Journal of clinical and diagnostic research

Oxidative Stress and Nutritional Status in Chronic Obstructive Pulmonary Disease

Background: Oxidative stress and malnutrition are shown to have pathogenic effect in Chronic Obstructive Pulmonary Disease (COPD). Aim: This study was done to assess the burden of oxidative stress in COPD and to determine its relation to their nutritional status. Materials and Methods: In this cross-sectional study, 100 COPD cases from emergency and medical ward and meeting inclusion criteria, along with age, sex and occupation (mainly farmers, housewives and drivers) matched 100 controls without COPD and meeting inclusion criteria were enrolled. Oxidative stress was assessed by measuring lipid peroxidation product, Malondialdehyde (MDA) and antioxidants, like Vitamin C, E and Red Blood Cell Catalase (RBCC). Mini Nutritional Assessment (MNA) tool and Body Mass Index (BMI) were used to assess nutritional status. Statistical Analysis: Chi-square test was applied for categorical variable. Student t-test was applied for comparison of means. Analysis of Variance (ANOVA) was applied for comparison between groups followed by Bonferroni post hoc analysis. Pearson correlation method was used for quantitative variables. Statistical significance was defined as p< 0.05 (two tailed). Results: COPD cases had significantly high MDA level with low level of Vitamin E and catalase as compared to controls (p < 0.001). Most of the COPD cases were underweight (BMI = 18.5 Kg/m 2 ) and malnourished (MNA score less than 7). Bonferroni post-hoc analysis, showed significantly high burden of oxidative stress in underweight and malnourished cases as compared to normal weight (p < 0.05) among COPD cases. Highly significant correlation was seen between BMI and plasma MDA level (r = -0.27, p = 0.008) in COPD cases. Conclusion: This study shows impaired oxidant/antioxidant balance along with malnutrition and underweight in COPD, which signals for considering antioxidant therapy along with nutritional management.

Evaluation of Adhesive Bonding of Lithium Disilicate Ceramic Material with Duel Cured Resin Luting Agents

Dipti Pravin Lambade, Sham M. Gundawar, Usha M.Radke

Purpose: The purpose of this vitro study was to comparatively evaluate the adhesive bonding of dual cured resin luting agents with lithium disilicate ceramic material. Materials and Methods: Porcelain laminate veneers were prepared with lithium disilicate ceramic material i.e. IPS Empress II( E-Max Press). These laminates were bonded with RelyX ARC, Panavia F 2.0, Variolink II, Duolink and Nexus NX3. The porcelain laminates were etched with 9.6% hydrofluoric acid (Pulpdent Corporation) for one minute, washed for 15 sec with three way syringe and dried for 15 sec with air syringe. The silane (Ultradent) was applied with the help of applicator tip in a single coat and kept undisturbed for one minute. The prepared surfaces of the premolars were treated with 37% phosphoric acid (Prime dent) for 15 sec, thoroughly rinsed and dried as per manufactures instructions. The shear bond test was carried out on all samples with the Universal testing machine (Instron U.S.A.) The scanning electron microscopic study was performed at the fractured interface of representative samples from each group of luting agents. Result: In this study, the highest value of shear bond strength was obtained for NEXUS NX3 and the lowest for VARIOLINK II. Conclusion: The difference in bond strength can be interpreted as the difference in fracture resistance of luting agents, to which shearing load was applied during the shear bond strength test. It is inferred from this study that the composition of the luting agent determines the adhesive characteristics in addition to surface treatment and bonding surface area.

Effect of Insulin Resistance in Assessing the Clinical Outcome of Clinical and Subclinical Hypothyroid Patients

Background: The effect of thyroid status on insulin sensitivity is of great interest but despite various studies there is conflicting data on this subject. Hypothyroidism has been associated with disorders of glucose and insulin metabolism involving defective insulin secretion in response to glucose, hyperinsulinemia, altered peripheral glucose disposal and insulin resistance. Thyroid dysfunction leads to alterations in glucose and lipid metabolism which is an important risk factor for cardiovascular diseases. The dyslipidemia and insulin resistance should be managed aggressively to reduce the impending risk. Objectives: The prime objectives of the study were as follows: 1. To compare and correlate insulin resistance levels with T3, T4, and TSH in hypothyroidism patients. 2. To compare and correlate lipid profile with T3, T4, and TSH in hypothyroidism patients with healthy controls. Materials and Methods: Forty hypothyroidism patients and Forty healthy age and sex matched controls in the age group of 18 to 45 years were taken for the study. The venous blood samples collected were used for estimation of thyroid hormones, insulin, glucose and lipid profile. Results and Discussion: There is significant increase in insulin, Homa-IR and glucose levels in hypothyroidism cases when compared to controls. Cholesterol, LDL, VLDL and triglycerides were significantly increased, whereas HDL was significantly decreased in hypothyroidism cases when compared with controls. Insulin was moderately correlated with cholesterol but there was no correlation with other lipid profile parameters in hypothyroidism patients. Homa-IR was significantly correlated with TSH in hypothyroidism cases when compared with controls. TSH was significantly correlated with cholesterol and LDL in hypothyroidism cases (both clinical and subclinical) when compared with controls. The present study helps to evaluate changes in insulin resistance and lipid risk factors. These factors should be managed aggressively to reduce the impending risk of cardiovascular diseases.

High Prevalence of Symptomatic Hepatitis A Infection in Rural Area of Chaharmahal VA Bakhtiari Province, Iran

Ali Karimi, Seifollah Mortazaei, Mohammad-Taghi Moradi

Introduction: Hepatitis A virus (HAV) is the most common cause of hepatitis during childhood and is an important public health problem. Therefore, the aim of this study was to investigate an outbreak of symptomatic viral hepatitis in children and in young adults in a rural area from Chaharmahal Va Bakhtiari Province, Iran. Materials and Methods: Serum samples from the 70 patients with icterus, who were suspected for HAV infection, referred to a therapeutic center in a central province of Iran from February to July, 2010 were tested for IgM specific antibody to HAV, using Enzyme linked Fluorscent assay (ELFA) Kit (General Biological Corp., Hsinchu, Taiwan). Results: All of the 70 children had jaundice. The ELFA results showed that 48 out of 70 (68.6%) tested positive for anti-HAV specific antibody (IgM). The mean age of the individuals were 12.81+12.2 and 23 of them (32.8%) were females. There was significant relationship between seropositivity for IgM anti-HAV antibody and age group in the patients studied (p<0.05). Conclusion: The high number of cases identified, may indicate an outbreak of hepatitis A in this region with the children as the most susceptible age group to this symptomatic infection.

Status of Eye Donation Awareness and Its Associated Factors Among Adults in Rural Pondicherry

Introduction: The value of anything is realized only when it is lost, one such thing is vision. Though all the causes of blindness can’t be cured, corneal blindness can be reverted by corneal transplantation, for which a suitable donor cornea is required at right time. There is lack of awareness about eye donation among general population, so practice of eye donation is also lacking. Studies about awareness of eye donation among general population are lacking in rural India, keeping this in mind, present study was conducted. Aim: To determine the awareness about eye donation and its associated factors among adults in rural Pondicherry, India. Materials and Methods: A cross-sectional study was conducted at Rural Health and Training Centre (RHTC) of Community Medicine department. Total 196 adults visiting to RHTC were interviewed after obtaining informed written consent. Data were collected by investigator using pre-designed and pre-tested questionnaire in local language (Tamil). The data were analyzed using epi info 7 software. Chi-square test was used for statistical significance between awareness and socio-demographic factors like age, sex, education, occupation, etc. Ethical permission was obtained before conducting the study. Result: Of 196 participants, 80.6% subjects were aware about eye donation. Education and occupation had significant association with awareness. Main source of information about eye donation was television (65.2%). The employed persons had significantly more awareness about the correct timing to donate eyes. Education and occupation were found to be the predictors for awareness about eye donation. Conclusion: Although the awareness is good in this population, the quantum of people pledged is very low. To make the dream of converting the awareness into pledging and procurement of eyes, the knowledge about eye donation is highly required.

Prescribing Patterns of Drugs in Acute Respiratory Distress Syndrome (ARDS): An Observational Study

Rahul Magazine, Shobitha Rao, Bharti Chogtu

Introduction: Acute respiratory distress syndrome (ARDS) is characterized by acute respiratory failure and is associated with wide range of clinical disorders. Controversy prevails over the pharmacological intervention in this disease. The aim of the study was to observe the prescribing pattern of drugs in patients with ARDS managed at a tertiary care hospital. Materials and Methods: This observational study was conducted at tertiary care hospital in India. Data of patients admitted from January 2010 to December 2012 was collected. Patients aged more than 18 years admitted in ICU, who were diagnosed to have ARDS during the study period, were included. A total of 150 patients of ARDS were selected. Data was collected as per the pre designed proforma and it included patients’ age, gender, clinical disorders precipitating ARDS, prescribing pattern of drugs and outcome. The data of the subjects was collected till discharge from hospital or death. Results: Infection was the cause of ARDS in 81.3% (n=122) of subjects. Antibiotics were prescribed in all the subjects and beta- lactams were prescribed in 97.3% (n=146). 41.3% (n=62) were prescribed corticosteroids, 39.3% (n=59) diuretics and 89.3% (n=134) intravenous fluids. Conclusion: The outcome of patients on different pharmacological treatment did not show any statistically significant difference.

Study of Morbidity Profile of a Rural Population in Tamil Nadu

S.Gopalakrishnan, P. Ganeshkumar, Ajitha Katta

Objective: To identify the reported morbidity profile of people according to age, gender and organ system affected using International Classification of Diseases (ICD) coding, in a demographically defined area in Tamil Nadu in order to identify their health care needs and to plan appropriate interventions strategies. Materials and Methods: This is a-cross sectional study using a convenience sample of 12308 persons sceened from the 41 panchayat units of the Kattankulathur block, comprising 90 villages with a population of about 2,00,890, over a period of one year. Diagnosis made were coded using ICD 10 version and data collected was analysed by appropriate statistical methods to explain the distribution of morbidity profile among the study population. Result: Out of total, 38.1% screened were males and 61.9% were females. Underfives were 5.3%, school going children 43.3%, adults 39.2% and elderly 12.3%. Majority had illness affecting respiratory system (20%), ‘symptoms and signs’ (19%), musculo-skeletal system (16.1%) and digestive system(11.9%). ‘Symptoms and signs’ classification, is a group of conditions which is of nonspecific diseases, signs, symptoms, abnormal findings and complaints, apart from the system specific conditions diagnosed properly and not elsewhere classified, More males were affeced with respiratory, digestive and illnesses with ‘symptoms and signs’ while more women were affected with musculo-skeletal problems. Only 9.7 % of patients reported with non-communicable diseases. Among them, 55 % women and 42.3 % men had osteoarthritis and 15.7 % women and 21.3 % men had cataract. About 15.8 % women and 18.1 % men had hypertension and other heart diseases while 9.7 % women and 8.4 % men had diabetes and 10.0 % men and 3.9 % women had chronic respiratory diseases. Conclusion: School going children and adults have higher levels of morbidity when compared to elderly and under five children. More females reported with illness but morbidity was found to be higher among males. The burden of illness increased with age. Acute ailments were responsible for high morbidity among children, while chronic ailments caused high morbidity among the elderly.

Strategy to Increase Awareness and Involvement of Private Medical Practitioners in RNTCP in Taluka Rahata of District Ahmednagar

Background: The global annual incidence of Tuberculosis (TB) is 9 million cases of which estimated 2.3 million cases occur in India. In many parts of India, the private sector has remained alienated from Directly Observed Treatment Short course (DOTS) implementation; hence, case detection has remained low. The performance of Taluka Rahata in terms of TB control was poorest before the year 2000; RNTCP was started in Taluka Rahata on 24 th March 2001. From 2001-2010, there was improvement in the performance but was not satisfactory. Hence, present study is an attempt to devise strategy, to increase awareness and involvement of private practitioners in Revised National TB Control Programme in a rural area of Rahata Taluka. Aim: To adopt strategies to improve the awareness and increase involvement of Private Practitioners about RNTCP in Rahata Taluka of Ahmednagar district. Setting & design: It is an Interventional study conducted in Rahata Taluka of District Ahmednagar from June to November by giving personal visits to all the Private Medical Practitioners of Rahata Taluka at their workplace. Materials and Methods: Personal visit was given to 143 private medical practitioners at their workplace. Workshop used as the major strategy was arranged as per RNTCP guidelines. Health education material was distributed. Statistical analysis: Tables, proportions, diagrams and standard error of difference between two proportions z-test. Results: Out of the 148 PMPs, 143 could be covered by giving personal visits to their clinic for pre-interventional assessment.110 (76.93%) were males while 33 (23.07%) were females. The mean age of PMPs was 41.60 y. Around 60 percentages of PMPs were non- allopathic practitioners. Sensitization workshop was attended by 132 PMPs. Though no significant difference was observed in their assessment regarding etiology about TB, a significant and highly significant value was obtained after assessing their KAP regarding their diagnosis & referral for sputum diagnosis, categorization and treatment, DOTS provider and TB case management. Conclusion: The PMPs due to its non-involvement and non- reinforcement are lagging with the update knowledge. The PMPs who have attained their higher qualification before implementation of RNTCP (before year 2001) are in majority unaware of RNTCP r ecommendations: Public-Private partnership involving PMPs & private hospitals need to be strengthened by additional inputs in the form of incentives, free IEC materials and periodic modular training in RNTCP

Evaluation of Clinical Outcomes in Patients Undergoing Dual Vessel Percutaneous Coronary Intervention Using Sirolimus-Eluting Coronary Stent System in India

Introduction: Coronary artery disease is the most common catastrophic disease in India. The safety and effectiveness of dual vessel sirolimus-eluting stent (SES) implantation (used as an intervention in CAD) is currently unknown in Indian population. The purpose of this study was to investigate one year clinical outcomes of patients with dual vessel coronary artery disease after implantation of the Supralimus-Core SES, in a "real-world" setting. Materials and Methods: We evaluated 60 patients between April-2011 and August-2012, who underwent dual vessel percutaneous coronary intervention (PCI) with the Supralimus- Core SES implantation at the same index procedure. Dual vessels were defined as involvement of two major epicardial vessels (right, left anterior descending, circumflex, or left main coronary arteries) or one major epicardial vessel and a branch ( = 2.5 mm in diameter) originating from another major epicardial vessel. The primary endpoint was target lesion failure (TLF) defined as the composite of cardiac death, myocardial infarction (MI), and clinically-driven target lesion revascularization (TLR) at one year. Secondary endpoint included combined (definite, probable and possible) stent thrombosis (ST). Results: A total of 120 lesions were treated in 60 enrolled patients (mean age 56.0±9.2 y; 80.0% male) with average stent length of 23.1±8.5 mm. Among 60 patients, diabetes, hypertension and hypercholesterolemia were present in 15 (25.0%), 22 (36.7%) and 25 (41.7%) patients respectively. Indications for PCI were unstable angina in 30 (50.0%) patients and stable angina in 11 (18.3%) patients. Overall, 40 (33.3%) lesions were classified as complex (American College of Cardiology/American Heart Association type B2/C). The cumulative TLF rate was 5.0% (n=3) at one year. Cardiac death, MI and clinically-driven TLR occurred in 1 (1.7%), 0 (0%) and 2 (3.3%) patients, respectively at one year follow-up. The Kaplan-Meier curve of the freedom from overall events at one year was 95.0%. According to the Academic Research Consortium definition, there were no events of stent thrombosis during one year. Conclusion: Our study shows that, dual vessel Supralimus- Core SES implantation allows safe and effective treatment with low rates of TLF at one year follow-up in Indian population.

The Study of Efficacy, Tolerability and Safety of Theophylline Given Along with Formoterol Plus Budesonide in COPD

Subramanian, Ragulan, Apar Jindal, V.Viswambhar, Arun Babu.V

Background: Chronic obstructive pulmonary disease (COPD) is a common disease causing significant socioeconomic burden. COPD patients, commonly smokers develop resistance to inhaled steroids attributed to deficiency of histone deacetylase 2 (HDAC2). The study of relationship between systemic inflammation and functional performance demonstrated that increased CRP level is inversely related to six minute walk distance (SMWD) and Forced Expired Volume in one second (FEV1). Theophylline restores HDAC2 activity thereby unlocking steroid resistance and potentiating inhaled corticosteroids (ICS) action culminating in reduced airway inflammation and mortality. Aim: To study the effects of addition of Theophylline to the combination of Formoterol plus Budesonide on various objective and subjective parameters in moderate to severe COPD patients and to assess the safety profile of the combination. Setting and study design: A single blinded, prospective, randomized, placebo controlled study at a tertiary care hospital in Jaipur, India. Materials and Methods: Fifty eight patients diagnosed with moderate to severe COPD were randomized into two groups. Group A patients received Formoterol 24 µ g plus budesonide 800 µ g daily in divided doses along with Theophylline while group B patients received Formoterol 24 µ g plus budesonide 800 µ g daily in divided doses along with placebo tablets. Both groups were followed up on 15 th , 30 th & 60 th day. During every visit all patients were assessed subjectively (symptom scoring) and objectively (spirometry, CRP, SMWT) and adverse effects if any were recorded. The obtained data subject to statistical analysis using“Graph pad Instat3” software. Results: Statistically significant improvement with a decline in total symptom score (p < 0.0001) was found with respect to “Night symptoms”& “SOB on rising” in group A. Theophylline group showed significant improvement in SMWD and FEV1. Mean fall in CRP was greater in Group A (not statistically significant). No side effects requiring withdrawal of drug were noted with Theophylline. Conclusion: Addition of Theophylline to Formoterol plus Budesonide reduces dyspnea, improves exercise performance and pulmonary functions in moderate to severe COPD. Further studies are required to explore if reduced dosage would have equal efficacy with better safety and tolerability profile.

Plasma Levels of Uric Acid, Urea and Creatinine in Diabetics Who Visit the Clinical Analysis Laboratory (CAn-Lab) at Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

N.A.A. Amartey, K. Nsiah, F.O. Mensah

Introduction: Diabetes mellitus is one of the most common meta bolic diseases worldwide. This metabolic disorder contributes greatly to the significant proportion of the burden of renal damage and dysfunction. The aim of the study was to investigate the renal function of the diabetic patients who visit the Clinical Analysis Laboratory (CAn Lab) at the Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana. Materials and Methods: Demographic data as well as medical history were obtained through the administration of a questionnaire. Anthro pometric measurements were taken and blood samples were analysed for glucose, uric acid, urea and creatinine. Data collected were analysed using SPSS version 16.0. Results: A total of 34 diabetic patients, aged from 40 77 y were recruited, 22 (64.7%) of them were males with mean age of 57.40 ± 11.8 y (±SD), while 12 (35.3%) were females with mean age of 58.17 ± 7.47 y. There was a statistically significant difference between the mean duration of the disease, as the females had longer duration, 12.50 ± 6.95 y, as compared to 7.32 ± 4.48 y in males (p=0.033). The mean plasma creatinine level in the females was 84.17 ± 54.73 µmol/l. In the diabetic population, there was a positive correlation between age and plasma creatinine level, (r=0.375, p=0.029). In the female diabetics, there was a positive correlation between fasting blood sugar (FBS) and the measured metabolic end products (r>0.5, p<0.05), a positive correlation between body mass index (BMI) and uric acid (r=0.576, p=0.005) and a positive correlation between BMI and FBS (r= 0.625, p= 0.030). Conclusion: Our results on the parameters measured; show that the diabetic population was experiencing mild kidney dysfunction, compared to non diabetic controls.

Effect of Probiotic Containing Ice-cream on Salivary Mutans Streptococci (SMS) Levels in Children of 6-12 Years of Age: A Randomized Controlled Double Blind Study with Six-months Follow Up

Introduction: To evaluate the caries risk based on the salivary levels of streptococcus mutans in children of 6-12 years of age group before and after consuming probiotic ice-cream containing Bifidobacterium lactis Bb-12 and Lactobacillus acidophilus La-5. Materials and Methods: A double blind, placebo controlled trial was carried out in 60 children aged between 6 to 12 years with zero decayed, missing, and filled teeth (DMFT). They were randomly divided into two equal groups. Saliva sample were collected before the consumption of ice-cream and Streptococcus mutans count was calculated and recorded as baseline data. For the next seven days both the groups were given ice creams marked as A and B. Saliva samples were collected after ice-cream consumption at the end of study period and also after a washout period of 30 days and again after six months. Samples were inoculated and colonies were counted. Results: On statistical evaluation by students paired t-test, probiotic ice-cream brought significant reduction in the Streptococcus mutans count after seven days of ice-cream ingestion (p>0.001) and also after 30 d of washout period (p<0.001). There was no significant reduction (p=0.076) by normal ice-cream consumption. After six months of the study period in both the groups the salivary levels of Streptococcus mutans was similar to the baseline. Conclusion: Probiotic ice-cream containing Bifidobacterium lactis Bb-12 and Lactobacillus acidophilus La-5 can cause reduction in caries causative organism. The dosage of the probiotic organisms for the long term or synergetic effect on the oral health are still needed to be explored.

Prevalence of Clostridium Difficile Among Paediatric Patients in a Tertiary Care Hospital, Coastal Karnataka, South India

Sherin Justin, Beena Antony, K. Varadaraj Shenoy, Rekha Boloor

Introduction: The study was intended to analyse the burden of Clostridium difficile (C. difficile) and associated intestinal pathogens from children with diarrhoea who were hospitalized in a tertiary care teaching hospital of South India. Materials and Methods: Stool samples from 138 children with diarrhoea belonging to the age group 0-14 years were analysed by semi quantitative culture, latex agglutination and enzyme immunoassay for C. difficile . The associated intestinal pathogens were also detected from the specimens by standard procedures. Results: Stool samples of 138 children were tested during the period; 21 (15.22%) samples were culture positive for C. difficile and the isolates were confirmed by biochemical reactions. 9(6.52%) were positive by latex agglutination. EIA for C. difficile toxins A and B was done on all the stool specimens and 15 were found to be positive (10.87 %). According to the reference standard method employed in our study, 4 toxigenic C. difficile isolates (2.90%) were obtained from 138 specimens. Among the other intestinal pathogens, Escherichia coli predominated (22.46%). Rota virus was detected in 7.27% stool samples of children under the age of five years. Conclusion: The study shows the prevalence of C. difficile in hospitalized children in our locality which highlights the importance of judicious use of antibiotics and strict infection control measures

A Comparison of Platelet Count and Enrichment Percentages in the Platelet Rich Plasma (PRP) Obtained Following Preparation by Three Different Methods

Ram Sabarish, Vamsi Lavu, Suresh Ranga Rao

Introduction: Platelet rich plasma (PRP) represents an easily acces sible and rich source of autologous growth factors. Different manual methods for the preparation of PRP have been suggested. Lacuna in knowledge exists about the efficacy of PRP preparation by these different manual methods. Aims: This study was performed to determine the effects of centrifugation rate revolutions per minute (RPM) and time on the platelet count and enrichment percentages in the concentrates obtained following the three different manual methods of PRP preparation. Setting and design: In vitro experimental study. Materials and Methods: This was an experimental study in which platelet concentration was assessed in the PRP prepared by three different protocols as suggested by Marx R (method 1), Okuda K (method 2) and Landesberg R (method 3). A total of 60 peripheral blood samples, (n=20 per method) were obtained from healthy volunteers. Baseline platelet count was assessed for all the subjects following which PRP was prepared. The platelet count in the PRP was determined using coulter counter (Sysmex XT 2000i). Statistical Method: The mean of the platelet count obtained and their enrichment percentage were calculated and intergroup comparison was done (Tukey’s HSD test). Results: The number of platelets and enrichment percentage in PRP prepared by method 1 was higher compared to method 2 and method 3; this difference in platelet concentrates was found to be statistically significant (p < 0.05). Conclusion: The centrifugation rate and time appear to be important parameters, which influence the platelet yield. Method 1 which had lower centrifugation rate and time yielded a greater platelet count and enrichment percentage.

Relationship between Antimicrobial Consumption and the Incidence of Antimicrobial Resistance in Escherichia coli and Klebsiella pneumoniae Isolates

Introduction: Gram negative organisms are one of the major causes of nosocomial diseases. Development of resistance to antibiotics by these organisms increases their risk in clinical treatment of patients. It also affects morbidity and mortality hence needs to be monitored and controlled. Aim: The aim of the present study was to analyse the correlation between consumption of parenteral antibiotics and the rates of antimicrobial resistance among the Escherichia coli and Klebsiella pneumoniae isolates collected during Dec 2010 - Jun 2013 from JIPMER hospital. Materials and Methods: Consumption data of parenteral antibiotics in J01 category of Anatomical Therapeutic Chemical (ATC) in JIPMER was obtained and expressed in Defined Daily Doses (DDD) per 1000 inhabitants. Valid consumption and resistance data during the period Dec 2010 to Jun 2013 were obtained at 6 month intervals and were correlated to draw a relationship between antimicrobial consumption and its impact on drug resistance for Escherichia coli and Klebsiella pneumoniae. Results: Escherichia coli isolates showed high resistance for increased use of gentamycin and ciprofloxacin. Increase in antibiotic consumption increases the resistance for Escherichia coli except for amikacin. Among the Klebsiella isolates, meropenem and gentamycin showed high correlations followed by ceftazidime, amikacin, ceftriaxone and ciprofloxacin. Conclusion: In summary, a statistically significant association was noticed between consumption of the studied antimicrobials and resistance of Escherichia coli isolates, except for amikacin and ceftazidime. In the case of Klebsiella pneumoniae, there was a statistically significant association between the resistance rates and consumption of gentamycin, ceftazidime and meropenem. Further, a linear relationship was noted between antimicrobial consumption and resistant isolates of Escherichia coli and Klebsiella pneumoniae, except for Escherichia coli resistance to amikacin.

Changes in Transforming Growth Factor-ß1 in Gingival Crevicular Fluid of Patients with Chronic Periodontitis Following Periodontal Flap Surgery

Vignesh Vikram, Ramakrishnan T., Anilkumar K., Ambalavanan N.

Introduction: The aim of the study was to assess changes in Transforming Growth Factor– ß 1 (TGF- ß 1) levels in gingival crevicular fluid (GCF) and examine correlation of TGF- ß 1 levels and periodontal parameters: probing pocket depth (PPD) and clinical attachment level (CAL) in sites with chronic periodontitis at various time intervals before and after periodontal surgery. Materials and Methods: The effects of non-surgical and surgical therapy on periodontal parameters and GCF TGF- ß 1 levels in 18 sites affected with chronic periodontitis were assessed upto 6 weeks post conventional flap surgery. GCF was collected and PPD, CAL recorded at Baseline. GCF was collected and PPD, CAL recorded at Pre-surgery and flap surgery performed. GCF was collected from all sites at Two Weeks Post-surgery. GCF was collected and PPD, CAL recorded at Six Weeks Post-surgery. The concentration of TGF- ß 1 in GCF was determined using a human TGF- ß 1 enzyme immunometric assay kit. Results: Mean TGF- ß 1 concentrations were significantly reduced at Pre-surgery, at Two Weeks Post-surgery and at Six Weeks Post-surgery (p<0.05) when compared to Baseline TGF- ß 1 values. There was a statistically significant reduction in PPD and gain in CAL following non-surgical and surgical therapy when compared to baseline (p<0.05). Conclusion: Results indicate that TGF- ß 1 may play a role in the pathogenesis and diagnosis of periodontal disease and could be considered as a disease predictive biomarker.

Versatile but Temperamental: A Morphological Study of Palmaris Longus in the Cadaver

Asha Joselet Mathew, Tintu Thottiyil Sukumaran, Susan Joseph

Introduction: Palmaris longus (PL) is one of the most variable muscles in our body and is vestigial functionally. Its long tendon and its superficial location make it an ideal source for tendon harvesting. Variations such as absence, duplication and reversal have far reaching clinical impact. The aim of this study is to estimate the presence, variants and nerve supply of the PL. Materials and Methods: Upper extremity of 24 cadavers was dissected and PL was examined. The results were compared to other studies on the PL and literature survey was carried out. Results: Thirty nine specimens showed normal morphology and four showed complete agenesis. Other morphological variations seen included - reversed, hybrid, fusiform, fleshy and bifurcated tendon of insertion. Conclusion: Every surgeon must be aware of the variations of the versatile but temperamental PL. Prior knowledge of the layout of the muscle helps in planning intricate surgeries to which this tendon is put use to.

Cruciate Incision For Treatment of Primary/Recurrent Cases of Seroma/Hematoma of Pinna : A Novel Approach

Mahesh Bhat T, Vinay V Rao, David Rosario

Introduction: Seroma of pinna have a high predisposition for recurrence. Its surgical management requires excision of cartilage and perichondrium which can cause scarring, deformity of pinna, perichondritis and abscess formation, postoperatively.The aim of the current study is to the access the outcome of a novel approach using cruciate incision for surgical treatment of seroma/ hematoma of pinna. Materials and Methods: Study was conducted at Father Muller Medical College in the Department of Otorhinolaryngology for a period of three months between January 2014 to March 2014 during which period 30 patients with seroma of the pinna were taken up for the study. Procedure was done under local anaesthesia with all aseptic precautions. A cruciate incision was given over the most dependent part of the swelling and flaps were raised. The collection was drained and the under surface of the flap was scraped using Rosen’s knife followed by pressure dressing for three days. Patients were followed up for three months. Results: A total of 30 patients with seroma were studied. Out of the 30 cases 24 were primary cases and 6 were recurrent cases. Majority of the patients were in the age group 41-50 y. Out of 30 patients 18 were males and 12 were females. Out of 30 patients studied, none of them had recurrence. Four patients however developed perichondrial reaction with pain and inflammation which required analgesics and antibiotics. In 6 cases a thickening of the auricle at the site of incision was noticed which resolved over a period of 4 to 5 months. Overall cosmetic deformity was negligible with most of the patients showing a negligible scar after 6 months of follow up. Conclusion: Cruciate incision is a good technique for treatment of seroma and hematoma of pinna as the outcome is good with no recurrence.

Effect of Yoga Module on Pro-Inflammatory and Anti-Inflammatory Cytokines in Industrial Workers of Lonavla: A Randomized Controlled Trial

Pratibha Hemant Rajbhoj, Sanjay Uddhav Shete, Anita Verma, Ranjit Singh Bhogal

Introduction: Inflammatory markers play a very important role in body’s defense mechanism. Pro-inflammatory markers and anti-inflammatory markers counterbalance each other. It is extremely essential for the body to maintain their balance for a good immune response. Objectives: To study the effect of yoga practices on selected pro-inflammatory and anti-inflammatory cytokine among industrial workers. Materials and Methods: Forty eight male study participants, aged 30-58 years, were randomly divided into experimental (n=24) & control (n=24) groups. Pro-inflammatory cytokine IL-1ß and anti-inflammatory cytokine IL-10 were evaluated at the baseline and at the end of 12 wk of yoga training in both the groups. During the experimental study, all the study participants continued with their daily lifestyle and diet. Data were analysed using paired t-test and independent t-test. Results: The result of within group comparison revealed that the yoga group showed a significant decrease in IL-1 ß while significant increase in IL-10 (p < 0.05), whereas the control group revealed no change in IL-1 ß (p > 0.05) and IL-10 (p > 0.05). Further, the results between the groups confirmed that the yoga group had significantly lower level of IL-1 ß and increase in IL-10 as compared to control group (p < 0.05). Conclusion: The present study has demonstrated that yoga practices could reduce pro-inflammatory cytokine and increase anti-inflammatory cytokine in industrial workers.

Effect of Intra–Orifice Barriers on the Fracture Resistance of Endodontically Treated Teeth – An Ex–Vivo Study

Introduction: The purpose of this study was to evaluate and compare the fracture resistance of roots obturated with guttapercha using bonded amalgam, GC Light cure GIC (resin modified glass ionomer cement) and Tetric N Flow (flowable hybrid composite) as different intra orifice barriers. Materials and Methods: Eighty freshly extracted mandibular premolars with straight roots were reduced to 14 mm from the coronal aspect. All canals were enlarged to size 30 and specimens were obturated with gutta percha cones, except for control group specimens the coronal 3 mm of root fillings of all other group specimens were removed with the aid of heated plugger. All samples were randomly divided into 4 groups of 20 specimens each. They were control, Fuji GC LC GIC, Tetric N Flow and Bonded Amalgam. After the placement of the intra orifice barrier materials, specimens stored at 37oC and 100% humidity for one week to allow the materials to set completely. After one week, all the groups were subjected to fracture resistance testing by using Universal testing machine. Results: Data was analysed for significance by ANOVA (Analysis of variance) and further pair wise comparison was performed by Benferroni test. Level of significance was taken as 0.05. Tetric N Flow group showed better fracture resistance as compared to all other groups and Control group is least among the groups. Fracture resistance of Tetric N Flow compared with bonded amalgam was statistically significant. Conclusion: Tetric N Flow and Fuji GC LC GIC can be used as intra-orifice barriers with good fracture resistance in endodontically treated teeth.

A Morphologic and Morphometric Study of Foramen Vesalius in Dry Adult Human Skulls of Gujarat Region

Binita B. Raval, Praveen R. Singh, Jaba Rajguru

Introduction: The foramen Vesalius is located within bony plate between the foramen ovale and the foramen rotundum in the floor of middle cranial fossa. This foramen allows passage of emissary veins which communicate cavernous sinus and pterygoid plexus of veins. AIM: To study the morphological and morphometric variations of foramen Vesalius in dry adult human skulls. Materials and Methods: One hundred and fifty dry adult human skulls were studied for variations in size, shape, presence/absence and any duplication/multiplication of the foramen Vesalius. After collecting data, appropriate statistical analysis was done. Results: The mean maximum dimension of foramen Vesalius was 0.98±0.67 mm on right side and 1.12±0.73 mm on left side. Foramen Vesalius was present in 90 (60%) skulls out of 150 observed. The incidence was 41(27.33%) on right side and 49 (32.67%) on left side. Foramen Vesalius was present unilaterally in 32 (35.56%) and bilaterally in 29 (32.23%) out of 90 skulls. Duplication of this foramen was observed in two skulls (one right side and one on left side). Foramen Vesalius was round in 72%, oval in 24% and irregular in 4% of total foramina present. Conclusion: Foramen Vesalius was present in 60% of total skulls studied. The foramen showed variations in incidence and shapes, while there was no statistically significant difference in the maximum dimension between foramen Vesalius on right and left side. There could be some developmental reasons to explain these variations. The findings of this study could be important to anatomists and also equally essential for clinicians who approach middle cranial cavity for various procedures.

Incidental Findings on Cone Beam Computed Tomography and Reasons for Referral by Dental Practitioners in Indore City (M.P)

Introduction: Cone beam computed tomography is a new diagnostic innovation to dental imaging. Despite the use of CBCT in oral and maxillofacial imaging, reports on its use either by individual practitioners or referral patterns to CBCT centers is lacking. Hence, a study was conducted to determine incidental findings on CBCT and reasons for referral by dental practitioners in Indore city. Materials and Methods: A retrospective analysis of 795 records that were referred for CBCT imaging at Institutional and Oracal CBCT Centre, Indore was undertaken. Referrals from both within and outside institution, as well as from private practitioners were considered. The reason for CBCT referral, provision diagnosis, final diagnosis and any incidental diagnosis were recorded. Results: This retrospective chart audit revealed that 56.7 % were male and 43.3% were females. Greatest source of patients was referred by oral surgeons (21.9%) followed by oral and maxillofacial radiologist (14.2%) and prosthodontist (9.3%). The most common reason for referral was for implant analysis (24.2%) and the most common incidental finding diagnosed by CBCT was oral malignancies. Conclusion: In Institutional set-up, CBCT referrals were mostly for the reason of planning implant placement followed by trauma whereas private practitioners used CBCT mostly for implant placement followed by impaction. CBCT was being utilized more by Oral surgeons in private sector whereas it in an Institutional setup majority of referrals from Department of Oral Diagnosis and Radiology. Findings that were most commonly diagnosed incidentally on CBCT were Orofacial malignancies followed maxillary sinus pathologies.

Evaluation of Periodontal Risk in Adult Patients using Two Different Risk Assessment Models – A Pilot Study

Objective: The aim of the present study was to evaluate the periodontal risk of individuals using periodontal risk assessment (PRA) model and modified PRA model. Materials and Methods: A total of 50 patients with chronic periodontitis, age 30-60 years were selected randomly and charting of the periodontal status was performed and those who met the inclusion criteria were enrolled in the study. Parameters recorded were- percentage of sites with bleeding on probing (BOP), number of sites with pocket depths (PD) = 5mm, number of the teeth lost, bone loss (BL)/age ratio, Clinical attachment loss(CAL)/age ratio, diabetic and smoking status, dental status, systemic factors like diabetes were assessed. All the risk factors were plotted on the radar chart in (PRA) and (mPRA) models, using Microsoft excel and periodontal risk were categorized as low, moderate and high risk. Results: Among 50 patients 31 were in low risk, 9 in moderate risk, and 10 in high risk identified by modified (PRA) model, whereas 28 patients were in low risk, 13 in moderate risk and 9 in high risk identified by (PRA). Statistical analysis demonstrated that there was no significant difference between the risk scores (X² = 0.932 with degree of freedom = 2, P = 0.627). Conclusion: Both the periodontal risk models are effective in evaluating the risk factors and can be useful tool for predicting proper diagnosis, disease progression and therapeutic strategies during the supportive periodontal therapy.

The Comparative Evaluation of the Translucency of Crowns Fabricated with Three Different All-Ceramic Materials: An in Vitro Study

Y. Sravanthi, Y.V. Ramani, Asha M. Rathod, Sabita M. Ram, Hetal Turakhia

Introduction: All-ceramic crowns with different core materials of different strength and aesthetics are available in recent years. The aesthetics of the crown depends mainly on the shade and translucency. Clinician should be aware of the quality and characteristics of these materials so that they will be able to opt for good material for successful clinical use. Aim and Objective: The aim of this study was to evaluate and compare the translucency of crowns fabricated with three different commercially available all-ceramic materials viz. Alumina - CAD-CAM Procera, Lithium disilicate - Pressable IPS e.max Press, Zirconia - CAD-CAM Lava. Materials and Methods: All-ceramic crowns (5 per each group and total of 15 samples) were made of Alumina – CAD-CAM Procera (Group I), Lithium disilicate – Pressable IPS e.max Press (Group II), Zirconia – CAD-CAM Lava (Group III) and veneered with their respective layering ceramic. Evaluation for the Translucency (CR=Yb/Yw) over the White (Yw) and Black (Yb) backgrounds at the Incisal, Middle, Cervical, Mesial and Distal thirds of each crown were done using the Spectrophotometer. The results obtained were statistically analyzed by Paired t-test (p<0.05) and Analysis of Variance (p<0.05) for the test of significance among the groups. Results: Significant differences in the contrast ratios were obtained among the three Groups (p<0.001). In this study, Group II Lithium disilicate–Pressable IPS e.max Press showed higher translucency (0.54). Group III Zirconia – CAD-CAM Lava showed the least translucency (0.75) and the translucency of Group I Alumina – CAD-CAM Procera (0.7) was in between both the groups. Conclusion: Translucency of material gives fair idea to clinician for the choice of material in different zones during replacement and suitability for restoration in aesthetic zone. Selection of all ceramic system depends on the translucency needed for successful prosthesis of artificial tooth so that it mimics patient’s natural dentition. The qualitative measurement of translucency will give the evidence for the clinicians during selection of high or low value translucent tooth for successful replacement. Lithium disilicate – Pressable IPS e.max Press is having better translucency in comparison with other two materials in our study.

In Vitro Fractional Inhibitory Concentration (FIC) Study of Cefixime and Azithromycin Fixed Dose Combination (FDC) Against Respiratory Clinical Isolates

Introduction: Acute respiratory infections (ARI) contribute to more than 75% of health care seeking in primary health care facilities in India. Respiratory tract infections (RTIs) are managed frequently by ß-lactam, macrolide and fluroquinolone class of antibiotics. However, these recommended classes of antibiotic have shown resistance in community settings. Antibiotic combinations may provide broader spectrum not only in terms of coverage but also to overcome multiple resistance mechanisms overcoming individual class limitations. Aim: The study aimed to determine In vitro interactions interpreted according to calculated fractional inhibitory concentration (FIC) index between cefixime and azithromycin against common respiratory clinical isolates. Materials and Methods: Forty four bacterial respiratory clinical isolates from microbiology department of tertiary care hospital from Mumbai were used to determine the minimum inhibitory concentration (MIC) values of cefixime and azithromycin. Synergy testing of cefixime combination with azithromycin was performed by checkerboard method. Interaction was determined according to calculated FIC index. Results: MIC values were ranging from 2–128 µg/ml and 0.24–128 µg/ml for cefixime and azithromycin respectively against K.pneumoniae, M.catarrhalis, S.pneumoniae and H.influenzae isolates. All the tested isolates were resistant to cefixime. Azithromycin resistance was noted in all the isolates except six M. catarrhalis isolates. FIC index showed synergy and additive effect in 66% (29/44) and 34% (15/44) all bacterial clinical isolates. Maximum synergy between cefixime and azithromycin was observed against K. pneumoniae in 91% isolates. Conclusion: This is one of the first attempts to check the rationality of fixed dose antibiotic combination of cefixime and azithromycin in India market. Though results of this study cannot be generalized considering the limitations of low sample size and in vitro model, our data provides stepping stone for further validation of cefixime and azithromycin fixed dose combinations (FDCs) in clinical setting by conducting randomized controlled trials. We think that judicious and rational use of FDCs may help to reduce the risk of selection of further drug resistance along with better clinical outcome.

Optical Coherence Tomography Assisted Retinal Nerve Fibre Layer Thickness Profile in High Myopia

Introduction: To evaluate the association of high myopia with retinal nerve fibre layer (RNFL) thickness by Fourier domain optical coherence tomography (FD OCT). Materials and Methods: Fifty highly myopic eyes (25 patients) and forty emmetropic eyes (20 Normal subject) were randomly selected after excluding concomitant ophthalmic disorder and RNFL thickness measured using the Fourier domain optical coherence tomography (FD OCT). Results: The overall mean RNFL thickness in the myopic groups and control were 87.89 µm and 111.64 µm respectively. The mean retinal nerve fibre thickness was significantly less in myopic eyes as compared to control group (p =0.0001). Retinal nerve fibre layer thickness shows topographic double hump pattern in both the groups (myopes and emmetropes). Conclusion: Retinal nerve fibre thickness was significantly less in myopic eyes as compared to emmetropic eyes. The retinal nerve fibre layer thinning in high myopes may be confused with open angle glaucoma, a disease also prevalent in high myopes. There is therefore a need to have retinal nerve fibre layer thickness normogram for high myopes of a given population group to avoid wrong interpretation.

Comparison of Diagnostic Accuracy of Conventional Intraoral Periapical and Direct Digital Radiographs in Detecting Interdental Bone Loss

Background: Periodontitis is an inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms, resulting in destruction of the periodontal ligament and alveolar bone. Progressive loss of alveolar bone is the salient feature of periodontal disease. Accurate detection of periodontal disease with the use of radiographs helps in diagnosis, treatment and prognosis. Aims: The present study aims to compare the efficacy of conventional intraoral periapical (IOPA) and direct digital radiographs (RVG) in detecting interdental alveolar bone loss using intrasurgical (IS) measurements as the gold standard. Materials and Methods: Thirty patients elected to undergo periodontal flap surgery with periodontitis computing to 60 interdental alveolar defects on mandibular first molars were considered. IOPA and RVG were captured using standardized techniques. Bone loss measurements in IOPA and RVG were compared to the IS measurements. Statistical Analysis: Statistical analysis was carried out using student t test and ANOVA with the help of SPSS software and p-value <0.05 was considered as significant. Results: Both IOPA and RVG underestimated the bone loss measurements when compared to IS measurements which was statistically significant (p<0.0001). Bone loss measurements in RVG were closer to IS measurements than IOPA. Conclusion: Both the radiographic techniques IOPA and RVG underestimated bone loss by 1.5–2.5 mm. RVG was superior to IOPA for the detection of interdental bone loss due to reduced time and radiation exposure to obtain the same diagnostic information.

A Comparitive Study to Evaluate the Role of Serum Lipid Levels in Aetiology of Carcinoma Breast

Vipan Kumar, Amandeep Singh, D S Sidhu, K M D S Panag

Introduction: Breast cancer is the most common occurring cancer in women worldwide. Various factors that have lead to change in lifestyle are thought to be associated with increase in breast cancer incidence in Asian countries. Several clinical studies suggest the prognostic significance of serum lipid levels in breast cancer. Present study was planned to confirm the association of lipids levels with breast cancer. Materials and Methods: Lipid analyses was carried out on serum samples from 100 breast cancer patients and 100 control women, with a age group of 25 y and above. The case & control group included 50 premenopausal women and 50 postmenopausal women. Results: Patients of study group had high Low density lipoproteins (LDL) (p-value - 0.00), Triglycerides (TG) (p-value -0.001) and Total cholesterol (TC) (p-value -0.00) as compared to control group. There was no association of VLDL (p-value -0.436) and HDL (p-value -0.797) among study group and control group. There was no association of lipid levels in different grades of carcinoma. Conclusion: High levels of LDL, TG and TC were associated with breast cancer. However, no association was there in different grades of carcinoma. So it may be concluded that, LDL, TG and TC may be having some role in aetiology of breast cancer. Therefore, early detection and control of these factors may help in reducing the incidence of breast cancer and ultimately social and economic burden on society.

Relationship Between Occlusal Plane and Three Levels of Ala Tragus line in Dentulous and Partially Dentulous Patients in Different Age Groups: A Pilot Study

Saquib Ahmed Shaikh, Lekha K., Gaurav Mathur

Statement of problem: Correct orientation of the occlusal plane plays a vital role in achieving optimal aesthetics, occlusal balance and function of complete dentures. The use of ala tragus line for determination of occlusal plane has been a topic of debate over past many years. Also, the effect of age on level of ala tragal line has not been investigated in the past. Purpose: To determine the effect of age on location of Ala-Tragus line. Materials and Methods: A total of 180 patients (90 males and 90 females) were selected with complete dentition and were grouped according to their age in three age groups with 60 subjects in each age group (Group A: 20-35 y, Group B: 36-50 y, Group C: 51-65 y). Right lateral profile photographs were taken with subjects having fox plane placed intraorally parallel to occlusal plane. Reference points corresponding to inferior border, middle or superior border of tragus and inferior border of ala of nose were marked on photographs. These were joined to get three different levels of Ala-Tragus line. Images were analysed photometrically and most parallel relationship was determined in between arms of fox plane (that represented the occlusal plane) and three different levels of ala tragus line. Data obtained was subjected to statistical analysis using Pearson chi-square and Likelihood-ratio chi-square test. Results: Significant correlation was found between age and level of Ala-Tragus line. The occlusal plane was found to be more parallel to Ala-tragus line when inferior border of tragus was considered as posterior reference point in young adult age group (20-35 y). In older age groups, occlusal plane was found to be more parallel to Ala-tragus line when middle of tragus was considered as posterior reference point. Conclusion: Within the limitations of this study, it can be concluded that a definite relationship exists in between age and level of ala tragus line.

Study on Serum Cortisol and Perceived Stress Scale in the Police Constables

Sanjeev S. Walvekar, Jeevan G. Ambekar, Basavaraj B. Devaranavadagi

Introduction: The occupational stress may be more among the police constables. Under the stressed conditions, the body secretes more Cortisol. Elevated serum cortisol levels significantly correlate with the symptoms of metabolic Syndrome. Perceived stress scale (PSS) is the most widely used psychological tool for measuring the perception of stress. The objective of this study was to examine the association between perceived stress and Serum Cortisol and also to explore stress as an occupational risk factor which may lead to metabolic syndrome. Materials and Methods: We measured Serum Cortisol, Lipid profile, Blood Glucose and HbA1c in both Police constables and the general population. Also to evaluate the occupational stress, the questionnaire consisting of Perceived stress scale -14 items was used. Results: A positive correlation was found between Serum Cortisol and perceived stress scale, Blood Glucose, HbA1c. The biochemical parameters were found to be elevated in police constables compared to controls. It was found that among 108 policemen, 38% were confirmed with cardiometabolic syndrome. Conclusion: The relation between Serum Cortisol and perceived stress scale indicates the severity of occupational stress the police constables are experiencing. So the occupation based health program for lifestyle changes, modification in job related rules and regulations will help to avert further complications and keep police personnel healthy.

Variations of Gonadal Veins: Embryological Prospective and Clinical Significance

Raman Gupta, Anupma Gupta, Navita Aggarwal

Introduction: An adequate knowledge of anomalies of gonadal veins will help the radiologists and surgeons in recognition and protection of these veins which play major roles in thermo-regulation that is essential for the efficient functioning of testis on which the survival of the human species depends. Aim: The aim of this work is to present an analysis of the anatomical variations of gonadal veins. An effort has also been made to explicate the possible embryological model of development of such variants and to present the variable clinical aspects concerning them. Materials and Methods: Gonadal veins in 60 dissection room cadavers were examined for variations from the classic anatomic description. Result: In the present study, out of 60 cases, male: female ratio was 2:1(40:20) in which no variation was found in ovarian veins. In the 18 (45%) cases, testicular veins showed variations which consist of duplication and atypical drainage. Discussion: Variations of drainage of gonadal vein are due to error of embryological development in venous shift and alteration in anastomotic channel of post-cardinal, supra-cardinal and sub cardinal veins. Conclusion: The gonadal veins present numeric variations as well as variations in its site of drainage, which attributed to the various pathological conditions as varicocele and pelvic congestion syndrome, leading to infertility in patients. Hence, in -depth knowledge of these developmental anomalies of gonadal veins is important.

Evidence of Paternal N5, N10 - Methylenetetrahydrofolate Reductase (MTHFR) C677T Gene Polymorphism in Couples with Recurrent Spontaneous Abortions (RSAs) in Kolar District- A South West of India

Shiny Vinila, Dayanand C.D., Pushpa F Kotur, Moideen Kutty A, Pradeep Kumar Vegi

Introduction: Recurrent spontaneous abortion (RSA) is a multifactorial clinical obstetrics complication commonly occurring in pregnancy. Many research studies have noted the mutations such as C677T in N5, N10 - Methylenetetrahydrofolate reductase (MTHFR)gene which is regarded as RSA risk factor. This study was carried out to determine the occurrence of frequency of C677T of the MTHFR gene mutations with RSA. Aim: The purpose of present study is to determine the frequency of MTHFR C677T polymorphisms in couples with recurrent pregnancy loss and the impact of paternal polymorphisms of MTHFR C677T in recurrent pregnancy loss in population of couples living in Kolar district of Karnataka with RSA. Design: A total of 15 couples with a history of two or more unexplained RSA were enrolled as subjects in the study and a total of 15 couples with normal reproductive history, having two or more children and no history of miscarriages were enrolled as controls. Materials and Methods: DNA extraction from samples case and control group couples and its quantification by Agarose gel electrophoresis, assessment of DNA purity, MTHFR C 677T gene mutation detection by PCR-RFLP method. Statistical analysis: Carried out by web based online SPSS tool. Results: The frequency of C677T genotype showed homozygous wild type CC (80%), heterozygous CT type (13.3%) and homozygous mutation TT type (6.67%) observed in males. Similarly from female’s homozygous wild type CC (86.6%), heterozygous type (13.3%), and homozygous type mutations TT (0%) was recorded. In couple control groups, we observed homozygous wild type CC (86.6%), heterozygous CT type (13.3%) and homozygous type mutations TT type (0%). Conclusion: We noticed a high frequency of MTHFR specifically T allele associated with paternal side.Therefore, the present study indicated the impact of paternal gene polymorphism of MTHFR C677T on screening in couples with recurrent pregnancy loss.

Effect of Cell Phone Use on Salivary Total Protein, Enzymes and Oxidative Stress Markers in Young Adults: A Pilot Study

Introduction: The present study aimed to assess the levels of salivary enzymes, protein and oxidant-antioxidant system in young college-going cell phone users. Materials and Methods: The cell users (students) were categorized in to two groups – less mobile users and high mobile users, based on the duration and frequency of cell use. Unstimulated whole saliva samples of the volunteers were analysed for amylase, lactate dehydrogenase (LDH), malondialdehdye (MDA) and glutathione (GSH). Results: High mobile users had significantly higher levels of amylase (p = 0.001), LDH (p = 0.002) and MDA (p = 0.002) in saliva, when compared to less mobile users. The marginal decrease in salivary total proteins, GSH and flow rate were statistically not significant (p >0.05). Conclusion: Significant changes in salivary enzymes and MDA suggest adverse effect of high use of cell phones on cell health.

A Glimpse Towards the Vestigiality and Fate of Human Vermiform Appendix-A Histomorphometric Study

Aniruddha Sarkar, Anubha Saha, Sanchita Roy, Santanu Pathak, Shyamash Mandal

Introduction: The vermiform appendix in human is considered to be a vestigial organ by most of the authors. Absence of appendix is already reported in Indian population. Whether the human appendix is performing any function is debatable but when present it can create trouble. So if there is no appendix we can escape the ill-effects of the organ. With this hope the study has been done to see whether the appendix is really going to be rudimentary or absent or not. Marerials and Methods: Length, external diameter, number of lymphoid follicles, maximum diameter of the follicle or submucous coat, thickening of the muscle coat and seromucosal thickening of freshly removed appendix from human cadavers were seen. After fixation in 10% formal saline tissues were stained with haematoxylin-eosin stain and photographs were taken. The results had been tabulated and statistically correlated. Result: The parameters like number of lymphoid follicles, length and diameter all are changed as per the age advancement which is strictly indicating some functional activities of the organ which is against the idea of vestigiality of the appendix. Conclusion: Human appendix cannot be called a vestigial organ unless the functional inactivity is proved. Lymphoid changes which occur after birth to provide the gut immunity is needed to be proved by further studies. There might be incidental absence or rudimentary appendix in human body, but that does not indicate that we would not have any appendix in future.

Skin and Soft Tissue Infections due to Shewanella algae – An Emerging Pathogen

Srinivas Jampala, Pillai Meera, Vinod Vivek, Dinesh. R. Kavitha

Introduction: Shewanella spp. are emerging human pathogens, the predominant species being Shewanella algae. Shewanella skin and soft tissue infections are more commonly seen in immunocompromised patients with a pre-existing cutaneous ulcer and most often associated with exposure to marine environments. Aim: The study was conducted to investigate the epidemiological and clinical characteristics of Shewanella skin and soft tissue infections (SSTIs) for a period of five years. Materials and Methods: All Gram-negative non-fermenting motile isolates which produced pigmented colonies and positive for oxidase and H2S were further identified with Vitek 2 system. Results: A total of 16 patients with SSTIs due to Shewanella species were identified during the period from 2010 to 2014. Majority of patients were urban, elderly and fisher men. Shewanella algae (n=12, 75%) was the predominant isolate. Skin or mucosal portal of entry was found in all patients and seawater contact was recorded in 56.25% of the patients. 81% of infections were polymicrobial, common concomitant pathogens being gut and marine flora. Peripheral vascular diseases were the predominant risk factors with comorbidities like diabetes, hypertension and hepatobiliary diseases. Third generation cephalosporins, meropenem and gentamicin were the most effective antibiotics while two of the isolates were multidrug resistant. 75% of the infected patients recovered completely and three patients died of complications. Conclusion: Shewanella algae should be considered as an emerging pathogen of SSTIs mainly in patients with chronic ulcers and at times be multidrug resistant. These infections have a good clinical outcome if prompt medical, surgical and supportive treatment is offered.

Outcome of Ovarian Drilling in Women with Polycystic Ovary Syndrome

Niraj K Yanamandra, Sirisha Rao Gundabattula

Objective: To determine the effectiveness and safety of laparoscopic ovarian drilling (LOD) in inducing ovulation in women with polycystic ovary syndrome (PCOS) who failed to conceive after medical methods of ovulation induction. Materials and Methods: A retrospective study of all women who underwent LOD as a treatment for anovulatory infertility between January 2010 and December 2011 was conducted. Women diagnosed to have PCOS by the Rotterdam criteria were considered for the study. Those who had PCOS but were associated with male factor infertility, deep infiltrating endometriosis and submucous fibroids were excluded. Results: A total of 43 women underwent LOD during the study period. Majority were aged 26 to 30 years and two-thirds were overweight or obese. Most (72%) of them had primary infertility. Other factors which could have contributed to infertility such as superficial endometriosis, septate uterus and unilateral tubal block were observed in 30.2% of the women, which were dealt with concomitantly. When we excluded the 14% who were lost to follow up, 23 of 43 (53.5%) women achieved pregnancy and almost 70% of them did so within the first 6 months. None of our study population had ovarian hyperstimulation or multiple pregnancy. Conclusion: LOD thus not only helps in regulating ovulation and enhancing conception rates but also provides an opportunity to assess the pelvis for other potential causes of subfertility which could be treated at the same time. We therefore believe that diagnostic hysteroscopy and laparoscopy should be offered quite high-up in the hierarchy of infertility investigations and treatment.

To Evaluate the Different Rapid Screening Tests for Diagnosis of Leptospirosis

Tanvi Panwala, Sangeeta Rajdev, Summaiya Mulla

Introduction: Leptospirosis is an acute febrile disease, in tropical and sub-tropical regions of world. It has been under-reported in India, due to presence of non-specific symptoms and unavailability of appropriate laboratory diagnostic facilities in most part of the country. The diagnosis of leptospirosis is usually based on demonstration of antibodies by different serological tests. Aim: The present study aims to evaluate and compare commercially available rapid test. Design and Settings: Case control study. Materials and Methods: Three screening tests (Leptocheck WB, Latex agglutination test and SD leptospira) were compared by using 100 serum samples randomly obtained from clinical cases of Leptospirosis admitted in new civil hospital, Surat, Gujarat. All the patients with acute Leptospirosis were included in this 4-months pilot study from July 2011 to October 2011. All the results were compared with IgM ELISA and MAT for confirmation of diagnosis. Results: Leptocheck WB, Latex agglutination test and SD leptospira had sensitivities of 84.8%, 84.8% and 72.7% & specificities of 37.3%, 71.2% and 71.2% respectively as compared to MAT. Leptocheck WB, Latex agglutination test and SD leptospira had sensitivities of 90.7%, 89.7% and 53.7% & specificities of 93.4%, 90.9% and 60% respectively as compared to IgM ELISA. Conclusion: Latex agglutination test kit and Leptocheck WB were found to be highly sensitive and specific. Neither of these tests require specialized equipment, and could be performed in peripheral laboratories with relatively little expertise.

Identification of Predictable Biomarkers in Conjunction to Framingham Risk Score to Predict the Risk for Cardiovascular disease (CVD) in Non Cardiac Subjects

Rama Krishna Reddy Y.V., Jaideep Mahendra, Prema Gurumurthy, Jayamathi, Sai Babu

Introduction: Although the cardiovascular disease (CVD) burden is rising in different countries, the morbidity and mortality rate is not reduced to much extent because of lack of application of the biomarkers for diagnosing CVD. Hence, we aimed to establish the predictable biomarkers in conjunction to framingham risk score in order to predict the risk for CVD in non cardiac patients. Materials and Methods: Three hundred subjects were screened for the study who came for the master health checkup. Out of them 50 patients were excluded as they were under medication. 23 patients were excluded due to various systemic diseases like fever and infection etc. The remaining of 227 patients with age range of 30-80 y was randomly selected for investigation. These subjects were divided into four different groups: Group I – controls with age range: 30-60 y (n=50) these subjects were free from all the systemic ailments and risk factors. Study groups comprised of Group II - (n=44) with age range: 30-40 y, Group III - (n=50) with age range: 41-50 y and Group IV - (n=83) with age range: 51-80 y. Patients with different risk factors without medication participated as study groups. Routine biochemical parameters were analysed using fully automated analyser and atherosclerotic biomarkers was analysed using ELISA kit. In addition to this, framingham risk scores was calculated in all the groups, for 30 y risk prognosis for CVD. Results: The atherosclerotic biomarkers such as E-selectin, Leptin, osteoprotegerin (OPG) and Ox-LDL were elevated among the study groups as compared to control group. Pearson correlation showed a significant association between the individual risk score (30 y framingham risk for CVD) of individuals, and the above biomarkers. The Receiver operating curve (ROC) analysis also showed a greater area under curve with higher sensitivity and specificity. Conclusion: We conclude the application E-Selectin, leptin, OPG and Ox-LDL as biomarkers along with the framingham risk scores in prediction risk for CVD in the individuals with subclinical atherosclerosis. It is more reliable and predictable as compared to the individual biomarkers alone.

Study of Morphometry of Carotid Canal in Skulls of South Indian origin

Vidya C S, Shamasundar N M

Background: The internal carotid artery supplies the anterior part of the brain, the eye and its appendages and sends branches to the forehead and nose.Carotid canal is a curved channel in the petrous temporal bone through which internal carotid artery enters the skull. Aim: In the present study 20 skulls of unknown sex were considered. The morphometric study of carotid canal was studied by direct bone method and by silicone cast method. The present study aimed to show the differences of measurements by two methods and the silicon cast method is of its kind to measure the length of the carotid canal. Materials and Methods: Carotid canal were measured at three different levels by both methods. Length of carotid canal to bend, diameter at the bend, length from the bend to foramen lacerum. The data was analysed for all the measurements of two methods and comparison of mean and SD at three different levels was done.Significant difference between two methods at three different levels was observed. Independent sample t-test was applied for total length of carotid canal. Results: By observation there is a mean significant difference between two methods in the measurements of carotid canal from lower opening till the angulation on left side of the skull.The study showed that there is a bilateral significant difference in measurements of diameter between two methods. There was no significant difference observed in total length of the canal in both left and right sides. Conclusion: Morphometrical details of the canal are of great significance to neurosurgeons and otologists. Silicon cast method was cost effective and much easier method to study the length and measurements of caroti

Microleakage Evaluation Around Retrograde Filling Materials Prepared Using Conventional and Ultasonic Techniques

Pragna Mandava, Nagesh Bolla, Jayaprakash Thumu, Sayesh Vemuri, Sunil C.H.

Introduction: The importance of the retrograde cavity preparation and the material used to restore is of utmost importance to achieve successful surgical endodontics. Aim: The aim of the present study is to evaluate the apical microleakage of root end cavities filled with Mineral trioxide aggregate, Biodentine and light cure GIC using two different cavity preparation techniques that is conventional bur preparation and ultrasonic tip preparation. Materials and Methods: Eighty extracted single rooted human teeth (except mandibular incisors) with one canal, fully developed apices and without any major carious lesion are collected for the study. The teeth were sectioned at CEJ to standardize the length. Roots are instrumented upto master apical file 40 K size and obturated with gutta percha and AH plus sealer in lateral condensation technique. The teeth were then resected apically at 90° angle axis to the long axis of the root removing 3 mm of the apex. The teeth were divided in to four groups of 20 each- • Group I- samples restored with MTA. • Group II- samples restored with Biodentine. • Group III- (Positive control group)- samples restored with Light activated GIC. • Group IV - (negative control group)- no filling material. Each group is divided into two subgroups (a, b) of ten teeth each 1. Retropreparation done with ultrasonic retrotip. 2. Retropreparation done with conventional bur. The teeth were then immersed in 0.5% Rhodamine B dye for 48 h. The teeth were split longitudinally and the interface between the restored material and the canal wall is observed under Confocal laser scanning microscope. Depth of dye penetration was examined under stereomicroscope. Results: The statistical analysis was performed by One way ANOVA, t test. Pair wise comparision was done by Newman – Keuls multiple post hoc test. The mean values of Dye penetration for Group Ia (321.23), Group Ib (490.11), Group IIa (1065.14), Group IIb (1170.96), Group IIIa (1888.90), Group IIIb (2025.35). The samples prepared with ultrasonic retrotip showed less microleakage but it is statistically not significant. Conclusion: MTA showed significantly less microleakage when compared to Biodentine and light cure GIC and there is no statistical difference between the ultrasonic retrotip preparation and conventional bur preparation.

Comparison of Time Required by D-RaCe, R-Endo and Mtwo Instruments for Retreatment: An in vitro Study

Introduction: To evaluate and compare the amount of time required by three rotary NiTi instruments in removing gutta-percha from root canal during retreatment with hand file as control. Materials and Methods: Eighty human mandibular premolars with single straight root canals were prepared and obturated by cold lateral condensation with gutta-percha and AH Plus sealer. After two weeks, the 80 teeth were divided into one control group and 3 retreatment groups (n = 20 each). Gutta-percha was removed using H-files, the D-RaCe, or the Mtwo or the R-Endo retreatment systems. Retreatment time was calculated using stopwatch. Results: D-RaCe and Mtwo required significantly less time than R-Endo and hand file. Hand file took maximum time, which was significantly slower than all groups. However, D-RaCe and Mtwo retreatment time was statistically insignificant. Conclusion: D-RaCe and Mtwo remove gutta-percha faster than R-Endo and Hand files.

Comparative Evaluation of Antibacterial Efficacy of Six Indian Plant Extracts against Streptococcus Mutans

Introduction: To assess the antimicrobial efficacy of six plant extracts of Indian origin often used as traditional medicine against standard strains of Streptococcus mutans. Materials and Methods: The antimicrobial activity of six plant extracts was determined by the agar well diffusion method. The minimum inhibitory concentration (MIC) for the crude (raw), Organic solvent based, aqueous extracts was determined by the agar well diffusion method. Results: Out of all the six extracts evaluated, organic solvent based and aqueous extracts of all the extracts were found to have variable antimicrobial activities against the oral pathogen. The crude extract of Garlic was the most effective against Streptococcus mutans with the highest zone of inhibition (24.62 mm) followed by the aqueous extract of Amla (19.47mm) and organic solvent based extract of Ginger (18.76 mm). Conclusion: Despite of the fact that the extracts were not pure compounds and antimicrobial results were obtained. This recommends the potency of these extracts. The figment of the derivation of antimicrobial compounds from plants seems lucrative as it will lead to the development of a phytomedicine to act against microbes.

An In-Vivo Correlation Analysis of the Distance Between Lingual Frenal Attachment and Mandibular Incisal Edge Position as an Aid in Establishing Mandibular Occlusal Plane in South Indian Population

Balasubramanian. R, Leoney. A, Krishna Raj

Statement of problem: The aim of the study is to find the reliability in measuring the distance between the anterior attachment of the lingual frenum and the incisal edge of the mandibular central incisor on casts to be used as a pre-extraction record. Purpose: The objective of this study is to give a range of numerical values from anterior attachment of lingual frenum to mandibular central incisors in a class I ridge relation in south Indian population, which may be used in establishing the vertical dimension of the edentulous patient and also to locate the mandibular incisors in teeth arrangement of complete denture fabrication. Materials and Methods: One hundred subjects (50 males and 50 females) under the age group of 21-28y, with class I dental relationship and who have never undergone orthodontic treatment were selected. Two models were made for each subject using irreversible hydrocolloid impression material and type III gypsum product to obtain an average value for each subject. The distance between the incisal edges of the lower central incisor and the anterior attachment of the lingual frenum is measured using a divider and digital vernier caliper. Statistical Analysis: Mean and Standard deviation using descriptive statistics tool using SPSS software version 18. R esult: The distance between the anterior attachment of the lingual frenum and incisal edges of mandibular central incisors among the 100 subjects was 14.50mm ± 2.2245 mm. Conclusion: The value obtained aided in establishing the vertical dimension easier by making a pre-determined height of mandibular occlusal rim.

Combination Versus Monotherapy for the Treatment of HIV Associated Cryptococcal Meningitis

Shashank Anant Vaidhya, Bharat Bhushan Gupta, Rajesh Kumar Jha, Ravindra Kumar

Objective: To study the efficacy of anti Cryptococcal treatment by cerebrospinal fluid (CSF) fungal negativity after two weeks of treatment with amphotericin B alone or combined with fluconazole in treatment of HIV associated Cryptococcal meningitis (CM). Materials and Methods: A total of 84 human immunodeficiency virus (HIV) associated CM patients confirmed by CSF culture positivity were recruited for the study. Patients were randomly divided into two groups. Group A was given amphotericin B alone whereas Amphotericin B in combination with fluconazole was given in group B for the treatment of CM. Patients were followed for 14 days. Results: Maximum number of patients was in the age group 21-49 y. All the 84 patients had <100 CD4 counts/µl. After 14 days of the treatment in group A and B, there was no significant difference in terms of fever, headache and neck stiffness as a clinical outcome. But in group B there was improved in altered sensorium and focal neurological deficit as compared to group A. After 14 days of the treatment CSF culture negativity was more in group B as compared to group A. Conclusion: Amphotericin B in combination with fluconazole is recommended for the treatment of HIV associated CM.

Agreement of Arterial Sodium and Arterial Potassium Levels with Venous Sodium and Venous Potassium in Patients Admitted to Intensive Care Unit

Sunil Kumar Nanda, Lopamudra Ray, Asha Dinakaran

Introduction: Electrolyte abnormalities are one of the common causes of morbidity and mortality in critically ill patients. The turnaround time for electrolyte reporting should be as low as possible. Electrolytes are measured conventionally in serum obtained from venous blood by electrolyte analyser which takes 20 to 30 min. Point of care analysers are now available where in electrolytes can be measured in arterial blood within 5 min. This study was done to study the agreement of arterial sodium and arterial potassium with venous sodium and venous potassium levels. Materials and Methods: Venous sodium and venous potassium levels and arterial sodium and arterial potassium levels were analysed on 206 patient samples admitted to Intensive Care Unit (ICU). The venous values were compared with the arterial values for correlation. Venous sodium was compared with arterial sodium by spearman correlation. Venous potassium was compared with arterial potassium by pearson correlation. Results: The mean value of arterial sodium was 134 and venous sodium was 137. The mean value of arterial potassium was 3.6 and venous potassium was 4.1. The correlation coefficient obtained for sodium was 0.787 and correlation coefficient obtained for potassium was 0.701. There was positive correlation of arterial sodium and arterial potassium with venous sodium and venous potassium indicating agreement between the parameters. Conclusion: Arterial sodium and arterial potassium can be used instead of venous sodium and venous potassium levels in management of critically ill patients.

The Ability of Oral & Maxillofacial Surgeons to Perform Basic Life Resuscitation in Chattisgarh

Vinay Kharsan, Rahul Singh, Ramnik Madan, Yogesh Mahobia, Anil Agrawal

Aim and Objective: This study was conducted to assess the ability of oral & maxillofacial surgeons regarding basic life resuscitation in case of medical emergencies. Materials and Methods: This cross-sectional study was conducted among oral & maxillofacial surgeons through a mailed questionnaire. The sample size was finalized to 152 including 108 – males and 44 – females with mean age of the subjects as 30.65 y. The Statistical software namely SPSS version 16.0 was used for data analysis. Statistical Analysis: The student’s t-test, ANOVA test and post-hoc test were used as tests of significance for statistical evaluation at p = 0.05. Results: The study revealed that most of the participants were aware about the administration of drugs. Around half of the surgeons (52.4%) were able to understand correct reading of ECG. It has been seen that, 66.8% were properly knowing, how to maintain the airway and 77.4% were experienced in the administration of oxygen in case of emergencies. Overall the knowledge was more among experienced dental surgeons. Conclusion: It was found that most of the participants were aware to handle the medical emergencies in dental practice and the awareness was higher among senior surgeons. Still the surgeon should have more knowledge for initial stabilization in a patient with risk happening at dental office.

XIAP and Ki-67: A Correlation Between Antiapoptotic and Proliferative Marker Expression in Benign and Malignant Tumours of Salivary Gland: An Immunohistochemical Study

Background: Impaired balance between cell proliferation and apoptosis is crucial to the development of malignant neoplasm. The purpose of this study was to evaluate and compare the expression of X-Linked inhibitor of apoptotic protein (XIAP) (antiapoptotic marker) and Ki-67 (proliferative marker) expression in benign and malignant salivary gland (SG) tumours. Materials and Methods: The study consisted of 40 cases of benign SG tumours and 50 cases of malignant SG tumours. The immunohistochemistry was carried out by using Ki-67 antibody (clone MIB-1) and XIAP antibody in all the groups. Results: XIAP expression was significantly higher in malignant SG tumours than benign SG tumours (p = 0.016). Ki-67 LI was significantly higher in malignant SG tumours than benign SG tumours (p = 0.0002). Statistically significant positive correlation between Ki-67 count and XIAP expression was noted in benign and malignant SG tumours (p = 0.000). Conclusion: As the expression of an antiapoptotic marker (XIAP) increases, the expression of a proliferative marker (Ki-67) also increases from benign to malignant SG tumours. Thus, targeted therapy of XIAP may play a future role in the management of SG malignancy.

Reserve Drug Indent Form and Its Impact on Antimicrobial Consumption and Sensitivity Pattern in the Medical Intensive Care Unit of a Tertiary Care Hospital

Deepthi Shridhar P., Anitha K.B., Mohandas Rai, Anisha Fernandes

Objectives: A world without effective antibiotics is a terrifying but a real prospect. Overuse or misuse especially of newer and higher antimicrobials (AM) is of particular concern, as this contributes to development of resistance among microorganisms. To check this trend, the Reserve Drug Indent Form (RDIF) was introduced in our hospital and its impact on AM consumption, cost of therapy and the sensitivity pattern was studied in the medical intensive care unit (MICU). Materials and Methods: A retrospective descriptive study in the medical ICU of a tertiary care hospital from July 2012 to August 2013. From March 2013, RDIF was made mandatory to be filled up prior to prescribing reserve antimicrobials. AM consumption (expressed as DDD/100 bed days) and sensitivity pattern (expressed in percentage) six months prior to and six months after implementation of the form were analysed. Results: The total Reserve AM consumption was 125.79 per 100 bed days during the study period. Average occupancy index was 0.50 and length of ICU stay was 6 days. The total consumption reduced from 85.55/100 to 40.24/100 bed days after the introduction of the RDIF. However, Imipenem usage increased from 11.35/100 to 23.94/100 bed days, which can be attributed to sensitivity profile to Imipenem (82.1%) compared to Meropenem (65.7%). Cost of therapy reduced from Rs 6,27,951 to 4,20,469. Conclusion: Reserve AM consumption showed a declining trend after introduction of the RDIF. Hence, the RDIF served as an important tool to combat inappropriate use, reducing the cost burden and also helped to improve the sensitivity to reserve drugs.

Evaluation of Potential Drug - Drug Interactions in General Medicine Ward of Teaching Hospital in Southern India

Background: Polypharmacy is considered as one of the major risk factors in precipitation of drug-drug interactions (DDIs). Patient population at high risk include the elderly and patients with co morbidities as they are usually prescribed with more number of drugs. Critical evaluation of such prescriptions by pharmacist could result in identification and reduction of such problems. Objective: The study aims to assess the prevalence, severity and significance of potential DDI (pDDI) in general medicine wards of South Indian tertiary care teaching hospital. Materials and Method: A prospective observational study was conducted in a general medicine ward for a period of six months (September 2012 to February 2013). The socio-demographic, clinical characteristics and medication prescribed was documented in a specially designed form. Analysis was carried out to assess the prevalence, severity and significance of identified pDDIs using Micromedex. Descriptive and Univariate analysis were used to report the findings. Results: A total of 404 case records reviewed, 78 (19.3%) patients had pDDIs. A total of 139 (34.4%) pDDIs were reported during the study period. Majority (53.95%, n=75) of the interactions were moderate in intensity and significant in nature (53.23%, n=74). Positive association between number of pDDIs and age was observed. Conclusion: The prevalence of pDDIs was 19.3% which is lesser then previously reported studies from India. Patient with more co-morbidities and elders were observed with more pDDIs. The study highlighted the need to effectively monitor and patients prevent pDDIs to improve patient safety.

Knowledge and Attitudes of General Dental Practitioners Towards Posterior Composite Restorations in Northern Saudi Arabia

Iftikhar Akbar

Introduction: The restoration of posterior teeth with composite restoration is a common clinical practice nowadays. Opinions regarding posterior composite restorations vary among dentists. The aim of the present study was to determine the knowledge and opinions of general dental practitioners towards composite resins for posterior teeth restorations. Materials and Methods: A questionnaire was devised to elicit information regarding placement of composite restoration in posterior teeth in northern Saudi Arabia. It was distributed to 230 dentists by hand and e-mail. A response rate 136 (59%) was obtained. The questionnaire sought details about case selection criteria for composite restoration, problems associated with composites and reasons for selecting composite restoration in posterior teeth. The data was processed and analysed by SPSS statistical software 19. Frequencies and percentages were calculated for various responses of the participants. Results: Regarding the selection of composite restoration in posterior teeth, 97% of the dentists did not prefer composite placement for class I restoration with heavy occlusal contacts. 83% of the participants did not select composite for class II restoration. 78% of the respondents opted for restoring composites in small defects. Patients’ aesthetic demands (90%), amalgam replacement (22%) and restoration of endodontically treated teeth (42%) were the contributing factors. Regarding the problems associated with posterior composite restorations. Recurrent caries (87%), post-operative sensitivity (84%), restoration fracture (83%) and polymerization shrinkage (73%) were the major problems reported by respondents associated with composite restorations. The other minor concerns were wear (60%), contact build up in case of class II cavity restorations (51%) and isolation for composite restorations (36%). Conservative cavity preparation (78%), aesthetics (73%) and patient preference (65%) were the main reasons for choosing composite restoration for the posterior teeth. Conclusion: Posterior composites are not popular among dentists practicing in northern Saudi Arabia and there is a need of continued professional education and clinical training for the dentists for posterior composite restorations.

Access to Abutment Screw in Cement Retained Restorations: A Clinical Tip

Abutment screw loosening has been reported to be the most common prosthetic complications occurring in screw retained as well as cement retained implant restorations. Different methods to treat this issue have been reported in the literature so far; however these have their own short-comings. Retrievability of an implant restoration intact becomes a clinical challenge when the restoration is cement retained especially with an angulated abutment. This technique is aimed at accurately determining the position of the abutment screw in 3 dimensional relationships using a vacuum formed clear stent. This technique can be used as a viable protocol for management of screw loosening in cement retained implant restorations.

Spontaneous Bacterial Peritonitis (SBP) caused by Bacillus Cereus in an Alcoholic Patient: Case Report and Review of Literature

Spontaneous bacterial peritonitis (SBP) is infection of peritoneal covering of the abdomen caused by bacteria, without any known etiology. Common known predisposing factors are cirrhosis of liver and old age among others. Bacillus cereus is an uncommon cause of SBP and often wrongly interpreted as a contaminant. We hereby report a case of peritonitis in chronic alcoholic, elderly male patient presenting in the outpatient department. Bacillus cereus is often regarded as contaminant but must be carefully identified and correlated clinically in case of isolation from peritoneal fluid.

Giant Aggressive Mesenteric Fibromatosis- A Case Report

Anandaravi BN, Jagadish Kumar CD, Sreejith PS, Mayur M, Roopa URS

Fibromatosis are rare, accounting for 0.03% of all tumours. Mesenteric fibromatosis is a very rare (8% of all desmoid neoplasm). Aggressive fibromatosis of mesentery is a rare surgical problem affecting 2-4 per million people. Females are more commonly affected than males (Estrogen acts as a growth factor). It is locally invasive and tends to recur but never metastasize. Here, we are discussing about 24-year-old male presented with progressive abdomen distension associated with pain since one month. Abdominal examination showed a firm non-tender intra-abdominal mass, measuring around 15x14 cm size, with intrinsic mobility, which was perpendicular to mesenteric line, all borders were well-made out. CECT abdomen showed features suggestive of GIST . Elective Laparotomy was done and a giant mass arising from mesentery without any infiltration to the surrounding structures was noted. The entire mass was excised and mesentery repaired. Histopathology showed uniform band of spindle shaped cells arranged in fascicles admixed with blood vessels in a collagenous stroma. Immunohistochemistry showed Beta Catenin +ve, CD 117-ve, CD 34 –ve and SMA-ve, which is confirmative of Fibromatosis. Postoperative period was uneventful.

A Rare Case of Autoimmune Hypophysitis Presenting as Temperature Dysregulation

Ankur Jain, Dinesh K. Dhanwal

Autoimmune hypophysitis is a rare cause of pan-hypopituitarism. Hypothalamic involvement in autoimmune hypophysitis is rare and usually manifests as central diabetes insipidus due to antibodies against arginine vasopressin. Temperature dysregulation is occasionally seen with suprasellar tumours but has never been reported with hypophysitis. We report a case of a middle aged man who presented to us with the complaints of documented body temperature fluctuations since two months followed gradually by hoarseness of voice, sexual dysfunction and syncope. Examination was remarkable for postural hypotension, dry coarse skin and delayed ankle reflexes. Patient’s hormone profile revealed pan-hypopituitarism and elevated titre of anti-TPO antibodies. Patient’s work up for secondary causes of hypopituitarism was negative. MRI brain revealed typical findings of hypophysitis. Patient was suspected as a case of autoimmune hypophysitis and was immediately treated with prednisolone along with hormone replacement. Rapid response within 30 days was observed in the form of subsidence of temperature fluctuations, improvement in general well being, sexual function and repeat MRI done after one month which revealed a partial empty sella. Autoimmune hypophysitis as a potentially treatable cause of temperature dysregulation has been highlighted in this case.

Dental Management of Cornelia de Lange Syndrome: A Rare Case Report

Meera Sandhu, Mehak Nagpal, Shweta Gulia, Vinod Sachdev

Cornelia de Lange syndrome (CdLS) is a rare, multiple congenital defect often called as Amsterdam dwarfism. The physical phenotype of CdLS includes low birth body weight, short stature and facio-cranial dysmorphia. The diagnosis of the syndrome is based on clinical grounds as there is no biochemical or chromosomal markers for CDLS that makes its diagnosis more complicated. The purpose of this paper is to present a clinical report of a boy emphasizing the importance of multidisciplinary approach for the diagnosis and treatment of this syndrome.

Osteochondroma (OC) of the Condyle of Left Mandible: A Rare Case

Harish M., Bhari Sharanesha Manjunatha, Anoop N. Kumar, Yasin A. Alavi

Osteochondroma (OC) is one of the most common benign condylar tumours having both chondroma and osteoma. However, this tumour is most frequently found on the metaphyses of long bones and is unusual on the skull. When it affects the mandibular condyle, the cause could be due to trauma to the tempero mandibular joint (TMJ). Here, in this report we present a rare case of osteochondroma of left condyle region in a 36-year-old man. The patient had noticed pain in the left TMJ for six months. The lesion is surgically removed and histologically evaluated which composed of chondrocytes dispersed in hyaline matrix along with a rim of calcified bone at one end.

Cutaneous Angiosarcoma - A Rare Case Report in Indian Female!

Meenakshi Shetty, Raghavendra Bhat, Parul Kodan

Cutaneous angiosarcoma is a rare vascular tumour especially of elderly males. We present a rare case of elderly female who presented with scalp lesion, parotid swelling and posed a diagnostic challenge. Further work up including biopsy of the lesion revealed the diagnosis of cutaneous angiosarcoma. Rarity of the case due to presence of this rare tumour in a darkcolored female and wide spread presentation of the tumour prompted us to report the case. This case adds to the literature of few cases describing this rare tumour in Indian subcontinent. It attempts to alert the clinicians of this entity, as early diagnosis of the tumour may possibly improve the already known dismal prognosis!

Tuberculosis of Waldeyer’s Ring with an Atypical Presentation as Chronic Adeno-Tonsilitis

Primary tuberculosis of the oropharynx and nasopharynx is a rare clinical entity.It usually arises secondary to pulmonary tuberculosis. We report a rare case of a 20-year-female, who presented with fever and throat pain. Examination revealed hypertrophied adenoids and tonsils, which was ultimately proved as tuberculosis.Enlargement of the palatine tonsils could be due to a multitude of causes, and a thorough evaluation is necessary to arrive at the right diagnosis.Increased awareness of nasopharyngeal and oropharyngeal tuberculosis is important in tropical countries, as the disease may be overlooked resulting in inappropriate management.

Cycloserine Induced Late Onset Psychosis and Ethambutol Induced Peripheral Neuropathy Associated with MDR-TB Treatment in an Indian Patient- A Rare Case Report

Alveolar Rhabdomyosarcoma on the Left Maxillary Alveolus: A Unique Presentation

S. Sudhakar, V. Geethika, Nageswara Rao, B. Smitha, Ch. Sai Kiran

Rhabdomyosarcomas (RMSs) are a group of soft-tissue malignant tumours. They derive from primitive skeletal muscle tissue with head and neck as its principle location. These tumours are extremely rare in adults and it is believed to have a different natural course, treatment response, and prognosis. The invasiveness of tumour, metastasis, lymph node involvement, and the age at diagnosis is a predictor of outcome in patients with RMC. Hence early recognition and histological sub-typing is of critical importance in the therapy of the disease. We report a rare case of RMC in a 50-year-old female patient involving the left maxillary alveolus with a detailed clinical, radiological, histopathological and immunohistochemical findings.

A Case of SSRI Induced Irreversible Parkinsonism

Siddharth Dixit, Shahbaj A Khan, Sudip Azad

Serotonin specific reuptake inhibitors (SSRI) are widely used antidepressants for variety of clinical conditions and have found popularity. They are sometimes associated with extrapyramidal side effects including Parkinsonism. We report a case of generalized anxiety disorder on treatment with SSRI (fluoxetine / sertraline) who developed irreversible Parkinsonism. SSRI are known to cause reversible or irreversible motor disturbances through pathophysiological changes in basal ganglion motor system by altering the dopamine receptors postsynaptically. Clinician should keep risk benefit ratio in mind and change of antidepressant of different class may be considered. Case is reported to alert physicians to possibility of motor system damage while treating with SSRI.

Unusual Foreign Body in a Routine Lateral Cephalogram

Shobha Sundareswaran, Jean James, Praveen S, Latheef V.P, Sreehari S

Routine radiographs made in the orthodontic office can often give way to detection and diagnosis of unusual syndromes, signs or foreign bodies. A case report of one such accidental detection of a very unusual foreign body within the nasal cavity of an orthodontic patient has been presented here to emphasize the importance of routine radiographic views, which over and above aiding in Orthodontic diagnosis, can also often detect potentially life threatening problems in the Oro-facial region.

Giant Omental Fibromatosis Presenting as Pelvic Mass

Channabasappa Kori, Pradyumn Singh, Neelesh Jain, Jaswant Jain, Vijay Kumar

Omental fibromatosis (abdominal desmoids) is a rare benign but locally aggressive neoplasm characterized by mass like or infiltrative growth of fibrous tissue. It usually arises from the abdominal wall or the extremities, however rarely it may also arise in the omentum, ileocolic mesentery, transverse or sigmoid mesocolon and ligamentum teres. Here, we present an 18-year-old male, who presented with lower abdominal pain and palpable lump in hypogastric region. Computed tomography of the abdomen showed large heterogeneous mass in lower abdomen, possibly arising from mesentery with regional adenopathy. Patient underwent exploratory laparotomy with a preoperative diagnosis of mesenteric tumour possibly gastrointestinal stromal tumour (GIST). Histopathological examination revealed the lesion as omental fibromatosis. To the best of our knowledge, very few cases of omental fibromatosis are noted in literature. Here, we describe a rare case of giant omental fibromatosis which resembled mesenteric GIST clinically but finally diagnosed as fibromatosis by histomorphology and immunohistochemistry (IHC). The present article describes fibromatosis of greater omentum and the difficulty in preoperative diagnosis, as it is frequently misdiagnosed as GIST.

Adenosquamous Variant of Metaplastic Carcinoma of Breast – An Unusual Histological Variant

P.U.Swathy, P.Arunalatha, K.Chandramouleeswari, S.Mary Lily, S.Ramya

Metaplastic carcinoma of breast refers to a heterogeneous group of neoplasms characterized by intimate admixture of adenocarcinoma with dominant areas of spindle cell, squamous cell and/ or mesenchymal differentiation. They constitute the rarest histological variant of invasive ductal carcinoma. These carcinomas have aggressive clinical behaviour and show suboptimal response to standard treatment. A 49-year-old female presented with lump in the left breast for one year. She was diagnosed as infiltrating ductal carcinoma breast with triple negative hormone status by trucut biopsy. She completed four cycles of neoadjuvant chemotherapy. Postchemotherapy, axillary nodes decreased in size but the size of the primary tumour remained the same. Hence, she underwent modified radical mastectomy and the specimen sent for histopathological examination. Grossly, there was a solitary cyst measuring 4x3cm. Histologically, cyst enclosing malignant cells which resemble mature squamous epithelial cells. Also, seen are malignant cells in glandular pattern.

Eventful Anaesthesia: Can We Prevent It?

To ensure the utmost safety, it is recommended that prior checking the machine and breathing systems as mandatory. Certain factors beyond the control of the anaesthesiologist lead to the operative room incidences jeopardizing the anaesthetised patient which otherwise cannot be prevented by prior custom checking. Delayed occlusion of a spiral reinforced endotracheal tube during prone position anaesthesia and faulty dual control knob of fresh gas flow of an anaesthesia machine leading to inadequate ventilation are given as examples. In above events, a prior checking the machine or tracheal tube, could not prevent its occurrence. However, use of a deputy of the objects resulted in uneventful anaesthesia.

Non-Functional Paraganglioma of Retroperitoneum Mimicking Pancreatic Mass with Concurrent Urinary Bladder Paraganglioma: An Extremely Rare Entity

Ankur Verma, Diwakar Pandey, Azaz Akhtar, Ashish Arsia, Nain Singh

Paragangliomas are extra-adrenal tumours of the autonomic nervous system, which rarely present as primary retroperitoneal mass mimicking pancreatic malignancy (incidence 2-8 per million populations). Urinary Bladder Paraganglioma are also extremely rare (0.06% of all Bladder Tumour and 6% of Paragangliomas) with most being malignant and high grade tumours. Non-functional varieties of both tumours are usually incidentally diagnosed. The possibility for malignant transformation in them makes surgical excision the treatment of choice. A 45-year-old lady with abdominal pain was investigated to have a complex retroperitoneal mass behind head of pancreas and a urinary bladder mass. Complete excision of retroperitoneal and bladder lesion was done. Histopathological examinations of both specimens were suggestive of Paraganglioma with no abnormal mitotic activity and capsular/vascular invasion. Although concurrent non functional paragangliomas had been reported but the synchronous non-functional paragangliomas of retroperitoneum and urinary bladder reported in this case is extremely rare and is not reported so far in English literature.

Rhabdoid Meningioma: Report of Two Cases

Ch. Karunakar Reddy, A. Divakar Rao, Chandra K. Ballal, Shrijeet Chakraborti

Rhabdoid meningioma is an uncommon anaplastic variant of meningioma. We describe the clinicoradiological and histomorphological features of two such cases of meningioma, with a brief review of literature. One case in a 9-year-old girl, presented initially as an atypical meningioma in the right fronto-parietal region, which on recurrence 18 months later, evolved into a rhabdoid meningioma. The second case in a 33-year-old male was located in the right parieto-occipital region.

Incontinentia Pigmenti: A Rare Genodermatosis in a Male Child

Incontinentia pigmenti is rare X-linked dominant disorder. There is no consistent expression of Incontinetia pigmenti in female child, but in male child, they always lead to death in utero. Vesicular, verrucous, hyperpigmented, and atrophic stages are the four stages of Incontinetia Pigmenti and it is uncommon for all stages to be seen in a same case. It is a rare genodermatosis, with only very few cases of male child with Incontinentia pigmenti have been reported. Thus, we report this case due to its extreme rarity and the child showed all the first 3 stages on followup.

Postpartum Acute Pulmonary Oedema with Subclinical Rheumatic Heart Disease

Padmaja R, Sri Krishna Padma Challarao. Gande

Acute dyspnea with pulmonary oedema in postpartum is uncommon but life-threatening event. Contributing factors for pulmonary oedema include, administration of tocolytics, underlying cardiac disease, iatrogenic fluid overload and preeclampsia acounting 0.08% of pregnancies. Pulmonary embolism, amniotic fluid embolism, pneumonia, aspiration and pulmonary oedema are some of the potentially devastating conditions that should be considered by the attending physician. Here, we report a case of postpartum acute pulmonary oedema referred to causality after an emergency caesarean section in a private hospital. No matter what the underlying pathology, prompt administration and appropriate resuscitation is always the first priority. Only after the patient has been stabilized attention must be turned to diagnosis and specific treatment. A diagnosis of severe Mitral Stenosis, probably of rheumatic origin was made after stabilizing the patient.

Amyand’s Hernia: Case Report -Current Dilemma in Diagnosis and Management

Jonathan Sadhu, Vasanth Mark Samuel, Thomas Kodiatte, Pranay Gaikwad

Amyand’s hernia is an extremely rare condition, often misdiagnosed as a strangulated inguinal hernia, in which the inguinal hernial sac contains the vermiform appendix. It is often a surgical surprise. The reported incidence is approximately 1% of all adult inguinal hernia cases. Acute appendicitis in the Amyand’s hernia is even less common. We report a rare presentation of acute appendicitis associated with Amyand’s hernia managed by en masse reduction of the hernia followed by laparoscopic appendicectomy and open Lichtenstein’s tension free inguinal hernioplasty.

Neurocysticercosis (NCC) with Hydrocephalus, Optic Atrophy and Vision Loss: A Rare Presentation

Nagendra Chaudhary, Shyam Kumar Mahato, Salamat Khan, Santosh Pathak, B.D Bhatia

Neurocysticercosis (NCC) is one of the most common parasitic infestations (Taenia solium) of central nervous system (CNS) in children. Seizures are the common presenting symptoms. Hydrocephalus and optic atrophy are rare complications which may require neurosurgical interventions. We report a case of NCC with hydrocephalus and bilateral optic atrophy associated with vision loss in a Nepalese patient who improved with anti-parasitic therapy followed by ventriculo-peritoneal (VP) shunting.

Disseminated Langerhans Cell Histiocytosis Presenting as Cholestatic Jaundice

Rohit Kapoor, Anthony M. Loizides, Soumya Sachdeva, Premila Paul

Langerhans cell histiocytosis (LCH) is a disorder associated with proliferation of Langerhans cells in various organs. LCH secondary to multisystem involvement can present in a variety of ways. Because of its infiltrative nature, LCH can involve the skin, lymph nodes, the lung or the liver. Jaundice in LCH is a manifestation of liver disease; biliary dilatation secondary to lithiasis or may be due to coexistent Niemann-Pick disease. However, a case of cholestasis has been very rarely described. Cholestasis may result from lymph nodes obstructing the porta hepatis. In this report, we describe a case of type II histiocytosis X with obstructive cholestasis and pulmonary involvement in the form of cysts without significant lymphadenopathy at the porta.

Metastatic Amelanotic Melanoma with Occult Primary Masquerading as Sarcoma

Niyaz Ahmed, Ranjit Kumar Padhiari, Praveen G P, Vishnu Kurpad

Malignant melanoma with occult primary is extremely rare. It is found that survival is almost same or even better than the melanomas with known primary site. Surgeons should have a high index of suspicion when a patient presents like sarcoma which bleeds profusely when planning for excision. Here, is an unusual case of young adult which presented initially with granulomatous lymphandenitis in axilla with primary suspicion of tuberculosis, later turning out to be sarcoma on FNAC and MRI. On immunochemistry (IHC), the final diagnosis of amelanotic melanoma was made and further workup did not show up any primary site of origin.

Magnetic Resonance Imaging (MRI) Appearances of Primary Amelanotic Malign Melanoma in the Nasal Cavity: A Rare Case

Hediye Pinar Gunbey, Emre Gunbey, Asli Tanrivermis Sayit, Kerim Aslan

Malign melanoma of the nasal cavity that arises at such an unusual location is an exceptional case only occasionally mentioned in the literature. An amelanotic form, which is an uncommon type for this malignancy, also has an unusual radiological appearence from the classic melanotic form. We report here the magnetic resonance imaging (MRI) findings of a 46-year-old man who had a nasal cavity mass diagnosed as an amelanotic malign melanoma and discuss the importance of differential diagnosis with such an unusual radiological manifestation in this location.

Osteoblastic and Osteoclastic Metastases in a Single Vertebra-A Rare Presentation

Gian Chand, Ajay Chhabra, Deepshikha Mangat, Suparna Grover

Malignancies may produce bony metastases which may be osteoclastic or osteoblastic. Vertebrae are a common site for bony metastases. Prostatic adenocarcinoma is an important source of vertebral metastases that are mainly osteoblastic in nature. As the osteoblastic metastases are developing there is an ongoing osteoclastic activity which is going on at the microscopic level. Presence of gross osteoblastic and osteoclastic lesions, in the same vertebra, have not been reported at the time of presentation. Here a rare case of vertebral metastases is being presented which shows osteoblastic and osteoclastic gross lesions in the same vertebra.

Mucoid Cyst of the Penis: A Case Report

Penile cysts are rare benign lesions. Their clinical or pathological diagnosis is extremely difficult. Less than 200 cases have been reported in literature. Most of them are asymptomatic and present since birth, but usually they are only detectable in adolescence or adulthood. These lesions rarely interfere with sexual function. These cysts most likely arise from ectopic urethral mucosa sequestered in the penile skin during embryologic development. We report a rare case of a 55-year-old man with a 4.5 × 4 cm nodule on the prepuce (ventral surface), which appeared two years ago and interfered with his sexual function. The nodule was excised by circumcision and a histopathological examination revealed a mucoid cyst of penis with squamous metaplasia. No recurrence was observed at a one year follow-up and the patient’s sexual function returned to normal.

Local Anaesthetic Systemic Toxicity in a Patient under General Anaesthesia (GA): A Diagnostic Challenge

Ravi Prakash, Shefali Gautam, Sanjeev Kumar, Ritu Singh

Local anaesthetic systemic toxicity (LAST) is one of the most dreadful complications after local anaesthetic (LA) use and it is very difficult to manage. The diagnosis of LAST is purely clinical and its presentation is usually obscured in a sedated or anaesthetized patient. A 25-year-old male patient undergoing laparotomy for acute duodenal perforation under general anaesthesia developed seizures after epidural administration of 0.5% bupivacaine. All other possible causes of seizures were ruled out. Seizures were controlled with antiepileptic drugs and patient recovered fully after withholding LA administration. Although, lipid rescue is recommended for LAST, our patient was managed without its use. We, therefore, recommend that utmost care and vigilance should be exercised while using local anesthetics as there is no perfectly accurate method to rule out intravascular administration of LA. Even, if LA is correctly used, LA is detected in plasma due to its systemic absorption from injection site.

Jejunal Diverticulosis with Perforation – A Challenging Differential Diagnosis of Acute Abdomen: Case Report

Kiruthiga Natarajan, Manjiri Phansalkar, Renu G’Boy Varghese, G. Thangiah

Multiple diverticulosis of the jejunum represents a very rare entity. Jejunal diverticula are found to be the rarest of all small bowel diverticula. The disease is usually asymptomatic and often becomes clinically relevant when complicated. This rarity makes it a difficult differential diagnosis. Related complications such as diverticulitis, perforation, and bleeding and/or intestinal obstruction appear in about 10-30% of the patients which increase the morbidity and mortality rates in such individuals. Here, we present a case of jejunal diverticulosis with perforation who presented with symptoms of acute abdominal pain, vomiting and fever along with a brief review of literature.

Normokalemic Thyrotoxic Periodic Paralysis with Preserved Reflexes- A Unique Case Report

Subrata Chakrabarti

Although serum potassium levels are usually subnormal in Thyrotoxic Periodic Paralysis (TPP), but in exceptionally rare circumstances, it may be normal leading to the entity called normokalemic TPP. The diagnosis of normokalemic TPP is more often overlooked and/or delayed due to lack of awareness among the physicians and associated mild symptoms of hyperthyroidism. Here, the author describes the case of a 27-year-old male with newly diagnosed but untreated Grave’s disease and TPP who was normokalemic during the acute phase of paralysis. Hypokalemia was documented only after resolution of paralytic attacks during subsequent days of admission. The importance of the case report is to highlight upon the fact that TPP should always be considered in an “previously asymptomatic” young Asian individual with acute paralysis with or without hypokalemia , and thyroid function and serial potassium values should be evaluated for diagnosing the usual hypokalemic type or the more rarer variant normokalemic TPP. This case report also deserves mention as the patient of TPP had a notable feature of having preserved reflexes in the face of hypokalemia.

Infected Gap Non Union of Radius Treated with Modified Nicoll’s Technique-A Case Report

B.S.S.Venkateswarlu, C.J. Manikumar

Management of atrophic non union of forearm bones is a challenging task. Various methods of treatment available in the literature are cortical tibial graft (Boyd), ulnar segment graft (Miller and Phalen), iliac crest graft (Spira), cancellous insert graft (Nicoll), vascularized fibular graft (Jupiter), and bone transport by ring fixator (Tesworth). We here report a case of infected non union of radius managed with modified Nicoll’s method. Here, intra medullary nailing is preferred over plating which was originally described by Nicoll. At two years follow up, the patient is symptom free and is able to carry out his daily activities with ease.

Non Traumatic Keratitis Due to Colletotrichum Coccodes: A Case Report

Aarti Kotwal, Debasis Biswas, Barnali Kakati, Harsh Bahadur, Neeti Gupta

Colletotrichum species, a rare and emerging fungus is a well- known plant pathogen and an uncommon cause of human infection. It has been implicated as the etiological agent of cutaneous phaeohyphomycosis and keratitis, particularly following colonization of traumatized tissues or in immunocompromised patients. However, it has hardly ever been reported in the absence of such predisposing risk factors. Here, we report a case of keratitis with Colletotrichum coccodes occurring in a middle- aged, immunocompetent person without any history of trauma or co-morbidity. The isolate was sensitive to Amphotericin B and Voriconazole, and accordingly the patient was treated successfully with ocular administration of Amphotericin B.

Multiple Variations in the Pelvic Vasculature – A Case Report

A thorough knowledge of possible variations of pelvic vasculature is very useful for surgeons, gynaecologists, radiologists, urologists and orthopaedic surgeons. We report multiple vascular variations in the left half of the pelvis of an adult male cadaver. Iliolumbar artery arose from the main trunk of the internal iliac artery. Posterior division of the internal iliac artery gave two lateral sacral arteries and a superior gluteal artery. The anterior division of the internal iliac artery gave origin to superior vesical, inferior vesical, inferior gluteal and internal pudendal arteries. The internal pudendal artery gave origin to a common trunk before leaving the pelvis. The common trunk divided into middle rectal artery and deep artery of the penis. The obturator artery took origin from the inferior epigastric artery and descended downward to the pelvis and left the pelvis by passing through the obturator foramen. Most of the other veins accompanying the arteries joined to form a plexus on the superior surface of the pelvic diaphragm. This plexus condensed to form anterior and posterior divisions of the internal iliac vein. Apart from this, the posterior part of the plexus drained directly into the common iliac vein through a large unnamed vein.

Papulonecrotic Tuberculid with Scrofuloderma: An Uncommon Association

Vinita Gupta

Cutaneous tuberculosis can be classified as true cutaneous tuberculosis and tuberculids which is regarded as a hypersensitivity reaction to M. tuberculosis in patients with a high degree of tuberculin sensitivity. Papulonecrotic tuberculid (PNT) is a form of tuberculid. It is an uncommon manifestation even in areas with high prevalence of tuberculosis. We report a case of 35-year-old man who presented with necrotizing papules in symmetrical fashion over the trunk and extremities for last one year along with a discharging sinus in right axilla for last two months. Papulonecrotic tuberculid (PNT) with scrofuloderma were suspected on clinical examination. Mantoux test was strongly positive with 20x20mm. He was treated successfully with ATT without any further appearance of new lesions.

Systematised Epidermal Nevus - A Case Report

Manoharan Dhanaraj, Manoharan Ramalingam

A 20-year-old female presented with raised skin lesions all over the body since birth. Clinical examination revealed multiple pigmented macules and hyperkeratotic papules seen along Blaschko s lines over the face, neck, trunk and both lower limbs. Histopathological examination revealed hyperkeratosis with moderated acanthosis and uniform pigmentation over basal zone. Systemic examination was found to be normal. A diagnosis of systematised epidermal nevus in the absence of epidermal nevus syndrome was diagnosed and the patient was asked to undergo carbon dioxide laser mediated destruction of the skin lesions. The patient was also advised to be under surveillance for late onset neurological symptoms.

Apicoectomy Versus Apexification

Paul Chalakkal, Francis Akkara, Ida De Noronha De Ataide, Rajdeep Pavaskar

The aim was to evaluate treatment outcomes after apicoectomy and apexification in adjacent non-vital maxillary central incisors with large periapical radiolucencies, in a 10-year-old boy. The patient had complained of tenderness in the upper central incisors on mastication and gave a history of trauma to those teeth three years ago. On examination, there were found to be non-vital. Apexification (using Metapex) and apicoectomy (obturation with gutta percha) were performed on 11 and 21, respectively. Radiographical observations were made six months, one year and two years, post-operatively. Apical repair was found to be more favorable after apicoectomy than apexification, for a non-vital maxillary central incisor with an open apex and large periapical radiolucency.

Anaplastic Thyroid Carcinoma (ATC) with Superior Vena Cava (SVC) Syndrome, Cardiac Tamponade and Pleural Effusion: An Unusual Clinical Presentation

Naresh Kumar, Hemant Kumar Nayak, Mradul Kumar Daga, Shyama Jain, Mukesh Kumar

Superior vena cava (SVC) syndrome and cardiac tamponade are potentially life-threatening conditions that are not uncommon in the oncological setting but their occurrence together in a patient is infrequent. Herein, we present a case of 50-year-old male who presented with SVC syndrome and pleural effusion; developed recurrent cardiac tamponade in the hospital. Fine needle aspiration cytology (FNAC) of left supraclavicular lymph node which appeared during hospital stay revealed high grade carcinoma and diagnosis of anaplastic thyroid carcinoma was established by FNAC of thyroid nodule. Despite rarity, clinicians must be aware of such presentation of thyroid malignancy.

Recurrent Mandibular Supplemental Premolars: A Case Report with 5 Year Follow Up and Review of Literature

A 12-year-old girl reported for a routine dental checkup. Radiographic survey disclosed the presence of two developing structures resembling premolars one on either side of the mandible in premolar region, which were of supplemental type and surgical removal of supernumerary premolars facilitated eruption of the left second premolar. On six months follow-up, there was radiographic evidence of another supernumerary premolar in the left side of mandible that is left in situ, patient is on regular follow-up. This emphasizes the importance of thorough clinical and radiographic examination, early diagnosis and follow-up of the developing dentition in children. The patient has been followed-up from the age of 12 year to 17 year. This paper describes a case of recurrent supplemental supernumerary premolars in the mandible along with review of literature.

Cirrhosis: An Unusual Presentation of Sickle Cell Disease

Rupal Dosi, Rushad Patell, Pooja Jariwala, Purav Shah, Sarfaraz Jasdanwala

Hepatobiliary complications of sickle cell disease are relatively rare but well recognised in literature. Clinical syndromes range from mild intrahepatic cholestasis and gallstones to life threatening sequestration crisis. Most patients, homozygous for sickle cell anaemia, present before adolescence. We report a case of an adult man with no prior symptoms who presented for the first time with decompensated cirrhosis, which was found to be due to underlying previously unrecognised sickle cell anaemia.

Autoimmune Pancreatitis - A Case Report

Varuna Mallya, KR Rathi, Kavita Sahai, CK Jakhmola

Autoiommune pancreatitis (AIP) is a rare disease that has distinct histological, immunological, serological and radiological findings. It is characterised histologically by lymphoplasmacytic infiltrate, storiform fibrosis, obliterative phelibitis and presence of IgG4 positive plasma cells and lymphocytes. Elevated serum levels of IgG4 are also noted. It is usually misdiagnosed preoperatively as pancreatic cancer. It may involve extrapancreatic sites also and responds well to steroid therapy. Here, we share our experience of AIP in a 52-year-old male.

Type 1 and Type 3 Gaucher Disease in Two Siblings in A Family: 2 Unusual Case Reports

Dolanchampa Modak, Sasmit Roy, Uttam Nath, S.K.Guha

Gaucher disease (GD) is an autosomal recessive disorder, characterized by lack of acid ß-glucosidase (glucocerebrosidase) enzyme resulting in accumulation of glucosylceramide in different organs. It is common in Ashkenazi Jews but rare in India. Around five hundred cases are identified and diagnosed in India. We are reporting two interesting cases of type 1 non-neuropathic and type 3 juvenile subacute neuropathic variant of adult Gaucher disease in two of three siblings in a family.

Tetra-Phocomelia: The Seal Limb Deformity - A Case Report

Sunil Kumar Samal, Setu Rathod, Seetesh Ghose

We report a case of term live baby with tetra-phocomelia born to a 35-year-old G3P2L2A0 with history of consanguineous marriage. She was an unbooked case from a tribal community with no previous antenatal visits. At 39 wk of gestation, she was admitted to our hospital with complaint of pain abdomen and on examination was found to be in second stage of labour. She delivered vaginally a term live 2.5 kg female baby with multiple anomalies. There was no history of drug intake, radiation exposure, maternal diabetes or family history of congenital anomalies to support the occurrence of tetra-phocomelia in this baby. The neonate also had multiple facial abnormalities like hypertelorism, microretrognathia and partial cleft palate. Further investigations revealed no abnormalities of internal organs. At present the baby is being followed up at our paediatric department. The case is reported owing to its rarity and term live birth.

Ghrelin O Acyl Transferase (GOAT) as a Novel Metabolic Regulatory Enzyme

Background: Obesity and Type 2 Diabetes Mellitus (T2DM) presents a growing threat to the global health. Evidences highlight an important role of ghrelin as a key regulator of glucose metabolism. The physiological functions of ghrelin are mediated by enzyme ghrelin-O-acyltransferase (GOAT) which is capable of generating the active form of this metabolic hormone. However, its exact mechanism of action and influence on energy balance and glucose metabolism is yet to be explored. Objectives: To review the physiological role of GOAT in the regu - lation of energy balance and glucose metabolism and explore the potential therapeutic avenues of modulators of GOAT to counter the progression of obesity and T2DM. Methods: Publications were sought through electronic searches. The bibliographies of all papers, book, chapters and editorials were scanned and hand searches were also conducted for journals, and conference proceedings. Conclusion: GOAT peptide modulates the insulin secretion as well as insulin sensitivity. Modulators of GOAT signaling like inhibitors of GOAT increases insulin secretion, enhance peripheral insulin sensitivity and thus counters obesity and T2DM. Modulators of GOAT can be a probable therapy for modifying food intake and for countering obesity and T2DM.

Schistosome Infections: An Indian Perspective

Arunava Kali

Schistosomiasis is an endemic helminthic disease of human. Schistosomes display considerable biodiversity in habitat, host range, and epidemiology globally. In spite of the noticeable presence of sero-positivity for schistosomal antibody and passage of schistosome eggs in human faeces, Indian subcontinent has always been considered as a low risk region for human schistosomiasis. Several species has been described in India which may have association with human infection and cercarial rash. Although sporadic cases are not uncommon, the status of human schistosomiasis in India is not well investigated. In this review different aspect of schistosomal infection in human in India has been described briefly.

Rushton Bodies: An Update

Suresh Babburi, Amrutha Rajesh.Rudraraju, Aparna V., Sowjanya P.

Rushton bodies are peculiar, eosinophilic, linear, curved or straight, polycyclic, glassy structures occurring with variable frequency in the epithelial lining of odontogenic cysts, whose presence occasionally contributes to the diagnosis. Presence of these structures depends upon the sectioning plane of specimen. They are easily identifiable by their peculiar morphological and staining patterns. There is considerably ambiguity about the nature and epithelial, vascular, odontogenic or keratinous origin of these hyaline bodies. This article highlights the occurrence, light and electron microscopic features and histogenesis of Rushton bodies.

Human Epidermal Growth Factor Receptor 2 (HER2/neu) in Salivary Gland Carcinomas: A Review of Literature

The aim of our study is to assess the relation of human epidermal growth factor receptor 2 or HER2/neu with the development of salivary gland carcinomas and use of Herceptin in the treatment of these cancers. A literature search was conducted using MEDLINE accessed via the National Library of Medicine PubMed interface searching for articles from 1994 up to 2014 relating to the existence of HER-2 protein and gene in salivary gland carcinomas and HER2/neu targeted therapy, written in English language. Almost all the studies in literature reported a frequent over expression and amplification of HER2/nue in salivary duct carcinomas (SDC) compared to other salivary gland cancers. Herceptin given as a monotherapy was not effective. The data on Herceptin combined chemotherapy are potentially promising but inadequate to evaluate drug activity, as patients also received a variety of cytotoxic agents. Therefore, Herceptin contribution to tumour response outcomes could not be precisely determined and the total number of cases is not sufficient. It is recommended that further work involves a large series of HER2/neu positive salivary gland cancers (randomized control trial) treated with chemotherapy with and without Herceptin. This might need multi-institutional cooperation.

mHealth in the Prevention and Control of Non-Communicable Diseases in India: Current Possibilities and the Way Forward

Mobile health technology has been used effectively for healthcare delivery in many developing countries. India is currently facing an epidemic of Non-Communicable Diseases (NCDs). With greater availability of cheaper phones in the market, the user base of mobile phones in India is increasing rapidly. The present review was thus conducted to explore the current possibilities and future scope of mobile health for NCD prevention and control in India. Literature search was conducted using MEDLINE, EMBASE, and Cochrane Library to collect information regarding mobile health interventions. Two authors extracted the data and included studies if at least the abstract was available. Information from key reports and government websites were also included. We examined information from domains such as need for mobile health in NCDs in India, and the advantages, scope and challenges of mobile health for healthcare delivery in India. Existing mobile health systems in India, current evidence of mobile health use in NCDs, and the recent mobile health related initiatives taken by Government of India were also assessed. Though we found some examples of current mobile phone usage in many health related programmes in India, data from mobile health research is scarce, particularly for NCDs. The current evidence base needs to be strengthened. There is also a need for identifying various opportunities in the recent initiatives taken by Government of India. It can be concluded that though mobile health has many advantages, there are numerous challenges which need to be addressed before scaling it up at the national level.

Role of Homeobox Genes in Tooth Morphogenesis: A Review

Sreevalli Suryadeva, Mohammadi Begum

In oral cavity, disturbances due to genetic alterations may range from lack of tooth development to morphological defects. Due to technical advances in genetic engineering and molecular biology, valuable information regarding dentofacial growth could be studied in detailed manner. This helped us to explain the aetiology and pathogenesis of many dentofacial disorders. The success in treatment lies first in determining the aetiology of tooth anomalies and finally differentiating the effect of genes and environment on the orofacial diseases of that particular individual. Several genes belonging to class II homeobox families are expressed during odontogenesis however homeobox genes are not directly imvolved in tooth formation as they are not directly expressed in the first branchial arch derivatives.

Efficacy of Garcinia Cambogia on Body Weight, Inflammation and Glucose Tolerance in High Fat Fed Male Wistar Rats

Ramalingam Sripradha, Sridhar Gopalakrishna Magadi

Introduction: Obesity leads to derangements in lipid and glucose homeostasis resulting in various metabolic complications. Plants containing vital phytochemicals are known to posses anti obesity properties and have proved to exert beneficial effects in obesity. Objectives: The present study was aimed to investigate the effects of Garcinia Cambogia on body weight, glucose tolerance and inflammation in high fat diet fed male Wistar rats. Materials and Methods: Five month old male wistar rats (n=40) were divided into four groups. Two groups were fed with standard rodent diet and the remaining two with 30% high fat diet. One group in each of the two sets received the crude ethanolic extract of Garcinia Cambogia at a dose of 400mg/kg body weight/day for ten weeks. Body weight, intraperitoneal glucose tolerance test, leptin, tumour necrosis factor-a (TNF-a) and renal function (urea, creatinine, uric acid) were studied. Results: High fat diet fed rats showed increased body weight gain, glucose intolerance, elevated levels of plasma leptin and TNF-a. Supplementation of Garcinia Cambogia extract (GE) along with high fat diet significantly decreased body weight gain, glucose intolerance, plasma leptin and TNF-a level. No significant changes were observed in the renal function parameters in any of the groups. Conclusion: Supplementation of the Garcinia Cambogia extract with high fat diet reduced body weight gain, inflammation and glucose intolerance.

Allopurinol Induced Stevens – Johnson Syndrome – A Case Report

Sabyasachi Paik, Sukanta Sen, Joydip Das, Bibhuti Saha, Santanu K Tripathi

Pregnancy with Uterine Didelphys with Obstructed Hemivagina and Pyocolpus

Mahija Sahu, Sushree Samiksha Naik

Saccular Aortic Aneurysm Causing Hoarseness: An Alarming Bell..!

Surender Deora, Pooja Mehta, Tejas Patel

Internet Sex Addiction and Its Negative Consequences: A Report

Jaswinder Kaur, M.S Bhatia, Priyanka Gautam

Effect of Platelet-Rich-Plasma (PRP) Implant Surface Topography on Implant Stability and Bone Revisited

Levent Tekin, Selim Akarsu, Emre Ata

Embryonic Metastatic Rhabdomyosarcoma Compressing the Trachea

Srinivas Sankuratri, Kartika Balaji Samala, Krishna V.P., Srinadh Babu Atiketi

Asymptomatic Cervical Mature Teratoma in a Child: An Unusual Presentation

Correction

Priyanka Banerjee, Tavleen Jaggi, Mehvash Haider, Bibhabati Mishra, Archana Thakur, Prevalence of Carbapenemases and Metallo-ß-lactamases in Clinical Isolates of Enterobacter Cloacae (Published in Journal of Cilinical and Diagnostic Research. 2014 November: 8(11):). DM01-DM02 In this article a change has been done in Authors name. A conflict arose between the authors post publication. This was finally resolved between the author and conveyed to the editorial. After assessing the case editorial agreed upon the changes as a rare exception.