Journal of clinical and diagnostic research

Comparative Evaluation of Advanced and Conventional Diagnostic Aids for Endodontic Management of Periapical Lesions, An in Vivo Study

Aim: To evaluate efficacy of Colour Doppler ultrasonography (CDUSG), direct digital radiography (DDR) and conventional radiography (CR) in diagnosis of periapical lesions and to clinically correlate treatment plan of periapical diseases. Materials and Methods: Thirty patients which were diagnosed with periapical lesions in anterior region by using both conventional and digital radiography were examined using colour doppler ultrasound imaging at the site of lesion. The images of each lesion were analysed by two endodontists and by an expert oral radiologist. A tentative differential diagnosis was agreed upon, based on certain principles discussed in article, then a diagnosis between cyst, granuloma and mixed lesions was made. Periapical lesions diagnosed as mixed lesions by colour doppler ultrasonography (CDUSG) were treated non-surgically whereas other periapical lesions were treated surgically. Tissues obtained during endodontic surgery were processed and examined for histopathological findings, and compared with the diagnosis made by ultrasound images. Statistical analysis was done with Chi-Square test and using one-way-Anova. Results: The periapical lesions which were diagnosed as granuloma by ultrasonographic findings, was confirmed by the results of histopathological examination in all 16 surgically treated cases. The lesions in rest of the 14 cases which showed vascularity and were diagnosed as mixed lesions by ultrasonography, were treated non-surgically and had a favourable prognosis. Conclusion: CR and DDR facilitate diagnosis of the presence of periapical disease, but do not provide and information of its nature. CDUSG imaging facilitates accurate information on the pathological nature of the lesion and hence can lead to predictable treatment planning.

Evaluation of Cytotoxicity of Silorane and Methacrylate based Dental Composites using Human Gingival Fibroblasts

Aim: The effects of leached substances from the restorative dental materials may induce local and systemic adverse effects. Thus the biological and toxic properties of the restorative dental materials must be compatible with the oral tissues or with general health. Therefore, the need for biocompatible restorative dental material implies the necessity of toxicity testing. It was the purpose of this investigation to determine and compare the possible toxic effect of silorane based composite (Filtek P90) on human gingival fibroblast (HGF) in vitro using cytotoxicity measuring parameters (MTT assay) in comparison with its methacrylate counterpart (Z100) for their viability, proliferation rate. Materials and Methods: Fresh healthy biopsy specimens of human gingival tissue of patients were obtained. For HGF, cells were cultured in Dulbecco’s modified Eagle medium and grown to sub confluent monolayers. After attaining confluence, cells were treated with different doses of the Filtek P90 or Z 100 for different time point. HGF cells were observed for their proliferation, viability by MTT assay. Results: The results of the cytotoxicity assay showed that, the percentage of viable cells was very good in the first 24h and marginally decreased in the next 48h period in all groups. However, the proliferation rate was never below 84% in all the groups, at any given concentration. Filtek P90 and Z100 treated cells exhibited insignificant decrease in the cell proliferation both in 24h and 48h exposure when compared to significant decrease in the cell survival rate in the positive control (Mitomycin C 250 µg/ml).) Comparison of the toxicity between Filtek P90 and Z100 in 24h & 48h separately showed that there was no significant difference (p<0.05) between these two composites in 24h and 48h’ time period at all concentrations of the composites. Conclusion: To conclude, the new silorane based restorative composite showed comparable cytotoxic characteristics to clinically successful dimethacrylate composites suggesting the non-toxic nature in the oral environment and hence contributing to clinical success of these new restorative materials.

Correlation of RAPD-PCR Profiles with ESBL Production in Clinical Isolates of Klebsiella pneumoniae in Tehran

Fereshteh Eftekhar, Parvaneh Nouri

Background: Multidrug resistant K. pneumoniae, particularly the extended-spectrum ß-lactamase (ESBL) producing strains, are often responsible for the failure of antibiotic treatment in nosocomial infections. Employing molecular methods to distinguish between ESBL and non-ESBL producing isolates can help quick identification of these multidrug resistant pathogens and thereby initiating appropriate antibiotic therapy. The aim of this study was to employ RAPD-PCR to distinguish the genetic fingerprints of ESBL producing clinical isolates of K. pneumoniae from ESBL negative strains. Materials and Methods: Antibacterial susceptibility of 104 K. pneumoniae clinical isolates was determined to 13 antibacterial agents by disc diffusion. ESBL production was measured by the double disc synergy test followed by phenotypic confirmatory tests. Genetic fingerprinting was carried out by RAPD-PCR. Results: All isolates were susceptible to imipenem. Antibiotic resistance rates were: piperacillin (100%), ceftazidime (62.5%), cefotaxime (57.6%), aztreonam (52.8%), cefepime (51.9%), kanamycin (50.9%), gentamicin (41.3%), ciprofloxacin (37.5%), nitrofurantoin (30.6%), nalidixic acid (22.1%), piperacillin/tazobactam (21.1%) and amikacin (9.6%). ESBL production was observed in 14 isolates (13.4%). Genetic fingerprinting performed on 43 isolates (14 ESBL positive and 29 ESBL negative) by RAPD-PCR, showed that 46.5% of the isolates belonged to a single profile (genotype 1), of which, the majority (62.1%) were non-ESBL producers. Conclusion: RAPD-PCR results showed heterogeneity among the isolates. There was no association between ESBL production with any specific genetic fingerprint.

Relationship of Caffeine with Adiponectin and Blood Sugar Levels in Subjects with and without Diabetes

Geetha Bhaktha, B Shivananda Nayak, Shreemathi Mayya, Manjula Shantaram

Introduction: Coffee though not usually thought of as healthy food but can be treated as one of the beneficial drink. Many researchers have found strong evidence that coffee reduces the risk of several serious ailments, including diabetes, heart disease, cirrhosis of the liver, etc. The long term beneficial effect of coffee on diabetes is now understood to be more influential and obliging. Materials and Methods: This study comprised 220 healthy subjects of which 143 consumed coffee and 77 did not. These were matched with 90 diabetic subjects. Among the 90 diabetics, 48 consumed coffee and 42 did not consume coffee. Results: The mean adiponectin value was significantly higher in coffee consumed normal and diabetic subjects than the subjects who did not consume coffee. The decrease in fasting blood sugar and HbA1c values were also observed in normal and diabetic subjects who consumed coffee than the other groups who did not consume coffee. Significant difference (p<0.05) in mean FBG, PPBS, HbA1c and adiponectin were observed between coffee consumed and no coffee consumed groups. Conclusion: The long term use of caffeine is more efficient on blood sugar and adiponectin levels, which needed in the prevention of complications in diabetic subjects.

Clinico-Radiological Correlation in a Cohort of Cervical Myelopathy Patients

Praveen Kumar S., Kalpana R.Y.

Objective: Though both clinical evaluation and MRI are complimentary in detection and precise localization of the level of lesion in patients with cervical myelopathy, there is paucity of data comparing segment specific clinical features with the MRI abnormalities in cervical myelopathy. Materials and Methods: Thirty one patients with cervical myelopathy and abnormal MRI of the cervical spine (signal changes in the cord) admitted to the neurology and neurosurgery wards during the study period were included in the study. The patients were prospectively evaluated by a detailed neurological examination. Clinically, the site of lesion was determined by highest of the pyramidal, sensory or segmental features of involvement. The MRI lesions were categorized based on the vertebral level at which the abnormalities were seen. The patients were divided into three groups according to the site of lesion on MRI: (1) cervico-medullary (foramen magnum to C1) lesions (2) upper cervical (C2-C4) lesions and (3) lower cervical (C5-T1) lesions. Comparisons of clinical symptoms, signs and level of lesion with MRI abnormalities were done and the level of significance was set at p < 0.05. Results: Clinical evaluation showed limb weakness in all, sensory loss in 90%, sphincter disturbances in 67.7%, scissoring gait in 32.2%, diaphragmatic weakness in 12.9% of patients. Based on clinical examination the site of lesion was cervico-medullary in 9, upper cervical region in 4 and lower cervical region of involvement in five patients. The maximal antero-posterior extent of the lesion and neurological deficits were concordant (p-0.05). As compared to pyramidal signs or sensory abnormalities, segmental features – segmental sensory loss, weakness, wasting or ‘reflex’ loss – were most concordant with the MRI level of lesion (p - 0.03). Among ‘motor’, ‘sensory’ and ‘reflex’ levels, the ‘reflex (DTR)’ levels were most concordant with the MRI level of lesion (p – 0.04). Conclusion: Segmental features form the foundation for clinical localization of the level of lesion. Though the clinical level of lesion and MRI level of lesion were discordant in 14 patients, clinical evaluation may still provide useful information.

The Evaluation of Serum Levels of Testosterone in Type 2 Diabetic Men and Its Relation with Lipid Profile

Nirmali Mattack, Runi Devi, Tridip Kutum, Dibyaratna Patgiri

Introduction and Aim: Type 2 diabetes mellitus (T2DM) is the predominant form of diabetes worldwide and much is known about its patho-physiology. Yet, newer aspects related to it are being constantly explored. For ages, testosterone has been known to men as the male sex hormone but now it has been shown by certain studies that it might have a role in the development of metabolic disorders like type 2 diabetes. This study was carried out to determine the relation of testosterone levels with type 2 diabetes mellitus and lipid profile in North East Indian men aged 31 to 73 years. Materials and Methods: This case control study comprised of 40 type 2 diabetic men and 40 age matched non diabetic healthy men. Testosterone, SHBG levels and lipid profile were evaluated in both the groups along with anthropometric measurements and were statistically analysed. Results: Serum total and free testosterone and Sex Hormone Binding Globulin were significantly lower in the test group than in the control group. Prevalence of type 2diabetes was five times higher in men having a total testosterone less than 8nmol/L and 5.57 times higher in those having a free testosterone of less than 0.225nmol/L. Fasting blood glucose showed a strong negative correlation with total and free testosterone. Glycated haemoglobin correlated negatively with SHBG but no such correlation was seen with total or free testosterone. Serum total and LDL cholesterol showed significant negative correlation with total testosterone and SHBG but no significant correlation was found with free testosterone. Serum VLDL, HDL and triglycerides did not show any significant correlation with total or free testosterone and SHBG levels. Conclusion: Low testosterone might have a role in the development of type 2 DM and to the associated altered lipid profile. This study, though a small one is among the few of its kind in India and it thrives to assist other studies related to the matter.

In Vitro Evaluation of Shear Bond Strength of Nanocomposites to Dentin

Aims: To compare the shear bond strength of nanocomposites to dentin using three different types of adhesive systems; and to test few specimens under Scanning Electron Microscope (SEM) for analysing whether the bond failure is adhesive or cohesive. Materials and Methods: Sixty human premolar teeth were selected and were randomly grouped, with 20 specimens in each group: group 1 - fluoride releasing dentin bonding agent; group 2 - antibacterial containing dentin bonding agent; and group 3 - one step conventional self etch adhesive. Each group was treated with its respective bonding agents, composite resin build up was done, and shear bond strengths were tested using Instron Universal testing machine. Few of the specimens were tested under SEM. Results: The results were statistically analysed using One-way ANOVA and paired t-test. It was observed that group 3 has the highest shear bond strength followed by group 2, and then group 1. Adhesive failures and mixed failures were most frequent types of failures as seen under SEM. Conclusion: Addition of antimicrobial agent decreases the bond strength of dentin bonding agent and addition of fluoride further decreases the bond strength. From SEM results it can be concluded that the zone of failure could not be defined and also that the failure mode was independent of the dentin bonding agent used.

Differentiation of Leptomeningeal and Vascular Enhancement on Post-contrast FLAIR MRI Sequence: Role in Early Detection of Infectious Meningitis

Armeen Ahmad, Sheenam Azad, Rajiv Azad

Objective: To qualitatively and quantitatively differentiate leptomeningeal and vascular enhancement on Post-contrast Fluid Attenuated Inversion Recovery (PCFLAIR) sequence compared to post-contrast T1-weighted (PCT1W) sequence with fat suppression (FS) and evaluate its role in early detection of infectious meningitis. Materials and Methods: Thirty-one patients with diagnosis of meningitis were evaluated with pre and post-contrast FLAIR and T1-weighted sequences with fat suppression (FS). Qualitative assessment was done by two observers for presence, absence or equivocal status of leptomeningeal enhancement. Further, quantitative estimation of single pixel signal intensities (SPSI) for meningeal and vascular enhancement was undertaken. A statistical comparison was performed using Kappa coefficient and t-test. Results: The overall qualitative accuracy was 90.3% for PCFLAIR compared to 54.8% for PCT1W with FS sequence. PCFLAIR was found to be 100% accurate in the detection of tubercular and pyogenic meningitis and 70% accurate in the detection of viral meningitis while PCT1W with FS sequence showed the corresponding accuracy to be 76.2% and 0% respectively. Both observers rated PCFLAIR images better than PCT1W with FS at detecting meningitis (p<0.05). The quantitative assessment revealed that the SPSI difference between the average meningeal and vascular enhancement on PCFLAIR was significantly greater than that on PCT1W with FS sequence (t= 6.31, p<0.01). Conclusion: PCFLAIR sequence has insignificant component of vascular enhancement compared to meningeal enhancement. This makes meningeal inflammation easily discernable and aids in early detection of infectious meningitis.

Is It Safe to Provide Abortion Pills over the Counter? A Study on Outcome Following Self-Medication with Abortion Pills

Nivedita K., Fatima Shanthini

Background: Medical abortion is a safe method of termination of pregnancy when performed as per guidelines with a success rate of 92-97 %. But self-administration of abortion pills is rampant throughout the country due to over the counter availability of these drugs and complications are not uncommon due to this practice. The society perceives unsupervised medical abortion as a very safe method of termination and women use this as a method of spacing. Aim of the Study: The aim of this study was to study the implications of self-administration of abortion pills by pregnant women. Materials and Methods: Retrospective observational study done in Sri Manakula Vinayagar Medical College & Hospital between the period of July 2013 to June2014. Case sheets were analysed to obtain data regarding self-administration of abortion pills and complications secondary to its administration. The following data were collected. Age, marital status, parity, duration of pregnancy as perceived by the women, confirmation of pregnancy, duration between pill intake and visit to hospital, whether any intervention done elsewhere, any known medical or surgical complications, Hb level on admission, whether patient was in shock, USG findings, evidence of sepsis, blood transfusion, treatment given and duration of hospital stay. Descriptive analysis of the collected data was done. Results:Among the 128 cases of abortion in the study period, 40 (31.25%) patients had self-administered abortion pills. Among these 40 patients 27.5% had consumed abortion pills after the approved time period of 63 days of which 17.5% had consumed pills after 12 weeks of gestation. The most common presentation was excessive bleeding (77.5%) Severe anaemia was found in 12.5% of the patients and 5% of patients presented with shock. The outcome was as follows : 62.5% of the patients were found to have incomplete abortion, 22.5% had failed abortion and 7.5% of patients had incomplete abortion with sepsis. Surgical evacuation was performed in 67.5% of the patients whereas 12.5% of the patients required surgical evacuation with blood transfusion. Medical methods were used in 15% of the patients whereas 2.5% required transfusion along with medical methods. Conclusion: Unsupervised medical abortion can lead to increased maternal morbidity and mortality. To curtail this harmful practice, strict legislations are required to monitor and also to restrict the sales of abortion pills over the counter and access to abortion pills for the public should be only through centers approved for MTP. Large scale prospective studies are required to assess the actual magnitude of this problem.

Comparative Evaluation of Disc Diffusion and E-test with Broth Micro-dilution in Susceptibility testing of Amphotericin B, Voriconazole and Caspofungin against Clinical Aspergillus isolates

Background: Clinical importance of Aspergillus has increased over the past few decades because of rise in immunosuppressive drugs and immune-modulating diseases. Antifungal susceptibility of Aspergillus is rarely performed by clinical laboratories because of lack of easier method. This study has investigated and compared susceptibility pattern of Aspergillus isolates by disc diffusion, E-test and broth micro- dilution for amphotericin B, voriconazole and caspofungin. Materials and Methods: Disk diffusion (DD) method of antifungal susceptibility (AFS) was evaluated for three different classes of antifungals: amphotericin B (AMB), voriconazole (VCZ) and caspofungin (CAS). Forty four clinical isolates of Aspergillus were selected; these included 34 A.fumigatus , 8 A.flavus and 2 A. terreus . AFS by DD and E-test was done on non-supplemented Mueller Hinton Agar (MHA) and was compared to Clinical Laboratory Standard Institute(CLSI) broth micro-dilution (BMD) method of AFS. Results: Disk diffusion method for amphotericin B showed 87.5% agreement while E-test showed 93.8% agreement with broth micro-dilution. The agreement with broth micro- dilution was similar for both disk diffusion and E-test in case of voriconazole (93.8%) and caspofungin (100%). 31.8% and 9.1% Aspergillus isolates were found to have amphotericin B and voriconazole MIC values above epidemiological cut off value (ECV) respectively. All isolates were within ECV for caspofungin. Conclusion: CLSI method of DD promises to be easier, reproducible and cost effective method of susceptibility testing, but this method must be interpreted with caution in case of amphotericin B susceptibility testing. E-test correlates better than DD with BMD.

Evaluating Estradiol Levels in Male Patients with Colorectal Carcinoma

Atreyee Basu, Shashi Seth, Kanchan Arora, Monica Verma

Background: Globally more than 1 million people suffer from colorectal cancer (CRC) per annum, resulting in about 0.5 million deaths. The role of estrogen in CRC is being researched with great interest; expression of estrogen receptors (alfa and beta) is being explored. Aims and Objective: Our objective was to compare the serum estradiol levels in diagnosed male patients of CRC, with age-matched controls; and to study the estradiol levels across the different stages of CRC. Setting and design: A cross-sectional study was conducted from January, 2012 to March, 2013 at a tertiary care hospital in north India. Materials and Methods: Fifty one male preoperative CRC patients were enrolled along with 50 age-matched male controls. Ethical approval and informed written consent from each participant were duly obtained. CRC patients were staged as per TNM (T- Tumour, N- Node, M- Metastasis; I, II, III and IV) criteria. Serum estradiol level was measured by Chemiimmunofluroscence method (normal = 11.6 - 41.2 pg/ml). Statistical analysis used: We used student’s t test and ANOVA (analysis of variance) to analyse the data (SPSS version 17.0, SPSS, Inc., Chicago, Illinois) Result:The mean serum estradiol level among CRC patients (43.4, sd=27.1) was significantly more than that among controls (mean=24.7, sd=17.5), (p<0.0001). Across the four TNM stages of CRC patients, mean estradiol level was highest in Stage II (55.9, sd=15.5); followed by Stages III (44.1, sd=24.9), IV (36.3, sd=30.0) and I (26.4, sd=38.8). However, significant difference was obtained only between Stages I and II. Conclusion: Our study revealed increased levels of serum estradiol in Indian male CRC patients. Further research is warranted to corroborate this finding, and to understand the role of estradiol across different TNM stages of CRC.

Biofilm Producing Multidrug Resistant Acinetobacter baumannii: An Emerging Challenge

Gitanjali Kailas Badave, Kulkarni Dhananjay

Aim: To study the quantitative method for biofilm formation and examine the correlation between biofilm formation and antibiotic resistance among the clinical isolates of Acinetobacter baumannii. Materials and Methods: A total of 72 A. baumannii isolates from different clinical specimens were processed and confirmed by conventional microbiological methods. Antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method using six antibiotics. Biofilm formation was studied by microtitre plate assay. Results: Forty five (62.5%) of 72 isolates produced biofilm. Resistance to ampicillin-sulbactam was least. 36.1% isolates were resistant to imipenem, 66.6% to ceftazidime, 72.2% to ciprofloxacin, 80.5% to amikacin and 84.7% to piperacillin. Biofilm formers showed greater resistance to ampicillin- sulbactam, amikacin, ciprofloxacin and ceftazidime as compared to imipenem and piperacillin. In all 65 (90.3%) isolates showed multiple drug resistance. Correlation between multidrug resistance and biofilm formation was analysed statistically and p-value was found to be significant (p-value =0.0004; p-value < 0.05 is significant by Chi – Square Test). Conclusion: The study concludes that there a positive correlation between biofilm formation and multiple drug resistance in A. baumannii.

Colour Stability of Heat and Cold Cure Acrylic Resins
Introduction: To evaluate the colour stability of heat and cold cure acrylic resins under simulated oral conditions with different colorants. Materials and Methods: Three different brands of heat cure acrylic resin and two rapid cure auto polymerizing acrylic resin of commercial products such as Trevelon Heat Cure (THC), DPI Heat cure (DHC), Pyrax Heat Cure (PHC), DPI Cold cure (DCC) and Acralyn-R-Cold cure (ACC) have been evaluated for discoloration and colour variation on subjecting it to three different, commonly employed food colorants such as Erythrosine, Tartarizine and Sunset yellow. In order to simulate the oral condition the food colorants were diluted with artificial saliva to the samples taken up for the study. These were further kept in an incubator at 37°C ± 1°C. The UV-visible spectrophotometer has been utilized to evaluate the study on the basis of CIE L* a* b* system. The prepared samples for standard evaluation have been grouped as control group, which has been tested with a white as standard, which is applicable for testing the colour variants. Results: The least colour changes was found to be with Sunset Yellow showing AE* value of 3.55 with heat cure acrylic resin branded as PHC material and the highest colour absorption with Tartarizine showing AE* value of 12.43 in rapid cure autopolymerzing acrylic resin material branded as ACC material. Conclusion: ACC which is a self cure acrylic resin shows a higher colour variation to the tartarizine food coloration. There were not much of discoloration values shown on the denture base resins as the food colorants are of organic azodyes.

Study of Serum Zinc in Low Birth Weight Neonates and Its Relation with Maternal Zinc

Shrivastava Jyotsna, Agrawal Amit, Aravind Kumar
Objective: Assessment of serum Zinc in LBW (Low Birth Weight) and appropriate for gestational age (AGA) neonates in relation to their maternal zinc level. Materials and Methods: A prospective study was conducted in a tertiary care teaching hospital of central India between August 2011 to July 2012. Serum samples were collected from the eligible LBW (preterm & term IUGR) and term AGA healthy neonates and their mothers for zinc level estimation. Serum zinc was measured by atomic absorption spectrophotometer. Newborn of mothers having any medical illness, on any medication, with anaemia (Hb <10 gm/dl) were excluded from the study. Neonates with any perinatal insult were also excluded. Results: Out of 100 newborn-mother pairs enrolled in the study, 46 newborns (18 preterm and 28 term IUGR) with birth weight <2.5kg comprised the case group and rest 54 term AGA newborns (birth weight >2.5kg) were categorized as control group. Mean serum zinc level was significantly low in LBW neonates (83.45±16.74 µg/dl) in comparison to term AGA newborns (93.74±19.95 µg/dl), (p-value <0.05). Similarly, zinc level was also low in mothers of LBW babies (67.02±15.99 µg/dl) in comparison to mothers of term AGA newborns (83.59±18.46 µg/dl), (p-value < 0.05). Low maternal zinc levels were significant correlated with lower serum zinc in LBW neonates (Pearson correlation value - 0.938). However, maternal zinc levels have shown no significant correlation with neonatal serum zinc levels in term AGA (0.029). Conclusion: LBW neonates and their mothers have significant zinc deficiency as compared to term AGA neonates and their mothers and this deficiency is correlated with zinc deficiency in mothers of these LBW neonates.

Performance of a Rapid Strip Test for the Serologic Diagnosis of Latent Tuberculosis in Children
Background: The serodiagnostic tests for tuberculosis (TB) present a high variability in terms of sensitivity and specificity. Data on patients with latent TB infection (LTBI) and children in high prevalence settings are still limited. The present study aimed to evaluate an in-house strip test for detection of anti- M. tuberculosis antibodies in TB patients, mostly children aged under 15 y, grouped into four diagnostic categories: active TB, LTBI, healthy TB contacts, and other non-TB diseases. Materials and Methods: The diagnostic performance of strip test was compared with the tuberculin skin test (TST) and interferon-gamma release assay (IGRA). Sensitivity and specificity were assessed for all three diagnostic tests. The detection accuracy among the tests was calculated by using a receiver operating characteristic analysis. Results: TST and IGRA could diagnose the active TB cases correctly (100%). The sensitivity of strip test for active TB was 58.3% and 37.5% for LTBI, while the sensitivities of TST and IGRA for LTBI were 90.3% and 37.5%, respectively. The overall specificities of strip test and IGRA were 91.5% and 95.7%, respectively, which were superior to that of TST (68.1%). Conclusion: The strip test did not appear to be useful for diagnosis of active TB in comparison with the current diagnostic standard. The assay may be particularly significant in situations where TB is clinically difficult to diagnose like LTBI and could be a meaningful tool in terms of high specificity and simplicity for ruling in pediatric TB in countries with high TB infection rate. Further studies are needed to determine whether strip test can be improved in its sensitivity and should be implemented into routine clinical practice.

Assessment of Lecture Strategy with Different Teaching Aids

Manoj Kumar, Indu Saxena, Jayballabh Kumar, Gaurav Kumar, Sangeeta Kapoor
Background and Objectives: Medical/dental colleges in Northern India cater to students with diverse backgrounds, mother tongues, levels of comprehending English, and intelligence levels. This study was conducted to identify lecture strategy and teaching aid best suited for North Indian dental and medical students. It was conducted in two parts – 1. Survey of teachers’ and students’ opinion to obtain their preferences in teaching-learning practices followed in a conventional lecture, and 2. Comparison of students’ performances after a single trial lecture with different groups of students, using different teaching aids (TAs). Materials and Methods: Opinions of 33 faculty teaching first year dental/ medical students and 506 volunteer students (320 female) were compiled. Students were divided into four groups. A single trial lecture was held with each group (on the same topic, using identical lesson plan, by the same teacher) using a different teaching aid with each group. Lecture strategy was designed according to students’ preferences (as obtained from opinion survey) regarding language of instruction and the number of mental breaks. TAs used with different groups were chalk and board (C&B), PowerPoint (PPT), overhead projector (OHP), and a combination of C&B and PPT. Pre- and post-tests using multiple choice questions were conducted with each group. Results of post-test questionnaire and feedback from faculty attending the lecture were assessed for students’ satisfaction and attentiveness in all four groups. Results: Survey results indicated that although 97.6% students believed they had good/fair proficiency in English, 83.6% preferred being taught in a combination of English and Hindi; 44.3% students preferred C&B, 40.1% preferred PPT and 15.6% preferred the use of OHP as TA. After conducting a trial lecture with different TAs with each group, more than 90% students expressed satisfaction with the TA used for that group. Significantly better performance was observed in the post-lecture test when C&B was used. Conclusion: The needs of students in India are different from those of their Western counterparts, and should be considered during didactic lectures to improve the students’ understanding. Post-test results were better when C&B was used, as more students were attentive and/or took notes.

The Importance of Cytokeratin 19 Expression in the Differentiation of Basal Cell Carcinoma and Trichoepithelioma
Introduction: Basal cell carcinoma (BCC) is the most common skin neoplasm reported in human. On the other hand, trichoepithelioma (TE) is a rare, benign tumour of skin adnexa. The differentiation of BCC and TE may be difficult since their morphological findings are similar. In a few studies, it has been determined that undifferentiated basaloid cells are highly positively stained with cytokeratin 19. Aim: The aim of this study was the comparison of cytokeratin 19 expression in cases of BCC and TE. Materials and Methods: Sections of skin tissues of 17 TE, 25 BCC and 12 non-neoplastic cases were used for cytokeratin 19 (CK19) immunohistochemical staining. Results: Staining with CK19 of the BCC cases gave 15(60%) diffuse, 7 (28%) focal and 3 (12%) negative staining. On the other hand, among TE cases, 2 (12%) gave diffuse, 5 (29%) focal and 10 (59%) negative staining with CK19. In the non-neoplastic skin tissue samples, while positive staining with cytokeratin 19 in the outer root sheath of hair follicles and sweat glands were observed, there was no staining in basal layers. Conclusion: CK19 expression may be helpful in the differential diagnosis of BCC and TE especially in small skin biopsy samples in which morphologic differentiation is difficult.

Using Wood’s Light as a Diagnostic Tool for Vaginal Atrophy
Introduction: Wood’s light lamp is a device that emits ultraviolet (UV) light and is a useful diagnostic tool for dermatologic disorders. The change in the thickness of vaginal mucosa, in vaginal atrophy, causes a change in its colour under Wood’s light. We wanted to assess the feasibility of Wood’s light (WL) as a diagnostic tool for vaginal atrophy. Materials and Methods: The study was conducted at the Department of Obstetrics and Gynaecology from 1 March 2013 to 1 September 2014. We evaluated 45 healthy postmenopausal women with atrophic vaginitis (study group) and 45 healthy, reproductive-aged women as a control group. All patients underwent WL and routine gynaecological examinations for this study. Results: Ninety patients were selected for this study: 45 postmenopausal women suffering atrophic vaginitis symptoms like vaginal dryness, dyspareunia, vulvar pruritus, and signs like pale, smooth, dry, fragile vaginal epithelium, areas of petechiae, and rash, and 45 healthy reproductive-aged women without vaginal atrophy. Thirty-six of the postmenopausal women’s vaginal mucosa appeared pale royal green under WL indicative of vaginal atrophy. Thirty-nine of reproductive-aged women’s (n: 45) vaginal mucosa were not visualized as pale royal green fluorescent images under the WL. Conclusion: Using Wood’s light to diagnose vaginal atrophy is a new use for the old device and may be a reliable, and cheap tool for diagnosing vaginal atrophy. Diagnostic accuracy and cost-effectiveness of Wood’s light will be better optimized in further trials.

Morphological Pattern of Cutaneous Adverse Drug Reactions due to Antiepileptic Drugs in Eastern India

Punit Kumar Singh, Mani Kant Kumar, Dharmendra Kumar, Prashant Kumar
Introduction: Cutaneous manifestations of adverse drug reactions are a common occurrence and need to be differentiated from other causes of similar manifestations. Antiepileptic drugs (AED) usually are responsible for severe cutaneous adverse drug reactions (CADR) like Stevens-Johnson Syndrome/Toxic epidermal necrolysis (SJS/TEN) and drug rash with eosinophillia and systemic symptoms (DRESS). There is paucity of published research regarding morphological pattern of CADR due to various antiepileptic drugs AED. Objective: To study the morphological patterns of CADR due to AED and common anticonvulsant drugs implicated particularly in severe CADR such as SJS/TEN and DRESS in a tertiary care teaching hospital in eastern India. Materials and Methods: A prospective, observational study was conducted over a period of 4 years from August 2009 to July 2013 after the approval of the Institutional Ethics Committee using self-reporting method for selection of cases. Settings: All patients with CADR after AED consumption for various conditions presenting to the Dermatology outpatient department (OPD) and Pediatric OPD and Indoor patients of a tertiary care teaching hospital located in Rohtas district of Bihar were included in this study. Results: During the study period, 64 cases of severe CADRs were included in this study. Out of 64 patients, 28 were male and 36 were female with mean age 36.1 years (range 6 years to 72 years). Most common AED implicated for CADR was Phenytoin. Maculopapular rash was the most common cutaneous manifestation of ADRs (42.85%). Serious CADR like TEN and SSJS were more likely in patients prescribed Phenytoin and Carbemazepine simultaneously. Conclusion: CADRs are a common occurrence and awareness about the same is essential for diagnosis and prevention. This study identified combined use of phenytoin and carbamezepine as a most important risk factor for serious CADR like SJS and TEN.

Share of Tobacco Related Cancers: Gender and Time Gaps-Indian Scenario

Atul Juneja , Tulsi Adhikari, Arvind Pandey, Shashi Sharma , Ashok Sehgal
Introduction: Cancer is one of the leading causes of mortality in Indian population with control approach of varied kind which the health system of the country needs to prioritize. The tobacco related cancer which account for major share of all the cancers could be largely controlled through primary prevention a strategy effective in terms of resources hence take priority in terms of cancer control activities. It would be worthwhile to study the cancer of sites and relative magnitude of the cancers which are tobacco related and are amenable for prevention. Materials and Methods: The age specific cancer incidence rates of cancer as available from the consolidated reports of the National Cancer Registry Program of Indian Council of Medical Research for the years 1990-96 an 2001-04 were utilized for computing proportion of tobacco related cancers which included population based cancer registries at Bangalore, Bhopal, Barshi a rural registry in Maharashtra, Chennai, Delhi and Mumbai. As defined cancer of the sites oral cavity, lip, tongue, oropharynx, hypopharnx, pharynx, oesophagus, larynx, lung, urinary bladder were considered as tobacco related cancers. The statistical evaluation of proportion of tobacco related cancers between two time periods under consideration was carried out by proportion test. Results: There was a significant decline of proportion of tobacco related cancers from 1990-96 to 2003 for all the registries except Bhopal where around 50% of the total cancers attributed to tobacco habits for the two time periods under consideration. The Barshi also reported a decline but was not statistically significant. In females the proportion of tobacco related cancers ranged between 17% in Bangalore 10% in Delhi for the two time periods under review. All the registries showed significant decline in proportion of tobacco related cancers for the periods under consideration, except Delhi and Bhopal, while rural registry at Barshi revealed an increase of 3.3 %. The gender difference of the proportion of tobacco related cancers ranges between 19.8% to 34% during the period 1990-96, while it was 18.5% to 35% for the period 2001-03. While examining the difference between gender gap between the two time periods, the results from Mumbai registry revealed significant decline.

Comparative Trial to Study the Effectiveness of Clonidine Hydrochloride and Buprenorphine–Naloxone in Opioid Withdrawal – A Hospital Based Study

Syed Sajad Hussain, Samina Farhat, Yasir Hassan Rather, Zaffar Abbas
Objectives: Prevalence of opioid addiction has alarmingly increased over the recent years. In South Asian region alone there are more than 10 million opioid abusers amounting to 2% of world population. Detoxification remains to be the first step for the successful treatment of opioid addiction. The present study was carried out to compare the relative efficacy and safety of buprenorphine –naloxone and clonidine hydrochloride in the detoxification of opioid-dependents. Materials and Methods: Present trial was conducted at De- addiction centre of Institute of Mental and Neurosciences (IMNS), GMC Srinagar. Fifty four (54) treatment seeking subjects, 15-50 years of age, fulfilling DSM-1V TR (American Psychiatric association`s Mental Disorders-1V text revision) criteria for opioid dependence were included and randomized into two groups. The groups received either clonidine hydrochloride (Group A) or buprenorphine- naloxone (Bup-Nax) (Group B) for the duration of 10 days. The efficacy of the two drugs in controlling the opioid withdrawal was evaluated by Clinical Opioid Withdrawal Scale (COWS) and their effect on the desire for the abused substance was measured by Visual Analogue Scale (VAS). The safety of the two drugs was measured by taking the side effect profile of the two compared drugs into consideration. Results: There was significant difference of COWS-score between the two groups which was evident from day 3 (14.85 ± 3.43 vs. 11.67 ± 2.40, p<0.005) and continued till day 6 (2.56 ± 1.40 vs. 0.30 ± 0.61, p<0.005), for Group A and group B respectively. The effect of two drugs in controlling the craving for the abused substance also showed significant difference from day 2 (66.30 ± 10.80 vs. 47.40 ± 12.90, p<0.005) till day 5 (7.78 ± 6.41 vs. 1.85 ± 6.22, p<0.005), for Group A and Group B respectively. Conclusion: Administration of buprenorphine-naloxone was more efficient in reducing the signs and symptoms of opioid withdrawal and in controlling the craving for the abused substance during the first few days of detoxification

Heart Rate Variability in Overweight Health Care Students: Correlation with Visceral Fat

Kiran Kumar Chintala, Bandi Hari Krishna, Mallikarjuna Reddy N.
Background and Objectives: Increased sympathetic activity, decreased parasympathetic activity and sympathovagal imbalance (SVI) has been reported in obese individuals. However, the SVI and its association with visceral fat in overweight health care students have not been explored. Therefore, in the present study, we have assessed heart rate variability (HRV) and its association with visceral fat in overweight health care students. Materials and Methods: Frequency domain parameters of HRV, body fat distribution and baseline anthropometric parameters were recorded in the control (n=40) and overweight (n=40) individuals. Further, the association of visceral fat with HRV was analysed. Results: There was no significant difference in age and height of overweight group and control group (p = 0.732). The baseline heart rate and blood pressure (p<0.001) were higher in the overweight group. Total body fat, subcutaneous fat and visceral fat were higher in the overweight group (p<0.001). Among frequency domain parameter of HRV, LFnu and LF: HF were more in the overweight group (p<0.001). Further, HFnu was less in the overweight group (p<0.001). Conclusion: Sympathovagal imbalance due to increased sympathetic activity and its association with visceral fat was observed in overweight individuals.

A Novel Way to Monitor Urine Concentration: Fluorescent Concentration Matrices

Katarina Dubayova, Iveta Luckova, Jan Sabo, Anton Karabinos
Background: The amount of water found in urine is important diagnostic information; nevertheless it is not yet directly determined. Indirectly, the water content in urine is expressed by its density (specific gravity). However, without the diuresis value it is not possible to determine whether the increase in density of urine is due to a decrease in water secretion or an increase in the concentration of secreted substances. This problem can be solved by the use of fluorescent concentration 3D-matrices which characterise urine concentration through the p f (or -log f ) value of the first fluorescence centre. Materials and Methods: The urine fluorescent concentration 3D-matrix was created by the alignment of the synchronous spectra of the dilution series of urine starting from undiluted (p f = 0) to 1000-fold diluted urine (p f = 3). Results: Using the fluorescence concentration 3D-matrix analysis of the urine samples from healthy individuals, a reference range was established for the value p f , determining the normal, concentrated or diluted type of urine. The diagnostic potential of this approach was tested on urine samples from two patients with a chronic glomerulonephritis. Conclusion: The p f value of the urine fluorescence concentration 3D-matrix analysis determines whether the urine sample falls within the normal, concentrated or diluted type of urine. This parameter can be directly utilised in sportsmen’s hydration state monitoring, as well as in the diagnosis and treatment of serious diseases. An important advantage of this novel diagnostic approach is that a 12/24 h urine collection is not required, which predetermines it for use especially within paediatrics.

Evaluation of Serum Prolactin Level in Patients of Subclinical and Overt Hypothyroidism

Parul Goel, Kahkasha, Shveta Narang, Bharat K Gupta, Kapil Goel
Background: Prolactin secretion is controlled by prolactin inhibitor factor that is secreted from hypothalamus; factors like vasoactive inhibitory peptide (VIP) and thyroid releasing hormone (TRH) lead to increase in prolactin secretion. Hyperprolactinemia is a common condition that can result from a number of causes including hypothyroidism. Objective of the study was to determine correlation between serum levels of prolactin and thyroid hormones in euthyroid, subclinical and overt hypothyroid cases. Materials and Methods: Consecutive patients presenting for various thyroid related problems were segregated into two groups subclinical and overt hypothyroidism according to their diagnosis based on history and clinical examination, laboratory reports, inclusion and exclusion criteria. Newly diagnosed 75 patients in each group were finally enrolled. Similar number of age and sex matched controls were selected. All subjects filled a predesigned questionnaire for the evaluation of hypothyroid symptoms. Thyroid profile for T3, T4 (total and free), TSH and prolactin were determined in all the subjects and analyzed. Results: Prolactin elevation was found in 16 patients (21.33 %) with overt hypothyroidism, and in six patients (8%) with subclinical hypothyroidism. The control group and subclinical hypothyroid patients exhibited no significant difference in terms of total and free T3, total and free T4. For TSH and prolactin on the other hand, a statistically significant elevation was found in patients with overt hypothyroidism when compared with subclinical hypothyroidism; and in patients with subclinical hypothyroidism when compared to the controls. A significant statistical difference was observed between the two groups of hypothyroid patients for all hypothyroid symptoms except alopecia and hirsuitism. Conclusion: The incidence of hyperprolactinemia in hypothyroidism was found to be higher when compared with normal controls. Serum prolactin assessment should be performed on all patients with hypothyroidism (overt and subclinical) before performing further tests.

Effect of Family-centered Care on Improving Parental Satisfaction and Reducing Readmission among Premature Infants: A Randomized Controlled Trial

Farideh Bastani, Tayebe Ali Abadi, Hamid Haghani
Introduction: Healthcare quality is usually evaluated through analysing medical outcomes including neonatal readmission and patient and family satisfaction. Parental involvement in neonatal care is considered as one of the most important factors, which directly affects these outcomes. The aim of the present study was to determine the effect of family-centered care including maternal participation, presence, and information about neonatal care, on maternal satisfaction and neonatal readmission; the care services were provided by the primiparous mothers of preterm infants. Materials and Methods: One hundred and ten primiparous mothers with preterm infants participated in this clinical trial. All samples were randomly divided into family-centered care (FCC) and control groups, through simple random sampling. The FCC program, which consisted of information about neonatal care, maternal presence, and participation in the care process, was implemented in the FCC group, while the control group was provided with routine care. Data were obtained using demographic and satisfaction questionnaires and readmission checklist. Results: In the FCC group, the mean score of satisfaction increased after the implementation of the program (22.36 and 59.28 before and after the program, respectively) (p<0.001); however, this increase in the control group was not significant. The obtained results regarding the different aspects of satisfaction indicated that mothers in the FCC group were more satisfied with maternal presence in the neonatal intensive care unit (NICU), compared with aspects of information and participation. In addition, the number of neonatal readmission was less in the FCC group compared with the control group, and the mean duration of hospitalization was 6.96 and 12.96 days in the FCC and control groups, respectively (p<0.001). Conclusion: FCC program seems to be effective in increasing maternal satisfaction and decreasing neonatal readmission. Therefore, it seems necessary that healthcare authorities of the departments of obstetrics and gynecology in Iran provide the opportunity for the implementation of such programs in clinical environments, which follow the policy of parental absence and participation in the intensive care units.

Variation of Axial Ocular Dimensions with Age, Sex, Height, Bmi -and Their Relation to Refractive Status

Abhijit Roy, Maitreyee Kar, Dhruba Mandal, Ramen Sinha Ray, Chinmaya Kar
Background: Myopia is one of the most common causes of visual impairment worldwide.It is proved in earlier studies that the eye shape is different in myopic and nonmyopic children even at a very young age, with the former manifesting asymmetric axial globe elongation and the latter global expansion but limited information is available regarding hypermetropia. Aim: To find out the variations of axial ocular dimensions in relation to age, sex, height and to demonstrate any possible correlation of body mass index (BMI) in myopic hypermetropic and emmetropic patients. Settings: It is a cross-sectional observational study. Materials and Methods: All the patients attending eye OPD in the Regional Institute of Ophthalmology (R.I.O.), Medical College, Kolkata, West Bengal, India from June2010 to May 2011.Axial dimensions were measured by B-mode USG. Refractive status was measured.Age, gender, height and BMI were also observed. After collecting all the data,all the variables were summarised by descriptive statistics followed by correlation testing by Pearson’s Correlation Coefficient r. Results: Height was positively correlated with axial length, anterior chamber depth, vitreous chamber depth ;age was positively correlated with axial length, vitreous chamber depth and negatively correlated with anterior chamber depth. Subjects with higher BMI tended to had refractions that were more hypermetropic. Conclusion: The findings of the present study can highlight not only the normal range of the different ocular parameters namely axial length, anterior chamber depth, vitreous chamber depth and lens thickness but their variation with age, gender, height and weight.

Comparision Between Bupivacaine and Ropivacaine in Patients Undergoing Forearm Surgeries Under Axillary Brachial Plexus Block: A Prospective Randomized Study

Anupreet Kaur, Raj Bahadur Singh, R.K.Tripathi, Sanjay Choubey

Angiogenesis in Breast Cancer and its Correlation with Estrogen, Progesterone Receptors and other Prognostic Factors

Jyotsna Naresh Bharti, Poonam Rani, Vinay Kamal Prem, Narayan Agarwal
Purpose: The aim of study is to evaluate angiogenesis using CD34, in estrogen, progesterone positive and negative breastcancer and to correlate the microvessel density with known histological prognostic factors, morphological type of breast carcinoma and lymph node metastasis. Materials and Methods: Twenty eight untreated cases of breast cancer were included in the study and paraffin embedded sections were obtained from representative mastectomy specimen of breast cancer patient. The sections were stained with hematoxylin and eosin stain and immunohistochemistry was performed using CD34, estrogen, progesterone, cytokeratin and epithelial membrane antigen antibody. Angiogenesis was analysed using CD 34 antibody. For statistical analysis, cases were grouped into estrogen, progesterone positive and negative receptors. Results: Mean microvessel density in ER-/PR-, ER-/ PR+, ER+/PR-, ER+/PR+ was 15.45, 14.83, 11, 10.89 respectively. A significant correlation was found between ER receptors and mean vascular density with p-value (< 0.05). A significant difference was observed in mean vascular density between the four groups comprising (p-value < 0.05). Infiltrating duct carcinoma (NOS) grade III has got the highest mean microvessel density (14.17) followed by grade II (12.93) and grade I (12.33). Conclusion: Information about prognostic factors in breast cancer patients may lead to better ways to identify those patients at high risk who might benefit from adjuvant therapies.

Comparison of Ranolazine and Trimetazidine on Glycemic Status in Diabetic Patients with Coronary Artery Disease – A Randomized Controlled Trial
Introduction: Cardiovascular diseases have become the leading cause of death around the globe and diabetes mellitus (DM) is considered to be a coronary artery disease (CAD) risk equivalent. Ranolazine, an anti anginal drug has been found to reduce Glycated haemoglobin (HbA1c) in diabetes patients with chronic angina. However the effect of another antianginal drug trimetazidine, on glycemic status is not clear. Aim: To compare the effect of ranolazine and trimetazidine on glycemic status in diabetic patients with CAD. Settings and Design: Patients diagnosed with CAD and diabetes mellitus attending Cardiology Out Patient Department (OPD), Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India were recruited for this randomized open label parallel arm trial. Materials and Methods: The study conducted from January-2012 to April-2013 had 47 eligible patients diagnosed with CAD and diabetes mellitus. They were randomized to receive either ranolazine 500 mg BD or trimetazidine 35 mg BD for 12 weeks. HbA1c levels, fasting blood glucose (FBG), lipid profile, QT and QTc intervals were measured at baseline and after 12 weeks. Statistical Analysis: Unpaired t-test was used to compare the baseline characteristics of between the groups while comparison within the groups were done using Paired t-test. Wilcoxon and Mann Whitney U-tests were used for non parametric data. Graph pad instat version-3 was used for statistical analysis. Values were expressed as mean ± SD. A p < 0.05 was considered statistically significant. Results: The study could not find any change in HbA1c levels in both ranolazine and trimetazidine groups. The adverse effects reported from patients on ranolazine include angina, constipation, postural hypotension, headache, dizziness, nausea and weakness while patients on trimetazidine complained of constipation, weakness, palpitations, angina, dizziness, nausea, dyspepsia, headache, gastric discomfort, joint pain, etc. Conclusion: In patients with chronic angina and diabetes mellitus Ranolazine 500mg BD and Trimetazidine 35mg BD did not show any effect on HbA1c and fasting blood glucose lebel.

Plasma Fibrinogen in Type 2 Diabetic Patients with Metabolic Syndrome and its Relation with Ischemic Heart Disease (IHD) and Retinopathy
Introduction: Metabolic syndrome or Syndrome X is characterized by hyperlipidemia, increased blood pressure, abdominal obesity and hyperglycemia, which increases the risk of cardiovascular complications. In addition to these, it is also associated with nontraditional risk factor like C- reactive protein, Plasminogen activator and fibrinogen. Various studies have documented association of these nontraditional risk factor, in Type 2 diabetes mellitus. Thus patients with diabetes mellitus are higher risk of developing micro and macro vascular complications like ischemic heart disease (IHD) and diabetic retinopathy. Diabetic retinopathy is the leading cause of decreased visual acuity, which is associated with maculopathy and profierative complications of it. Chronic hyperglycemia and its associated nonenzymatic glycation play an important role in the development of microangiopathy. Aims and Objectives: To study the prevalence of the metabolic syndrome in type 2 diabetes mellitus. To study the plasma fibrinogen and its relationship with IHD and retinopathy in type 2 Diabetes mellitus patients with metabolic syndrome. Materials and Methods: Patients of type 2 diabetes Mellitus were recruited based on the inclusion and exclusion criteria. History of IHD and ECG evidence of ischemia was obtained. Retinopathy was diagnosed by direct opthalmoscopy. Fasting glucose, lipid profile and plasma fibrinogen were analyzed. Stastical analysis was carried by Chi square test and student‘t’ test. Results: The prevalence of metabolic syndrome in study population of 100 type 2 diabetic patients is 58% and is significantly associated with duration of the disease (p<0.001). Fifty eight patients have hyperfibrinogenemia and mean fibrinogen level is significantly high in diabetic patients with metabolic syndrome when compared to diabetic patients without metabolic syndrome (p<0.001). Diabetic patient with metabolic syndrome and hyperfibrinogenemia have higher prevalence of IHD and retinopathy in comparison with diabetic patients without metabolic syndrome (p<0.05). Conclusion: The prevalence of metabolic syndrome is higher in type 2 Diabetes mellitus patients. The combination of metabolic syndrome and hyperfibrinogenemia increases the risk of developing micro and macro vascular complications.

Paediatric Surgical Pathology – a Profile of Cases from Western India and Review of Literature

Nilesh Shah, Ami Shah, Jayul Kamdar, Jigar Shah
Aim: The paediatric surgical pathology specimens manifest a wide spectrum of morphological and histological features. The present work has been undertaken to know the prevalence and to describe the profile of paediatric surgical pathology specimens from western India as seen in Ahmedabad, India from 2008 to 2010. Materials and Methods: We reviewed 140 paediatric surgical specimens, 118 specimens rendered definitive diagnosis were included for the analysis. Cases were divided in two groups, one of developmental and congenital conditions and another of acquired lesions. Results: This study included 118 patients of which 79.3 % were male and 20.7 % were female. Age range of the patients was one day to twelve years. Children of one month to one year age group (infants) were the most vulnerable (31.3% cases). Group of developmental and congenital conditions consisted of 45.7% cases where as 55.3 % cases were of acquired lesions. Gastrointestinal tract was most frequently affected organ (43.2%) followed by head and neck region (14.4%) and testis (7.6%). Hirschsprung’s disease (HD) cases (6.7%) were commonest among the group of developmental and congenital conditions followed by juvenile polyps of colon (5%), Meckels diverticulum of small intestine (5%) and neural tube defect (5%). In acquired lesions, Appendicitis was the most frequent lesion (21.2%) followed by haemorrhagic infarct of testis due to torsion (5%) and intussuception of intestine (5%). Malignant cases were (4.2%) and the most common cancer was yolk sac tumour. Conclusion: Paediatric surgical specimens, unlike adults, represent significant number of developmental and congenital conditions in addition to acquired lesions; accounting for wide spectrum of morphological and histological features. Study provides insight into the trends of paediatric surgical lesions in the western region of India.

Utility of Heart-type Fatty Acid Binding Protein as a New Biochemical Marker for the Early Diagnosis of Acute Coronary Syndrome
Introduction: Acute coronary syndrome (ACS) refers to a constellation of clinical symptoms caused by acute myocardial ischemia. Cardiovascular diseases (CVDs) are major and growing contributors to mortality and disability in India. Aims and Objectives: Especially patients with non-ACS-related troponin elevations have an adverse outcome and require careful patient management. So, we look forward for another marker Heart-type Fatty Acid Binding Protein (H-FABP) that reliably detects myocardial ischemia in the absence of necrosis and would be useful for initial identification and for differentiating patients with chest pain of aetiology other than coronary ischemia. Materials and Methods: The study was done on 88 subjects of whom 34 subjects were with ischemic chest pain, 29 were with non-ischemic chest pain and 25 were normal subjects. Results: Receiver operating characteristic (ROC) curve analysis was done which showed that area under the curve (AUC) for H-FABP was 0.885(0.79-0.94) and that of high-sensitive Troponin T (hs-TnT) in initial six hours was 0.805(0.70-0.88). The specificity of H-FABP was higher compare to hs-TnT while sensitivity was comparable during 0-6 h of presentation of chest pain. Conclusion: H-FABP can be used as an additional marker to hs-TnT in diagnosis of myocardial infarction (MI) and for exclusion of non-AMI (acute myocardial infarction) patients.

An Analysis of Global Research Trends in Cardiology Over the Last two Decades

Rohit Kapoor, Soumya Sachdeva, Jerome S Zacks
Introduction: Heart disease today is a major cause of morbidity and mortality plaguing mankind worldwide. Aim: The present research was undertaken to ascertain global research trends in clinical trials in Cardiology involving human subjects over the last two decades. Materials and Methods: Cross-sectional study. A detailed search strategy was employed in December 2013, using the PubMed database. All papers published in 1993–2013 were evaluated. The research trends of various cardiologic subspecialties in the United States and worldwide have been analysed and detailed statistical analysis was done. Results: United States had maximum number of researches. Clinical trials involving infarction were maximum followed by coronary angiography and coronary angioplasty in that order. The year 2013 had the most researches. The United States was the top country and Boston was the top city. Author Christodoulos Stefanadis had the greatest number of researches in this field. American Journal of Cardiology was the most favored journal and Circulation was the journal with the highest impact factor. This effort may help funding agencies, prospective job seekers, fellowship applicants, policymakers and patients Conclusion: The research output in cardiology has increased and improved significantly over past decade. The publication per diplomat is more in transplant cardiology, Also more clinical trials involving coronary restenosis have to be done to know in depth to add to current knowledge and database.

Prospective Analysis of 55 Cases of Tuberculosis Meningitis (TBM) in North India

N—Acetyl Cysteine in the Management of Rodenticide Consumption — Life Saving?

Smitha Bhat, Kumar P. Kenchetty
Background and Aim of Study: Rodenticide is a commonly ingested poison in India. Many rodenticides contain hepatotoxic agents and can cause acute liver failure (ALF). There is no antidote for rodenticide poison, and consumption is often fatal. The Role of N acetyl cysteine (NAC) in acetaminophen induced ALF is well established. Additionally some studies have shown that it may be useful in non-acetaminophen induced ALF also. Cases with ALF secondary to suicidal rodenticide consumption have been reported, and some reports show that NAC is beneficial in these cases. Our study was a retrospective analysis of patients admitted with rodenticide consumption, comparing outcomes in those receiving standard of care management and those who were treated with NAC also. Materials and Methods: Case sheets of all inpatients of a tertiary medical college hospital between January 2010 and December 2012 admitted with an alleged history of rodenticide consumption were surveyed and data was extracted and analysed. Statistical Analysis: Patients were analysed with respect to age, sex, mode of presentation, interval between consumption of rodenticide and starting NAC; the outcome in patients treated with acetylcysteine was compared to outcomes in those not treated with acetylcysteine Results: A total of 100 patients were studied out of which 18 died. Sixteen of the deaths were in patients who had not been treated with NAC. We found that patients who had received NAC had lower mortality, lower peak values of AST/ALT, and shorter hospital stay. Conclusion: NAC may have a role in the management of ALF associated with rodenticide consumption.

Cephalometric Appraisal of Tongue and Related Soft Tissues in Normal and Open Bite Subjects at Rest

Usha Shenoy, Pushpa Hazarey, Pankaj J Akhare, Bhumika K Mute
Aim: To compare the tongue position of normal and open bite subjects at rest and to study if there is any difference in the hyoid bone and posterior pharyngeal wall positions in normal and open bite subjects. Materials and Methods: Sample size consisted of 48 individuals with 24 subjects having normal occlusion and 24 subjects having open bite malocclusion within the age range of 16 to 25 y. Standardized Lateral cephalograms were taken for all the subjects. The subjects were asked to protrude their tongue as much as possible. The dorsum of the tongue was then coated with a palatable suspension of Barium Sulphate (MICROBAR). The subjects were asked to swallow on command, after 10 sec of the swallow, lateral cephalograms were taken. Statistical Analysis: t-test Results: The antero-posterior relationship of maxilla and mandible to the cranial base is normal in both the groups. The open bite subjects had a larger over jet and as compared to the normal subjects, and had steeper mandibular planes.It was also seen that as the total tongue occupancy area increased so did the partial tongue occupancy area. Conclusion: A significant positive correlation was found between the horizontal position of the tongue tip and the lower incisor position in the normal group, also for the ratio of total tongue area to total oral area & the ratio of upper tongue area to the anterior oral area in the normal and openbite groups. There was no difference in the position of the tongue, hyoid bone and posterior wall in the normal and openbite groups. The mandibular plane angle and palatal plane - mandibular plane angles were found to be larger in the openbite subjects as compared to normal subjects. Supra-eruption of the maxillary molars was seen in the openbite group leading to a downward and backward rotation of the mandible. The maxillary and mandibular incisors were more proclinated in the normal as well as openbite groups.

Sizing the Shape: Understanding Morphometrics

Neha
Purpose: One of the most fundamental limitations associated with the conventional cephalometrics is its inability to delineate size from shape as it depends mainly on linear and angular measurements. However, the biological structures warrant greater description in terms of shape and form for better comparison of variation in a particular population. To overcome these shortcomings, morphometrics are now being employed for describing the biological structures in terms of quantifying the shape and form. Also, statistical analysis is being applied to find the variability of this form in the population. The present paper assesses the use of the Procuste superimposition technique and the subsequent form analysis by the principal component analysis (PCA). Materials and Methods: The lateral cephalograms of 10 adult females were taken from existing records, traced & digitized & then superimposed by means of procuste superimposition. A comparison was made with the conventional superimposition methods based on arbitrary reference planes like cranial base, FHP, SN. The statistical analysis for assessment of shape variability of the structures seen on the lateral cephalogram was done by calculating the principal components for 3 out of these 10 samples. Results: The conventional superimposition methods do not provide realistic picture of variation in the biological structures as they themselves are prone to variability even in a particular population. Conclusion: Concepts in Morphometrics can be applied for the purpose of orthodontic assessment of a particular patient with regards to his craniofacial morphology. With the help of morphometrics, norms for a population can be determined based on all the kinds of variations present naturally in that particular population & individuals can thus be compared more realistically regarding the morphological variations.

Shear Bond Strength Evaluation of Resin Composite Bonded to GIC Using Different Adhesives

Ruchi Gupta, Sonam Mahajan
Aim: To evaluate the bonding of composite to glass ionomer cement (GIC) using two different bonding systems. Materials and Methods: The occlusal surface of 30 teeth was flattened and they were divided into three groups. In Group A, composite (Filtek™ Z350 XT, 3M ESPE, USA) was bonded to GIC (Fuji II, GC Corporation, Japan) after initial setting of the GIC being employed as a total-etch adhesive(AdperSinglebond 2, 3M ESPE, USA). In Group B and C, self-etch primer(Adper™ Easy One, 3M ESPE, USA) was employed to bond composite to GIC before and after initial setting of GIC respectively. Shear bond strength and nature of fracture of specimens was determined. Statistical analysis: One-way analysis of variance (ANOVA) was used. Results: Group B showed higher bond strength than Group A & Group C (p<0.01). Group C showed the least bond strength. Conclusion: Bond strength of composite to GIC was significantly higher for self-etch primer group employed on unset GIC.

Comparative Study of Pineapple Juice as a Negative Oral Contrast Agent in Magnetic Resonance Cholangiopancreatography-Article Retracted

Fahad Mohammed Ali AlShehri
This article has been retracted by the Editorial due to problems with Data discovered on post publication reanalysis of paper following a complaint. Details of the issues related to the data methodology and results, found on re-evaluation can be obtained from the Journal (editors@jcdr.net) . Date of Retraction: 25.07.17

High Levels of Physical Inactivity Amongst Dental Professionals: A Questionnaire Based Cross-Sectional Study
Introduction: A Dentist plays an important role in providing health education (General and Oral) to the community. Questions arise regarding their own health, which in turn affects their patients’ counselling for leading a healthy and a physically active life. Aim: To measure and compare the amount of physical activity present amongst dental professionals with the general population of Greater Noida. Materials and Methods: The International Physical Activity Questionnaire (IPAQ) was used to measure physical activity and statistical significance was calculated using SPSS version 21.0. Statistical significance was kept as p <.05. Results: Compared to the general population, Dentists were more obese and reported increased levels of low physical activity. Dentists had an increased and significant transportation and leisure time activity (p= .03 and .01) whereas, the general population had a higher level of vigorous activity(p = <.01). The MET hour/week for dentists and general population was 33.72 and 36.24 respectively, which was quite low as compared to European population. Conclusion: The results indicate that dentists report a lower level of physical activity as compared to the general population of Greater Noida. However, on a global scale, the physical inactiveness of dentists and general population alike could pose a serious health hazard and if kept unchecked, shall increase the global burden of chronic disease.

Tretinoin Nanogel 0.025% Versus Conventional Gel 0.025% in Patients with Acne Vulgaris: A Randomized, Active Controlled, Multicentre, Parallel Group, Phase IV Clinical Trial
Background: Conventional topical tretinoin formulation is often associated with local adverse events. Nanogel formulation of tretinoin has good physical stability and enables good penetration of tretinoin into the pilo-sebaceous glands. Aim: The present study was conducted to assess the efficacy and safety of a nanogel formulation of tretinoin as compared to its conventional gel formulation in the treatment of acne vulgaris of the face. Materials and Methods: This randomized, active controlled, multicentric, phase IV clinical trial evaluated the treatment of patients with acne vulgaris of the face by the two gel formulations locally applied once daily at night for 12 wk. Acne lesion counts (inflammatory, non-inflammatory & total) and severity grading were carried out on the monthly scheduled visits along with the tolerability assessments. Results: A total of 207 patients were randomized in the study. Reductions in the total (72.9% vs. 65.0%; p = 0.03) and inflammatory (78.1% vs. 66.9%; p = 0.02) acne lesions were reported to be significantly greater with the nanogel formulation as compared to the conventional gel formulation. Local adverse events were significantly less (p = 0.04) in the nanogel group (13.3%) as compared to the conventional gel group (24.7%). Dryness was the most common adverse event reported in both the treatment groups while peeling of skin, burning sensation and photosensitivity were reported in patients using the conventional gel only. Conclusion: In the treatment of acne vulgaris of the face, tretinoin nanogel formulation appears to be more effective and better tolerated than the conventional gel formulation.

Categorization of Pathology Causing Low Back Pain using Magnetic Resonance Imaging (MRI)

Nirmalkumar Gopalakrishnan, Kulasekaran Nadhamuni, T. Kartrthikeyan
Background: Low backache is the most common ailment flooding the orthopaedic clinic. Most of the population at least once seek medical attention for low back ache. Magnetic Resonance Imaging (MRI) is a non invasive, commonly used diagnosing modality and accurate in diagnosing pathology causing low back ache. Aim: To classify and quantify the causes of low back pain referred to radiology department by MRI. Materials and Methods: Patients with back pain referred to radiology department were subjected to single MRI scan after ruling out any contraindications using the following sequences: T1W Turbo Spin Echo, T2W Turbo Spin Echo, Gradient-echo, Myelogram and short TI inversion recovery (STIR), in all imaging planes. Gadolinium enhanced T1W turbo spin echo sequence was used wherever necessary. Results: Data were analysed using Excel 2007, SPSS 14, Students t-test. Degenerative disc diseases were the commonest pathology followed by congenital and traumatic lesions. Neoplastic lesions were the least common. Commonest herniation type being the disc bulge (79%) followed by disc protrusion (15%), disc extrusion (6%) and disc sequestration (<1%). The posterolateral disc herniation as the commonest and foraminal the least. Sacralisation was the most common congenital spinal anomaly, followed by lumbar scoliosis and perineural cyst. There is no sex difference in disc protrusion but male preponderance in disc extrusion with subligmentous extrusion. Conclusion: MRI is useful in classifying the spinal lesions which again influences the treatment modality and clinical outcome. Degenerative disc disease is the single most common category which accounts for most the Low Back Ache for which a preventing strategy should be drafted.

A Qualitative Analysis to Compare the Effects of Surface Machining of Conventional Denture Base Resin and Two Soft Liners: A Scanning Electron Microscopic Study
Introduction: The denture base acrylic resins require adjustments for various reasons. During this process there is an alteration in the surface characteristics of the denture base. Rough surfaces promote the bacterial adhesion and plaque accumulation; therefore it is important to know the character of the surface left by instrumentation on denture base materials. This study evaluated the surface characteristics of the machined surfaces of heat-cured acrylic denture base resin, GC supersoft and Permasoft softliners. Materials and Methods: Thirty 15×15×1.5mm acrylic resin specimens were fabricated with each of three acrylic resins: Lucitone 199 denture base resin (Group I), GC supersoft (Group II) and Permasoft (Group III) softliners. They were further divided into three sub Groups A, B and C, in which Sub Group A was control group that is smooth produced against the glass. Sub Group B was produced by machining with the tungsten carbide bur and Sub group C is machined with the stone bur. Each surface was evaluated by a Scanning electron microscope and data were analyzed by analysis of variance followed by Tukey’s HSD test. Results: Stone bur produced smoother surface (Ra 3.6681µm± 0.254) on Lucitone199 than the tungsten carbide bur (Ra 5.3881µm ± 0.3373). Carbide bur produced a smoother surface on the GC super soft (Ra 1.617097µm ± 0.191767) and Permasoft softliners (Ra 2.237419µm ± 0.354259). Whereas stone bur produced rougher surface on GC supersoft(Ra 2.6µm) and Permasoft (Ra 4.184839µm ± 0.409869) softliners. Conclusion: The present study shows each type of rotary instrument produces its own characteristic surface on each type of denture base materials and that care is needed when selecting the most appropriate instrument to adjust denture base materials. These results can have a significant clinical implication. While using Lucitone 199 stone bur can be used for chair side adjustments. Tungsten carbide bur can be used for GC supersoft and Permasoft softliners to achieve smoother surface.

Surrogate Markers of the Kidney and Liver in the Assessment of Gestational Diabetes Mellitus and Fetal Outcome

Hong Liu, Shao-Gang Ma, Liang Cheng, Feng Bai, Wei Xu
Introduction: To investigate whether serum levels of butyrylcho linesterase activity, cystatin C, and pre albumin has the potential value as ? glutamyl transferase in reflecting gestational diabetes mellitus and its fetal outcome. Materials and Methods: Seventy six gestational diabetes mellitus women and 76 pregnancies with normal glucose tolerance in the second trimester were enrolled. Maternal serum parameters of butyrylcholinesterase activity, ? glutamyl transferase, cystatin C, and pre albumin were detected and evaluated. The pregnant complications and fetal outcome were also evaluated. Results: Levels of butyrylcholinesterase activity, ? glutamyl transferase, cystatin C, pre albumin and glycemic variables were higher in the gestational diabetes mellitus patients than in the controls. Levels of butyrylcholinesterase activity were significantly correlated to the levels of fasting plasma glucose, cystatin C, and ? glutamyl transferase ( p < 0.05) in the gestational diabetes mellitus group. There were statistical differences in cases of preterm delivery, preeclampsia and postpartum hemorrhage. Higher levels of ? glutamyl transferase and pre albumin were risk markers for gestational diabetes mellitus ( p < 0.05). The diagnosis curve demonstrated that ? glutamyl transferase had a significant advantage over other markers ( p < 0.001) but no significance compared with pre albumin ( p = 0.096). None of the detected markers showed predictive value for fetal outcome. Conclusion: Serum levels of butyrylcholinesterase activity, ? glutamyl transferase, cystatin C and pre albumin were cor related with gestational diabetes mellitus status but not with the fetal outcome. Pre albumin can be equivalent as ? glutamyl transferase in reflecting the presence of gestational diabetes mellitus.

Serum Levels of Metal Ions in Female Patients with Breast Cancer
Background: Breast cancer is the second commonest form of cancer among women. Several studies have been conducted to identify potential risk factors. However, role of trace elements or metals in causing breast cancer has not been studied to great extent. Aims: To estimate the serum levels of calcium, copper, magnesium, iron, phosphorus and zinc and determine their role in causing breast cancer in female patients. Settings and Design: A case-control study on female patients with breast cancer was conducted in a private superspecialty hospital and Cancer centre situated in Southern part of India. Materials and Methods: Newly diagnosed female patients with breast cancer in the age group of 30-60 y attending Oncology clinic were included in the study. These cases were selected irrespective of type and stage of the disease. The age matched control subjects were drawn from apparently healthy women attending master health check at superspecialty hospital. The patients or controls suffering from co-morbid conditions which affect serum levels of metal ions and other malignancies, and those undergoing treatment for breast cancer were excluded from the study. Serum was separated and tests were performed according to standard procedure for each metal ion on the same day. The estimation of metal ions was done by UV-Visible Spectrophotometer-CHEM 7. Statistical Analysis: Independent Samples T-test was used to calculate difference between the two means. The p-value of <0.05 was considered as significant. Results: The study was conducted on 54 female patients with breast cancer and 54 female controls with mean age of 47.2±8.14 y and 46.8±8.4 y respectively. There was statistically significant increase in serum levels of calcium, copper, iron and phosphorus in patients with breast cancer when compared to controls. The increase in serum levels of magnesium was insignificant. A statistically significant decrease in serum zinc levels was observed in patient with breast cancer when compared to controls. Conclusion: The present study highlights the role of calcium, copper, iron, phosphorus, magnesium and zinc in the pathogenesis of breast cancer. The estimation of serum levels of these metal ions has a potential role in early detection and monitoring of breast cancer.

Magnetic Resonance Imaging (MRI) Evaluation of Developmental Delay in Pediatric Patients
Introduction: Developmental delay is defined as significant delay in one or more developmental domains. Magnetic Resonance Imaging (MRI) is the best modality to investigate such patients. Evaluation of a child with developmental delay is important not only because it allows early diagnosis and treatment but also helpful for parental counseling regarding the outcome of their child and to identify any possible risk of recurrence in the siblings. Thus this study was undertaken to evaluate the developmental delay in Indian children which will help the clinicians in providing an estimation of the child’s ultimate developmental potential and organize specific treatment requirement and also relieve parental apprehension. Aims and Objectives: To study the prevalence of normal and abnormal MRI in pediatric patients presenting with developmental delay and further categorize the abnormal MRI based on its morphological features. Materials and Methods: It is a prospective, observational & descriptive study of MRI Brain in 81 paediatric patients (46 Males and 35 Females), aged between three months to 12 years; presenting with developmental delay in Deccan College of Medical Sciences, Hyderabad; over a period of three years (Sept 2011 to Sept 2014). MRI brain was done on 1.5T Siemens Magnetom Essenza & 0.35T Magnetom C with appropriate sequences and planes after making the child sleep/sedated/ anesthetized. Various anatomical structures like Ventricles, Corpus callosum, etc were systematically assessed. The MRI findings were divided into various aetiological subgroups. Results: Normal MRI findings were seen in 32% cases and 68% had abnormal findings of which the proportion of Traumatic/ Neurovascular Diseases, Congenital & Developmental, Metabolic and Degenerative, neoplastic and non specific were 31%, 17%, 10%, 2.5% and 7.5% respectively. The ventricles and white matter mainly the corpus callosum were the most commonly affected anatomical structures. The diagnostic yield was found to be 68% and higher yield was seen in patients presenting with developmental delay plus. Conclusion: The clinical diagnosis of developmental delay should not be the end point, but rather a springboard for an effective search for causal factors. MRI is the best investigation with a high yield in such patients.

Intercondylar Humerus Fracture- Parallel Plating and Its Results

Sanjiv Kumar, Sudhir Singh, Dharmender Kumar, Neeraj Kumar, Reetu Verma
Background: Intercondylar fracture of humerus is one of the commonest fractures of young adult and counts for about 30% of all elbow fractures. The treatment of these fractures continues to present challenges despite advances in internal fixation. Although orthogonal plating use to provid adequate functional results in these fractures, parallel plating is said to be mechanically more stable construct thus allowing early mobilization and better range of motion Aim: Aim of the study is to assess the clinical as well functional results of these fractures treated with parallel plating. Study and design: Prospective study in a tertiary care hospital. Materials and Methods: A total of 23 fresh patients of intercondylar fracture of humerus from Jan 2013 to May 2014 were included in the study and were treated with parallel plating. These patients were followed at 3, 6, 12, 24 weeks and at 1year of follow up and assessed in terms of time for union, range of motion, MAYO score, DASH score and complication rate. Results: At fi nal follow up Mayo score was 96.32±04.96 from 5.00±01.26 and DASH SCORE was 31.42±2.04 which dropped from 150±05.34, Range of motion improved from 21.38±05.70 to 116.1±07.92 with 100% union rate and complications less than 19%. Conclusion: Parallel plating for intercondylar fracture of humerus is excellent method of fi xation and results are similar to those treated with orthogonal plating.

Anaemia in Relation to Body Mass Index (BMI) and Socio-Demographic Characteristics in Adult Nigerians in Ebonyi State
Introduction: Anaemia, a multifactorial health challenge has been found to affect every stage of human development with negative health impacts. Providing information on the factors associated with Anaemia will help in formulating mitigating strategies against this important public health problem. Objective: To determine the prevalence of Anaemia and its relationship with body mass index (BMI) and sociodemographic characteristics in adult Nigerians in Ebonyi State, South-eastern Nigeria. Materials and Methods: Adults (n=428) aged = 18 y (mean=38.4±13.7 y) randomly selected from 130 political wards from the 13 Local Government Areas of the state were studied. Sociodemographic data was collected with questionnaire while blood samples were collected for hemoglobin determination using colorimetric cyanmethemoglobin method. Data was analysed using statistical package for social sciences (SPSS ® for Windows ® ver. 16). Results: In general, 21.7% of the subjects were anemic with Anaemia prevalence of 9.9%, 15.8% and 39.8% in male, non-pregnant and pregnant female, respectively. About four percent (3.7%) of the subjects were underweight, while 37.6% had excess weight with hemoglobin concentration having no relationship with BMI and sociodemographic parameters. Conclusion: It may be conclude that the Anaemia in adult Nigerians in Ebonyi State has no definite relationship with BMI and sociodemographic characteristics studied. Further studies are needed to document other factors that may be associated with Anaemia among adults in the State.

Effectiveness of Outreach Program: A Three Year Follow-Up Study Among 12 Years School Students in Lucknow
Aim: To assess the effectiveness of outreach program in the 12 years school going children during a three year follow up period of Lucknow city. Materials and Methods: A random sample of 298 school going children of age 12 years was drawn from adopted schools of Lucknow. Three years later the same population was re-examined with a population of 242 children of 15 y age group. The oral health status of these children was accessed by using WHO 1997 profoma. Results: Significantly (p<0.001) higher proportion of children had healthy gingival, healthy periodontal status after three years. The difference in regard to crowding in the incisal segment in 2010 and 2013 was statistically highly significant (p<0.001). Conclusion: The findings of the study showed that after providing regular dental check up and treatment camps in the three adopted schools after three year follow up study from 2010-2013 showed positive impact on the children oral hygiene status and has been estimated to be on the more positive aspect in future also.

Co Relation between PUFA Index and Oral Health Related Quality of Life of a Rural Population in India: A Cross-Sectional Study
Introduction: A new measuring system called PUFA index had been identified to quantify the consequences of untreated dental caries. The co relation between PUFA index and oral health related quality of life has not been documented so far in India and thereby the need for this study Design: Cross-sectional observational study. Materials and Methods: Sample size of 212 subjects, who are the residents of a town in Rangareddy district were included to be a part of this study. The subjects were interviewed for the OHIP score and the clinical examination done to record the PUFA scores. Results: The main objective of this study was to find out if there was any correlation between the OHIP scores and the study subjects and using the Pearson’ s co relation coefficient, there was a significant correlation between the OHIP and the PUFA scores.(Pearson’ s correlation= 0.31) Conclusion: The mean OHIP and PUFA scores of the study subjects were 2.21 and 0.40 respectively. There is a positive correlation between the OHIP score and the PUFA score among the study population i.e. with the PUFA scores increasing, it has a detrimental effect on the oral health related quality of life of the individual.

Guillain-Barré Syndrome: A Clinical Study of Twenty Children

Maneesh Kumar, Shrikiran Aroor, Suneel Mundkur, Sandeep Kumar
Background: Guillain-Barre Syndrome (GBS) is an acute monophasic demyelinating neuropathy characterized by progressive motor weakness of limbs with areflexia. Aim: To study the clinical pattern and outcome of children with Guillain-Barre syndrome. Materials and Methods: It was a cross-sectional study conducted in a pediatric unit of tertiary care hospital over a period of 18 months. We assessed the clinical manifestations, results of electro-diagnostic tests, functional status, treatment instituted and outcome of 20 children diagnosed with GBS. Results: Of the 20 (male to female ratio = 2.3:1) children studied, all had motor weakness, 5 (25%) had sensory loss, 4 (20 %) had cranial nerve palsies and 4 (20%) had autonomic disturbances. Respiratory paralysis was found in 7 (35%) children requiring assisted ventilation. Antecedent illness preceding GBS was recorded in 50% children. The GBS subtype distribution as per electrodiagnostic studies was as follows: acute motor axonal neuropathy (AMAN) in 7 (38.9%), acute motor sensory axonal neuropathy (AMSAN) in 4 (22.2%), acute inflammatory demyelinating polyradiculoneuropathy (AIDP) in 4 (22.2%) and both axonal and demyelinating neuropathy in 3 (16.7%). Intravenous immunoglobulins (IVIG) constituted the treatment given in majority of the patients. Plasmapharesis was performed in one child in view of poor response to IVIG. Complete recovery was observed in 14 children and the remaining 3 children experienced only incomplete recovery. Conclusion: Male preponderance and presence of antecedent illness in a majority of subjects was observed in our study. Regardless of the severity of illness at admission and electrophysiological subtypes, a majority achieved full recovery. Intravenous Immunoglobulin and supportive care form the cornerstone of management in childhood GBS.

Left Ventricular Diastolic Dysfunction (LVDD) & Cardiovascular Autonomic Neuropathy (CAN) in Type 2 Diabetes Mellitus (DM): A Cross-Sectional Clinical Study

Mythri S., Rajeev H.
Introduction: Cardiovascular autonomic neuropathy (CAN) is one of the major complications of Diabetes Mellitus (DM) seen in a significant number of patients, which is often ignored and is also least frequently diagnosed. It can be diagnosed by performing five standard non-invasive bedside autonomic function tests based on Cardiovascular reflexes, which are quite cumbersome. Studies have revealed an increase in mortality in the diabetic patients with CAN due to silent cardiac ischemia, sudden cardiac death, arrhythmias. The precursor of diabetic cardiomyopathy is Left ventricular diastolic dysfunction (LVDD). In the present study we are studying the association between LVDD and CAN, in order to identify high mortality risk patients by performing 2D Echo and looking at LVDD instead of performing the cumbersome bedside cardiovascular autonomic function tests. Aims and Objectives: To study the association between LVDD and CAN in patients with Type 2 DM. Materials and Methods: This study is a cross-sectional observational study with a sample size of 100. Both outpatients and inpatients between 35 y and 65 y of age with Type 2 DM coming to Department of General Medicine, KIMS hospital, Bangalore were studied from November 2011 to October 2013. Patients with macrovascular complications, Hypertension, congenital & acquired heart diseases etc. were excluded from the study. The standard five autonomic function tests based on cardiovascular reflexes and 2D Echo were performed. Individual scores for each of the five tests were added to produce Ewing’s score. Ewing’s score of >2.5 is positive for CAN. Statistical Analysis: Chi-square/ Fisher Exact test has been. Results: There was a significant association between individual non-invasive bedside tests of Ewing’s score and LVDD. Significant association was also seen between LVDD and positive Ewing’s score. Conclusion: Positive Ewing’s score is strongly associated with LVDD in patients with Type 2 DM in this study .This suggests that patients with LVDD have CAN and hence, are at increased risk of sudden cardiac death. As bedside tests are cumbersome, patients with LVDD on 2D Echo can be concluded to have CAN.

Ibuprofen-Mediated Reversal of Fluconazole Resistance in Clinical Isolates of Candida
Introduction: In view of the increasing prevalence of invasive Candidiasis in today’s health-care scenario and the emergence of fluconazole resistance among clinical isolates of Candida , we sought to determine if Ibuprofen could elicit a reversal of fluconazole resistance and thereby offer a potential therapeutic breakthrough in fluconazole-resistant Candidiasis. Materials and Methods: We selected 69 clinical isolates of Candida , which demonstrated an MIC of >32 µg/ml for fluconazole, and subjected them to broth microdilution in presence and absence of Ibuprofen. Results: Forty two of the 69 isolates (60.9%) demonstrated reversal of Fluconazole resistance with concomitant use of Ibuprofen. This was characterized by significant species-wise variation (p=0.00008), with all the C. albicans isolates and none of the C. glabrata isolates demonstrating such reversal. Only 22.2% and 37.7% of C. krusei and C. tropicalis isolates respectively showed Ibuprofen-mediated reversal of Fluconazole resistance. Conclusion: Since Ibuprofen is a known efflux pump inhibitor, our findings hint at the possible mechanism of Fluconazole resistance in most of our Candida isolates and suggest a potential therapeutic alternative that could be useful in the majority of Fluconazole-resistant clinical isolates of Candida .

Accuracy of Four Dental Age Estimation Methods in Southern Indian Children
Introduction: For various forensic investigations of both living and dead individuals, the knowledge of the actual age or date of birth of the subject is of utmost importance. In recent years, age estimation has gained importance for a variety of reasons, including identifying criminal and legal responsibility, and for many other social events such as birth certificate, marriage, beginning a job, joining the army and retirement. Developing teeth are used to assess maturity and estimate age in number of disciplines; however the accuracy of different methods has not been assessed systematically. The aim of this study was to determine the accuracy of four dental age estimation methods. Materials and Methods: Digital Orthopantomographs (OPGS) of South Indian children between the ages of 6 and 16 y who visited the department of Department of Oral medicine and Radiology of GITAM Dental College, Visakhapatnam, Andhra Pradesh, India with similar ethnic origin were assessed. Dental age was calculated using Demirjian, Willems, Nolla, and adopted Haavikko methods and the difference between estimated dental age and chronological age were compared with paired t-test and Wilcoxon signed rank test. Results: An overestimation of the dental age was observed by using Demirjian and Nolla methods (0.1±1.63, 0.47±0.83 years in total sample respectively) and an underestimation of dental age was observed by using Willems and Haavikko methods (-0.4±1.53, -2.9±1.41 years respectively in total sample). Conclusion: Nolla’s method was more accurate in estimating dental age compared to other methods. Moreover, all the four methods were found to be reliable in estimating age of individuals of unknown chronological age in South Indian children.

A Rare Case of Malignant Fibrous Histiocytoma/ Pleomorphic Undifferentiated Sarcoma of the Kidney

Gregory Pathrose, Nirmal Thampi John, Ramani Manojkumar
Malignant Fibrous Histiocytoma (MFH) usually arises from the extremities with the retroperitoneum being the second most common site. We present the case report of a 58-year-old man presenting with fever and was detected to have a renal mass on evaluation. He underwent a radical nephrectomy with a preoperative diagnosis of renal cell carcinoma. But the final histopathological report was MFH. Primary renal MFH is extremely rare and is usually diagnosed on histopathology with the aid of immunohistochemistry.

Extradural Spinal Metastasis of Adenoid Cystic Carcinoma (ACC): A Case Report

Vinod Kumar, Rajesh Nair, Sunil Upadhyaya, Bhavna Nayal, Arjun Shetty
Adenoid cystic carcinoma (ACC) is a rare malignant tumour of the major salivary glands. It accounts for 10-15% of all salivary gland tumours and 1% of all head and neck tumours. Surgical resection followed by radiation is the choice of treatment for ACC. However, late loco-regional recurrence and metastasis is often seen emphasizing the importance of long-term follow-up. We report an unusual case of extradural metastasis of ACC in the dorsal spine. The primary submandibular gland tumour was resected 11 y back. A recurrence had been detected two years prior to the occurrence of spinal metastasis. Surgical decompression was done which was followed by palliative radiotherapy. Patient is symptomatically better, ambulant and on regular follow-up.

Combined Gastric and Duodenal Perforation Through Blunt Abdominal Trauma

Bimaljot Singh, Adarshpal Kaur, Rachan Lal Singla, Ashwani Kumar, Manish Yadav
Blunt abdominal traumas are uncommonly encountered despite their high prevalence, and injuries to the organ like duodenum are relatively uncommon (occurring in only 3%-5% of abdominal injuries) because of its retroperitoneal location. Duodenal injury combined with gastric perforation from a single abdominal trauma impact is rarely heard. The aim of this case report is to present a rare case of blunt abdominal trauma with combined gastric and duodenal injuries.

Drug Induced Gingival Overgrowth: A Rare Case Report

Setu Mathur, Rohit Kumar Khatri, Ranjan Mathur, Rashi Srivastava, B.P. Nag
Gingival overgrowth is well documented side effect associated with three major classes of drugs viz, anticonvulsants, calcium channel blockers, and immunosuppressants. Despite our greater understanding of pathogenesis of Drug induced Gingival Overgrowth (DIGO), its treatment still remains a challenge for the periodontists and treatment is still largely limited to maintenance of improved level of oral hygiene and surgical removal of overgrown tissue. Dental Surgeons need to discuss this issue with their medical colleagues and to practice care while prescribing the drugs associated with gingival overgrowth. The aim of present article is to report a rare case where even after extraction of all teeth; the enlargement did not subsided for one month.

Unusual Ventriculoperitoneal (VP) Shunt Tube Extrusion through Anus in a Child with Dandy Walker Malformation: A Rare Case Report

Hanish Bansal, Gulzar Gupta, Mayank Gupta, Rakesh Kaushal
Aim of this paper is to report a case of extrusion of Ventriculo peritoneal shunt tube through anus in a one year female child ( k/c/o dandy walker malformation ) treated with placement of ventriculo peritoneal shunt for post operative hydrocephalus after excision of Subtorcular occipital meningocoel. The exact cause of such extrusion is not known. Unusual migration of distal catheter tip of VP shunt is a rare and bowel perforation is reported to occur between 0.1% and 0.7%. The possible factors responsible for this complication are thin bowel wall in children, sharp and stiff end of the VP shunt, use of trocar by some surgeons, chronic irritation by the shunt, previous surgery, infection and silicone allergy. In view of the potential for meningitis prompt and aggressive management is essential to avoid morbidity and mortality.

Limb Girdle Muscular Dystrophy (LGMD): Case Report
We report a young male of autosomal recessive limb girdle muscular dystrophy (LGMD) with positive family history presented with gradual onset proximal muscle weakness in all four limbs since eight years and thinning of shoulders, arms and thighs. Neurological examination revealed atrophy of both shoulders with wasting of both deltoids thinning of thighs and pseudo hypertrophy of both calves, hypotonia in all four limbs. Gower’s sign was positive. Winging of scapula was present. Power was 3/5 at both shoulders, 4/5 at both elbows, 5/5 at both wrists, 3/5 at both hip joints, 3/5 at both knees, 5/5 at both ankles. All deep tendon reflexes and superficial reflexes were present with plantars bilateral flexors. Electromyography (EMG) showed myopathic pattern. He had elevated creatinine phosphokinase levels and muscle biopsy findings consistent with muscular dystrophy.

Unilateral Ankylosis of Temporomandibular Joint (TMJ) with Contralateral Condylar Aplasia and Related Orthopedic Deformity – Syndromic or Nonsyndromic?

Pradkhshana Vijay, Nilesh Pardhe, VSB Sunil, Manas Bajpai, Neha Chhibber
Condylar aplasia which means “failure of development” is a rare condition and can be unilateral or bilateral. Mandibular condylar Aplasia without any association with syndrome is extremely rare. Temporomandibular joint (TMJ) ankylosis results from trauma, infection and inadequate surgical treatment of the condylar area. Congenital cases are very rare. We report case of congenital unilateral aplasia of left mandibular condyle with ankylosis of right condyle, with an associated orthopedic deformity in a nine-year-old male patient, which may be a part of some unreported syndrome that has not been mentioned so far in literature. As per our best knowledge, no other case including such clinical features has been reported.

Ultrasonics: A Novel Approach for Retrieval of Separated Instruments

Harleen Chhina, Manoj Kumar Hans, Subhash Chander
An instrument fracture within the root canal interferes and hinders the outcome of the successful root canal treatment. Fracture of endodontic instrument often results from incorrect use or overuse. This article reports a case of retrieval of separated endodontic instrument with help of ultrasonic and discusses the factors influencing the removal of fractured instrument.

Management of Large Preiapical Lesion with the Combination of Second Generation Platelet Extract and Hydroxyapatite Bone Graft: A Report of Three Cases
The pulp tissue necrosis and extensive periodontal diseases leads to the development of the inflammatory periapical lesion which causes a local response of bone around the apex of the tooth. Depends upon the nature of wound and available biological growth factors the outcome will be either regeneration or repair. Being a rich source of growth factors, platelet rich fibrin (PRF) posses many advantages in bone regeneration. The purpose of this case report is to present an attempt to evaluate the healing potential of the combination of PRF and Hydroxyapatite bone graft as opposed to using these materials alone. A periapical endodontic surgery was performed on three patients with a large periapical inflammatory lesion and a large bony defect. The defect was then filled with a combination of PRF and Hydroxyapatite bone graft crystals. Clinical examination exhibited uneventful wound healing. The HA crystals have been replaced by new bone radiographically at the end of two years in Case 1 and Case 2, Case 3 were followed upto one year. On the basis of our cases outcome, we conclude the use of PRF in combination with HA crystals might have accelerate the bone regeneration.

Facial Asymmetry in Young Adults with Condylar Hyperplasia-Unusual Changes in the Facial Bones
Facial asymmetry can be caused by various pathological conditions, condylar hyperplasia (CH) is one of such condition, characterized by unilateral or bilateral mandibular condylar overgrowth, causing facial asymmetry, mandibular deviation, malocclusion and functional impairment. Advanced imaging and scintigraphic methods, helps the clinicians in diagnosing and monitoring its macroscopic aspects. Here we report three interesting and illustrative cases of facial asymmetry with unilateral CH discussing the unusual changes in the facial bones.

Diagnostic Dilemma in Cornual Pregnancy- 3D Ultrasonography may Aid!!

Nilanchali Singh, Reva Tripathi, YM Mala, Atul Batra
Interstitial or cornual pregnancy is a rare and dangerous type of ectopic gestation. It poses a diagnostic difficulty and differentiating from eccentrically located intrauterine pregnancy may be challenging. We are reporting a case of nulliparous woman diagnosed as having interstitial pregnancy on three-dimensional ultrasonography. We managed the patient successfully with weekly intramuscular doses of methotrexate. The ß HCG levels were high throughout the therapy (89,000 to 1,48,000 IU/ml). The patient was admitted throughout the course of treatment. After three doses of methotrexate, the ß-HCG levels began to fall. Weekly monitoring was done thereafter till normal values of ß-HCG were reported. Early and prompt diagnosis and treatment of interstitial pregnancy is important to prevent catastrophic hemorrhagic complications. Three-dimensional sonography is an important diagnostic tool as it may impart better anatomical orientation and precise location of the gestational sac as compared to other imaging modalities. Methotrexate therapy may be considered in selected cases.

An Unusual Variation of Axillary Artery: A Case Report

Aastha, Anjali Jain, M. Santhosh Kumar
An unusual unilateral variation was observed in branching pattern and course of branches of the axillary artery of the left upper limb in an adult male cadaver. The superior thoracic branch of axillary artery had a very unusual course as it passed between the two divisions of the lateral cord of the brachial plexus and then descended down towards the first two intercostal spaces. A common trunk was seen arising from the third part of the axillary artery which divided into anterior and posterior circumflex humeral, subscapular and Profunda brachii artery. The ulnar and radial collaterals arose from the Profunda brachii artery rather than the brachial artery. The knowledge about such variations becomes essential and of utmost significance in various clinical procedures performed by the vascular surgeons, radiologists and clinical anatomists. Moreover, the injuries of the brachial plexus are quite common and require exploration and repair. During such repair surgeries the abnormal arterial branch may be a matter of definite concern if its presence is not kept in mind.

Appendicitis in a Child due to Streptococcus Pneumoniae: A Rare Case Report
A variety of bacterial species play a major role in appendicitis. Both aerobic and anaerobic gram positive and gram negative bacteria such as, Bacteroides fragilis, Streptococcus species, Escherichia coli, Klebsiella species and Citrobacter freundii cause appendicitis. Appendicitis is usually polymicrobial. The case assumes importance because of single aetiological agent i.e. unimicrobial and no predisposing factors are present to cause infection. We report a rare case of appendicitis due to Streptococcus pneumoniae in child. This case emphasizes that Streptococcus pneumoniae can cause wide spectrum of disease like appendicitis.

Giant Submucosal Lipomatous Polyp Causing Perforation of Sigmoid Colon: A Case Report and Review of Literature

Kumar Lakshman, Triza Kumar Laksman
Colonic lipomas are rare benign tumours that are usually asymptomatic. Large colonic lipomas can present with symptoms such as constipation, abdominal pain, bleeding per rectum, and intussusception. We report the case of an 82-year-old man presenting with sudden onset lower abdomen pain and features of peritonitis. An exploratory laparotomy revealed a perforation of sigmoid colon with a fleshy mass protruding through the perforation. No case of spontaneous perforated sigmoid colon by submucous giant lipoma is reported yet in the literature. We discuss the details of first such case, our management, the outcome and also briefly review the literature.

A Rare Collision Tumour of Infiltrating Ductal Carcinoma and Squamous Cell Carcinoma of Skin Overlying Breast: A Case Report

Geetha. RL., Kalyani. R., Srinivas Murthy. V., Shakthidasan Chinnathambi
Collision tumour is the concrescence of two neighbouring independent neoplasm occurring in the same site. Collision tumours are rare and are reported in various organs. Collision tumours in breast are reported in various combinations. The treatment of these tumours is not tailored and prognosis depends on the histologic type and pathologic stage of the most aggressive component. We report a rare case of breast collision tumour of infiltrating ductal carcinoma and squamous cell carcinoma of skin overlying breast in a 44-year-old female.

Gingival Veneer: A Novel Technique of Masking Gingival Recession

Praful Choudhari, Arpita Pillai, R. Zade, Ramesh Amirishetty, Sunaina Shetty
One of the most distressing aspects of periodontitis is the unesthetic appearance of maxillary and mandibular anteriors. The elongation of the crowns due to root exposure and increased interdental spacing results in unesthetic appearance. Surgical procedures for gingival recession coverage do not have acceptable results in cases of severe gingival recession. So nonsurgical methods like gingival veneers should be considered as a treatment modality in such cases. This article aims to revisit the gingival veneer: its uses, advantages, disadvantages, and its fabrication. The case discussed here highlight clinical situation where the gingival veneer prosthesis helped in achieving optimum esthetics and patient satisfaction thus proving to be a feasible and simple treatment modality in certain clinical cases. This may offer a good interim solution for patients who may wish to have time to consider their options of more advanced and complex treatment

A New Variant of Choledochal Cyst Diagnosed on Magnetic Resonance Cholangiopancreatography

Shailesh Gupta, S. Rajesh, Nitesh Agrawal, Somsharan S. Betgeri, Ankur Arora
Choledochal cysts (CDC) have been traditionally classified into five types and subtypes based on the pattern and location of involvement of intra and extra hepatic biliary tree. Herein, we describe a new variant of choledochal cyst which has not been previously described in the English-language medical literature.

Osteomyelitis in Pycnodysostosis – Report of 2 Clinical Cases

Rohit S., Praveen Reddy B., Sreedevi B., Sandeep Prakash
Pycnodysostosis is a rare craniofacial syndrome characterized by dwarfism, cranial anomalies, diffuse osteosclerosis where multiple fracture of long bones and osteomyelitis of jaw are frequent complications. This clinical entity was first described in 1962 by Maroteaux and Lamy. This article presents two clinical cases of pycnodysostosis with their clinical and radiological characteristics.

Small Bowel Obstruction- A Surprise

Jeffrey Daniel Mathew, Ganesh Babu CP, Balachandar M, Ramanathan M
Trans - omental hernia is very rare, accounting to 1-4% of all internal hernias which is an unusual cause of small bowel obstruction. Here we present a case report of a small bowel obstruction in a female due to trans - omental hernia presenting with central abdominal pain, distension and bilious vomiting. She had no previous history of trauma, surgery. Plain X-ray abdomen erect showed multiple air fluid levels with dilated small bowel loops. Emergency laparotomy revealed a segment of congested small bowel loop (ileum) through a defect in greater omentum. On table the herniated bowel loop was reduced and the defect in greater omentum was closed primarily. There was no necessity for bowel resection as it regained normal colour after reduction. Postoperative period was uneventful with complete resolution of symptoms. This case is presented for its rarity and its importance in clinical differential diagnosis of acute abdomen due to small bowel obstruction.

An Unusual Presentation of Neurofibroma Masquerading as a Vascular Hamartoma, Post-Iatrogenic Intervention
Neurofibroma is a localized discrete mass of benign nerve sheath tumour in the peripheral nervous system. Mostly present as skin lesions. Solitary neurofibroma may occur in deep soft tissue or subcutaneous plane in rare cases associated with syndromes like NF1. The neurofibroma most commonly present as skin lesions as isolated soft papules or nodules arising in any cutaneous site. Present case depicts unusual presentation of a neurofibroma as a vascular hamartoma post an iatrogenic intervention.

Isolated Single Umbilical Artery in Twin Pregnancies and its Adverse Pregnancy Outcomes - A Case Report and Review of Literature

Showkathali Iqbal, Iqbal Raiz
Single umbilical artery is the most common congenital abnormality of the umbilical cord and is seen in 4-11% of twin pregnancies. It is usually associated with intrauterine growth retardation, preterm labour, small-for-dates and other structural anomalies. There is no significant difference in the incidence between monochorionic and dichorionic twins. The left artery is usually absent more commonly than the right. The female co-twin was predominantly more affected than their male counterparts. Single umbilical artery is found twice more common in white women than in Afro-Asians and Americans. The hemodynamic disturbances occur early in the embryonic development, influence greatly in the development of single umbilical artery. Genetic and environmental factors also play a major role in the development of this anomaly. The pregnancies with single umbilical artery were classified as high risk group, because the overall perinatal mortality rate was estimated to be as high as 20%. There is a significant increase in the occurrence of single umbilical artery in pregnancies due to artificial reproductive technologies, as well as in spontaneous miscarriages. Prenatal ultrasonography is the principal diagnostic technique employed to identify single umbilical artery during 3 rd trimester of pregnancy. The present case, reports the presence of a single umbilical artery in a monozygotic, monochorionic twin pregnancy, which is acardiac-acephalic fetus, small for dates, female sex, associated with other major structural anomalies, and was still born. Authors analyse its incidence, clinical presentations and pregnancy outcome and also review the pertinent literature.

Intracranial Fungal Granulomas Mimicking High Grade Gliomas. A Decisive Role of Squash Cytology (SC): A Report of Two Cases

Parth A. Desai, Ronak K. Patel, Nita Khurana, P.N. Pandey
Intracranial fungal granulomas can be misdiagnosed clinically and radiologically as neoplastic lesions. They also rarely occur without any history of immunodeficiency or diabetes. We report two such cases of fungal granulomas that were unsuspected clinically and radiologically but were detected on intraoperative squash cytology (SC) and later confirmed on histopathology. Timely intervention was hence possible and patient was saved from the hazards of unnecessary removal of eloquent areas of brain and was shifted on proper medical management. SC remains an indispensible tool for the neurosurgeon to get a provisional intraoperative diagnosis and in such surprising scenarios, change the surgical management of the patient, save the resection of eloquent brain areas and begin immediate postoperative medical management. These cases are being presented for their rarity and for highlighting the importance of SC as a regular tool for intraoperative neurosurgical consultation of intracranial mass lesions.

Primary Ewings Sarcoma of the Lung

Kunal K Deokar, Nanag Kunjir, Shivhari Ghorpade
Extraosseous ewings sarcoma is an extremely rare neuroectodermal tumour. We report the case of a 30-year-old female who presented with right sided pulmonary mass. Radiology, histopathology and immunohistochemistry confirmed the diagnosis of primary pulmonary Ewings sarcoma. This case highlights the fact that Ewings sarcoma should be considered in differential diagnosis of patients presenting with pulmonary mass.

ALK Positive Anaplastic Large Cell Lymphoma Presenting as Extensive Bone Involvement

Smeeta Gajendra, Ritesh Sachdev, Lipika Lipi, Shalini Goel, Ruchira Misra
Anaplastic lymphoma kinase (ALK) positive Anaplastic large cell lymphoma (ALCL) represents approximately 2% of all Non-Hodgkin’s lymphomas that commonly involves nodal as well as a wide variety of extra nodal sites, as skin, soft tissue, bones and lungs, although primary or secondary involvement of bone is rare. Herein, we report a case of 14-year-old female child presented as extensive bony involvement with a clinical diagnosis of bone tumour/ small round cell tumour, which was proved to be ALK positive ALCL on histopathological examination.

Meningoencephalocoele in a Mastoid Cavity: A Case Report and Review of Literature

B.Y. Praveen Kumar, P. Vijay, Neelesh Tiwari, Shilpa Tubajirao Hotkar
A young adult male presented to us with a discharging mastoid cavity. Clinical and radiological examination revealed cholesteatoma recidivism along with a meningoencephalocoele (ME) which was managed successfully. Two year follow-up revealed no recurrence of the pathology.

Benign Paravertebral Ancient Neurilemmoma in a Young Adult: A Rare Occurrence
Neurilemmoma is a benign neurogenic tumour arising from Schwann cells of the peripheral nerve sheath, which is commonly seen in women in the 5th decade. It rarely arises in the retroperitoneum, being more common in the head and neck region and extremities. Ancient variety of schwannoma is a long-standing tumour, is seen in the middle age and elderly age groups, and is associated with secondary degenerative changes. Herein, we report a case of benign retroperitoneal paravertebral ancient neurilemmoma occurring in a young male adult.

Large Congenital Nevus Scalp Managed by Tissue Expansion– A Case Report

Surya Rao Rao Venkata Mahipathy, Alagar Raja Durairaj
Tissue expansion is an emerging trend in the reconstruction of various defects of the human body when there is insufficient adjacent tissue for direct closure of the defect or repair with a local tissue transfer. It is the most important armamentarium for aesthetic hair-bearing scalp reconstruction in cases of congenital or acquired defects. In this case, a large linear verrucous epidermal nevus is excised and covered with expanded hair-bearing scalp tissue.

Accidental Intra–Arterial Injection of Diclofenac –Case Report

Mohinder Kumar, Jasdeep Singh, Pratibha Sharma, Aadhar Khera, Puneet Singh
Diclofenac sodium is a very common drug used in medical practice for analgesia and is freely available over the counter without any medical prescription. The drug is also the most commonly used or misused by quacks working all over India. Many case reports have been published on upper limb catastrophe of unintentional intra-arterial injection of barbiturates, thiopental sodium, narcotics, and tranquilizers but only two cases of inadvertent intra-arterial injection of diclofenac have been reported till date. Potential serious complication of inadvertent intra-arterial injection of diclofenac sodium leading to gangrene has been recently reported in medical literature. It is a medical emergency and literature has shown that timely diagnosis with early intervention can salvage the limb. We hereby report a case of accidental intra-arterial injection of diclofenac sodium in the ulnar artery by a quack for pain abdomen leading to gangrene of the distal part of affected little, ring and part of middle finger of right hand.

Congenital Kyphosis in Thoracic Spine Secondary to Absence of Two Thoracic Vertebral Bodies

Priya Kale, A. Dhawas, S. Kale, A. Tayade, S. Thakre
Congenital thoracic kyphosis at D6-D7 vertebral body level has been encountered in an 18-month-old boy without neurological deficit. The constellation of the spine malformation complex such as incomplete development of the vertebral bodies associated with defective ossification of the thoracic pedicles causing effectively the development of spinal cord injury at the kyphotic level of D6-D7 were present. Congenital kyphosis in thoracic spine secondary to absence of two thoracic vertebral bodies has been reported in a few studies. It is the absence and asymmetry of growth plates that may contribute to a congenital defect. Congenital Kyphosis refers to the normal convex curvature of the spine as it occurs in the thoracic and sacral regions since birth. Congenital kyphosis is an uncommon, but potentially devastating anomaly of the spine. It is one of the important aetiology for spinal cord compression leading to further neurological complications. Congenital kyphosis although rare, is more associated with neurological complication. Early identification not only helps in understanding its natural history but also helps in deciding its management.

Metastases of Squamous Cell Carcinoma of Uterine Cervix to Duodenum: A Case Report
We report a case of squamous cell carcinoma of uterine cervix metastasizing to the duodenum through lymphatics. Para-aortic group of lymph nodes were involved which ultimately infiltrated the duodenum. On endoscopic examination, peri-ampullary growth was noted. Endoscopic biopsy from the growth was studied by routine histopathology and metastasis of squamous cell carcinoma involving duodenum was reported.

Blastic Phase of CML with Microfilaria: A Rare Case Report

Suniti Pahwa, Annapurna Saksena, Ashu Singh, M. K. Daga, Tejinder Singh
Filariasis is a major public health concern in tropical and subtropical countries including India. There have been very few case reports of incidental filariasis in the bone marrow aspirate smears in patients with hematological malignancies. We present a case of blastic phase of chronic myeloid leukemia (CML) with associated filariasis with monocytosis. Such an association, to the best of our knowledge, is hitherto unreported. Moreover, eosinophilia was not a feature in our case. A 37-year-old male, diagnosed case of CML, presented with low grade fever, weight loss and abdominal distension for one month. Physical examination revealed massive splenomegaly and hepatomegaly. However, there was no lymphadenopathy. His hemoglobin was 10.5 g/dl, total leukocyte count was 52.31x 109 / L with platelet count of 30x 109/L .Differential leukocyte count on peripheral smear showed 21% blasts, 30% polymorphs, 16% lymphocytes, 1% myelocyte, 1%metamyelocyte, 30%monocytoid cells and 1% eosinophils. Bone marrow aspirate smears were diluted with peripheral blood and showed blasts and monocytoid cells constituting 25% and 15% of marrow nucleated cells respectively. In addition, occasional microfilaria of Wuchereria bancrofti were also seen both in the peripheral blood and aspirate smears. Based on the above findings, a diagnosis of blastic phase of CML with monocytosis with microfilaria of W.bancrofti. Hence this was an unusual case of CML blastic phase which was associated with filariasis. Moreover, inspite of having filariasis and CML, patient lacked eosinophilia and instead showed monocytosis, which is hitherto unreported.

A Rare Case of Multple Myeloma (Mm) Presented With Pancytopaenia in A Patient of HIV – At Very Early Age

Sisir Kumar Patra, Manoj Soren, Anjan Kumar Das, Srishtidhar Mangal
Non-hodgkin`s lymphoma (NHL) is the most common haematological malignancy which is seen in HIV infected patients. Among NHLs, immunoblastic lymphomas are most common and a majority of these are diffuse large B-cell lymphomas. Multiple myeloma is a disease of the elderly. It is extremely rare below 30 years of age. On the other hand, in HIV infected individuals, the average age of presentation with plasma cell disorders is 33 years, which is far younger than the average age of presentation in general population. The incidence of AIDS defining malignancies has declined markedly, whereas non-AIDS defining cancers are being increasingly diagnosed in patients with HIV infection during the HAART-era and they may be the presenting manifestations of AIDS. Multiple myeloma, however, usually is not a first presenting feature of AIDS. The usual clinical presentation of multiple myeloma is bone pain and pallor. Pancytopaenia is a rare presenting feature of multiple myeloma. Here, we are reporting a case of pancytopaenia which occurred in a 28-year-old, newly diagnosed, HIV-1 positive female, who with the help of bone marrow examination and further investigations, was subsequently diagnosed as multiple myeloma.

Surgical Management of Fractured Orthodontic Mini-Implant- A Case Report

Manthan Desai, Anoop Jain, Nida Sumra
The idea of absolute anchorage has always been an elusive goal for clinicians. Orthodontic mini-implants or temporary anchorage devices allow tooth movements previously thought to be impossible or difficult. Although extensive literature exists on use of temporary anchorage devices, their failures have been hardly focused upon, especially implant fracture. The following case report describes successful management of fractured orthodontic mini-implant.

Giant Central Ossifying Fibroma of the Maxilla Presenting with a Pus Discharging Intra-Oral Sinus
Central ossifying fibroma (COF) is a rare benign fibro-osseous neoplasm which has a predilection for mandible and is encountered in middle aged women. It arises from mesenchymal blast cells of the periodontal ligament, and with a potential to form fibrous tissue, cementum and bone. It is a well circumscribed lesion mainly comprising of fibrous tissue with varying amounts of bone or cementum or osteo-cementum like tissue. We present an uncommon case of COF of the maxilla in a 35-year-old male who presented with a pus discharging sinus in the maxilla. Due to the bizarre size of the lesion we have termed as ‘giant’ COF. There is extensive facial asymmetry on the right side with obliteration of the maxillary antrum, deviation of the nose and upward displacement of the orbit.

Isolated Plexiform Neurofibroma of Arm with Unusual Presentation - A Rare Case Report
Plexiform neurofibroma (PNF) arises as a diffuse mass from nerve trunk and leads to overgrowth of cutis and subcutis structure. This is a case report of 20-year-old male, presented to our hospital with a giant ulcerated swelling over his left arm. Differential diagnosis of sarcoma, neurofibroma, hemangioma and angiolipoma was made but biopsy confirmed the diagnosis of plexiform neurofibroma. Isolated PNF with ulceration of overlying skin over arm is a rare presentation and here we are presenting it as a perusal of rare entity.

Cerebral Venous Sinus Thrombosis and Posterior Reversible Encephalopathy Syndrome in a Preeclamptic Woman

Nadiye Köroglu, Sinem Sudolmus, Elif Asli Sarioglu, Alpay Alkan, Ramazan Dansuk
Cerebral venous sinus thrombosis (CVST) and posterior reversible encephalopathy syndrome (PRES) are two rare diseases which may present with similar symptoms and signs. We report a case with coexisting PRES and CVST in a preeclamptic woman. A 24-year-old woman, G2 P1, at 33 wk and 5 d of pregnancy presented with headache. Her blood pressure was 180/120 mmHg and urinary test revealed +3proteinuria. Cesarean section was performed with indications of severe preeclampsia, intrauterine growth retardation and fetal distress. Cranial MR venography of the patient revealed thrombiin superior sagittal sinus, confluenssinuum, right transverse and right sigmoid sinus and diffusion MRI showed increased signal intensity (vasogenicoedema) in cortical and subcortical areas of parietooccipital and posterior frontal lobes.The patient was treated with magnesium sulfate and heparin successfully. After treatment period, control cranial MRI and diffusion MRI were normal. Thrombi within the sinuses were totally regressed. Albeit rare, these two diseases should be kept in mind especially in preeclamptic/eclamptic patients that present with neurological symptom and/or sign.

Histogenesis and Clinical Analysis of 2 Cases of Congenital Gingival Granular Cell Tumour
Dentistry for babies aims to contribute to the formation of a generation with fewer dental problems, higher quality of oral health and more aware of the importance of prevention. The congenital gingival granular cell tumour (CGCT) is a rare benign soft tissue tumour in the newborn that can lead to respiratory difficulties and feeding. The aim of this work was to report two cases of CGCT in babies and discuss the clinical and histological differential diagnosis and their treatment, as well as the importance of knowledge of this pathology for dentists. Clinical features and treatment approaches are presented and discussed. The surgical approach improved the child quality of life and restored the parent’s confidence and emotional stability. Knowledge of this pathology helps in better diagnosis and treatment, which lead to a better quality of life of children and return confidence and emotional stability to parents.

Delayed Recovery from Anaesthesia in a Patient with Optimised Hypothyroidism and Incidental Hypokalemia

Preeti More, Vandana V Laheri, Tejasi Waigankar, Charchill Wagh
Delayed recovery/awakening/ emergence can occur under anaesthesia and is multifactorial, could be drug or non drug related. Similarly, we report a case of delayed recovery in a 68-year-old patient, for laparoscopic cholecystectomy, a known case of hypertension, bronchial asthma and hypothyroidism. Preoperatively, she was optimised for her medical disorders; however, she had delayed recovery from general anaesthesia. The delayed recovery, often, would be expected in a case of hypothyroidism, however in our patient it was found to be associated with inadvertent hypokalemia.

Transvaginal Small Bowel Evisceration in Known Case of Uterine Prolapse Due to Trauma

Umesh Gheewala, Abhishek Agrawal, Radha Shukla, Ravi Bhatt, Shirish Srivastava
Spontaneous transvaginal bowel evisceration is a rare surgical emergency with only a few cases reported and particularly postmenopausal, posthysterectomy, multiparous elderly women are considered to be at higher risk for development of bowel evisceration. It is difficult to manage such a patient for any surgeon and poses significant challenges especially intraoperatively. Here, we report a case of vaginal vault rupture with small bowel evisceration through the vagina in a known case of uterine prolapse and highlight the risk factors, clinical presentation, and treatment options for this rare surgical emergency.

Successful Transradial Percutaneous Coronary Intervention in a Patient with Dextrocardia and Situs Inversus

Ramanand P Sinha, Deepesh Agarwal, Arohi Mehul Sarang, Ashok Suryakant Thakkar
Dextrocardia with situs inversus is a rare clinical entity with an estimated incidence ranges from 1 in 8000 to 1 in10,000. Percutaneous intervention in patient with dextrocardia and situs inversus is clinically challenging due to abnormal orientation of coronary geometry and the intervention requires appropriate use of guiding catheters, engagement technique, appropriate radiological angles as well as views. In this case-report, we describe percutaneous intervention with stenting in 48-year-old male patient with dextrocardia and situs inversus. We successfully deployed drug-eluting stents in right coronary artery and left circumflex artery.

Accidental Subclavian Artery Catheterization During Attempted Internal Jugular Central Venous Catheter Placement: A Case Report

Bharat Paliwal, Manoj Kamal, Anamika Purohit, Kirti Rana, Dilip Singh Chouhan
Central venous catheter placement has been routinely employed for anesthetic and intensive care management. Despite proper technique used and expertise complications do occur; some of which are related to catheter misplacements. We report a case in which subclavian artery was accidently catheterized during attempted internal jugular venous cannulation.

Effect of Unintentional Periapical Extrusion of Metapex in Immature Teeth- A Case Report

Virat Galhotra, Anshu Singla, Sanjeev Jindal, Anjali Sofat
The paper discusses a case of an immature premolar tooth with a large periapical lesion, in which Metapex (calcium hydroxide paste containing iodoform and barium sulphate as a radiopacifier) was used. There was an un-intentional extrusion of calcium hydroxide during application. The patient was evaluated for periapical healing at 12 and 24 months. The follow up revealed that the accidental extrusion of metapex did not have any detrimental effect on periapical healing. However, delayed resorption of Metapex as well as healing of the periapical lesion may be attributed to the presence of BaSO4 and iodoform as compared to plain Calcium hydroxide.

Magnetic Resonance Imaging Characteristics of Persistent Vegetative State Due to Prolonged Hypoglycemia

Ayse Guler, Emre Kumral, Tuba Cerrahoglu Sirin, Hadiye Sirin, Omer Kitis
Hypoglycemia is the sudden decrease in serum glucose level <50mg/dL. Neurological manifestations complicating profound and prolonged hypoglycemia range from reversible focal deficits and transient encephalopathy to irreversible coma. Here, we report magnetic resonance imaging characteristics of a patient with prolonged hypoglylicemia. A 47-year-old woman with a history of insulin dependent diabetes mellitus has been brought to the emergency room by her relatives. She used mistakenly overdose insulin injection and probably stayed 11 hours with low level blood glucose. The initial blood sugar level was 39.6 mg/dL at the emergency department visit, which was recovered urgently by 50% dextrose. MR imaging revealed high intensities at the bilateral posterior parietal cortices, corona radiata and hippocampus, but not in the basal ganglia. Seventy-two hour after admission, confluent lesions in the posterior parietal, temporal, frontal cortices and splenium of corpus callosum were more prominent on DWI and FLAIR, and did not match typical arterial territories. None of the lesions were enhanced on contrast-enhanced T1-weighted images. The prognosis or neurologic sequelae of hypoglycemic encephalopathy may depend on the severity and duration of hypoglycemia and persistent, diffuse involvement of the cerebral cortex, basal ganglia, or hippocampus on the following MR imaging. MR imaging findings in hypoglycemic vegetative state can be helpful in the differential diagnosis distinguishing from other neurologic conditions.

Pancreatic Heterotopia of Small Intestine with Tubercular Ileitis

Dinesh Kumar, Romi Srivastava, Jay Prakash, Kachnar Varma, Vatsala Misra
Pancreatic heterotopia is defined as pancreatic tissue outside the boundary of pancreas that lacks an anatomic and vascular connection to it. Till today, no case of pancreatic heterotopia along with tubercular ileitis has been reported. We report one such case that presented in our institution.

Incidental Hypoglycemia with Suspected High Spinal in a Case for Emergency Caesarian

Mohammed Shahid, Ravi Madhusudhana, Archana Keshav Raichurkar
Spinal anaesthesia is a suitable choice for emergency LSCS (lower segment caesarian section). High spinal is common in parturients. We report a case of 25-year-old primigravida with cephalo pelvic disproportion coming for emergency LSCS with no comorbidities. The patient became unresponsive after 5 min of Sub Arachnoid Block (SAB), managed as a case of high spinal. Still the patient remained unresponsive at the end of surgery, 50 min after SAB. Patient started responding to oral commands after correction of hypoglycemia with 25% dextrose infusion.

Misdiagnosis of Abdominal Pain in Pregnancy: Acute Pancreatitis

P. Pallavee, Sunita Samal, Shweta Gupta, Jasmina Begum, Seetesh Ghose
We report a case of acute pancreatitis in a pregnant woman who presented to our emergency department with complaints of severe abdominal pain, was misdiagnosed as scar dehiscence and underwent emergency repeat caesarean section at 33 wks for fetal distress. The preterm baby developed severe respiratory distress and succumbed on the second postnatal day. Persistent severe pain in the postoperative period in the mother prompted further evaluation which led to a diagnosis of acute pancreatitis. Conservative and supportive management was instituted leading to an eventual favourable maternal outcome.

Incidental Intravascular Lipoleiomyomatosis in A Hysterectomy Specimen: How To Manage?
Leiomyomas are common benign tumors in female gynaecologic surgery. They are originated from smooth muscle cells of the uterus and/or sometimes of the uterine vessels. Intravascular lipoleiomyomatosis is a very rare form of leiomyomas which grow within veins and can extend up to vena cava inferior and right heart chamber with cardiac symptoms and is diagnosed by cardiovascular surgeons. We report a case of incidental intravascular lipoleiomyomatosis which was confined to the uterus being diagnosed after a total abdominal hysterectomy by pathology and its management strategy.

A Curious Case of Fever and Hyperpigmentation

Subrata Chakrabarti
Megaloblastic anaemia as a cause of pyrexia is a rare entity. Similarly, hyperpigmentation of skin has rarely been reported as the presenting manifestation of folate and/or vitamin B12 deficiency. The author reports the case of a patient who presented with fever and hyperpigmentation and was diagnosed to have megaloblastic anaemia secondary to vitamin B12 and folate deficiency after other infective, inflammatory/autoimmune, endocrine causes of pyrexia and hyperpigmentation were excluded by appropriate investigations. The patient responded remarkably well to the treatment with vitamin B12 and folic acid supplementation. Although presentation of megaloblastic anaemia as isolated fever or hyperpigmentation are noted in literature, simultaneous fever and hyperpigmentation as its initial presentation is exceedingly rare

Surgical Site Infection Caused by Aeromonas hydrophila in a Patient with Underlying Malignancy

Frincy Khandelwal Baruah, Nishat Hussain Ahmed, Rajesh Kumar Grover
Aeromonas skin and soft tissue infections in cancer patients can lead to serious life threatening conditions such as cellulitis, necrotizing fasciitis and myonecrosis. We report here a case of surgical site infection, post radical mastectomy, in a 58-year-old female with carcinoma breast. Cultures of exudates from the wound grew Aeromonas hydrophila on repeated occasions. Recovery was uneventful following targeted antimicrobial therapy and regular dressing of the wound. Early suspicion, diagnosis, and treatment with potent antibiotics are needed to prevent any further complications resulting from infection by this emerging pathogen.

Robertsonian Translocation t (21; 21) in a Female Born to Normal Parents: A Case Report

Giriraj Kusre, Mukul Sarma, Tulika Nirmolia, Priyanka Shankarishan
Downs syndrome (DS) occurs due to an extra copy of chromosome 21. About 3% of cases of Downs syndrome occur due to Robertsonian translocation, most commonly t (14; 21), other types of translocations are very rare cause of the syndrome. A 10-year-old patient with mental retardation was admitted following road traffic accident. Patient had flabby muscles, had delayed mile stones, stunted growth for the age, slanting of eyes, flat nasal bridge, and ineligible speech. On cytogenetic analysis the patient had karyotype showing one normal chromosome 21 and one Robertsonian translocation t (21; 21). Parents and siblings of the patient were phenotypically normal. Robertsonian translocation t (21; 21), can occur by transmission from carrier parent, due to ovarian mosaicism for Robertsonian translocation or may appear de novo. In the present case as the parents had normal karyotype and siblings were phenotypically normal, Robertsonian translocation probably have arisen de novo. The present case was a case of Downs syndrome with Robertsonian translocation t (21;21) probably arising de novo.

Stercoral Perforation of the Sigmoid Colon in a Schizophrenic Patient

Shiv Kumar Bunkar, Amit Singh, Rohit Pratap Singh
Stercoral perforation of the colon is a life threatening condition, due to pressure necrosis by hard fecaloma which, are commonly found in chronic constipated patients. We report the case of a 45-year-old schizophrenic woman, under psychiatric treatment for two years, presenting with a 10-day history of absolute obstipation and distension. On physical examination the patient had signs of generalized peritonitis. Preoperative diagnostic workup gave no clear-cut clues about diagnosis. Emergency laparotomy revealed a single perforation over the antimesentric border of the sigmoid colon with hard fecal matter protruding through perforation margin. A segmental resection of the sigmoid colon with colonic lavage and end to end anastomosis was performed. The patient made an uneventful recovery. We have discussed the diagnostic work-up, and the management of this rare entity. Patient was on antipsychotic, anticholenergic and NSAID’S drugs for long time with longstanding immobilisation and poor oral intake. Association of these etiological factors with chronic constipation which ultimately leads to stercoral perforation have been corroborated.

Oxcarbazepine Induced Maculopapular Rash - A Case Report

Arunava Biswas , Ritabrata Mitra, Sukanta Sen, Agnik Pal, Santanu Kumar Tripathi
Unlike carbamazepine, newer anti epileptic drug like oxcarbazepine, reports fewer side effects. In this report we describe a case of oxcarbazepine induced maculopapular rash probably happened because of a drug interaction with isoniazid, and a brief review of the existing literature is presented herewith. A 40-year-old male patient received oxcarbazepine 300mg twice daily along with other anti-tubercular drugs including isoniazid (300mg) once daily since two days. Extensive cutaneous rash with intense itching developed which subsided on discontinuation of oxcarbazepine. This case highlights the fact that there is a potential possibility of drug-drug interaction between oxcarbazepine and isoniazid and concomitant use of these two drugs should better be avoided during clinical practice.

Posterior Reversible Encephalopathy Syndrome with Involvement of the Cervical Cord and Medulla: a Case Report

Xuan Hou, Jinfeng Xu, Zao Chen, GG Uoliang Li, Hong Jiang
Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state, which is associated with symmetrical subcortical areas of vasogenic oedema that are preferentially parieto-occipital, and it typically resolves within a few weeks after appropriate treatment, We hereby report a case of a female with adrenal tumour presenting with PRES, who was featured by a very rare neuroimaging manifestation, the involvement of cervical cord and medulla.

Homosexual Obsessive Compulsive Disorder (HOCD): A Rare Case Report

Manjeet S. Bhatia, Jaswinder Kaur
Homosexual Obsessive Compulsive Disorder (HOCD) is marked by excessive fear of becoming or being homosexual. The subjects often experience intrusive, unwanted mental images of homosexual behaviour. The excessive uncontrolled thoughts/doubts are very distressing and lead to compulsions in form of checking. We present a rare such case who was suffering from HOCD.

Idiopathic Eosinophilic Synovitis of the Knee Joint with Peripheral Eosinophilia – A Rare Case Report
Synovitis, presenting as a synovial effusion is common. The most common cause include tuberculosis, osteoarthritis. Here with, presenting a rare case of monoarticular synovitis with synovial fluid and peripheral blood eosinophilia of unknown aetiology in an 18-year-old male. We review the clinical and pathological features and impress the need for synovial fluid examination in all cases

Inexplicable Co- Existence of Eccrine Spiradenoma and Lichen Planus in an old Case of Basal Cell Carcinoma

Hemalatha. A. L, Lavanya. M.S, Anoosha. K, Ashok. K. P, M. Rajani Deepa
Eccrine spiradenoma is a rare benign adnexal tumour usually seen in the head, neck or upper trunk in young adults. It is rare in the lower extremities and in the elderly. Co- existence of eccrine spiradenoma with other lesions like cylindroma, trichoepithelioma, hidradenoma and chondroid syringoma has been documented in literature. But, concomitant occurrence of eccrine spiradenoma with a non- neoplastic lesion like lichen planus in an old and treated case of basal cell carcinoma has not been documented in literature till date. We present a rare case of eccrine spiradenoma occurring on the right thigh in an elderly female along with lichen planus over the left breast. The lady had been diagnosed with basal cell carcinoma 10 years ago and treated with wide local excision. A brief review of literature is also included.

Adenoid Cystic Carcinoma–A rare Differential Diagnosis for a mass in the External Auditory Canal
Primary external auditory canal malignancies are very rare; in which, adenoid cystic carcinoma is extremely rare tumour accounting for approximately 5%. Majority of the patients presents with unilateral severe or dull aching constant ear pain of prolonged duration, reduced hearing and mass in the External Ear. These tumours are treated with aggressive surgical excision and adjuvant radiotherapy. Despite this, the overall prognosis is poor due to recurrences and distant metastasis. We report a rare case of adenoid cystic carcinoma in a 36-year-old female, who presented with right ear pain for the last one year. She was treated with wide local excision of the mass followed by adjuvant radiotherapy.

Gastroduodenal Intussusception Due to Pedunculated Polypoid Gastrointestinal Stromal Tumour (GIST): A Rare Case
Gastrointestinal stromal tumours (GISTs) account for less than 3% of all gastrointestinal tract tumours and 5.7% of all sarcomas, and the majority of these tumours are gastric in origin. Patients commonly present with gastrointestinal bleeding or abdominal pain with 10-30% of patients presenting with symptoms of gastrointestinal obstruction. We report a rare case clinically presenting as gastric outlet obstruction, gastroscopy suspecting it to be organo-axial gastric volvulus, CECT(Contrast Enhanced Computerised Tomography) suggesting features of gastric malignancy (leiomyosarcoma) keeping the possibility of differential diagnosis of GIST. Eventually on exploratory laparotomy we discovered gastric outlet obstruction due to transpylorically herniated pedunculated polypoid GIST leading to gastroduodenal inussusception.

Acquired Jejunal Atresia in a 2-Month-old Infant

Ankur Mandelia, Sandeep Agarwala
Acquired intestinal atresia in non–necrotizing enterocolitis affected patients is very rare. We report a 2 month old male infant who presented with bilious vomiting, abdominal distension and constipation. He was exclusively breast fed, gained weight and was asymptomatic till six weeks of age. Exploratory laparotomy revealed blind-ended, dilated proximal segment and collapsed distal segment of jejunum at approximately 30 cms from duedeno-jejunal flexure, with a V-shaped mesentery defect resembling a type III-a congenital jejunal atresia.

Fallopian Tube Choriocarcinoma Presenting as Ovarian Tumour: A Case Report

Anjali Mundkur, Lavanya Rai, Shripad Hebbar, Shyamala Guruvare, Prashanth Adiga
Choriocarcinoma of the fallopian tube is a rare form of gestational trophoblastic disease. It can be gestational or non gestational choriocarcinoma, based on the origin. Fallopian tube choriocarcinoma has been reported commonly after ectopic pregnancy. Choriocarcinomas are germ cell tumours formed by trophoblastic elements. A 26-year-old lady presented with pain and mass abdomen of 15 days duration. Clinical examination revealed a ovarian tumour with elevated beta HCG. The working diagnosis was ovarian choriocarcinoma. Patient was also found to be having pulmonary artery hypertension due to the metastasis to lungs. Staging laparotomy was done. Histopathology revealed it to be metastatic gestational choriocarcinoma of fallopian tube with vascular emboli. The stage was stage III and WHO scoring of 15. She received Etoposide, Methotrexate, Actinomicin, Cyclophosphamide and Oncovin therapy. Following treatment there was a significant drop in the beta HCG. Patient tolerated the chemotherapy well. This is a rare presentation of choriocarcinoma with good prognosis.

A Rare Case of Foreign Body Causing Recurrent Vaginal Discharge in Prepubertal Child

Vijayalakshmi.R.Gobbur, Raghavendra.H.Gobbur, Ashwini.G.Patil, Preetish Endigeri
Vaginal discharge in prepubertal children is mainly due to hypoestrogenic state of vaginal mucosa making it thin and alkaline leading to mucosal invasion by pathogen. In a paediatric case with persistent foul smelling , blood stained vaginal discharge not responding to medical therapy, vaginal foreign body should always be ruled out. Here, we report a 3 -year -old girl with complaint of recurrent vaginal discharge occasionally blood stained not relieved despite few antibiotics courses. On X -ray pelvis, a radioopaque foreign body hair clip was seen. Under sedation foreign body was removed by forceps following which child became asymptomatic.

Management of a Case of Ruptured Pseudoaneurysm and Stenosis of Femoral Artery Caused by Femoral Osteochondroma

Vikas Deep Goyal, Vipin Sharma, Sandeep Kalia, Shivam Pathak
We present a rare case of ruptured pseudoaneurysm of distal femoral We present a rare case of ruptured pseudoaneurysm of distal femoral artery due to osteochondroma in a 21-year- old male. The patient was initially treated for osteochondroma as ruptured pseudoaneurysm was not suspected. Diagnosis of ruptured pseudoaneurysm could only be made intraoperatively when rent in the femoral artery was found along with surrounding hematoma and obstruction in the distal femoral artery. Patient underwent multiple surgeries (resection of osteochondroma and femoro-popliteal bypass) and recovered well with palpable pulsations in the operated limb.

Community Medicine Teaching and Evaluation: Scope of Betterment

S. Gopalakrishnan, P. Ganesh kumar
There have been rapid and extensive changes in the way assessment is conducted in medical education. Assessment brings about standardization of the manner in which the syllabus is to be implemented and also gives guidelines regarding the teaching pattern, especially when the student is going to rotate through various departments in a medical college. Community Medicine is an important branch of medicine concerned with the health of populations. Existing forms of assessment of community medicine education mainly consists of internal [formative] assessment and final (summative) examination. Advantages of the present system is the similarity of the methods used for internal assessments and final examinations and is relatively easily done since only the knowledge application and recall ability of the student in theory and practical are assessed. Disadvantages in the current evaluation system are neglecting the assessment of psychomotor, affective and communication skills. Evaluation systems can be improved by implementing techniques to assess psychomotor skills, presentation and communication skills, organizational skills and the student’s ability to work in a team. Regular feedback from students should be taken periodically for the betterment of Community Medicine education. This article is meant to sensitise the academic experts in medical education to plan better need based methods of assessment in the subject of Community Medicine, in relation to the new MCI 2012 Regulations, in order to make it a better learning experience for the students.

Can Aspirin and Cancer Prevention be Ageless Companions?

Mohamed Farag
Over the past few decades, the rate of cancer diagnosis has increased worldwide due to the increase in population and average life expectancy, and also, due to the advances in diagnostic medical technology that facilitate early cancer detection and recognition. Nonetheless, the treatment options have not been developed proportional to this increase, with a huge number of patients frequently being diagnosed with different types of fatal cancer. This has prompted different health organizations to search for novel strategies to prevent cancer, or even halt its progression. Having failed to provide optimum vascular protection benefits, especially with the introduction of relatively superior antiplatelets, such as adenosine diphosphate (ADP) receptor inhibitors; clopidogrel and ticagrelor, regular aspirin use was proposed to reduce the risk of common cancers like colorectal cancer, gastric cancer, breast cancer, lung cancer, prostate cancer and haematological malignancies, as suggested by epidemiological studies. However, it is difficult to draw any firm conclusions on such weak data, as this could raise false hopes among patients and physicians and could potentially mislead scientific research. Clearly, current evidence highlights a gap in medical research and emphasizes the need to carry out interventional studies in high risk for cancer patients using specific aspirin doses in order to validate the data. This should also shed some light on the risk-benefit profile in view of the potential for bleeding complications, especially with the higher doses.

Non Viral Vectors in Gene Therapy- An Overview

Murali Ramamoorth, Aparna Narvekar
Non-viral vectors are simple in theory but complex in practice. Apart from intra cellular and extracellular barriers, number of other challenges also needs to be overcome in order to increase the effectiveness of non-viral gene transfer. These barriers are categorized as production, formulation and storage. No one-size-fits-all solution to gene delivery, which is why in spite of various developments in liposome, polymer formulation and optimization, new compounds are constantly being proposed and investigated. In this review, we will see in detail about various types of non-viral vectors highlighting promising development and recent advances that had improved the non-viral gene transfer efficiency of translating from “Bench to bedside”.

Oral Rehabilitation and Management of Mentally Retarded

Jitender Solanki, Jitendra Khetan, Sarika Gupta, Deepak Tomar, Meenakshi Singh
High level of periodontal problems of dental caries are frequently observed in mentally handicapped children. This group of patients presents various problems when they face dental treatments. Identification of such population and providing them affordable oral health care is the new concept. A systematic method for identification and screening of persons with mental retardation has been developed and is being followed. Cost and fear are the most commonly cited barriers to dental care. Physical or mental may lead to deterioration in self-care, and oral care state have a low priority. Risk factors are inter-related and are often barriers to oral health. With advancements in today’s world sufficient information and support is available for each and every individual to lead a healthy life which include the access to the oral health care. Factors such as fear, anxiety and dental phobia plays a vital role in acceptance of dental care and also the delaying of dental care. Lack of knowledge of oral and dental disease, awareness or oral need, oral side-effects of medication and organization of dental services are highlighted in the literature. All health personnel should receive training to support the concept of primary oral health care. Training about dealing with such mentally handicapped people should be addressed urgently among the health professionals.

Bonebiomarkers in Periodontal Disease: A Review Article
Periodontitis, is an inflammatory state of the tooth supporting structures and if left untreated, the disease continues to progressive bone destruction and subsequent tooth loss. The increasing prevelance of periodontal disease paved way to the development of new diagnostic tests that could detect the presence of active disease,the course of the disease and its response to treatment. Bone is a metabolically active tissue and undergo continuous remodelling, a process that largely relies on the activity of osteoclasts to remove bone and of osteoblasts to form bone. In health ,bone resorption and formation are coupled to each other and its long term maintenance of skeletal balance is brought about by the systemic hormones and local mediators.In contrasts,during disease there is a pronounced in balance in bone turnover. Bone biomarkers which are produced either in health or in disease state are tell tale markers which would be used to monitor the health status. This review highlights, the recent advances in the use of biomarkers of bone remodelling,that could facilitate the screening, diagnosis and management of periodontal diseases.

Localization of Impacted Canines
Impaction of maxillary canines is a frequently encountered clinical problem. The impaction of canine can be prevented in some situations if the canine displacement is diagnosed in the early mixed dentition period and this would be extremely useful for the clinician. Hence, it is very important to focus on the means of early diagnosis and interception of this clinical situation. In the present article, the different modalities used to diagnose the impacted canine are reviewed with an insight into current 3-D modalities.

Hand Schuller Christian Disease: A Rare Case Report with Oral Manifestation

Ch. Lalitha, M. Manjula, K. Srikant, Stuti Goyal, Shahela Tanveer
Langerhan’s Cell Histiocytosis (LCH) is disorders which include abnormalities that result from abnormal proliferation of langerhan’s cells or their precursors. LCH is clinically classified into three types-eosinophilic granuloma, Hand Schuller Christian disease and Abt-Letterer- Siwe disease. It is usually manifested in childhood as well as in adulthood. The clinical manifestations are the result of the accumulation and infilteration of the langerhan cells in organs and tissues. Here is a rare case report of 6-year-old boy with extraoral manifestation of exopthalmic right eye and oral manifestation of mobility of teeth and with typical radiological findings. Basing on the clinical, radiological and histopathological examination the diagnosis of Hand Schuller Christian Disease was given.

To Evaluate the Effect of Edrophonium on Blood Glucose Levels in Euglycemic Albino Rats Through OGTT
Objective: To evaluate the effect of Edrophonium on blood glucose levels in euglycemic albino rats through OGTT. Materials and Methods: Twelve Swiss albino rats weighing around 150-200 gms of either sex were randomly selected from the central animal facility, JSSMC, Mysore and divided into two groups. The control group received distilled water (25ml/kg body wt.) per orally, test groups received Edrophonium (6.3mg/kg/day) intravenously for five days. On the fifth day, following overnight fasting, half an hour after drug administration in all the groups of rats Oral Glucose Tolerance Test was performed, by administering oral glucose in dose of 0.6gm/kg body weight. The capillary blood glucose levels were measured at 0, 60 and 150 min, by rat tail snipping method using (ACCUCHEK) glucometer. Results: The Capillary Blood Glucose levels of Edrophonium group was less when compared to control group at all-time intervals. Conclusion: Edrophonium showed the hypoglycemic activity when given for five days intravenously in euglycemic albino rats through Oral Glucose Tolerance Test.

The Nuclear Maturation and Embryo Development of Mice Germinal Vesicle Oocytes with and without Cumulus Cell after Vitrification
Background: Cryobiology is an essential tool in assisted reproductive technology. Research in this area focuses on the possibility of restoring fertility in women with reproductive problems or after cancer treatments. Aim: The purpose of this study was to evaluate viability of oocytes, In vitro maturation and embryo development in vitrified germinal vesicle oocytes with and without cumulus cell after single and stepwise vitrification procedure. Materials and Methods: Germinal vesicle oocytes with or without cumulus cells were obtained from 4 weeks old female mice 48h after intraperitoneal injection of 7.5 IU pregnant mare serum gonadotropin (PMSG). For vitrification collected oocytes vitrification were exposed to cryoprotectant, which was composed of 30% (v/v) ethylene glycol, 18% (w/v) Ficoll-70, and 0.3 M sucrose, either by single step or in a step-wise way. After exposure to cryoprotectant and immerged in liquid nitrogen, the oocytes were thawed and washed in medium TCM199 two times. Then the oocytes transferred to IVM medium for maturation and embryo development to blastocyst. Results: The oocytes survival rates after vitrifying-warming, maturation rate, the capacity of fertilization and embryonic development to blastocyst were examined in vitro. The oocytes survival, maturation to MII, fertilization developmental rate in the step-wise exposure and with cumulus cell was significantly higher (p<0.05) as compared with corresponding rate in the single step procedure without cumulus cell. Conclusion: The results of present study indicated that oocytes vitrified with cumulus cells and stepwise procedure had positive effect on maturation and developmental rate to blastocyst than oocytes without cumulus cell and single step procedure.

Effect of Bacopa Monniera on Cold Stress Induced Neurodegeneration in Hippocampus of Wistar Rats: A Histomorphometric Study

Saravana Kumar S, Saraswathi P, Vijayaraghavan R
Introduction: Bacopa monniera/ Brahmi,is used over centuries in Ayurvedic medicine for memory development, learning, concentration and other mental illnesses such as nervousness and poor cognition. The present study aims to evaluate the effect of Bacopa monniera (Brahmi, BM) on cold stress induced histological changes in hippocampus of Wistar rats. Materials and Methods: Total 24 male rats divided into four groups were used (n=6) for this study. Group I was control in which rats were kept under ideal laboratory conditions, Group II was given 40 mg/kg of BM extract, Group III was cold water swim stress in which rats were forced to swim in the cold water maintained at 18±2oC till it started to sink for a period of one month and Group IV in which cold water swim stress given for a month followed by oral administration of BM extracts 40mg/kg treatment for a month. The whole study was carried out for a period of 60 d. The animals were sacrificed next day and their brains dissected out for histomorphometric analysis. The diameter, packing density and total number of neurons were calculated from stained histological section by using micrometry in the CA-1 region of the hippocampus. Statistical Analysis: The analysis and plotting of graphs were carried out using Sigma Plot 12 (Systat Software Inc., USA). Values are expressed as Mean + SEM (n = 6). One way analysis of variance followed by Student-Newman-Keul’s multiple comparisons test was used for the comparison of means. A probability of 0.05 and less was taken as statistically significant. Results: The results showed that there is no significant difference in the diameter of the cells between the groups but total number of the cells in Group II was statistically significant when compared with the others groups. Student–Newman–Keuls method showed that Group II and Group IV are statistically significant when compared to Group III (p<0.05). Conclusion: Results indicates that when BM extracts administered orally produce neuroprotective effect in cold stress induced hippocampal neurodegeneration of rats. Hence, the herb BM can possibly be used as an adjuvant to improve memory to combat stress in our day to day life.

Evaluation of Anti-Inflammatory Activity of Aqueous Extract of Leaves of Solanum Melongena Linn. in Experimental Animals

Umamageswari M S, Yasmeen A Maniyar
Introduction: Aqueous extract of leaves of Solanum melongena Linn was investigated for its anti-inflammatory activity. Materials and Methods: Acute oral toxicity study according to OECD425 guidelines was done to find out the LD50 of test drug. Carrageenan induced paw oedema method in Wistar Albino rats were used in this study. Aspirin in the dose of 300mg/kg was used as the standard drug and three doses of aqueous extract of leaves of Solanum melongena L. (100mg/kg, 200mg/kg, 400mg/kg b.w.) was used as the test drug. The results were measured at 1st h, 3rd h, and 5th h after the carrageenan injection. Results: In acute oral toxicity study none of the animals died at the dose of 2000mg/kg. Aqueous extract of Solanum melongena Linn leaf in the dose of 200mg/kg showed significant anti-inflammatory activity (p <0.05) at 3rd hr and highly significant anti-inflammatory activity (p<0.001) at 5th hr; in the dose of 400 mg/kg, test drug showed p<0.01 at 3rd and p<0.001 at 5th hr and in the dose of 100mg/kg it showed significant (p<0.05) anti-inflammatory activity at 5th hr. In doses of 200mg/kg and 400 mg/kg of aqueous extract of S. melongena L showed the percentage of inhibition of 42.62% which is less than the standard drug aspirin which showed 64.5% inhibition. Conclusion: Aqueous extract of leaves of Solanum melongena Linn has anti-inflammatory activity.

Occlusion Calculator

Abhishek Bansal, Anand Hiremath, Eby Aluckal
Start with end in mind’ is a popular cliché in orthodontics. This aptly applies to the therapeutic occlusion the orthodontist strives to achieve. Predicting the post treatment occlusion is an essential component of treatment planning. When no extractions or symmetric extractions are done predicting the final occlusion is somewhat easy. Prediction is challenging when we do unconventional and/or asymmetric extractions. To aid this decision Kesling proposed the ‘Kesling Setup’. Though it serves the purpose acceptably; it is time, energy and money consuming. We have developed a model which can help us visualize the final occlusion in matter of seconds. Although this model is primarily intended for orthodontic postgraduate teaching, it can be of considerable use even to a seasoned orthodontist. The regular use of “Orthodontic Calculator” in our department is a testimony to its usefulness.

Head Strap Double Fluid Level Device: An Innovative and User Friendly Design to Record Natural Head Position (NHP)

Lijo John, Nidhin Philip Jose, Siddarth Shetty
Head positions can be oriented in a standardized position when the patient stands upright and focusses his/her eyes into a point in infinity. This is the natural head position. This position offers the maximum reproducibility and correlates well with the clinical picture offered to the diagnostician. This article describes an innovative and user friendly method to record natural head position using the head strap double fluid level device, a design modified from the popular fluid level device by Showfety, Vig and Matteson.

A Simplified Method of Fabricating a Habit Breaking Appliance

Bhanu Prasad Meka, Sreevalli Suryadevara

Idiopathic Subareolar Breast Abscess in a Male Patient

Senthil Kumar Aiyappan, Upasana Ranga, Saveetha Veeraiyan
We present a case of left breast abscess in a young male patient who presented with acute onset swelling left breast. Imaging studies helped in accurate diagnosis and the case was managed by subareolar incision and drainage. Subareolar breast abscess is an uncommon entity in male and should be kept as a differential diagnosis for male breast swellings.

Unusual Cause of Chest Pain Mimicking Acute Myocardial Infarction: Congenital Left Ventricular Aneurysm

Oguz Karaca,Bekir Kayhan, Onur Omaygenc, Beytullah Cakal, Halil Turkoglu

Bipolar Hemiarthroplasty for Primary Abductor Deficiency with Femoral Neck Fracture

Sandesh Satendra Thete, Satish Goyal

Bilateral Supplemental Maxillary Incisors with Both Dens Invaginatus and Dens Evaginatus in a Non Syndromic Patient: A Rare Case Report

Prashant Babaji

Oral Malignant Melanoma

A Rare Case of Disseminated Cutaneous Rhinosporidiosis

Taste Pathway: What Do We Teach?

M Ganesh Kamath, Jay Prakash, Aparna Tripathy, Preethi Concessao

An Eagle´s Eye on ‘Gutkha Ban Legislation’ in India

Hodgkin’s Disease Presenting with Chronic Pruritis and Cutaneous Involvement

Turgay Ulas, Haci Gokhan Apucu, Emine Gulturk, Emel Yigit Karakas, Fatih Borlu

Risk of Cardiovascular Effects with Azithromycin

Ramachandran Kumaresan, Subish Palaian, Santosh Thapa, Pathiyil Ravi Shankar

Impacted Love: Mandibular Kissing Molars Advisable to Remove or Not

Jigar M. Dhuvad, Rajesh A. Kshirsagar

Optimizing the Roche LightCycler(R) for Single-Tube Multiplexed RT-PCR Assays

Clarise R. Starr, Elia T. Villazana, Richard R. Chapleau, David L. Masserang

Haemangioma, Thrombocytopenia and Coagulopathy- Kasabach Merritt Syndrome: An Appraisal for Anaesthesiologists

Babita Lahkar, Priyam Saikia, Bikash Bhaskar Bora