conclusion: LIFT offers the benefit of a shorter operative time, decreased postoperative pain, shorter hospital stay and faster wound healing with very low incidence of incontinence compared to fistulectomy or fistulotomy with a recurrence rate not significantly different from it.

Cymbopogon Citratus (Lemongrass Oil) Oral Sprays as Inhibitors of Mutans Streptococci Biofilm Formation

Introduction: Dental caries that occurs in young children or Early Childhood Caries (ECC) remains highly prevalent worldwide. Streptococcus mutans is not only one of the pioneer groups in plaque formation but is also crucial for its continuous development. It is important to prevent the presence of Mutans Streptococci (MS) for more effective prevention of dental caries. Aim: To evaluate the susceptibility of Streptococcus mutans (ATCC 25175), Streptococcus sobrinus (ATCC 6715) and three Streptococcus mutans clinical isolates from Thai children to three oral spray formulations (2%L38, 4%L40, 6%L42) of Cymbopogon citratus extracted oil, and evaluate the inhibitory effect of each formulation on growth and biofilm formation of each strain. Materials and Methods: S. mutans clinical isolations were obtained from children (12 males, 5 females aged 3.5-10-years-old) who came to the Paediatric Dental Clinic, Faculty of Dentistry, Chulalongkorn University, Bangkok. The inhibitory effect of each formulation on growth and biofilm formation was performed using a 96-well polystyrene plate biofilm assay. The inhibition effect was further analysed using fluorescent dyes (SYTO9 and propidium iodide) and Confocal Laser Scanning Microscopy (CLSM). All experiments were performed in triplicate. Data was expressed as mean±SD. For the determination of live/dead cells at the excitation wavelength of 485 nm, the green emission at 530 nm (live cells) and the red emission at 630 nm (dead cells) were measured and their ratio was calculated. The Kruskal-Wallis Test (Bonferroni and Dunn Test) was used to compare the experimental and control groups (significance at 95%). Results: All oral spray formulations showed excellent antibacterial activity. Results showed that 3 and 6 hours. preformed biofilms of all strains were sensitive to all formulations (100%) when compared to the controls. Biofilm formation of all strains was inhibited (100%) when compared to the controls by all formulations at different concentrations. Six percent (L42) oil formulations showed the maximum inhibition effect, followed by 4% (L40) and 2% (L38), respectively. Results from CLSM analysis of S. mutans (ATCC 25175) showed that 6% (L42) oil formulations gave the maximum inhibition effect, followed by 4% (L40) and 2% (L38), respectively. For S. sobrinus (ATCC 6715), 2% (L38) oil formulations showed the maximum inhibition effect, followed by 4% (L40) and 6% (L42). For all S. mutans clinical isolates, all formulations inhibited biofilm effectively and were not significantly different. Conclusion: In this study, all oral spray formulations from Cymbopogon citratus essential oil showed excellent antibacterial activity and they might be an alternative inexpensive natural medication to prevent dental caries in the near future.

Bone Mapping for Mini-Implant Placement with Various Facial Growth Patterns using Three Dimensional Volumetric Tomography

Introduction: Cortical bony morphology is influenced by force applications and stresses and strains produced by functional load of associated muscles of mastication. Also, Facial Growth Pattern is related to muscular function and there is a relationship between cortical bone thickness and facial divergence. Aim: To compare the thickness of cortical bone and inter-radicular distance in both the jaws among hypo divergent, hyper divergent and normal facial growth pattern. Materials and Methods: Total 45 individuals classified into hyper divergent, hypo divergent and normal facial growth pattern were selected for the study. Three-Dimensional Volumetric Tomography (DVT) scan was conducted for both the jaws and 3-DVT images were generated for each patient by using digital software, curved slicing images with sections of 76 µm thickness were chosen for measurements. The images were oriented in three planes of space so that the inter-radicular space and buccal cortical plates could be measured from the Cemento Enamel Junction (CEJ). One-way ANOVA test was used to analyse the data with statistical significance considered at a p-value lower than 0.05 at 95% confidence interval. Results: The average cortical bone thickness in hypo, hyper and normal facial divergent pattern was 1.16 to 1.5 mm, 0.92 to 1.28 mm and 0.96 to 1.5 mm respectively in maxilla whereas it was 1.48 to 2.82 mm, 1.14 to 2.30 mm and 1.24 to 2.62 mm respectively in mandible. The average inter-radicular space in hypo, hyper and normal divergent facial profile ranged from 1.7 to 4.32 mm,1.62 to 4.06 mm and 1.36 to 3.7 mm respectively in maxilla and 1.66 to 4.5 mm,1.52 to 4.32 mm and 1.86 to 3.4 mm respectively in mandible. Conclusion: Findings of the present study suggests that cortical bone thickness in the maxilla and mandible variably increases from anterior to posterior in different levels and mandibular cortical bone is thicker than maxillary cortical bone in all facial growth pattern individuals.

Assessment of Non-surgical Periodontal Therapy on IL-22 and S100A12 Concentration in Gingival Crevicular Fluid

Razieh Nejadi, Mandana Sattari, Ferial Taleghani

Introduction: Periodontitis is a disease of the periodontal tissues that results in attachment loss and destruction of alveolar bone. Several risk factors such as bacteria, the host immune responses and genetics are considered. Aim: The present study was undertaken to evaluate the effect of phase I periodontal treatment on the concentrations of IL-22 and S100A12 in patients with chronic periodontitis. Correlation between PD and CAL with the concentrations of IL-22 and S100A12 was also evaluated. Materials and Methods: In this study, 22 patients (14 female and 8 male), with a mean age of 39.55±10.25 years, and moderate to severe periodontitis were included. GCF samples were obtained and then Phase I periodontal treatment was rendered. The subjects were recalled after four weeks for collecting samples. Wilcoxon’s signed-rank test was used to analyse concentration of S100 and IL-22 before and after the treatment with CAL and PD. Results: There was an inverse correlation between the mean PD and S100 before treatment (p<0.05). In relation to CAL, although an inverse correlation was expected between CAL and S100 concentration, no significant correlation was found between them (p˜0.079). Conclusion: The periodontal tissues are weak cellular sources for the secretion of IL-22 and S100. Given the inverse correlation between the concentration of S100 and the mean PD before treatment and also the inverse and significant correlation between the concentration of S100 and the decrease in CAL and PD after treatment, a possible protective role might be considered for S100 for the incidence of periodontitis and success of phase I treatment.

Effect of Pharmacist Mediated Counselling on Knowledge, Attitude and Practice (KAP), Health Related Quality of Life (HR-QoL) and Glycaemic Control in Diabetic Patients on Insulin Therapy

Introduction: Education of the patients regarding KAP management has shown to improve patient outcomes in various health care settings across the world. Aim: To assess the impact of patient counselling by the pharmacist on KAP, Health related Quality of life and glycaemic control. Materials and Methods: A prospective observational study was conducted in hospitalised patients of various departments of the tertiary care hospital during the period of November 2016 to April 2017. Patient counselling was given by pharmacist at baseline visit and first follow-up (after three months). Patients were followed for six months with first follow-up at third month and with second follow-up at sixth month and KAP and HR-QoL were assessed using WHO-BREF QoL and KAP questionnaire respectively in all visits. Similarly, glycaemic control (HbA1C) values were noted at each visit. Results: A total of 50 patients were recruited in the study. KAP score at baseline visit, follow up-1 and follow up-2 were found to be 87.92±7.82, 117.47±6.98 and 119.9±5.30 respectively. Data analysis indicated that KAP score was improved at follow up-1 (p<0.001) and follow up-2 (p<0.001). HR-QoL has been significantly improved in all the domains during follow-ups. However, more degree of significance was observed in Domain 2 (psychological) and Domain 4 (environmental). HbA1C levels at baseline visit, follow up-1 and follow up-2 were found to be 9.1±1.65, 8.27±2.79 and 7.66±1.719 respectively. HbA1C levels were significantly decreased at follow up-1 (p<0.05) and follow up-2 (p<0.001). Conclusion: The study results support that pharmacist mediated patient counselling could remarkably influence on knowledge, attitude and practice and in turn patient’s quality of life and glycaemic control.

A Clinical, Randomised, Double-Blind Study on the Use of Nano-Hydroxyapatite and Arginine During at-Home Tooth Bleaching

Introduction: Home bleaching is a popular cosmetic technique that delivers quick results, reduces chair time, and has a lower risk of side effects compared to office bleaching. Aim: To evaluate the effect of nano-hydroxyapatite (n-HAP) and arginine on Bleach-Sensitive Teeth (BST) and colour change after at-home bleaching treatment across three months of follow-up. Materials and Methods: Sixty subjects were randomly allocated into one of three groups (n=20): 1) CONTROL, treated with 22% carbamide peroxide (CP)+toothpaste without a desensitising agent; 2) NANO, treated with CP +n-HAP; and 3) ARGININE, treated with CP + arginine. An air jet was used to evaluate BST associated with a modified Visual Analog Scale (VAS). A spectrophotometer was used to measure the colour of the maxillary incisors. Results: The Friedman vs Kruskal-Wallis tests showed that the BST reported in the experimental groups was lower when compared with the control group one day after the end of treatment (p=0.05). However, no significant difference was observed at 30, 60 or 90 days of evaluation (p>0.05). ANOVA showed no significant difference between groups when comparing mean ?E (p>0.05). Conclusion: The subjects treated with n-HAP and arginine presented lower sensitivity when compared to the control group one day after the end of treatment. In addition, there was no impairment of the efficacy of the at-home bleaching treatment over the 90-day evaluation period.

Comparative Study between Analgesic Effect of Breast Feeding and Oral Sucrose in Full Term Newborns

Milind Gajbhiye, Sunil Kumar Rao, H P Singh

Introduction: Non-pharmacological measures like oral sucrose and breast feeding are recommended modalities to treat acute procedural pain in newborns. Birth dose of hepatitis B vaccine exposes newborns to pain of intramuscular injection which is preventable. The present study has been carried out to assess the severity of pain and the effect of breast feeding and oral sucrose. Aim: To study the pain profile and the effects of breast feeding and oral sucrose solution on pain, in full term newborns. Materials and Methods: A prospective interventional case control study was carried out in the Department of Paediatrics and Post natal ward of Obstetrics and Gynaecology associated Gandhi Memorial Hospital. Randomly selected 150 full term vaginally delivered healthy newborns were enrolled in the study. Recruited newborn infants were grouped into three arms and each arm had 50 newborns. Group I as control group, and group II and III as intervention groups. A 1 mL of 25% oral sucrose solution was given two minutes before the vaccination in group II. Breast feeding was started 2 minutes before vaccination and continued till the end of injection in group III. The primary outcome of the study was to assess pain by Premature Infant Pain Profile (PIPP) score. PIPP score was compared by using ANOVA test and students t-test was used to compare continuous variables and two tailed Fisher-exact test or Chisquare test was used to compare categorical variables. The critical levels of significance of the results were considered at 0.05 levels i.e., p<0.05 was considered significant. Results: Mean PIPP scores were lower in group III (8.36) than in group II (11.06) and difference was significant (p<0.0001). The pain profile of newborns ranged from 9 to 18 with mean of 14.26 in group I, from 5 to 12 with mean of 11.06 in group II and from 1 to 12 with mean of 8.36 in group III respectively. Conclusion: Intramuscular injection produces moderate to severe pain response in group I and mild to moderate pain responses in group II and III. Breast feeding provides superior analgesia to oral sucrose and reduces moderate to severe painful response to mild to moderate grade in term newborns.

Body Mass Index and Weight Loss Efforts in Middle-Aged Saudi Women: The Mediating Role of Body Appreciation

Hala Hazam Al Otaibi

Introduction: Body Appreciation (BA) is the most widely used measure of positive body image and assesses an overall positive orientation to the body. Little is known about BA among Saudi middle-aged women related to weight status and weight loss efforts. Most published studies in Saudi Arabia have been conducted among college-age females. Aim: The primary aim was to identify BA, weight status Body Mass Index (BMI), and Weight Loss (WL) efforts among middleaged Saudi women. The second aim was to test the mediation effect of BA on the association between BMI and WL. Materials and Methods: A cross-sectional face-to-face interview design study included 326 middle-aged women recruited from all primary health centers in Hofuf city. Correlation analysis was used to describe univariate relationships among BMI, BA, and WL. Hayes tests for mediation were conducted, where BMI was the predictor, the WL score was the outcome, and BA was the mediator under investigation. Results: Mean age was 49.14±8.35 years, and mean BMI was 29.64±5.82 kg/m2. The mean BA score was 3.92±2.43. Majority of them (228; 69.9%) were unsatisfied with their body weight; and 256 (78.5%) had made an effort to lose weight. BMI and WL were significant correlates of BA. We found that BA fully mediated the relationship between BMI and WL in women. Conclusion: BA mediated the relationship between BMI and WL, which can contribute to our understanding of specific factors that can influence body image among middle-aged women.

Comparison of Intraoperative and Postoperative Morbidity between Carbondioxide Laser Tonsillectomy and Dissection Tonsillectomy: A Randomised Clinical Trial

Saranya Thangavel, Sunil Kumar Saxena, Arun Alexander

Introduction: Tonsillectomy is one of the most common procedures done in Ear, Nose and Throat department. Various methods of tonsillectomy have come into practice starting from dissection and snare to the recent coblation methods. Dissection and Snaring causes endothelial injury and release of tissue thromboplastin that results in aggregation of platelets and platelet plug formation and controls bleeding. It causes open wound that results in the exposure of nerves. On the other hand, CO2 LASER produces a characteristic wound that results in very minimal thermal effects on nearby non-targeted tissues. Postoperative morbidity is determined by the degree of thermal injury to the oropharyngeal mucosa that is less with dissection method. Reduced intraoperative time reduces unnecessary hospital stay and also increases patients turnover. Aim: To compare CO2 LASER tonsillectomy and dissection tonsillectomy in terms of intraoperative time, intraoperative bleeding and postoperative pain. Materials and Methods: This was a randomised study done on 126 consenting patients; randomised into two groups. Inclusion criteria were; children and young adults of age group 7-18 years with chronic tonsillitis and fulfilling diagnostic Scottish Intercollegiate Guidelines Network (SIGN) criteria. Results: The mean operative time for CO2 LASER group was 31.2 minutes (range 20 to 45 minutes) and 53.89 minutes (range 20 to 90 minutes) for dissection group with p<0.001. The mean intraoperative bleeding for CO2 LASER group was 40.8 mL (range 20.5 to 84.9 mL) compared with 80.2 mL for dissection group (range 44.4 to 117.2 mL) with p-value <0.001. The mean pain scores Visual Analog Scale (VAS) on postoperative day 1 in CO2 LASER group was 5.52 (range 3 to 8) and 4.87 (range 2 to 8) for dissection group with p=0.007. The mean pain score on postoperative day 7 in CO2 LASER group was 2.65 (range 2 to 6) and 2.00 (range 1 to 4) for dissection group with p-value <0.001. Conclusion: To conclude, tonsillectomy with CO2 LASER method is associated with less intraoperative time, less intraoperative bleeding but with more postoperative pain. Though laser tonsillectomy is proven for its efficacy and proven benefits, we suggest that the advantages of Laser tonsillectomy over conventional techniques have to be outweighed with respect to availability of resources and patient preferences.

Poor Quality of Sleep and its Association with Increased Body Mass Index and Mood Disturbances in Young Adults

Rajasegaran Rajalakshmi, Reddy Srija, Mani Thenmozhi

Introduction: The ill-health effects of inadequate sleep and sleep-related disorders are usually underestimated by the general population. Recent studies have reported a declining trend in the quality of sleep among young adults due to the extensive use of electronic media. However, data regarding the quality of sleep and its association with Body Mass Index (BMI) and psychological status of young adults is very limited. Aim: To assess the quality of sleep among young adults using simple self-reported pre-validated questionnaires and to measure the extent of its correlation with BMI and psychological status of the individuals. Materials and Methods: This cross sectional study was conducted between August 2016 and December 2016 in the Department of Physiology, Indira Gandhi Medical College and Research Institute, Puducherry, India. Four hundred young adults (20-23 years, both genders) were recruited in the study and their BMI was calculated using the Quetelet’s index. Quality of sleep, daytime sleepiness and symptoms pertaining to depression, anxiety and stress of the study participants were assessed using Pittsburgh Sleep Quality Index (PSQI) score, Epworth Sleepiness Scale score (ESS score) and Depression Anxiety Stress Scale Score (DASS score) respectively. The correlation between the study variables (PSQI scores, ESS scores, DASS scores, sleep hours and BMI) was determined using the Spearman correlation coefficient test. Results: Statistically significant positive correlation was observed between: a) PSQI scores and BMI (r=0.852, p<0.001); b) ESS scores and BMI (r=0.657, p<0.001); c) DASS scores and BMI (r=0.814, 0.929, 0.946 for Depression, Anxiety and Stress scores respectively, p<0.001); and d) PSQI scores and DASS scores (r=0.761, 0.838, 0.836 for Depression, Anxiety and Stress scores respectively, p<0.001). Duration of sleep hours showed a significant negative correlation with BMI (r=-0.533, p<0.001), PSQI scores (r=-0.714, p<0.001), ESS scores (r=-0.431, p<0.001) and DASS scores (r=-0.478, -0.532, -0.522 for Depression, Anxiety and Stress scores respectively, p<0.001). Conclusion: Poor quality of sleep predisposes to increased daytime sleepiness, increased BMIand mood changes in young adults.

Evaluation of Analgesic Activity of Extracts of Delphinium denudatum in Animal Models: A Dose-dependent Pre-clinical Trial

Imran Zaheer, Syed Ziaur Rahman, Rahat Ali Khan, Mehtab Parveen, Mushtaq Ahmad

Introduction: Pain is a common symptom of majority of clinical disorders which brings patients to a physician. Many traditional medicines have been introduced for relieving the pain and one such herb, Delphinium denudatum, is claimed to have an analgesic effect. Aim: To evaluate the analgesic activity of ethanolic extract and methanol fraction of Delphinium denudatum on Wistar albino rats. Materials and Methods: This experimental study was carried out in the Department of Pharmacology, JN Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India. The analgesic activity was evaluated by employing the Eddy’s Hot Plate method and Tail Flick responsemethod (Orchid Scientifics, India). In both the tests, Rats of either sex weighing 150-200 g were used. The total number of animals n=36 were allocated to six groups consisting of six animals each. Group I received propylene glycol 0.3 mL/100 g p.o., Group II received pentazocine 30 mg/kg i.p, Group III received ethanolic extract of Delphinium denudatum 300 mg/kg p.o., Group IV received ethanolic extract of Delphinium denudatum 600 mg/kg p.o., Group V received methanol fraction of Delphinium denudatum 200 mg/kg p.o., Group VI received methanol fraction of Delphinium denudatum 400 mg/kg p.o. The response noted in animals who were tested by hot plate method, was reaction time for licking/biting of both the paws before and after administration of control and test drugs. However, in Tail flick test, the pain threshold response was recorded before and after administration of control and test drugs. The statistical analysis was done by using one-way ANOVA. The data are expressed as Mean±SEM. p<0.05 was considered to be statistically significant. Results: A significant analgesia was produced in all the treatment groups when compared with control group in both the test models. A dose-dependent significant (p<0.001) analgesia was recorded in all the groups received ethanolic extracts and methanol fraction of Delphinium denudatum. However, a significant increase in reaction time and pain threshold in both the test models was observed in the groups who were given a higher dose of ethanolic extracts and methanol fraction of Delphinium denudatum. Interestingly, this study noted an approximately parallel degree of significant analgesia with a group who received extract of Delphinium denudatum in a dose of 600 mg/kg to a pentazocine group. Conclusion: The present study reveals the dose-dependent significant analgesic activity of the extracts of Delphinium denudatum in both the test. However, the degree of analgesia was recorded significantly higher in groups that received higher doses of extracts of Delphinium denudatum.

The Relationship of Internet Addiction with Quality of Life and Alexithymia in Students in Iran

Kamal Solati, Mohammad Ghasemi, Darioush Mohammadi

Introduction: Internet Addiction (IA) is one of the psychological disorders that have increased with the spread of technology, and its prevalence has also increased and leads to many complications on human health. Aim:This study was performed to investigate the relationship of IA with Quality Of Life (QOL) and alexithymia in students. Materials and Methods: In this cross-sectional study, 381 students of Islamic Azad University of Shahrekord, southwest of Iran, were randomly selected by multi-stage cluster sampling. Data were collected by the Internet Addiction Test (IAT), a Quality Of Life (QOL) questionnaire (WHOQOL-BREF), and the Toronto Alexithymia Scale. Data analysis was performed by SPSS v19 using Pearson’s correlation coefficient and regression analysis. Results: A significant, inverse correlation was observed between QOL and IA (p=0.04, r=-0.167), and the correlation was positive and significant with respect to alexithymia. Between IA and QOL, a significant, inverse correlation was observed (p=0.03, r=0.212). Regarding the dimensions of QOL and alexithymia, IA was found to predict the QOL dimensions, including the psychological, social relationships, and external environment dimensions as well as, in alexithymia, the difficulties describing emotions and externally oriented thinking subscales (p<0.05). Conclusion: IA was associated with QOL and alexithymia. With the increase in IA, QOL declined, and as IA increased, alexithymia also increased.

Financial Burden, Depression and Coping Strategies among Parents of Children Admitted to Paediatric Intensive Care Unit (PICU)

Introduction: In India, direct out of pocket expenditure on healthcare is about 70%. Taking care of an ill child is one of the most emotionally draining and difficult tasks a parent can face. Pursuing social support, positive reappraisals are most used strategies by parents to cope. There are few studies catering to these aspects among parents whose child is admitted in PICU in Indian population. Aim: The study aimed to assess financial burden and depression amongst parents of a child admitted in PICU and their variance with social support and household coping strategies. Materials and Methods: A cross-sectional survey was conducted on parents of 150 parents of patients admitted to PICU at rural tertiary care teaching hospital. Patient Health Questionnaire (PHQ-9) was used to measure depression. Socio-demographic and clinical profile, financial burden and social support were measured using semi-structured questionnaires. Descriptive statistics were used to depict the sociodemographic and clinical profile of the study population and Analysis of Variance (ANOVA) was used to assess associations. Results: Mean age of the fathers was 31.22 years (range 23-50) and of mothers was 30.39 years (range 22-42). Mean family income was 6186.3 rupees per month and median was 5000 rupees. Only 6% families had below poverty line status and majority (96.7%) had no health insurance. Median (IQR) duration of PICU stay was four days (IQR: 2, 6) and of hospital stay was six days (IQR: 3.75, 10). The median (IQR) medical and non-medical cost in INR incurred were 20,000 (IQR: 13725, 50375), 1,200 (IQR: 600, 2525) respectively. Borrowing money from friends/relatives (58%) was most frequently used household coping strategy. Using PHQ-9, 11(7.5%) parents screened positive for mild depression. Conclusion: Unplanned admission, lack of insurance cover and significant direct medical cost as inferred from the high income to cost ratio, indirect cost incurred by staying away from work push parents into financial and psychological distress.

Sex Differentiation of Humerus: An Osteometric Study

Shaikh Siraj Ahmed, Faiza Banu Siddiqui, Sujatha Banglore Bayer

Introduction: Forensic experts and anthropologists often have a task of identification of sex of skeletal remains which is an aspect of the biological profile of an individual. The humerus is among the long bones which have been found to remain in better condition after the death of the individual and can be used for analysis of sex of the individual. Aim: To assess the role of multivariate analysis of humerus metric parameters for sex differentiation of adult male and female humerus. Materials and Methods: The cross-sectional study was done on 176 adult human humeri of known sex from the bone bank of a medical teaching hospital in Marathwada region of Maharashtra in India. Following parameters of each humerus were recorded: weight, maximum length, vertical head diameter, transverse head diameter, circumference of midshaft, length of the shaft of humerus, circumference of head at anatomical neck, circumference of surgical neck, maximum width of upper end of humerus, width of bicipital groove, anteroposterior diameter of midshaft, transverse diameter of midshaft of humerus, biepicondylar distance, trochlear width, capitulum width, width of articular surface of lower end, height of medial flange of trochlea, circumference of shaft distal to deltoid tuberosity, trochlear distance, distance of articular margin from the apex of greater tubercle, distance between the nearest point of margin of lesser tubercle and articular margin of head, length index, and circumference index. “Multivariate linear discriminant analysis” was applied to weight, total length, vertical diameter of head, transverse diameter of the head, and the circumference of midshaft. Results: Total of 176 humeri were studied, 46 female humeri and 130 male humeri. It was observed that 119 of the male and 40 of the female humeri were accurately identified and the total number of humeri identified correctly was 159 out of 176 using the parameters of weight, maximum length, vertical head diameter, transverse head diameter, circumference of midshaft. The accuracy rate was 91.53% for males and 86.95% for females with an overall accuracy of 90.34%. Conclusion: Multivariate analysis of a group of metric parameters can be helpful for identification of sex from the humerus bones with reasonable accuracy.

Analysis of Cough in Post-stroke Individuals with Dysphagia

Introduction: Stroke is considered to be one of the major causes of morbidity and mortality globally, associated with numerous medical complications leading to an extended hospital stay and significant health care expenses. Dysphagia is one of the most common and life-threatening conditions seen in nearly 65% of stroke survivors. Stroke is reported to have an adverse effect on cough function. Aim: To analyse the cough in individuals with dysphagia. Materials and Methods: The study was conducted in the Department of Neurology, Kasturba Hospital, Manipal, Karnataka, India. A cross sectional research design with the convenient sampling was adopted. A total of 30 participants were recruited in the age range of 40-70 years. All the participants were tube dependent with a functional oral intake scale score of = Level 2. The clinical swallowing examination was initiated using Manipal Manual for Swallowing Assessment. The participants were asked to cough pre and post-swallow and the cough was analysed perceptually and acoustically. Perceptually it was rated by two experienced raters using 3-point rating scale and acoustically using Mel’s Frequency Cepstral Coefficients. Results: It was observed that the majority of the participants were rated as having weak cough both pre and post-swallow which is suggestive of overall effectiveness of cough being weak among the stroke individuals. The results showed a moderate agreement between the two raters for perceptual analysis of cough pre and post-swallow. The acoustic analysis using the Mel Frequency Cepstral Coefficients plots indicated that for majority of the participants, the cough pre-swallow had a higher likelihood value when compared to cough post-swallow. Conclusion: It can be concluded that the cough can also serve as a screening indicator, in identifying the signs of dysphagia. Cough is easier to elicit as compared to phonation task or speech, especially from post-stroke individuals. Since the results of the present study followed a similar trend as that of change of speech or voice post-swallow, cough also can be effectively used in probing the signs of possible aspiration.

Health Care Seeking Behaviour and Expenditure for Childhood Illness in Coastal District of India-A Community Based Study

Kiran Baliga, Shantaram Baliga, K Prashant Kini, Sucheta Rao

Introduction: Delay in access to health care involves problem in disease recognition, decision making and availability of health services. Health Care Seeking Behaviour (HCSB) is an important component of Health Systems Research (HSR) which is necessary for planning child health policies. Escalating health care expenditure and inaccessibility to health care facilities have been identified as major deterrent to seek health. Aim: To study: 1) HCSB of mothers for childhood illness; 2) Source of healthcare sought and expenditure incurred. Materials and Methods: Cross sectional community based study among representative sample of mothers of under 5 (U5), 1980 mothers from Dakshina Kannada district were interviewed and 431 reported illness. HCSB was predefined by Appropriate care, Appropriate and prompt care and prompt care. Health expenditure incurred was studied in various income groups. Results: Illness episodes were reported in 431 (22.6%) out of 1903 mothers. ‘Appropriate and Prompt care’ was given by 388 (90.02%) and most mothers interviewed were aware of danger signs. Private Health Care System (PHCS) was preferred by most, but expensive (Rs. 514.5) than Public Health System (PHS) (Rs. 236) per illness episode. Of 262 people with income less than 1000, 32(12.2%) did not have BPL card. Conclusion: Significant percentage of families with monthly income < Rs.1000 do not have BPL cards thereby deprived of benefits, contributing to “impoverished care”. Most mothers were aware of danger signs and health services were available within short distances, indicating good accessibility to healthcare. Most mothers (90.02%) sought prompt and appropriate care irrespective of economic status, literacy, occupation, parity and distance from health provider.

Stature Estimation Utilising Arm Span Measurements in Turkish Adults

Introduction: Stature is a significant biological profile for evaluating growth and development of an individual. It also provides important evidence in the forensic investigation process to the establishment of personal identification. Stature shows considerable variation between individuals. In situations where stature cannot be measured, different substitute parameters can be used to determine the stature. Arm span measurement has been demonstrated to be the best predictor of stature. Aim: To evaluate stature in Turkish adults for both sexes as well as to evaluate its correlation with arm span, as an alternative to estimating stature. Materials and Methods: A total of 324 students were selected from the Karadeniz Technical University, Turkey by stratified randomisation method. The research group comprised of 274 individuals (137 males and 137 females) aged between 20-27 years. The reliability of the equations was evaluated in the control group (25 males and 25 females) of same age range. The stature and arm span was measured by anthropometric technique. Stature estimation models were developed by using linear regression analysis and the interrelationship between stature and arm span was performed using pearson's correlation coefficient. Results: Arm span positively correlated with stature in male and female groups (r=0.785, r=0.807 respectively). Males were found to be taller in stature and larger arm span measurements compared to the females and this result was statistically significant (p<0.05). The equations derived from arm span and stature for males and females are: Stature=420.527+0.755x Arm Span; Stature=432.536+0.736x Arm Span, respectively. The coefficient of correlation for the regression equations obtained were 71.6% for males (F=216.791; df=1; p<0.001) and 75.1% for females (F=251.824; df=1; p<0.001). The reliability of estimated and measured stature values for control and research groups were regarded as good for both sexes (r>0.9, p<0.001). Conclusion: Stature and arm span have a high correlation and arm span can be used as a reliable parameter for forecasting the stature in Turkish adults. These equations can be used to estimate stature where the stature cannot be measured directly.

Cytological Study of Abdominal Lymph Nodes by Fine Needle Aspiration under Image Guidance

Rajeev Ranjan, Umesh Kumar Paliwal, Abhishek Anand

Introduction: Fine Needle Aspiration Cytology (FNAC) has become simple, safe, speedy, cost-effective, accurate and more diagnostic after advancement in imaging techniques. Sensitivity of image guided FNAC of intra-abdominal lymph nodes is relatively high. Ancillary techniques on FNAC material may increase the accuracy of diagnosis. Aim: To evaluate adequacy of material, cytologic assessment of samples obtained by image-guided aspiration and side effect/complication on account of the procedure. Materials and Methods: Image guided FNAC were performed on 60 patients which include retroperitoneal and abdominal nodes. A sterile 3.5/5-MHz micro convex sector probe was used for localisation of the node. FNAC was performed using a 0.7-0.9 mm needle with stylet removed and attached to a 20ml syringe and FNAC handle after the needle was visualised in the lesion. For each case a minimum of 4-5 smears were made and two observers without bias interpreted the smears. Results: A total of 60 patients were aspirated, of which adequate material for cytologic diagnosis was obtained in 58(96.6%) patients with a similar diagnostic accuracy. The 6th and 7th decade accounted for approximately half of the cases. Male to female ratio in our study was 2.16:1 (41:19). Most common cytologic diagnosis was metastasis 22(37%) followed by Non-Hodgkin lymphoma 17(28%) and followed by tubercular etiology seen in 16(27%) cases. All patients were followed by six monthly period for five years to further validate the study. Conclusion: Image-guided FNAC has a pivotal role, and is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is also helpful and accurate in follow-up of patients with a known malignant disease, thereby avoiding surgical intervention.

Are Indian Peacekeepers on Path to Mental Peace?

SIDDHARTH DIXIT, VINAY SINGH CHAUHAN, D BHATTACHARYYA

Introduction: There is paucity of literature on mental morbidity of United Nations (UN) peace keeping soldiers. Peacekeeping mission implies overseas deployment, hostile and harsh conditions, armed conflict and disregard on the part of some local parties for peacekeepers’ security and role. This places the Indian peacekeepers at risk for mental health problems. There is a considerable knowledge gap regarding mental health status of Indian peacekeepers. Aim: To study the socio-demographic profile and mental morbidity in soldiers repatriated from UN Peacekeeping mission. Materials and Methods: All consecutive Indian soldiers repatriated from various UN Missions on mental health grounds during the study period were assessed on a specially designed proforma for their socio-demographic profile and psychosocial stressors. Extent of their combat exposure was assessed post repatriation using Combat experience scale of Deployment Risk and Resilience Inventory (DRRI). Data was analysed where categorical data was described as per their frequency and continuous data as mean and standard deviation. Results: Total 37507 people were deployed during the study period (2011-2015) on various UN missions. A total of 23 patients were repatriated due to mental illness. Incidence of mental illness per year of UN stay was between 0.34 to 0.87. Out of 23 repatriated soldiers; within a month, three (13%) and within three months, five (21.7%) soldiers were repatriated. Of repatriated soldiers, people who outsourced their psychiatric treatment before disembarking were 8.6%, and people who had past record of mental illness were 4%. Amongst psychiatric morbidity, major depression was observed in 26%, substance use disorder in 17.4%, panic disorder and mixed anxiety disorder was diagnosed in 13% each. There were no cases of Post-Traumatic Stress Disorder (PTSD) and attempted suicide. Conclusion: This study is first of its kind on mental health of Indian peacekeepers. Low incidence of mental morbidity, absence of attempted suicide and PTSD validates the multidimensional steps taken by army to tackle stress. This study fills the factual void on peacekeepers and provides useful information for commanders and policy makers to reduce repatriation on mental health grounds. However, long term follow-up studies are needed to study the impact of overseas deployment on Indian soldiers.

Knowledge and Perceived Health Benefits of Percutaneous Transluminal Coronary Angioplasty among Patients with Coronary Heart Disease

Katha Mukherjee, Leena Sequira, Charlet Jasmine Vaz

Introduction: The determination of the knowledge and perceived health benefits of Percutaneous Transluminal Coronary Angioplasty (PTCA) from the patient’s view of understanding helps to develop a holistic approach to health care. Aim: The study aimed to assess the knowledge and perceived health benefits of PTCA and to find the association of knowledge with the perceived health benefits and demographic variables among the patients with Coronary Heart Disease (CHD). Materials and Methods: A descriptive survey design was used and data were collected from 130 participants of cardiac wards of a tertiary care hospital, Karnataka, using structured knowledge questionnaire about PTCA and post-PTCA health benefits scale. Later a leaflet about PTCA was given to the participants. Subjects diagnosed with CHD and on the first post procedural day of PTCA were included in the study and patients with psychiatric disorders and medical disorders except diabetes mellitus and hypertension were excluded. Descriptive statistics was used to describe the sample characteristics, Chi-Square was used for association. Results: The mean age of the sample was 54 years, the mean knowledge score was 7.35±2.855 and 15.4%, 69.2% and 15.4% of the participants had good, moderate and poor knowledge respectively. The PTCA procedure was perceived as highly beneficial by 79.2% of participants and association was not found between knowledge and perceived health benefits of PTCA (p>0.05). Conclusion: The study highlights the need for planning programs for continuing individualised health education on PTCA for the patients and their families to make changes in the patient’s wrong perception of health benefits after PTCA.

Correlation between Blood Glucose Level in Cord Blood and Capillary Blood of Neonates using Glucometer

Introduction: Metabolic disorders like hypoglycaemia and hyperglycaemia are much common in neonates as compared to any other age groups. Infants are born with a blood glucose concentration of 60 to 70% of the maternal levels and it falls during the first 24 hours. Transient low blood glucose levels are common after birth as the glucose supply to neonates changes from a continuous transplacental supply from the mother to an intermittent supply from feeds. Aim: To find out the correlation between glucose levels in cord blood and Capillary blood of neonates using glucometer soon after birth and to determine the prevalence of hypoglycaemia and hyperglycaemia among the study population. Materials and Methods:The study was a hospital based cross-sectional study and the study population included 1100 newborns who satisfied inclusion criteria. The glucose measurements were obtained using standard equipments and procedures. Data coded and entered into Microsoft excel, then analysed using SPSS software. Results: Results showed that there was a significant correlation between cord blood glucose and capillary blood glucose values (Pearson correlation coefficient r=0.894, p<.001). Linear regression done for predicting capillary blood sugar from cord blood sugar. The prevalence of hypoglycaemia as per the current study is 6.5%. Hyperglycaemia was detected in two of the study population accounting for 0.2%. Conclusion: There is significant correlation between cord blood glucose and capillary blood glucose. The prevalence of hypoglycaemia was higher among low birth weight babies. So cord blood glucose values can be used as a predictor for hypoglycaemia and hyperglycaemia in newborns soon after birth. Thereby early detection and intervention of these glycaemic disturbances can prevent grave complications.

Objective Acoustic Analysis and Comparison of Normal and Abnormal Voices

HT Lathadevi, Suresh Pundalikappa Guggarigoudar

Introduction: Acoustic analysis is commonly used to diagnose, document and treat voice disorders. Type I and Type II voices which are nearly periodic can be easily assessed with computerised acoustic analysers. Widely used voice parameters like Jitter, Shimmer and Harmonic Noise Ratio (HNR) are indices of voice pathology and indicate different diseases and help as an outcome measure. Aim: To study whether objective acoustic analysis is able to differentiate between abnormal and normal voices. Materials and Methods: In the present study, the patients were made to phonate sustained vowel /a/ and the voice was recorded to analyse parameters like Jitter (ddp), Shimmer (dda), HNR and Median pitch using the acoustic software, PRAAT. These parameters were compared with the values of the institute’s own normal voice database. They were analysed for Mean, Median, standard error of mean, and Kolmogorov-Smironov values. Results: The range of abnormal voice parameters like Jitter (ddp), shimmer (dda), median pitch and HNR measures were different from normal voices. The difference was significant in jitter (p-value of 0.026) in males, in Shimmer (p-value of 0.035) in females. HNR did not show any significance. Conclusion: The traditional methods of perturbation measures like Jitter, Shimmer, Median pitch and HNR can help the clinicians for characterisation of voice into either normal or abnormal voices. But the comparison needs a local or regional normal voice database.

The Effect of Group Sexual Counseling Based on Cognitive Behavioural Approach on Sexual Satisfaction of Women

Introduction: Sexual satisfaction is an important factor in the prevention of sexual dysfunction in women. It is an important factor in the healthy emotional and physiological aspects of sexual relationship. Aim: The aim of this study was to assess the effect of sexual counselling by cognitive behavioural approach on sexual satisfaction of women. Materials and Methods: This randomised clinical trial was conducted in two groups with pre-test and post-test on 198 women referred to selected health centres of Hamadan, 2016. The centres were randomised and taken as experimental and control group, three centres were selected as a control group and three as experimental group. The participants were selected by simple random sampling. The intervention group received four sessions (two hours) of group sexual counselling. Before and after the intervention, the demographic and sexual satisfaction questionnaires were completed. Results: After intervention, there were significant difference between two groups regarding sexual satisfaction (p<0.001). The mean score of the experimental group significantly decreased (p<0.001) and the mean score of sexual dissatisfaction in the control group didn’t changed significantly (p=0.625). Conclusion: The research findings showed that group sexual counseling based on CBT had an effect on the sexual satisfaction and increased women’s sexual satisfaction.

Analysis of Xenobiotics Biotransformation and DNA Repair Genes as Factors of Aetiology, Pathogenesis and Criteria of Progression in Children with Congenital Spine Deformities

Introduction: Spine congenital curvatures formed as a result of anomalies in the development of vertebral bodies leads to severe and rigid deformities of the spinal column in the adolescent age and are often accompanied by irreversible neurologic disorders. Therefore genetic markers study of the congenital malformations is an important and urgent task. Aim: The aim of the study is to determine the frequency of detoxification and reparation genes polymorphism in congenital spine deformities patients. Materials and Methods: The study of 200 children with Congenital Spine Deformities (CSD) between the age of 1 year 2 months to 16 years and 96 healthy children aged from 2 to 16 years without pathology of the spine was carried out by the methods of clinical and radiographic diagnostics. Molecular diagnostics was carried out by analysing multiple polymorphic regions in the genes of detoxification and DNA repair, which are of clinical importance due to their predisposing factors in various congenital malformations. Genotyping of the gene polymorphism was performed using Polymerase Chain Reaction (PCR) and the PCR products were visualised by gel electrophoresis. Results: The polymorphisms of the genes CYP1A2, GSTM1, GSTT1, GSTP1, NAT2, XRCC1, XRCC3 and their frequency distribution among patients with CSD and control group were investigated. Significant differences in the distribution of genotypes compared with the control group were found in the polymorphic regions of the genes CYP1A2, GSTM1, GSTT1, NAT2, XRCC3. However, in the GSTP1 and XRCC1 genes, no significant differences between the CSD patients and the control group was observed. Conclusion: All patients with congenital spine deformities had significant changes in some candidate genes alleles. It was found that the number of minor alleles in the genes under investigation correlate with the severity of congenital deformity and the variability of vertebral anomalies. It was determined that in children with multiple and combined defects in the spine development, there is a greater number of mutations in the detoxification and DNA-repair genes compared to children with isolated vertebral anomalies.

The Relationship of Quadriceps Angle and Anterior Knee Pain

Chandan Kumar, Sunil Singh Thapa, Arjun Prasad Lamichhane

Introduction: Anterior Knee Pain (AKP) is a very common symptom that poses a difficult diagnostic and therapeutic problem. Abnormal patellar alignment is described to be one of the causes. A common tool to assess patellar malalignment is the quadriceps angle (Q-angle). Aim: To evaluate the relationship between Q-angle and AKP. Materials and Methods: A total of 100 patients with AKP were included in this prospective, comparative observational study who qualified the inclusion criteria. Another group consisting of 100 subjects without AKP were kept as control. Along with demographic details, Q-angle was measured in both groups in standing position using universal goniometer and compared using standard statistical tests. Results: A total of 122 knees in 100 cases (52 Females and 48 Males) and 100 knees of 100 control group (50 Female and 50 Male) were evaluated with mean age 25.5 years in case and 25.4 years in control group (p>0.05). The mean duration of AKP was 7.13 months (ranging from 2-24 months). Left knees were involved in 40 cases right knees in 38 cases and both knees in 22 cases. The mean Q-angle among men, women and all participants in the case group were 15.2°, 20.4° and 17.9° respectively. In the normal control group, the angles were 12.2°, 16.3° and 14.3° respectively. All these difference in case and control group were statistically significant. Conclusion: The individual with AKP have large Q-angle than asymptomatic individual.

Sympathetic Overactivity Predicts Microalbuminuria in Pregnancy

Inder Pal Kaur, Sukanya Gangopadhyay, Kiran Singh, Mamta Tyagi, Gautam Sarkar

Introduction: Microalbuminuria is a frequent feature in pregnancy, as the latter is a state of haemodynamic changes and sympathetic overactivity. Both sympathetic overactivity {as measured by Heart Rate Variability (HRV)} and microalbuminuria are individually linked with hypertension. So, presence of these conditions in pregnant women could be the reason for the increasing prevalence of Pregnancy Induced Hypertension (PIH)/Preeclampsia. Aim: To measure HRV and urinary microalbumin excretion simultaneously in pregnant women. Materials and Methods: In this hospital-based study, pregnant women in 2nd and 3rd trimester were recruited along with age-matched controls. Their sympathetic activity and urinary albumin-creatinine ratio were recorded. The patients were followed till delivery to note progression to preeclampsia/ pregnancy-induced hypertension. Statistical analysis was done with appropriate tests using Graphpad Prizm (version 7.04). Results: The level of urinary microalbumin was found to be high in the pregnant group. Albumin Creatinine Ratio (ACR) was raised in pregnancy (72.35±50.29 in third trimester, 84.48±52.61 in second trimester and 17.59±6.19 in non-pregnant control group; p<0.001). The HRV study shows that sympathetic dominance is more during pregnancy as compared to non-pregnant (2.09±0.91 in pregnant and 1.04±0.65 in non-pregnant group). Conclusion: It was concluded that there is a neurogenic role for the causation of microalbuminuria in pregnancy. As this condition predicts the development of pre-eclampsia/eclampsia in later pregnancy, all the methods targeting generalised stress reduction could be advised to all pregnant women during their first visit.

Factors Associated with Severe Sepsis or Septic Shock in Patients with Gram Negative Bacteraemia: An Observational Cohort Study

Introduction: Sepsis is a systemic, host response to infection that progresses from sepsis to severe sepsis to septic shock. Severe sepsis carries significant morbidity and mortality. In the presence of individual risk factors such as old age, diabetes mellitus, chronic liver and renal disease, the death rate remains high despite treatment with antimicrobial agents. Aim: To determine the factors associated with severe sepsis or septic shock and to identify the factors influencing the mortality among patients with gram-negative bacteraemia. Materials and Methods: In this observational cohort study, 219 patients with gram-negative bacteraemia were screened for the presence of sepsis, severe sepsis and septic shock and detailed characteristics of the patients were analysed using independent sample t-test, chi-square test and logistic regression. Results: Among 219 patients with gram-negative bacteraemia, 43 (19.6%) were as classified as severe sepsis, 69 (31.5%) as septic shock and the remaining 107 (48.9%) as only sepsis according to clinical criteria. Diabetes mellitus (p-value=0.006), chronic liver disease (p-value=0.001), presence of urinary catheter (p-value<0.001) and organisms other than E. coli (p-value=0.036) had a significant association with severe sepsis. Mortality was observed in 82 (73.3%) patients with severe sepsis and septic shock. The factors that predicted mortality among patients with gram-negative bacteraemia were age =65 years, chronic liver disease, indwelling urinary catheter, endotracheal and nasogastric tube, central venous access, organisms other than E. coli, respiratory and abdominal sources of infection. The mean Pitt bacteraemia score of >4 was significant (p-value <0.001) for development of severe sepsis and septic shock and mortality was higher in those with high scores. (p-value <0.0001). Conclusion: The present findings suggest that diabetes mellitus, chronic liver disease, indwelling urinary catheter and organisms other than E. coli are important risk factors for the development of severe sepsis or septic shock. Patients with higher Pitt bacteraemia score may have higher risk of death.

Higher Risk of Motor Vehicle Accident in Female Motorcyclist with Type 3 Digit Ratio (2D:4D)

Shaifuzainab-Rahman, Muhammad Azhar Abdullah, Mohd Imran Yusof

Introduction: Digit ratio is the ratio of the lengths between the 2nd Digit (index finger) and the 4th Digit (ring finger) which is measured from base of the proximal phalanx to the tip of distal phalanx. Digit ratio pattern has been associated with a variety of psychological sex-dimorphic variables, such as aggression, risk-taking behaviour and a possible higher risk for involving in Motor Vehicle Accident (MVA). Aim: To assess the prevalence and significance of Type 3 digit ratio in female motorcyclists involved in the MVA. Materials and Methods: This study was a comparative cross-sectional study that included 194 female motorcyclists which were equally divided into MVA and non-MVA (control group). Radiograph of the right hand was used to calculate the digit ratio. The ratio were grouped into Type 1 (index>ring) common female pattern, Type 2 (index=ring) intermediate and Type 3 (indexResults: The result showed the MVA group was strongly associated with Type 3 pattern (53.6%) (p<0.05), while the non-MVA group was associated with Type 1 pattern (86.6%). Conclusion: The Type 3 digit ratio in female motorcyclists appears to be highly associated to involve in MVA.

The South African Dental Schools’ Educational Environment: Final Year Students’ Perceptions at Four Dental Schools

Ahmed Bhayat, Robert Barrie, Pagollang Motloba, Veerasamy Yengopal

Introduction: The Educational Environment (EE) can play a major role in the success and progress of students and their studies. The EE includes the infrastructure, clinical activities, the atmosphere created by staff and students and the clinical supervision of students both at the dental hospital and at outreach sites. Aim: To determine and compare the final year dental students’ perceptions of their EE at the four dental schools in South Africa (SA). Materials and Methods: A cross-sectional analytical study including all final year dental students registered in 2017 at the four dental schools in SA was undertaken. The Dundee Ready Educational and Environment Measure (DREEM) was used and this consisted of 50 items separated into five categories. All data was anonymous and information was kept strictly confidential. T-tests and ANOVA were used to compare demographics, item, domain and total scores of respondents between the dental schools. Descriptive statistics were used to report on the frequencies and percentages for categorical variables. Results: Out of total 210 final year students, 141 (67%) agreed to participate. The mean age was 23.9 years (±2.4) and 72% were female. The mean overall score was 124.5 and the mean scores for the domains were 30.3 for learning, 26.2 for the perception of lecturers, 23.4 for academic self-perception, 27.9 for the perception of the atmosphere and 16.2 for social self-perception; all of these indicated that the EEs were more positive than negative. A total of seven (14%) items had a mean score of less than 50%. All institutions except one, had a mean total score above 100 out of a total of 200 (50%). Items which scored the highest included the content being relevant to dentistry and the friendships that were formed. Items with the lowest scores included lecturers being authoritarian, over-emphasis of factual learning and being too tired. Conclusion: South African dental students perceived their EE to be positive. Older students and males were more satisfied compared to their counterparts. The content of the dental curriculum seemed to be appropriate and relevant but should be constantly re-evaluated to identify areas that need to be improved.

Ultrasound Evaluation of Foetal Nasal Bone and Maxillary Bone Length in the Second and Third Trimester

CS Prabhu, VN Amogh, Hiren Kumar Panwala

Introduction: Genetic diseases are the major causes of perinatal death and childhood disabilities. Fetus with a genetic disease have either major structural malformation or minor abnormalities (known as markers) that are detected during sonographic examination. Antenatal ultrasonography now permits the measurement of numerous parts of the fetal body, and nomograms have been developed that help to distinguish normal from abnormal fetal biometry. Aim: 1) To define a nomogram for Nasal and Maxillary bone length in the local population of Salem. 2) To assess the correlation between nasal bone and maxillary bone length with bi-parietal diameter, Head Circumference (HC), Abdominal Circumference (AC) and Femur Length (FL). Materials and Methods: The present study was a prospective, cross-sectional study conducted in Department of Radiodiagnosis, Vinayaka Missions Medical College, Salem Tamil Nadu, India. Study was conducted for period of one year from September 2012-September 2013. A total of 250 patients with routine antenatal check-up scan were included in the study. Measurement of Bi-Parietal Diameter (BPD), HC, AC, FL, NBL, MBL with 5th, 50th and 95th percentiles of each parameter was calculated. Pearson's correlation coefficients were calculated to examine the strength of the linear relationship between the nasal and maxillary bone with gestational age, BPD, HC, AC, and FL. For each parameter, regression analysis was used as a dependent variable to calculate the equation of the linear fitted function with each of the independent variables. Results: The maternal age ranged from 17 years to 37 years. The gestational age by Last Menstrual Period (LMP) ranged from 12 weeks to 40 weeks. The mean nasal bone length increased linearly with gestational age from 2.9 mm at 12 weeks to 13.1 mm at 40 weeks. The mean maxillary bone length increased linearly with gestational age from 8.7 mm at 12 weeks to 15.6 mm at 40 weeks. Significant statistical correlation was found between nasal and maxillary bone length and BPD, HC, AC and FL. Conclusion: Normative data for ultrasonographic measurements of the fetal nasal and maxillary bone lengths throughout pregnancy are provided for the local population of Salem Tamil Nadu, India. These data potentially allow the prenatal diagnosis of abnormal nasal and maxillary bone length which is a marker for chromosomal defects.

Comparison of Spontaneous versus Paced Breathing on Heart Rate Variability at High Altitude

Introduction: There is conflicting data at sea-level to suggest that Paced Breathing (PB) versus Spontaneous Breathing (SB) during short-term Heart Rate Variability (HRV) measurement improves data reliability. Aim: This study sought to examine the effects of SB versus PB on HRV, at High Altitude (HA). Materials and Methods: This was a prospective observational study on thirty healthy adult men who were investigated over nine days at altitudes of 800-4107 m. Cardiac inter-beat interval data were measured over 55 seconds, twice daily, using an ithlete finger sensor linked to a mobile phone to generate a HRV score. Agreements in the paired (SB vs PB) HRV scores were examined using paired t-tests, correlation coefficients and F-Testing. A factorial repeated measures ANOVA was used to examine the main effect of altitude and breathing method on the paired differences in HRV scores. Results: HA led to a significant reduction in SpO2 and increase in Acute Mountain Sickness (AMS) Scores. HRV scores (511 paired scores) were consistently higher with PB versus SB (mean difference +6.0; 96.1% within 95% agreement limit), though the variance was lower (F=1.2; p=0.04) and the scores strongly correlated (r=0.78; p<0.0001). HRV scores were lower with AMS (versus without AMS), but this difference was only significant with SB (68.1±12.1 vs. 74.3±11.4 vs; p=0.03) but not PB (76.3±11.8 vs. 80.3±10.4 vs; p=0.13). There was a significant main-effect for altitude (F=5.3; p<0.0001) and breathing (F=262.1; p<0.0001) on HRV scores but no altitude-x-breathing interaction (F=1.2; p=0.30). Conclusion: Ithlete HRV scores obtained with PB and SB strongly correlate at moderate HA but are consistently higher and the variance lower with PB. Whilst the actual per se does not affect this difference, the presence of AMS may be an important confounder.

Histological Evaluation of the Effect of Tamra Bhasma (Copper Based Metallic) and Jasada Bhasma (Zinc Based Mineral) Formulations on Testis of Wistar Albino Rats

Introduction: The metallic or herbo-mineral preparations used in the Indian system of medicine may cause a toxic effect on mammalian tissues. The broad therapeutic usage of these formulations in the form of Bhasmas is required to be ascertained for any adverse effects on the reproductive system. Aim: Present study was undertaken to evaluate the toxic effects of Tamra Bhasma and Jasada Bhasma on male gonads using Wistar albino rats. Materials and Methods: The experimental animals were divided into five different groups comprising of five male rats in each group. Group-I rats were used as the control. Group-II rats received Tamra Bhasma at a Therapeutic Dose (TED). Group-III rats received Tamra Bhasma at five times of therapeutic dose (TED×5). Group-IV rats received Jasada Bhasma at a therapeutic dose (TED), and Group-V rats received Jasada Bhasma five times of therapeutic dose (TED×5) for 28 days. The testes were harvested from these rats, the gross weight of each testes was noted and further processed for histological studies. Results: Testes of the experimental rats treated with both Bhasmas at therapeutic dose level did not show toxicity changes histologically. However, upon the exposure to a higher therapeutic (TED×5) level, it did show the histological features with the indication of decreased spermatogenesis. Conclusion: Test drugs were relatively safer and did not produce any marked toxic effect. However, at higher doses both drugs may produce toxicity on the testis. The higher dose used in the present study was much higher than routinely practiced clinical doses. Therefore, dose-dependent usage of these Bhasmas is recommended.

Effect of Socio-Economic Factors on Reproductive Health in Female Heads of Household: A Cross-Sectional Study in Iran

Somayyeh Khazaeian, Nourossadat Kariman, Abbas Ebadi, Malihe Nasiri

Introduction: Attention to reproductive health and its related factors is an essential step towards the promotion of health in societies and families with an emphasis on role of women. Considering the increase in the number of female headed households and the important role of social and economic factors on all aspects of their health, investigating the effect of these factors on reproductive health is necessary in this susceptible group. Aim: To investigate the effect of socio-economic factors on reproductive health in female heads of household. Materials and Methods: This cross-sectional study was conducted on 420 female-headed households from four regions of north, south, east and west of Zahedan using purposive sampling. Data was collected using a demographic characteristic form, socio-economic status questionnaire and reproductive health questionnaire. To analyse the data, descriptive and inferential (Chi-square test and binominal logistic regression) statistics in SPSS version 21 was used. Results: There was a significant relationship between reproductive health and the level of income, educational and occupational status of the participants (p<0.05). Level of income was revealed to have the highest effect on reproductive health (CI: 0.074-0.915, OR=0.26). As well as the chances of having undesirable reproductive health status were lower in the females with higher education (CI: 0.099-0.891, OR=0.296), and in employed women. (CI: 0.182-0.815, OR=0.385). Conclusion: The socio-economic factors, especially the level of income, played an important role in the reproductive health of the female-headed households. Consequently, extensive planning seems crucial to improve the level of income in this vulnerable group of society.

Patient Satisfaction with Dental Services and Associated Factors in a Saudi Dental Institution

Abdulrahman A Balhaddad, Ahmad Alshammari, Ahmed Alqadi, Muhammad Ashraf Nazir

Introduction: Patient satisfaction is associated with improved compliance and better health outcomes. However, the factors related to patient satisfaction are not fully understood. Aim: To evaluate patient satisfaction and the associated factors with facilities, services, and treatment received at a dental institution in Saudi Arabia. Materials and Methods: This cross-sectional study involved a convenience sample of male and female patients who visited a dental college in Dammam, Saudi Arabia. A questionnaire was designed using a five-point Likert scale to assess patient satisfaction. The instrument was piloted before its administration to study participants. Mann–Whitney U test was performed for statistical analysis. Results: The response rate was 81.9% as 262 out of 320 patients returned the questionnaire. The mean age of the patients was 34.7 years (SD±12.5). More males (65.3%) than females (34.7%) participated in the study. The highest mean score of patient satisfaction was reported for dental treatment (4.38), followed by facilities (4.34) and then appointments (4.27). Less educated patients (school education) than those with bachelor/master's degree were more satisfied with appointments (p=0.024), facilities (p=0.024), and treatment (p=0.016). Similarly, subjects aged 41-74 years demonstrated more satisfaction with facilities (p=0.001), and treatment (p=0.02) than those aged 17-40 years. However, gender, ethnicity, and monthly income were not significantly associated with patient satisfaction. Good quality of treatment was the main reason for visiting the institution. Conclusion: Most of the patients were satisfied with the dental services. Education and age of the patients were significantly associated with their satisfaction.

Assessment of the Self Perceived Hearing Handicap and its Associated Factors in Elderly People with Hearing Loss

Valli Rajasekaran, RB Gurulakshmi

Introduction: Hearing loss is one of the most common sensory deficits in elderly people. With an increase in life expectancy globally, presbycusis has become a major problem. The hearing loss can affect the social, emotional, psychological and functional well being of an individual. Determining the hearing handicap and the factors associated with the same becomes the major driving force for their health-seeking behaviour. Aim: To assess the degree of hearing handicap in elderly patients with hearing loss, to correlate the severity of hearing handicap with the severity of hearing loss and to identify various factors associated with hearing handicap. Materials and Methods: A cross-sectional study was conducted in 100 people more than 60 years of age with the sensorineural hearing loss. Hearing was assessed using pure tone audiometer. Hearing Handicap Inventory for the Elderly (HHIE) questionnaire was used to calculate the handicap scores from which the degree of handicap was assessed. The severity of handicap was correlated with the degree of hearing loss using chi-square test. Results: From the study, it was found that hearing loss in elderly people causes some degree of handicap (69%). There was statistically significant correlation between the severity of hearing loss and the degree of handicap (p<0.0001). There was a statistically significant association between education statuses, marital status with the severity of hearing handicap. Conclusion: From the findings in the study it can be concluded that older adults with hearing loss perceived social and emotional handicap. Any worsening in hearing will further impair the degree of handicap. People who were illiterate and living alone perceived significant handicap. Hence, identifying people with hearing handicap can help us in identifying and motivating people for further audiological screening and rehabilitation.

Introduction of Feedback for Better Learning

Jagminder Kaur Bajaj, Kulbir Kaur, Rajiv Arora, Satinder Jit Singh

Introduction: Feedback provided during formative assessment guides students to close the gap between their current and desired performance and enhances their learning and satisfaction. To get positive impact of feedback, it should be effective and timely. Perceptions and preferences of students for feedback may vary based on their attitude, cognitive style, gender and many other factors. Teachers may have different perceptions than the students about feedback. So present study tries to introduce feedback in the formative assessment of pharmacology and understand perceptions of students and teachers towards it. Aim: To provide effective, timely feedback to students for giving desired direction to learning and also, to assess students and teachers perceptions of feedback. Materials and Methods: A session on importance and techniques of feedback was conducted for sensitisation of faculty. EvidenceEffect-Change (EEC) technique was selected to provide feedback to students during formative assessment in tutorials and tests. A total of 150 students of third semester were divided into two batches for practical classes on alternate days. Each batch was subdivided into six subgroups. They were given one to one and face to face feedback, eight times in a period of four months, during tutorials and after tests of General pharmacology and Autonomic nervous system conducted in practical classes. The perceptions and preferences of students and teachers were recorded on self structured, prevalidated questionnaires using five-point Likert’s scale. Data were analysed using frequency distributions and median as measure of central tendency. Open ended questions were analysed descriptively. Results: There was consensus among students that feedback provided was effective, timely and had positive emotional effects. The students agreed having received feedback on all mistakes with corrections, content, organisation of content and handwriting. 88% students wanted the feedback process to be continued. Students (n=7) also suggested that more time should be spent by teachers in providing individual feedback to each student. All teachers agreed that during feedback they gave more emphasis on correcting mistakes, clarifying doubts and motivating students to work hard. 83% of teachers said that because of time constraint, all students didn’t get equal feedback and they spent more time giving feedback to academically weaker students who were consistently scoring less than passing marks. Teachers suggested that students should be divided into groups based on their performance and group feedback can be easily provided. Conclusion: Feedback has positive constructive effect on students’ emotions and learning. A large majority of students as well as teachers want feedback process to be continued throughout the session, but there is a difference in opinion of teachers and students about one to one or group feedback.

Assessment of Depression and Social Support in Elderly Subjects Residing in an Old Age Home: A Pilot Study

Introduction: Depression and lack of social support, particularly in institutionalised elderly population forms a major cause of concern. The problem statement of which in the current scenario, if precisely assessed could ensure adoption of effective policies to protect and promote the health of elderly. Aim: To assess the depression status and satisfaction with social support in elderly subjects residing in old age home and then investigate the possible association between depression and social support in them. Materials and Methods: The cross-sectional, questionnairebased pilot study interviewed 60 elderly subjects of either gender aged >60 years in a selected old age home in northern Kerala, India utilising standard tools like Geriatric Depression Scale-Short Form (GDS-SF) for assessment of depression and Multidimensional Scale for Perceived Social Support (MSPSS) for satisfaction with social support. Chi-square test and Pearson Correlation Coefficient tested relation between GDS and MSPSS score groups. Intergroup analysis of percent parameters was done by one sample t-test of percent/proportion. Results: GDS scores indicated that the percentage of subjects with depression (25%) was significantly low {t (59)=4.47, p=0.001} as compared to normal subjects (75%). GDS scores showed significant negative Pearson’s correlation with MSPSS scores (r=-0.268, p=0.038). MSPSS scores indicated that a significantly higher percentage of subjects (63.3%) showed low satisfaction with family support {t(59)=2.85, p=0.006}. General satisfaction with social support was perceived only as moderate by majority (45%) of subjects. Conclusion: Although the depression status is low, it certainly varies inversely as the satisfaction with social support. However the satisfaction with family support perceived in the old age home is poor. Thus, the need for improvement of family relationships of inmates with modification of social support system arises at institutional level.

Seroprevalence of Rubella Antibodies in Infertile and Pregnant Sudanese Women

Introduction: Primary rubella leads to serious consequences in pregnant women such as abortion, stillbirth and severe birth defect. Vaccination is the best strategy to give acquired immunity and to prevent the disease. However, screening women at reproductive age for rubella is not routinely used in many resource-limited countries like Sudan and data on prevalence of the disease lacks accurate information. Aim: We aimed to determine anti-Rubella IgM and IgG antibody profile of infertile women in Sudan to assess possible association of rubella with women infertility. Materials and Methods: This was a cross-sectional study conducted during April-July 2016 where a total number of 184 serum specimens were collected. Specimens included 92 sera of infertile women collected in antenatal care hospital for fertility in Khartoum and 92 sera collected from healthy pregnant women, as controls. Sera were screened for anti-Rubella IgM and IgG antibodies using ELISA kits (Fortress Diagnostics, UK). Results: Socio-demographic and clinical information were obtained from infertile women using a structured questionnaire and were analysed using Pearson’s Chi-square test by SPSS program version 16. Seropositivities of anti-Rubella antibodies among infertile women were found to be 75% (69/92) for IgM and 94.5% (87/92) for IgG. These values increased with age; however, there were no statistical differences among the different age groups. Interestingly, all infertile women at the age above 46 years demonstrated presence of IgM and IgG, accounting 100% seropositivity. A statistically significant difference was observed in the seropositivity of anti-Rubella IgM antibodies among infertile women of different duration of marriage (p-value 0.025). Among pregnant women (control group), 14.1% (13/92) and 92.40% (85/92) were positive for anti-Rubella IgM and IgG antibodies, respectively. Conclusion: The high anti-Rubella IgG antibody titres among the two cohorts in the absence of routine vaccination in the country suggest high endemicity and sustained transmission. Additionally, the higher IgM antibody titers among the infertile women suggest potential role of rubella to impair women fertility. Further studies are needed to determine high risk population and the need for an immunization policy for rubella in Sudan.

Comparative Evaluation of Antimicrobial Efficacy of Chlorhexidine, MTAD and Chitosan as Root Canal Irrigant against Enterococcus faecalis

Introduction: Endodontic irrigants play a role in disinfection of root canal. Inspite of wider options on selection of irrigant, there is always a search on ideal antibacterial irrigant against recurrent infections. Aim: To comparatively evaluate the antibacterial efficacy of chlorhexidine, Mixture of Tetracycline, Acid and Detergent (MTAD) and Chitosan against Enterococcus faecalis when used as a root canal irrigant. Materials and Methods: The bacterial E. faecalis culture was grown overnight in Brain Heart Infusion (BHI) broth and inoculated in Mueller-Hinton agar plates. The root canal irrigants were divided into four groups as follows. (Group I)-4% Sodium hypochlorite solutions; (Group II)-2% Chlorhexidine (CHX); (Group III)-MTAD; (Group IV)-2% Chitosan. Bacterial inhibition was assessed using agar well diffusion method. All four study irrigants were added to respective wells in agar plate (n=10) and incubated at 37°C for 24 hour. Diameter of bacterial inhibition zone around each well was recorded. The results obtained were statistically evaluated using one-way ANOVA test and the intergroup comparison was done using student’s t-test. Results: All the materials had statistically significant difference in zone of bacterial inhibition when compared to other materials. Based on the mean diameters, 4% sodium hypochlorite had the least zone of inhibition and MTAD had the highest zone of inhibition. 2% Chitosan polymer had greater zone of inhibition than 4% sodium hypochlorite, but less than 2% CHX and MTAD. Conclusion: MTAD showed the highest antibacterial efficacy against Enterococcus faecalis followed by CHX and Chitosan.

Characteristics of Sharp Injuries in Anaesthesia Providers in New York State: A Cross-sectional Study

Shamantha Reddy, Vilma Joseph, Zhen Liu, Tracey Straker

Introduction: Sharp instrument injury, defined as cuts, punches, scratches, nicks, or other injuries that break the skin and thus permit the entry of bacteria and viruses into the body, is the most common hazard faced by health care workers. Anaesthesiologists work in a rapid-paced environment, and are at high risk of injury from sterile sharps while preparing medication or dirty sharps that have been in contact with patients. Aim: This field study aimed to determine the incidence and distribution of sharp injuries among anaesthesia providers in New York State. Materials and Methods: The study was performed during year 2014 among the members of New York State Society of Anaesthesiologists (NYSSA). A total of 282 anaesthesia providers including anaesthesiology attendings, residents, fellow and interns participated in an anonymous online survey (Survey Monkey) of 18 questions. Results: Of 2965 NYSSA members polled, 282 anaesthesia providers responded (9.51% response rate). A total of 248 (95.04%) respondents responded a prior needlestick injury. A total of 165 (59.14%) experienced dirty sharp injury (DSI) in the course of their practice, and the most common cause was hollow bore needles. The most common cause of DSI occurred while the provider was holding the sharp himself. A total of 117 (42.4%) respondents had injury even though safety mechanism was available and used. Conclusion: Sharp injuries were a common risk to anaesthesia providers in New York State. Future research should investigate strategies to reduce injury and improve reporting among anaesthesia providers.

HPV Risk Factors and Prevention Behaviours: A Review

Introduction: Human Papillomavirus (HPV) is one of the most commonly diagnosed Sexually Transmitted Infections (STIs) that is responsible for the majority of Cervical Cancer (CC) cases. Aim: The present study aimed to review HPV risk factors and prevention behaviours. Materials and Methods: In this study, articles indexed in databases, such as PubMed, Scopus, EMBASE, and Google Scholar were reviewed. In total, 29 papers on the risk factors and the associated prevention methods in this area were evaluated. Results: Risk factors and prevention of HPV infection were classified into three domains: individual, behavioural, and psychosocial. There were differences with regard to age, race, marriage and the number of pregnancies, in the individual domain. In the behavioural domain, conflicting evidence was found on oral contraceptives and the use of condom. In the psychosocial domain, the main risk factors for HPV include: believing in fatalities of the cancer, the shame of the disease, and fear of vaginal examination. Meanwhile, the fear of developing HPV led to the prevention of high risk behaviours. Conclusion: Given the limited research on risk factors or HPV prevention in Iran and the contradictions observed in the results of studies, there is a need for further investigations to obtain basic information on risk factors and prevention. In this regard, widespread health education is a necessity for raising the awareness of individuals about HPV infection prevention.

Assessment of Healthcare Systems Across BRICS Nations, What India Can Learn from the Rest?

BRICS countries are the five important emerging economies of the world. This article is a situational analysis of the present healthcare system of these countries, their public health expenditure, and the health of their population. Since similarities exist between these countries in terms of their national economies, this article also takes a look at what and where India can improve and learn from the rest in terms of healthcare.

Three-Dimensional Printing-A Revolutionary Technology

Kanchan Rajkumari, Poornima Chandra, Pachipulusu Balaji

Three-dimensional printing has been hailed as a path-breaking technology which will change manufacturing. It is used in aerospace, defence, art and design, 3D printing is becoming a subject of interest in medical and dental fields. With CBCT and long history of CAD CAM in dentistry, 3D printing will pave a new path in diagnosis and management of various dental disorders. 3D printing, also known as rapid prototyping and additive manufacturing, was first introduced in late 1980s and early 1990s. The application of this technology involves 3D tissue/organ development, creating and developing field of tissue engineering and a variety of actual clinical applications. This paper highlights various 3D printing modalities and materials and its applications in dentistry.

Spindle Cell Tumours of the Head and Neck-A Taxonomic Review

Esha Singh

Spindle cell neoplasms of the head and neck region are relatively rare, yet there importance cannot be doubted. Spindle cells are of mesenchymal origin and constitute a part of the body’s connective tissue. Soft tissue spindle cell neoplasms may range from reactive lesions to benign and malignant tumours. This heterogenous group of lesions include those of neural, fibroblastic, myofibroblastic, myogenic and epithelial tumours. As the spindle cells contain both benign and malignant mimics, misclassification has the potential to result in either under or over treatment of the patient. The aim of this review is to evaluate available data on spindle cell neoplasms, to gain more insight into the molecular pathogenesis and immunohistochemistry of these lesions, and to integrate recent knowledge on spindle cell neoplasms and their emerging concepts for future prospects. An effort has also been made to add a few relevant neoplasms to the present working classification.

Elements of Integrating Traditional and Complementary Medicine into Primary Healthcare: A Systematic Review

Ahmad Negahban , Mohammadreza Maleki, Alireza AbbaSsian

Introduction: Patients prefer primary healthcare to include conventional medical services together with complementary medicine. The process of integration can be a stressful process for providers of both complementary and modern medical services. Aim: This study aimed to determine the elements of integrating traditional and complementary medicine into primary healthcare. Materials and Methods: This systematic review searched the Web of Science, Scopus, PubMed, Ovid, and EMBASE from January 2000 to February 2017. Data were analysed by the content analysis method. Results: The search of databases resulted in 1391 records. The duplicates were removed, titles and abstracts were screened, and irrelevant records were excluded. Finally, 25 studies were included and five elements identified that are important for integrating traditional and complementary medicine into primary health care. Eighteen studies addressed communication and collaboration, 12 studies addressed patient-centeredness, 12 studies addressed types of practice, 11 studies mentioned education and training, 8 studies mentioned policy and plan, 7 studies addressed financial support. Conclusion: Integrating traditional medicine into primary healthcare requires government support and policy-making. Communication, professional dealings, and training are important and influential in all stages of integration. Integrated services should be culturally acceptable and financially covered by insurance.

Identifying the Challenges and Cost-effectiveness of Telerehabilitation: A Narrative Review

Manisha Pramod Shenoy, Pramod Divakara Shenoy

Technology has been evolving at an exponential speed in the past decade and the evidence of a dramatic change is all around us such as self-driving cars, artificial intelligence, robotics, and many more. The fusion of physical, digital and biological worlds, the so-called 4th industrial revolution, has impacted all industries and disciplines including healthcare. It has changed the way we live, work, and interacts with people around the globe. Despite its numerous benefits it also brings several concerns such as organisations failing to adapt to this shift at an equal or adequate pace. It is imperative that we grab the opportunities it presents and together shapes a sustainable and highly productive future. The field of rehabilitation has begun to adapt to these changes and became known as Telerehabilitation (TR). A promising field can be instrumental in aiding healthcare delivery, enhancing compliance, and improving health outcomes and quality of life of patients. However, the development of TR has been at a much slower pace than expected in both developing and developed countries. This article is a review of status and trends in TR and will mainly deal with identifying challenges faced by its users, gaps and propose means for rectifying issues and for establishing cost-effectiveness. It is thus concluded that there should be future studies of high quality, analysing its cost effectiveness and cost benefit. Also, the challenges could be overcome by a combination of face to face delivery and TR.

Comparative Assessment of the Antibacterial Efficacy of Natural Products and Chlorhexidine Mouthwash against Streptococcus Mutans: A Systematic Review

Benoy Jacob, MS Nivedhitha

Introduction: Dental caries is still an existing challenge worldwide and continues to be the most prevalent of all oral infectious diseases. Mutans streptococci have been identified as the causative organism for dental caries and the elimination or reduction of such pathogenic bacteria is beneficial in controlling dental caries. This can be achieved by the addition of an anti-microbial mouth rinse to daily oral hygiene regimens. In accordance with the existing mouth rinses in which the effectiveness has been proved time and again, comes with a set of drawbacks which cannot be overlooked. Hence, natural alternatives have been focused on as the need of the hour. Natural products have been proven to be safe, consisting of biologically active compounds which may have potential therapeutic uses in dentistry. Aim: To compare and evaluate the antibacterial efficacy of natural products and chlorhexidine on Streptococcus mutans. Materials and Methods: The following databases were searched: PubMed, Cochrane Database of Systematic Reviews, LILACS, Science direct, Google scholar until December 2017. The primary outcome was to evaluate antibacterial efficacy of natural products and chlorhexidine mouthwash on Streptococcus mutans. Results: The results showed that natural products exerted almost similar antibacterial effect against Streptococcus mutans when compared with chlorhexidine. Conclusion: The present systematic review does not provide concrete evidence to show increased antibacterial efficacy of natural products as compared to chlorhexidine.

Efficacy of Endurance Exercise on Pain and Disability in Chronic Neck Pain-A Systematic Review

Introduction: Due to the prevalence of chronic neck pain, the international attention, in recent years, has increased to evaluate the efficacy of therapeutic exercise in the management. The course of neck pain is often characterised by exacerbations, a reduced range of motion of the cervical spine, development of chronic symptoms of pain for more than six months and weak neck-muscles. They are more common among women than men and they are related to functional limitations, disabilities and impairments. But the evidence in support of many of the standard treatment approaches in the management of neck pain is lacking. Aim: This systematic review aimed at analysing the literature systematically and to discuss the quality of evidence of endurance exercise in reducing pain and disabilities. Also it may help in improving the Quality of Life in subjects with chronic neck pain. Materials and Methods: Records were identified by searching multiple literature data bases, including MEDLINE, BIOMED CENTRAL, EMBASE, ACRM, Europa Medicophysica, BMJ, PEDro, Cochrane central register of controlled trials (CENTRAL), American Physical Therapy Association, Medicine and Science in sports and exercise. Additional records were searched through other sources to complement the database finding, relevant literature reviews and indexes of peer-reviewed journals were used. All published Randomised Controlled Trials (RCTs) without any restriction regarding time of publication, co-interventions, sample size and gender were referred. Study participants had to be symptomatic adults with chronic non-specific neck pain, chronic neck pain, whiplash injuries and the articles published in english. Results: In this systematic review, the literature search initially resulted in 250 RCTs among which 23 studies fulfilled the criteria and were finally included in the review. Almost all the studies showed that there was a significant difference between the endurance training group and the other intervention group in improving the neck functional abilities and in reducing the neck pain. Conclusion: In majority of the studies, the endurance exercises succeeded in reducing neck pain and in improving functional abilities of the chronic neck pain patients. The intensities and repetitions of the exercises should depend on progressive resistance given to the muscle. The endurance exercises were found to be promising when compared to control group; however, it yielded a less significant reduction in pain and improvement in functional abilities of neck when compared to the other strengthening exercises group.

Prescription of Metronidazole in Paediatric Dentistry-An Evidence Based Approach

Nuvvula Sivakumar, Saha Anupam, Mallineni Sreekanth Kumar

Introduction: Metronidazole belongs to the nitroimidazole group of drugs, specifically anti-anaerobic in the nature and has a broad spectrum of activity against protozoa and anaerobic bacteria. Aim: The purpose of this systematic review was to assess the requisite for metronidazole prescription among children with pulpal infection either during treatment or postoperatively. Materials and Methods: An electronic literature search was done using databases PubMed, Cochrane Database of Systematic Reviews, OVID and EBSCO Host from January 1991 to December 2015. Hand search were carried outbased on cross-references, to find additional citations. Articles that met criteria such as randomised clinical trials, cross-sectional studies, in-vivo human studies were included. Search was confined to English language. The primary outcome was to evaluate the necessity of metronidazole prescription in children with pulpal pathology. Two independent evaluators were involved in the search and kappa statistics were used to evaluate intra & inter-examiner reliability. Results: A total of 335 articles were available, among these, only two studies fulfilled established inclusion criteria. These available two studies were cross-sectional studies (Level III). Kappa statistics showed excellent inter and inter-examiner reliability. Conclusion: Although, metronidazole has antibacterial properties against anaerobic microorganisms, there is no clear evidence regarding its prescription among children with pulpal pathology. Further research is required to support or contradict the use of metronidazole prescription in children during or after pulp therapies.

Snake Venom, an Unbeheld Drug for Nipah Virus? A Lead from Ayurveda

Preethi Mohan

Newly emerging viral fevers are grabbing the people all over the world. Recently Nipah outbreak occurred in Kerala (May 2018) and claimed many deaths. Anti-viral drugs for these dangerous viruses have not been discovered yet. A major hurdle is the low incidence of discovery of efficient molecules with anti-viral property. In Ayurveda, a handful of formulations are explained for serious disorders especially fevers in which one of the constituent is snake venom. No researches have been conducted regarding this due to many ethical concerns and ignorance. Anyway, it is possible to draw a general outline of anti-viral activity of the snake venom in terms of available researches. Anti-viral property of snake venom is a known fact today based on researches done on dengue virus, parvo virus etc., Researches have shown that viruses have a strong affinity towards phospholipase 2 (PLA2), as most of these viruses use host machinery for infection and replication. Although, a structural homology between snake PLA2 and human PLA2 has also been proved. Likewise, due to affinity, virus may attach to snake venom PLA2. Further, snake venom PLA2 can inactivate the lipid bilayer of virus causing partial exposure of virus RNA, making it unable to attach with the host cells. It is high time to focus on snake venom research towards dreadful fevers taking the lead from Ayurveda.

Platelets as an Extra-Hepatic Reservoir of Hepatitis C Virus RNA: A Prospective Study

Pradheer Gupta, Manish Chandra Choudhary, Meenu Bajpai, Ekta Gupta

Introduction: In the era of Direct Acting Antiviral (DAA), elimination of HCV is possible but persistence in extra hepatic sites is hindrance. Detection of HCV has been reported in platelets, however its impact on DAA therapy not been studied. Aim: Detection and quantification of HCV RNA from the platelets and compare with parallel plasma levels. Materials and Methods: Whole blood collected from 62 chronic HCV infected patients. HCV RNA quantitation was done from paired plasma and platelet pool at baseline using commercial real time PCR assay (AbbottTM). Correlation calculated by Bland-Altman analysis. Bivariate association and p-value calculated using chi-square tests. Results: A total of 45 patients were viremic while 17 were non-viremic. Median plasma viral load was log105.7 (IQR: log103.55-6.7) IU/mL, median platelet viral load was log104.13 (IQR: log100-5.5) IU/mL. Genotype (GT) 3 (66.6%) was commonest followed by GT 1 (33.3%). Sustained Virologic Response (SVR) was attained in 39/45 patients (92.8%) patients while 3/45 patients (6.67%) were non-responders. Viral load at baseline in platelet pool was higher in non-responders when compared to those achieved SVR (median log104.46 vs. log103.27, p=0.456). Conclusion: HCV-RNA was efficiently detected in platelets. Persistence in platelets could be one of the factors associated with treatment failure.