Journal of clinical and diagnostic research

Urinary Iodine Excretion In Pregnancy: A Pilot Study in The Region of Nepal

Agrawal K, Paudel BH, Singh PN, Majhi S, Pokhrel HP

Background: Pregnancy is accompanied by profound alterations in the thyroid economy and the relative iodine deficiency. The median Urinary Iodine Excretion (UIE) is the most reliable indicator of the population’s iodine nutrition. The physiological alterations in normal pregnancy, such as an increased glomerular filtration rate, potentially invalidate UIE as an assessment tool in pregnancy. Objectives: To assess the Urinary Iodine Excretion (UIE) in pregnant mothers and to enquire about the current status of their iodised salt intake. Methods: We carried out a cross-sectional study in which urine samples were collected from 45 pregnant mothers who were admitted to the antenatal ward. The iodine level in the urine was analysed by a method which was provided by Singh and Ali, to determine the Urinary Iodine Excretion (UIE). A questionnaire was introduced to document the status of the dietary intake of iodised salt. The UIE was expressed in median (interquartile) and the other data are expressed in frequency and percentage. Fisher Exact test was applied to compare between UIE and iodine intake. Results: Thirteen (28.88%) pregnant mothers had UIEs of <150 µg/L, which were below the cut-off point of the UIE for pregnant mothers. Overall, 33 mothers were from the Terai region; among them, one third had UIEs of <150 µg/L. Among the 45 pregnant women, 15 (33.34%) were not using iodised salt and the rest were using iodised salt. Among those who were using iodised salt (30 out of 45), 8 pregnant women had UIEs of <150 µg/L and among those who were not using iodised salt, 5 pregnant women had UIEs of < 150 µg/L. Conclusion: The UIE was below 150µg/L in a substantial percentage (28.89%) of pregnant women of the Terai region, regardless of their intake of iodised salt.

Emergence of NDM – 1 in the Clinical Isolates of Pseudomonas aeruginosa in India

Atul Khajuria, Ashok Kumar Praharaj, Mahadevan Kumar, Naveen Grover

Objective: The present study was undertaken to detect the prevalence of the blaNDM-1 metallo beta lactamases (MBLs) in the isolates of Pseudomonas aeruginosa, which were recovered from various clinical samples from hospitalized patients in a tertiary care centre in Pune, India. Methods: A total of 200 isolates of P. aeruginosa which were obtained from various clinical samples were subjected to antibiotic susceptibility testing by the disc-diffusion method and their MICs were determined by the Vitek – 2 Automated Antimicrobial Identification and Susceptibility Testing System against imipenem, meropenem, ticarcillin, amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin, moxifloxacin, tigecycline, trimethoprim/sulfamethoxazole, ampicillin/sulbactam, piperacillin/tazobactam, cefoperazone/sulbactam, cefepime, tetracycline, ceftazidime, ceftriaxone and colistin. Their MICs were also determined by the Etest method against imipenem, meropenem, piperacillin, tobramycin, ceftazidime, tigecycline and colistin. The presence of blaNDM-1 was detected by PCR and it was confirmed by sequencing the gene which was present in the isolates which exhibited carbapenem resistance. The experimental transferability of the plasmids which carried blaNDM-1 was determined by using E. coli J53 as the recipient. Result: In the present study, four isolates of P. aeruginosa, which carried the blaNDM-1 gene, were resistant to imipenem and meropenem. These blaNDM-1 carrying isolates remained susceptible to colistin. The plasmid carrying blaNDM-1 was successfully transferred from the four isolates to E. coli J53 recipients. Conclusions: We are reporting the emergence of the P. aeruginosa carrying NDM-1gene, which exhibited resistance to imipenem and meropenem, for the first time from India.

A Study of Alternate Biomarkers in HIV Disease and Evaluating their Efficacy in Predicting T CD4+ Cell Counts and Disease Progression in Resource Poor Settings in Highly Active Antiretroviral Therapy (HAART) Era

K V Ramana, V Sabitha, Ratna Rao

Introduction: Human Immunodeficiency Virus (HIV), the causative agent of AIDS, has been a challenge to medical fraternity since it was first discovered in 1983. About 40 million people are living with HIV infection globally and 99% of the infected people are in south East Asia (SEA). Traditionally, HIV disease and progression, initiation of HAART and response to therapy is monitored by assessing in regular intervals, the T CD4+ cell counts and plasma HIV/RNA viral load. Resource poor, low and low – middle income group countries still have no finances to acquire infrastructure and scientific technology for performing such tests. Objectives: Since very few studies are available, they have demonstrated the role of alternate biomarkers that can be used to predict CD4 cell counts and thereby, monitor HIV disease progression and HAART. We aimed to measure certain haematological parameters in HIV seropositive patients and to evaluate their efficacy in predicting TCD4+ cell counts. Methods: The study group included 250 HIV seropositive patients with an age range of 18-65 years. 140(56%) males and 110(44%) females were included in the study. Absolute TCD4+cell counts and CD8+T cell counts were measured by using a flow cytometer. (MMWR Recommendations and Reports, 1992) TLC; HB%, AEC and ESR were estimated by using conventional haematological methods. CRP was evaluated by latex agglutination test (Immuno CRP Latex Agglutination Test). Results: Among the tested haematological markers, a TLC of <1800 cells/mm3 showed high specificity (100%) in predicting CD4 counts of < 200 cells/mm3, with an accuracy of 61.46%. Haemoglobin and Absolute Eosinophilic counts showed high specificities of 84.09% and 94.32% respectively in predicting CD4 counts which were below 350 cells/mm3. ESR with 98.98% sensitivity and AEC which had 83.67% sensitivity were able to predict CD4 counts of <200 cells/mm3. Conclusion: Among the tested biomarkers, it was seen that Absolute Eosinophilic counts of more than 550 cells/mm3, Blood Haemoglobin which was less than 10 g%, ESR which measured more than 20 mm, CRP values of >1.2 and TLC of <1800 cells/mm3 could be helpful in predicting CD4 cell counts of < 350 and <200 cells/mm3.

A Comparative Analysis of Community Acquired and Hospital Acquired Methicillin Resistant Staphylococcus Aureus

Vysakh P R, Jeya M

Purpose: Staphylococcus aureus has developed resistance against most of the therapeutic agents. The most notable example of this phenomenon was the emergence of Methicillin resistant Staphylococcus aureus (MRSA). We are reporting the prevalence and the antibiotic susceptibility pattern of the MRSA isolates from a tertiary care hospital. Methods: A total of 450 Staphylococcus aureus isolates from clinical samples were taken up for the study and they were screened for MRSA by using standard microbiological methods. An antibiotic assay was done for the confirmed MRSA isolates. The differentiation of the isolates into community acquired MRSA (CAMRSA) and hospital acquired MRSA (HAMRSA) was done according to the prescribed criteria. The double disc diffusion test was performed for both the groups, to identify the inducible clindamycin resistance. The HAMRSA and the CAMRSA isolates were subjected to a molecular analysis by PCR, to detect the presence of the Mec A gene and the PVL gene respectively. Results: Out of the 450 Staphylococcus aureus isolates, 121 were Methicillin Resistant Staphylococcus aureus (MRSA, 27%) and 329 were Methicillin Sensitive Staphylococcus aureus (MSSA, 73%). 91 MRSA isolates were grouped into HAMRSA and 30 were grouped into CAMRSA, with a prevalence of 20% and 7% respectively. All the MRSA strains were resistant to Penicillin (100%), Cefoxitin (100%) and Oxacillin (100%). 53.7% of the HAMRSA isolates showed inducible clindamycin resistance against that of 44.4% among the CAMRSA isolates. All the isolates were susceptible to Vancomycin and Linezolid. 64% of the HAMRSA isolates showed the presence of the Mec A gene and 48% of the CAMRSA isolates showed the presence of the PVL genes. Conclusion: The prevalence of the HAMRSA was higher than that of the CAMRSA and they showed a higher drug resistance.

Prevalence of the Trichomonas Vaginalis Infection in A Tertiary Care Hospital in Rural Bangalore, Southern India

Dharma Vijaya M N, Umashankar K M, Sudha, Abed Gulab Nagure, Kavitha G.

Background: The infection with Trichomonas vaginalis is one of the most common sexually transmitted diseases (STDs) in humans. The prevalence of this infection has been reported to be between 2 to 8%, depending on the different socio-cultural conditions. This study aimed to determine the prevalence of T. vaginalis in the women who were referred to the gynaecologic clinics at the MVJ medical college, Bangalore, India. Methods: This descriptive, cross-sectional study was conducted on 750 women who were referred to the gynaecologic clinics from October 2010 to September 2012. Vaginal samples were obtained from them and they were examined by wet mount and culture methods for the detection of T. vaginalis. Results: Sixteen out of the 750 vaginal swab specimens (2.1%) were culture positive for T. vaginalis and 13 among these positive specimens (1.7%) were wet mount positive. Only 12 of the 42 patients who were clinically diagnosed as having the T. vaginalis infection, were confirmed by the culture method. Five hundred and fifty of the participants (73.3%) had at least one of signs and symptoms of trichomoniasis. No statistical correlation was observed between the clinical manifestations and the parasitological results (p>0.05). Conclusion: This study showed a low prevalence of the T. vaginalis infection in the study population. Since the clinical signs of trichomonal vaginitis are the same as those of other STDs, a confirmatory laboratory diagnosis is necessary. Wet smears, as well as culture, are sensitive for the detection of T. vaginalis.

The Prevalence of Depression among the Rural Elderly in Chittoor District, Andhra Pradesh

Swarnalatha N

It has been documented that the elderly are more prone to psychological problems and depression is the commonest of the geriatric psychiatric disorders. In fact, the elderly in India face a multitude of psychological, social, and physical health problems. There is a dearth of community studies in India, which have investigated geriatric depression and its associated risk factors. Hence, the present study was undertaken with the following objectives. Study Objectives: 1. To assess the prevalence of depression among the elderly. 2. To determine the epidemiological factors which are associated with depression. Design: A cross-sectional, observational, community based study. Period: April 2009 to September 2009. Setting: A Rural Health Centre which was a rural field practice area which was attached to the Community Medicine Department, SV Medical College, Tirupati, India. Subjects: The individuals who were aged 60 years and above were interviewed and examined. Method: By random sampling, the villages were selected. This study was conducted through house-to-house visits in the selected villages. Clinical examinations, observations and interviews were carried out by using a pre-designed, pre-tested proforma in the local language. Size: Four hundred subjects. The data was analysed by using SPSS (Statistical Package for Social Sciences), version17. Results: The prevalence of depression was 47%. The depression was high among the elderly who were aged 80 years and above (54.3%), females (56.5%), illiterates (59.0%), those who were below the poverty line (86.1%), those who were living alone (87.3%), those who were economically partially dependent (63.3%) and those depended totally for the activities of daily living (100.0%). These factors were significantly associated with depression. Conclusion: The prevalence of depression was found to be positively associated with increasing age, the female sex, illiteracy, a low socio-economic status, those who were living alone, those who were economically partially dependent and those who were totally dependent for the activities of daily living.

The Incidence of Secretory Otitis Media in Cases of Cleft Palate

D Sridhara Narayanan, S Sundara Pandian, S Murugesan, Ramya Kumar

Objective: Children with a Cleft Palate (CLP) and with or without cleft lips (non-syndromic) universally present with Secretory Otitis Media (SOM). The purpose of this study was to determine the incidence of secretory otitis media that occurs in patients with cleft palates and to confirm the existence of these manifestations by doing a Basic Audiologic Evaluation (BAE). Materials and Methods: A retrospective study was done on forty four male and female children who were within the 2 to 14 years age range, with non-syndromic cleft palates with or without cleft lips, with the symptoms of SOM. Otoscopy examinations were done in all the cases. X-rays of the mastoids (both sides) were done in all the cases to detect the pneumatization of the mastoid air cell system. The Basic Audiologic Evaluation (BAE) includes an evaluation by tympanometry of the middle ear function and an evaluation by pure tone audiometry to establish the type of hearing loss. Results: A majority of the patients (47.27%) were in the age group of eight-to-fourteen (8-14) years. The Basic Audiologic Evaluation (BAE) revealed that 77.27% of the children had presented with normal hearing; 13.6% had conductive hearing loss and 2.2% had presented with a mixed hearing loss. We noticed that 68.2% of the children had type A curves; 21.2% of the children had type C tympanometry curves; 7.1% had type B curves and 3.5% had Ad curves. The contralateral acoustic reflex was present in 54.5% of the children and 45.5% did not have this reflex. A majority of the patients (46%) showed sclerotic changes in their mastoid air cell systems in the X-rays of the mastoids. Conclusion: The significantly higher prevalence of SOM in the children with cleft was confirmed by the study. Also, the hearing loss which was associated with SOM was evident and it demonstrated that there was a high prevalence of a mild conductive hearing loss when SOM was present. The cleft palate contributed to the occurrence of the secretory otitis media and it required proper ENT and audiological follow ups.

Effect of High Dose of Steroid on Plateletcount in Acute Stage of Dengue Fever with Thrombocytopenia

K.C. Shashidhara, K.A. Sudharshan Murthy, H. Basavana Gowdappa, Abhijith Bhograj

Background: Dengue infection is the most rapidly spreading mosquito-borne viral disease in the world and an estimated 50 million dengue infections reported annually. The pathogenesis of Thrombocytopenia in dengue fever (DF) is not clearly understood. Increased peripheral destruction of antibody coated platelets and acute bone marrow suppression were strongly suspected as the possible mechanism. This often leads to life threatening dengue hemorrhagic fever (DHF) and Dengue shock syndrome (DSS). Steroids are used in the treatment of Idiopathic thrombocytopenic purpura to increase the platelet count which is mediated by auto antibodies .This hypothesis would support the use of steroids in dengue fever. Aim and Objectives: The objective of this study was to test whether an intravenous high dose dexamethasone was efficacious in increasing the platelet count in acute stage of dengue fever with thrombocytopenia. Methods: During the study period between June 2010 - 2011 in JSS Hospital Mysore, 127 patients were screened for dengue fever with thrombocytopenia (<50000/cumm) and 61patients were randomly allocated, 30 to the study group and 31 to the control group, in an open labeled study. The study group received intravenous dexamethasone 8mg initially followed by 4 mg every 8 h thereafter for 4 days and IV fluids whenever required. The control Group received only IV fluids and antipyretics whenever it was indicated. The daily measurement of platelet count was carried out in all patients from the day of enrolment to the fourth day of post treatment. Results: The baseline data (age, sex, and the mean duration of the illness, Hb%, haematocrit, and platelets) were similar in both the groups. The analysis of variance (ANOVA) statistics showed a significant linear association of the mean platelet counts with the days in either group. The mean platelet counts increased steadily in both the groups from days 1 to 4: day1 (0.687), day2 (0.34), day3 (0.530) and day4 (0.844). There was no significant difference between the two groups. Conclusion: We conclude that at a high dose dexamethasone regimen was not effective in achieving a higher rise in the platelet count in the acute stage of dengue fever.

Tackling the Problems of Tumour Chemotherapy by Optimal Drug Scheduling

Ambili Remesh

Introduction: There are various strategies for overcoming the major pitfalls of cancer chemotherapy, such as toxicity and drug resistance. The scientific computing of drug scheduling by optimisation before drug administration is one among them. In a majority of these strategies, the pharmacodynamic variations are given more importance than the pharmacokinetic variations. This study was meant to analyse the importance of the pharmacokinetic parameters (?) of the individual patients in cancer chemotherapy scheduling, along with the pharmacodynamic factors. Methods: A mathematical model is developed and it is implemented in the open source OCTAVE GNU LINUX. Optimisation is done by using an optimization tool in OCTAVE. The present study was aimed at evaluating the daily drug dosaging and cyclic chemotherapy which are commonly practised in the chemotherapy scheduling. Four cases were analyzed with and without considering the pharmacokinetic parameters. The optimal therapy was meant to reduce the number of cancer cells to a minimum at the end of the therapy and to minimise the emergence of resistant cancer cells. Since the dose was within tolerable limits, the toxic effects could also be minimised. Results: Even with the consideration of a 1 per cent effect (?), the maximum possible dose and the performance index were increased in the daily scheduling. But in the cyclic therapy, even though the maximum tolerated dose or the performance index was not altered, the cumulative toxicity was greatly reduced. Conclusion: Daily scheduling and cyclic chemotherapy can be applied alternatively more effectively, by considering the interindividual variations in the pharmacokinetic effect (?).

Postmenopausal Intraocular Pressure Changes in South Indian Females

Panchami, Sheila R Pai, Jnaneshwara P Shenoy, Shivakumar J, Sharad B Kole

Background: Normal Intraocular pressure (IOP) is an essential prerequisite for the eye to serve its function as a light gathering and transducer organ. Various physiological factors which include age, gender and hormonal variations may influence IOP in normal subjects and these effects sometimes may be marked and relatively sustained. The present study was an attempt which was made to observe the effect of menopause on IOP and the contribution of altered Body Mass Index (BMI). Methodology: A total of 120 females who were in the age group of 40 – 55 years, who were recruited for the study, were divided into two groups of 60 each: premenopausal and postmenopausal, based on their menstrual history. The BMI of the subjects was then calculated. IOP was recorded in all individuals and it was compared between the two groups by using Student’s ‘t’ test. The IOP was also correlated with BMI. A p value of < 0.05 was considered as statistically significant. Results: The results of the present study showed that there was a significant increase in the IOP in the postmenopausal group as compared to that in premenopausal women. Moreover, it showed a significant positive correlation with BMI in post menopausal women. Conclusion: The higher IOP in postmenopausal women could be ascribed to dwindling levels of oestrogen and progesterone after menopause, which could act by altering any/several components of the IOP regulating mechanisms. A large body size, as was indicated by BMI, was associated with additional increases in IOP. The present study, therefore, provides further insights into the interactions between BMI and paucity of sex hormones in influencing the IOP.

Prevalence of Diabetic Retinopathy in Western Indian Type 2 Diabetic Population: A Hospital – Based Cross – Sectional Study

Context: Diabetic Retinopathy (DR) can be defined as a damage which is caused to microvasculature in the retina by prolonged hyperglycaemia. Various studies have been conducted in south India, to find out prevalence of DR. It remains a less explored domain among type 2 diabetic patients in western India. Objectives: (1) To assess prevalence of diabetic retinopathy in type 2 DM in western Indian population. and (2) To find out effect of duration of diabetes on severity of DR in this population. Study Design: A hospital – based, cross – sectional study. Materials and Methods: A total of 168 patients with type 2 DM underwent detailed opthalmoscopic examinations for DR. The ETDRS classification was followed to categorize retinopathy in different stages. Results: We observed that overall, prevalence of DR in type 2 patients of western India was 33.9%. Prevalences of non-proliferative DR and proliferative DR were 25.5% and 8.33% respectively. Statistically significant differences (p value<0.05) were observed between prevalences of DR in each group of patients which was classified, and duration of diabetes. Prevalence of CSME (clinically significant macular oedema) was 6.5%. Associated hypertension showed a statistically significant (p value<0.05%), higher prevalence of DR. Conclusion: This study concluded that prevalence of DR in type 2 DM patients of western India was 33.9% and that it increased with duration of diabetes. Associated hypertension is a risk factor for development of DR. It was further noted that proliferative DR was prevalent only after having diabetes for 11 years.

The Assessment of Sleep Apnoea as a Risk Factor in Glaucoma

Background: The risk of developing open angle glaucoma increases in the presence of associated disorders such as hypertension, Diabetes mellitus and migraine. In recent years, sleep apnoea is also being investigated as a risk factor in the development of open angle glaucoma. Aim: To ascertain the significance of sleep apnoea as a risk factor in patients with glaucoma. Study Setting and Design: A non – randomised, cross sectional study was undertaken at an urban teaching hospital. Materials and Method: A sleep disturbance questionnaire and the Epworth sleepiness scale were used to screen the potential cases of sleep apnoea amongst 40 glaucomatous subjects, with both Primary Open Angle Glaucoma (POAG) and Normotensive Glaucoma (NTG), as well as 40 controls. Those which gave a positive response to the questionnaire were subjected to poly- somnography for the diagnosis of sleep apnoea, with the calculation of the Apnoea Hypopnoea Index. The data was analysed by using the Chi – square test and the odds ratio calculations. Results: Positive responses to the sleep apnoea questionnaire were obtained from a total of twenty participants, 16 (40%) from the glaucoma Group and four (10%) were obtained from the control Group. In the glaucoma Group, ten (37.03%) of the 27 POAG individuals, and six (46.15%) of the 13 NTG cases showed significant positive responses to the questionnaire. Four subjects (10%) (1POAG, 3 NTG) from the glaucoma Group and one (2.5%) from the control Group were diagnosed to have sleep apnoea by polysomnography. The percentage of the sleep apnoea positive cases was higher among the NTG subjects (23.07%) than among the POAG subjects (3.7 %). This study had an odds ratio of 4.333 (>1) and a p value of 0.382. Conclusion: Although the odds ratio was significant, this study did not find the association between sleep apnoea and glaucoma to be statistically significant.

The Characteristics and the Pharmacological Management of Cancer Pain and Its Effect on the Patients´ Daily Activities and their Quality of Life: A Cross – Sectional study from Malaysia

Bhuvan K C, Zuraidah Binti Mohd Yusoff, Alian A Alrasheedy, Saad Othman

Context: Pain is a major health care problem for the patients with cancer and one of the most frequent and disturbing cancer related symptoms. Aim: To study the characteristics of pain in cancer patients and its pharmacological management by using a subjective self-assessment questionnaire and the World Health Organization (WHO)analgesic ladder for pain management. Settings and Designs: This study was conducted in the Oncology Wards of Penang Hospital, Penang, Malaysia. A questionnaire was developed to assess the pain characteristics and their effect on the patients’ daily life activities and the information on the pharmacological management of the cancer pain. The cancer pain intensity was noted from the patients’ medical database. Method and Material: By using the validated questionnaire, an observational, cross sectional study was conducted on the cancer patientswho were admitted in the oncology wards of Penang Hospital, Malaysia, for a period of 1 month. Statistical Analysis: Descriptive statistics like mean, frequency and percentages were used for this study. Results and Conclusion: A total of 42 patients out of 143, who fulfilled the criteria, were interviewed. The results showed mild pain in 66.7% (28) of the patients, moderate pain in 7.1% (3) and severe painin 26.2% (11). The normal daily life activities were affected by the pain in almost all the patients. Among the interviewed patients, sleep was affected in 88% (37) of the patients and the normal physical activity was affected in 92.9% (39) of the patients. Similarly, the pain decreased the appetite in 78.6% (33) of the patients, it affected the personal relationship in 35.7% (15), it affected the emotion in 71.5% (30) and it affected the visual activity in 33.6% (13) of the patients. Mild pain with distressing symptoms was not treated with any analgesic or adjuvant medications in 40.5% (17) of the patients. In contrast, all the patients with moderate and severe pain were treated with medications. Among them, 66.7% (2) of the patients with moderate pain and 90.9% (10) of the patients with severe pain were treated with analgesics as per the WHO analgesic ladder. The WHO analgesic ladder guide for pain management was followed in a majority of the cases, when analgesics were prescribed. However, there was inadequate treatment of the cancer pain in many patients with mild pain and, consequently, their quality of life was largely affected.

The Prevalence of the Beta Thalassemia Trait among the Pregnant Women who attended the ANC Clinic in a PHC, by using the NESTROF Test in Bangalore, Karnataka

Praveen Kulkarni, N R Ramesh Masthi, SR Niveditha, R Suvarna

Contaxt: Every year in India 6000 to 8000 children are born with thalassaemia major. The birth of such a child produces considerable physical and economic strain on the affected child, its family and the community at large. Thus, the emphasis must shift from the treatment to the prevention of such births in the future. Aims: To find out the prevalence of the Beta Thalassaemia trait among the pregnant women who attended the antenatal clinics in a Primary Health Centre, by using the NESTROF test; to describe the socio-demographic characteristics of the study subjects, to find out the pregnancies which were ‘at risk’ of delivering babies with Thalassaemia major and to find out the ‘awareness’ of the pregnant women regarding Thalassaemia. Methods and Material: This exploratory study was conducted in a PHC which was attached to the Department of Community Medicine of a medical college which was situated in Bangalore, India, for a period of 3 months. All the pregnant women who attended the antenatal clinic and the husbands of the NESTROF positive women were included in the study. The details regarding the sociodemographic characteristics of the women were collected on a structured proforma and the NESTROF test was performed. Results: Out of the 210 pregnant women who were tested, 18 (8.5%) were thalassaemia carriers. 12 (66.6%) of them were between 20 – 25 years of age. 5 (27.7%) were born out of 2nd degree consanguineous marriages. 7 (38.8%) had a history of abortions, among which 6 (33.3%) were in the 1st trimesters of their pregnancies. Out of the 18 positive women, 9 (50%) had turned up with their husbands. All of the husbands were negative for the Thalassaemia carrier status. Thus, there was no pregnancy which was at a risk of delivering babies with thalassaemia major. None (100%) of the pregnant women were aware of the disease, thalassaemia. Conclusions: The prevalence of the Beta Thalassaemia trait among the pregnant women was 8.5%.

Study of Mutations in Beta- Thalassemia Trait among Blood Donors in Eastern Uttar Pradesh

L P Meena, K Kumar, V K Singh, Anju Bharti, S K H Rahman, K Tripathi

Background: Knowledge on distribution of different mutations of thalassaemia, which are prevalent in a particular area, is a prerequisite for prenatal diagnosis. Objectives: Studying mutations in ß – thalassaemia trait among blood donors in eastern Uttar Pradesh, India. Material and Methods: One thousand non – remunerated voluntary blood donors who were between 18 – 40 years of age, were included in the study. Both replacement and voluntary healthy blood donors were included. 4ml of venous blood was collected and it was stored at 4ºC. Complete Blood Count (CBC), Haemoglobinopathy Screening and Molecular Analysis by ARMS – PCR (Amplification Refractory Mutation System – PCR) were done. Screening for ß thalassaemia was done in a blood bank by using D – 10, Bio Rad, which was based on High Performance Liquid Chromatography (HPLC). Results: Twenty Eight subjects with ß – thalassaemia trait were found among 1000 voluntary blood donors. IVS 1-5 (G-C) mutation was most common type (50%), followed by FS 8/9 (+G) 25% which was the second most common type. In our study, a rare mutation of CD 16 (-C) was also found. Out of 14 subjects who had IVS 1-5 (G-C) mutation (most common), six were from Varanasi (6/261) and five of them were Sindhis. It was seen that FS 41/42 (TCTT) mutation was distributed among all groups of populations which had higher prevalences of ß-thalassaemia trait. Conclusion: A comprehensive knowledge on beta thalassaemia mutations is necessary for determining a prenatal diagnosis. The occurrence of mutations may vary according to geographic region. Therefore, this studydealt with current problem of unknown mutations, in order to avoid complications.

Foramen of Civinini: A New Anatomical Guide for Maxillofacial Surgeons

Introduction: Study on Morphometric and radiological aspect on existence of foramen of civinini. Sphenoid bone comprises of some rare ossified ligaments, may encounter difficulty in surgical procedures. Incidence of Pterygospinous bars various with different racial groups and they are genetically controlled. Complete ossification of pterygospinous ligament form foramen of civinini. Entrapments of vessels or nerves may occur due to existence of pterygospinous bar. The bar may locate medially or inferiorly to formen ovale as seen in Hawaiian and lemurs. Co – existence of bar with the wide lateral pterygoid plate exhibits development of the bar from herbivore, carnivore and old world monkeys. Comparatively absence or small spine of civinini noted in new world monkeys, rodents and platyrrhines. Pterygospinousbar represents the phylogenetic remnant of Human beings. Materials and Methods: By using digital vernier caliper, the measurements of length, width of the pterygospinous bar and area of foramen of civinini including the length and breadth of lateral pterygoid plate were measured. Using X rays the radiological view was determined. Results: In this study from 160 cases of skull and sphenoid bones revealed that complete and incomplete foramen of civinini in 1.25% and 7.5% of cases respectively. Peculiarly accessory foramen of civinini noticed in 1.25% of cases. Maximum area of foramen of civinini was 94.2mm2. The maximum width of lateral pterygoid was noted as 19.6mm respectively. Mentocoronal view of skiagram clearly shows the bar. Conclusion: During Anaesthesia for trigeminal neuralgia may encounter difficult to pass the needle. The bar compress the mandibular nerve branches can cause lingual numbness, pain and speech impairment. Conductive anaesthesia on the mandibular nerve through the lateral subzygomatic route may be difficult to approach. Exploring the anatomical and clinical updates of pterygospinous bar may guide the surgeons and radiologists to overcome any difficulties in infratemporal and para or retropharyngeal regions.

Unexpected Hospitalisations at a 23-Hour Observation Unit in a Paediatric Emergency Department of Northern India

Vidushi Mahajan, Sumant Arora, Tarundeep Kaur, Sorab Gupta, Vishal Guglani

Background: The 23-hour Observation Unit (OU) is a novel and an effective means for tackling overcrowding in busy Paediatric Emergency Departments (PED) worldwide. However, unexpected hospitalisations in the OU involve transfer of care and they reduce the efficiency of the OU. Hence, we aimed to study the presenting diagnoses which were responsible for the unexpected hospitalisations in a 23-hour OU. Methods and Design: A prospective cohort study Setting: The PED at a tertiary care teaching hospital. Duration: 15th Feb-15th March 2011. Protocol: Consecutive children were triaged at presentation to the PED, according to the WHO paediatric emergency triage algorithm. Those who were transferred to the 23-hour OU, were further followed up for duration of the stay, the hospital course, and the outcome (discharge/hospitalisation). Results: Three hundred (228 males, 72 females) consecutive children who attended the PED over one month were enrolled. All the children, at presentation, were triaged by the medical intern/s who was/were posted in the PED, and they were crosschecked by a PED consultant. A majority (55%, n=165) of the children were triaged as non-urgent, 32% (n=97) as priority and 13% (n=38) as emergent. Out of the 300 children, 173(58%) were transferred to the 23-hour OU. Of these, 16 (9.1%) required unexpected hospitalisations. The children who required hospitalisations had the following diagnoses: bronchiolitis (4), bronchopneumonia (4), seizure (2), viral hepatitis (2), high fever (1), bronchial asthma (1), severe anaemia (1), and urticaria (1). The mean duration of the stay in the OU was 19 hours for those who needed hospitalisation, as against 13 hours for those who were discharged from the OU. Conclusion: The children with respiratory complaints (bronchiolitis and bronchopneumonia) need frequent monitoring in the 23-hour OU, as they have high hospitalisation rates in the OU.

Evaluation of Glycated Albumin and Microalbuminuria as Early Risk Markers of Nephropathy in Type 2 Diabetes Mellitus

Introduction: Since Glycated Albumin (GA) reflects short term variations and glycated protein shows degrees of hyperglycaemia, the objective of this study was to find GA and microalbuminuria as a early risk markers along with the duration of Uncontrolled Diabetes Mellitus in type 2 diabetic nephropathy. Materials and Methods: The present cross-sectional study included randomly selected Uncontrolled Type 2DM (n = 75), controlled Type 2DM (n = 75) and healthy controls (n = 75). Their fasting venous blood samples were obtained for GA and serum creatinine, while their morning urine samples were obtained for detection of microalbuminuria. Statistical analysis was done by using SPSS, version 16.0. One-Way ANOVA was performed. All p-values which were = 0.05 were considered as statistically significant. Results: The mean GA, microalbuminuria and serum creatinine were the highest in Uncontrolled DM as compared to those in Controlled DM respectively. Microalbuminuria and GA had a significant correlation with the duration of diabetes (p<0.0001). Conclusion: The present study identified that the risk of microalbuminuria increased with a poor glycaemic control. A persistent increase in GA and microalbuminuria may be considered as risk markers in diabetic nephropathy. Therefore, a regular screening for microalbuminuria and estimation of GA can help in the clinical management, to prevent complications.

The Role of ‘Paraoxonase– 1 Activity’ as an Antioxidant in Coronary Artery Diseases

Background and Objectives: A majority of the Coronary Artery Diseases (CAD) result from complications of atherosclerosis. There is a growing body of evidence which has revealed that the reduced activity of the HDL-associated enzyme, paraoxonase1 (PON1), is predictive of vascular disease in humans, which include the results from prospective studies. The mechanisms by which PON1 activity influences risk of vascular disease continue to be evaluated. It is generally thought that PON1 contributes to the antioxidant, and thus, to the antiatherogenic properties of High Density Lipoproteins (HDL). Depleted antioxidant levels could be a risk factor for coronary artery disease. Hence, this study was done to evaluate PON1, as antioxidant, in CAD patients. Methods: This study was done to determine serum levels of PON1 activity in 50 controls and in 60 clinically and ECG proven CAD cases and to compare PON1 activity with total cholesterol and triglycerides. Results: Serum levels of PON1 activity (p<0.001) were significantly lower in CAD cases than in controls. Serum total cholesterol (p< 0.001) and triglyceride (p< 0.001) levels were significantly higher in CAD cases than in controls. There was a negative correlation between PON 1 activity and total cholesterol and triglycerides. The negative correlation between PON1 activity and total cholesterol was significant (p<0.05). Interpretation and Conclusion: From our present study, we can conclude that PON1 can exert a protective effect on HDL by preventing its oxidative damage. Further, a decreased PON 1 activity may be a risk factor for CAD, which is likely to be explained by derangement of PON 1 activity towards lipid peroxidation. This study suggested that serum antioxidant activity of PON1 was an important factor which provided protection from oxidative stress and lipid peroxidation in CAD. Thus, evaluating the effects of PON 1 for CAD patients may be promising in the treatment and prognosis of CAD.

Nitric Oxide Levels in Patients with Chronic Renal Disease

S. R. Meenakshi, Rajni Agarwal

Background and Objectives: Nitric Oxide (NO), the L-arginine derivative, is tonically synthesised by the endothelium within the kidney and it plays a crucial role in the regulation of the blood pressure and the renal blood flow. NO regulates the renal function through the modulation of the vascular tone and sodium handling. With the progressive development of the renal insufficiency, it remains unclear whether the endogenous NO production is increased or decreased in the kidney. This study was carried out to determine whether there were any changes in the levels of NO and teir correlation with the routine parameters of the renal dysfunction in the patients of Chronic Renal Failure (CRF), as the disease progresses in conjunction with poor renal functions. Methods: Thirty patients with chronic renal disease which was caused by chronic glomerulonephritis and hypertension, who were on Maintenance Haemodialysis (MHD) with serum creatinine levels of > 2.5 mg/dl, were included in this study. Thirty healthy voluntary blood donors were taken as the controls. NO was estimated by a spectrophotometric method by using cadmium reduction. The routine renal function tests, BUN and Creatinine were performed by the standard clinical chemistry procedures. Results: The serum NO levels were found to be significantly increased (p < 0.01) in the CRF on MHD (98.77 ± 35.40 µmol/l) as compared to the controls (22.03 ± 7.23 µmol/l). The NO output correlated with the serum creatinine (r = 0.8123, p < 0.01) and the urea concentration (r = 0.5166, p = <0.01) in the CRF group. Conclusion: The NO levels were markedly enhanced in the CRF patients who were on MHD. This was due to the dialysis procedure itself, which led to the stimulation of cytokine induced NO synthase and also due to the platelets which generated more NO due to uraemia. At high concentrations, NO is a cytotoxic molecule which is responsible for the complications of dialysis and it results in Nitrosative Stress in these patients, as it is a highly reactive free radical. Since the no output correlated with the serum creatinine and urea concentrations, a higher no production probably indicated insufficient blood purification, due to the common effect on their elimination pathways via the renal tract. Therefore, the alterations of the renal function, that are reflected in the changes of the creatinine concentration, will be accompanied by the changes in the serum NO. Thus, the determination of the NO levels in the peripheral blood may be useful in the assessment of the dialysis and they can also be used as markers in the follow up and the prognosis in these type of patients.

The Evaluation of Serum Amylase in the Patients of Type 2 Diabetes Mellitus, with a Possible Correlation with the Pancreatic Functions

Rakhee Yadav, Jai Prakash Bhartiya, Sunil Kumar Verma, Manoj Kumar Nandkeoliar

Background: Diabetes mellitus is a chronic metabolic disorder which is associated with hyperglycaemia. It is caused by a derangement in the secretion or function of the endocrinal portion of the pancreas. There is a close anatomical and functional relationship between its exocrine and endocrine portions. To address this issue, the current study was designed to evaluate the blood glucose and the amylase levels of diabetic patients as representatives of the two portions of the pancreas respectively. Aims and Objectives: The aim of the present study was to determine the blood glucose, serum amylase and the serum lipid profile in known cases of type 2 Diabetes Mellitus and to compare and correlate these parameters with those of age and sex matched healthy controls. Materials and Methods: One hundred ten patients of type 2 Diabetes mellitus, who were already diagnosed and were taking treatment, were included in this study. 30 age and sex matched healthy individuals were recruited as the control group in our study. Fasting venous blood samples were collected from the patients as well as the controls and they were analyzed by using an automated analyzer for blood glucose, serum amylase and the lipid profile (serum triglycerides, total cholesterol, high density lipoproteins and low density lipoproteins). The results were analyzed statistically by using the Student’s “t” test and correlation coefficients. Results: Significantly low serum amylase levels were found in the diabetic patients as compared to those in the healthy controls (p value <0.001). Also, the levels of fasting serum total cholesterol, triglycerides and the low density lipoproteins were significantly higher in the patients as compared to those in the controls, with p values of <0.05, <0.001 and <0.001 respectively. The HDL (high density lipoprotein) level was found to be lower in the diabetic patients (p value <0.001). Conclusions: From our study, it was concluded that in type 2 Diabetes mellitus, wherever the blood glucose level was higher, the serum amylase activity was found to be significantly lower. This reflected the derangement in the endocrine-exocrine axis of the pancreas, as a disease which affected any portion of an organ would affect the adjoining area of that organ functionally. This fact must be kept in mind while the patients are treated.

Correlation of the Serum Insulin and the Serum Uric Acid Levels with the Glycated Haemoglobin Levels in the Patients of Type 2 Diabetes Mellitus

Anju Gill, Sahiba Kukreja, Naresh Malhotra, Namrata Chhabra

Background: Type 2 Diabetes mellitus (DM) is a heterogeneous disease which is characterized by variable degrees of insulin resistance and impaired insulin secretion. Insulin is a hormone that regulates the body’s use of glucose. The present study was undertaken to find the correlation of the serum uric acid levels in the patients of Type 2 Diabetes mellitus. Material and Method: This was a case control study. The subjects who were included in the study were divided into two groups. Group A included 50 normal healthy individuals who were in the age group of 40-65 years, who were of either sex and with no family history of Diabetes mellitus. Group B included 50 newly diagnosed patients of Type 2 Diabetes Mellitus, who were in the age group of 40-65 years, who were of either sex, from the same population. Fasting blood samples were drawn and they were investigated for the serum insulin, serum uric acid, fasting blood sugar and the HbA1C levels. The values were compared with those of normal healthy subjects. Results: All the three parameters, HbA1C, serum insulin and serum uric acid were found to be increased in the patients of Type 2 Diabetes Mellitus as compared to their levels in the controls (p<0.001). Conclusion: In the present study, it was concluded that the serum uric acid levels linearly increased with increasing serum insulin levels, in newly diagnosed diabetic patients. Therefore, uric acid serves as a potential biomarker of the glucose metabolism.

A Study on Interleukin —1Beta and Lipid Profile as Markers of Cardiovascular Risk in Rheumatoid Arthritis

Varun kumar D, B.V. Maruthi Prasad, H. L. Vishwanth, Vasantha Kamath

Introduction: The dyslipidaemia in Rheumatoid Arthritis (RA) is associated with accelerated atherosclerosis. A prospective clinical evaluation study was undertaken to find out the proportion of the rheumatoid arthritis patients who were suffering from dyslipidaemia, the change in the lipid levels and the disease activity after an intervention with antirheumatic therapy. Aims and Objectives: To study the disease activity in Rheumatoid arthritis patients by measuring the serum levels of interleukin-1ß (IL-1 ß), to find out the proportion of rheumatoid arthritis patients who were suffering from dyslipidaemia, to correlate the disease activity with the lipid profile and to look for the change in the lipid levels and the disease activity after an intervention with antirheumatic therapy. Materials and Methods: This study was done on 30 RA patients (fulfilling the American College of Rheumatology criteria). The lipid profile estimation was done by an enzymatic, colourimetric method and IL-1ß was estimated by a chemiluminescence method. Dyslipidaemia was defined by taking the cut-off values of the NCEP-ATPIII guidelines. The patients with other comorbid illnesses and those who were on statins were excluded. The patients were followed up after 12 weeks of starting with the anti-rheumatic therapy. Results: 36.7% of the patients had high total cholesterols, 53.3% of the patients had high triacylglycerol levels, 73.3% of the patients had decreased HDL-cholesterol and 33.3% of the patients had high LDL-cholesterols. 86.7% of the patients had IL-1ß levels which were above the reference range. After the treatment, the number of patients with dyslipidaemia came down, with 23.3% patients having high total cholesterol levels, 43.3% of the patients having elevated triacylglycerol levels, 46.7% patients having low HDL-cholesterol levels and 20% patients having elevated LDL-cholesterol levels. 66.7% of the patients had IL-1ß which was above the reference range. Conclusion: The proportion of dyslipidaemic patients had decreased in the follow up visit, along with a decrease in the disease activity, as were indicated by the decreased levels of IL-1ß. The management of dyslipidaemia in RA should be a part of the general cardiovascular risk management. Therefore, a good control of the disease activity should be given priority, so that both the quality of life and the long-term outcomes can be improved.

A Study of Serum Apolipoprotein A1, Apolipoprotein B and Lipid Profile in Stroke

Shilpasree AS, Savitri Sahukar, Jayaprakash Murthy, Kiran Kumar

Background: Role of Serum Lipids, Lipoproteins and Lipoprotein related variables in the prediction of Stroke is less clear. Abnormalities in plasma Lipoproteins are the most firmly established and best understood risk factors for Atherosclerosis and they are probable risk factors for Ischaemic stroke, largely by their link to Atherosclerosis. Apo B reflects the concentration of potentially atherogenic particles (LDL), and Apo A1 reflects the corresponding concentration of anti-atherogenic particles (HDL), represent additional lipoprotein related variables that may indicate the vascular risk. Aim: To study serum concentration of Apolipoprotein A1, Apolipoprotein B, Apo B/Apo A1 ratio and Lipid profile in Stroke Cases and to compare with healthy controls. Design: A total number of 100 subjects within 30 – 70 years were considered for the study. 50 subjects with Stroke (both clinically as well as Computed tomographically proven cases) and 50 age and sex matched healthy individuals were taken for the study. Materials and Methods: Total cholesterol, HDL cholesterol and Triglycerides are estimated by Enzymatic method using Semiautoanalyser. LDL cholesterol is estimated by Friedewald formula. Apo B and Apo A1 are estimated by Immunoturbidimetric method using Semiautoanalyser. Statistical Analysis: Student ‘t’ test was used to compare the data between cases and controls. Diagnostic validity tests were conducted to assess the Diagnostic efficiency of Apo A1, Apo B and Apo B/Apo A1 ratio. Results: Total cholesterol, LDL cholesterol and Triglycerides are significantly increased in Cases compared to Controls. HDL – cholesterol is significantly decreased in Cases compared to Controls. Apo B and Apo B/Apo A1 ratio are significantly increased and Apo A1 is significantly decreased in Cases compared to Controls. Diagnostic validity tests showed that, Apo B , Apo A1 and Apo B /Apo A1 ratio have highest Sensitivity, Specificity and Diagnostic efficiency. Conclusion: Apo B, Apo A1 and Apo B / Apo A1 ratio can be used as predictors of stroke along with traditional lipid profile components.

The Evaluation of Micronutrients and Oxidative Stress and their Relationship with the Lipid Profile in Healthy adults

Narasimha Rai K, N Suchetha Kumari, Damodara Gowda KM, Swathi KR

Introduction: Micronutrients are nutrients which are required by humans and other living beings throughout life in small quantities, to orchestrate a whole range of physiological functions, which the organism itself cannot produce. Therefore, the present study was undertaken to evaluate the status of the micronutrients, oxidative stress, and the lipid profile in healthy adults. Materials and Methods: The present study was conducted after getting the institutional ethical clearance and informed written consents from all the participants. The estimation of copper and zinc was done by the atomic absorption spectrophotometer method,the total antioxidant status was assessed by the phosphomolybdenum method, MDA was evaluated by the Malondialdehyde method, total cholesterol was evaluated by the CHOD-POD method, HDL-cholesterol was evaluated by the precipitation end point method, and total triglycerides were evaluated by the GPO-POD method. The data was analysed by one way ANOVA, followed by Pearson’s correlation. Result: We observed significantly increased (p <0.0001) copper and zinc levels in males and females as the age advanced, significantly increased (p <0.01) MDA and TAS levels, significantly declined (p <0.04) total triglyceride levels in adults, significantly declined (p <0.05) HDL levels and significantly declined (p = 0.04) VLDL levels in adults as the age advanced, in both the sexes. Conclusion: The increase in the levels of the micronutrients may have a direct correlation with the oxidative status as the age advances.

A Prospective Study on the Antimicrobial Usage in the Medicine Department of a Tertiary Care Teaching Hospital

Farhan Ahmad Khan, Vinod Kumar Singh, Sanjeev Sharma, Preeti Singh

Introduction: As we know, some of the species of animals are endangered, as there is an increase in their declining rate and a decrease in their survival rate. The same is true for the antibiotics also, as there is a rise in the antimicrobial resistance and a decline in the development of new antibiotics. Antimicrobial Resistance (AMR) has become a major obstacle in the way of the treatment of infectious diseases worldwide. Therefore, to fight against AMR, antibiotic utilisation studies are being carried out. Therefore, with the same perspective, this prospective study was done to evaluate the current usage of the anti-microbial agents in medicine department of a teaching hospital in northern India. Methods: This was a prospective study which was done for a period of three months from Nov 2012 – Jan 2013. The prescriptions and the patient records are reviewed and analysed. The rationality of the drug usage was also evaluated by analysing the drug prescriptions. Results: Out of the 494 drugs which were prescribed to 180 patients, 291 were antibiotics. The most commonly used AMAs were the ß-lactams (penicillins and cephalosporins) –n = 102, followed by the quinolones –n = 93, Nitroimidazoles –n = 43, aminoglycosides –n = 35 and the macrolides –n = 18. The most common indication for the antimicrobial therapy was infection. According to the evaluation, the use of the antimicrobial therapy was found to be rational in 77.77 per cent patients. The average number of antibacterial agents which were prescribed per patient per course was found to be 1.61 and the average numbers of drugs which were prescribed per patient were 2.74.The average cost per prescription per day was Rs.115 and the average antibiotic cost per encounter was Rs. 85. Conclusion: Antibiotic resistance is increasing at an alarming rate due to the irrational prescribing habits of physicians, leading to increasing morbidity, mortality and treatment costs. Therefore, the medical professionals as well as government personnel who are related to the health sector, need to understand that antibiotics are precious and finite resources. The remedy of this situation requires that regular educational awareness programmes should be conducted in hospitals at a regular basis.

The Concomitant Consumption of Cod Liver Oil Causes a Reduction in the Daily Diclofenac Sodium Usage in Rheumatoid Arthritis Patients: A Pilot Study

Vinay Kumar Gupta, Z. Y. Khan Zafer, Mushtaq Ahmad

Objective: To evaluate whether the concomitant consumption of Cod liver oil can reduce the daily dose of Diclofenac Sodium and probably the risk of the side effects which are associated with it in Rheumatoid Arthritis patients. Material and Methods: This longitudinal, prospective, open label study was conducted from April to September 2012 at Mahatma Gandhi Medical College and Hospital, Jaipur, India. 30 Rheumatoid Arthritis patients who were aged between 19 to 60 years, who fulfilled the inclusion criteria, were enrolled. Each patient was given five Cod liver oil capsules twice a day, for a period of 24 weeks. Each capsule which contained 300 mg of Cod liver oil had Eicosapentaenoic acid-20 mg and Docosahexaenoic acid-30 mg. The patients who took different Nonsteroidal anti-inflammatory drugs daily were switched over to Diclofenac Sodium 50 mg as a single dose, up to a maximum dose of 200 mg per day. The dose of Diclofenac Sodium which was consumed per day and the average daily requirement at different visits were recorded in each patient and they were compared. The patients were assessed for their pain scores by using the Visual Analogue Scale (VAS) at different weeks. In addition, the ‘Subjective Response’ to the pain was evaluated in each patient at the respective visits. The Student’s “t”-test was applied for the analysis of the VAS pain score and for the evaluation of the reduction in the mean daily dose of the Diclofenac Sodium consumption. A probability value of less than 0.05 (p< 0.05) was considered to be statistically significant. Moreover, the results of the ‘Subjective Response’ to the pain were expressed as percentage. Results: A significant decrease (p< 0.05) in the mean VAS pain score from 80.38 ± 6.4 at week 0 to 67.30 ± 5.3 at week 24 was noted in the patients. There was a significant reduction (p<0.05) in mean dose of Diclofenac Sodium consumed from 115.04 ± 24.56 at week 4 to 98.83 ± 22.32 at week 24. Moreover, the percentage of the patients who experienced a ‘Better’ Subjective Response increased from 15.38% at week 4 to 61.53% at week 24 of the treatment follow up. Conclusion: This study revealed that the concurrent use of Cod liver oil which contained n-3 Essential Fatty Acid in Rheumatoid Arthritis patients reduced the mean daily dose of Diclofenac Sodium consumed and probably the incidence of the side effects which were associated with it.

Effect of Telmisartan on the Regression of the Left Ventricular Hypertrophy in the Patients of Essential Hypertension

Kumar Haraprasad Misra, Mangala Charana Das, Y Roja Ramani

Introduction: An increase in the Left Ventricular Mass as a result of muscle hypertrophy, has emerged as a powerful pressure independent risk factor for the cardiovascular mortality and morbidity. It is associated with a risk of death that is 3 times greater than the risk which is associated with hypertension alone. For the development of Left Ventricular Hypertrophy (LVH), in addition to a chronic increase in the pressure and/or volume overload, an elevation in the plasma ACE activity, plasma aldosterone levels, and the angiotensin-II concentrations play a major role .In this study, the effect of Telmisartan, a selective angiotension-II receptor blocker, was compared with that of Atenolol, a selective ß1 adrenergic receptor blocker, on the regression of LVH in the patients of essential hypertension. Materials and Method: Essential hypertensive patients with LVH were selected for this study, as per the inclusion and exclusion criteria. This study was carried out on two groups of hypertensive patients with LVH: Group-1 : The patients who were taking telmisartan 80 mg OD. Group-2 : The patients who were taking atenolol 50 mg OD. The blood pressure was measured and echocardiography was done in both the groups, prior to the treatment and 6 months after the treatment in the Department of Cardiology, MKCG Medical College Hospital, Brahmapur, India. The data were analysed by using the Student’s ‘t’ test. Results: In the cases of Left Ventricular Mass Index (LVMI), which is a better indicator of LVH, in the Atenolol group, the mean value changed from 143.93 ± 2.44 gm/m2 to 130.16 ± 2.88 gm/m2 (t=5.83,p<0.01 versus baseline).In the Telmisartan group, the mean value changed from 184.67 ± 7.14 gm/m2 to 133.41 ± 4.24 gm/m2 (t=12.12, p<0.001 versus baseline). On comparing Telmisartan with Atenolol, Telmisartan was found to produce a greater (27.49%) reduction than Atenolol (9.68%). In the Telmisartan group, 13 patients out of 26 patients achieved a target value of LVMI that was <134 gm/m2 in males and <110 gm/m2 in females (50%). In the Atenolol group, only 9 patients out of 22 patients achieved a target value (40.90%). Conclusion: Thus, Telmisartan a selective AT1 antagonist, possesses pharmacological effects beyond a blood pressure reduction in which the blockade of the AT1 receptor may lead to attenuation of the growth promoting action of Ang II. From this study, it is clear that Telmisartan is superior to Atenolol in achieving a regression of LVH, which is a better indicator of the cardiovascular morbidity and mortality.

Immunohistochemical Profile and Morphology in Triple – Negative Breast Cancers

Chandrika Rao, Jayaprakash Shetty, Kishan Prasad HL

Background and Purpose: Triple Negative Breast Cancer (TNBC) is defined by a lack of expression of the steroid hormone receptors (oestrogen and progesterone), and the human epidermal growth factor receptor-2 (HER-2). It is characterized by distinct molecular, histological and clinical features. It is a high risk breast cancer that lacks the benefit of a specific therapy. Our study was aimed at pathologically illustrating triple-negative breast carcinoma and at evaluating the expression of the Epidermal Growth Factor Receptor (EGFR) ,cytokeratin 5/6 (CK 5/6) and Ki-67 among triple-negative breast cancer cases. Further, we aimed to probe whether triple–negative phenotype could be a surrogate marker for the basal phenotype and to correlate the expression of the basal markers (CK 5/6 and EGFR) with the clinico-pathological prognostic parameters. Methods: The expression of EGFR, CK 5/6 and Ki-67 were studied by immunohistochemistry (IHC) in 50 triple-negative breast cancer cases. Statistical Analysis: A statistical analysis was implemented by using the SPSS version 20.0. The Chi-square test was conducted to assess the relationship between the immunohistochemical markers and other variables. The Fischer exact test was used when the expected cell counts were less than 5. Results: The women with triple-negative breast cancer were younger, with the adverse pathological characteristics of a high tumour grade, tumour necrosis, frequent nodal metastases and high proliferation. 37 (74%) of the 50 triple-negative breast carcinomas showed the expression of the basal markers (EGFR and /or CK 5/6). We observed a statistically significant association between the basal marker expression and the presence of tumour necrosis. Conclusion: The triple-negative breast cancers in our population harbour adverse pathobiological features and a five marker immunohistochemical panel can be reliably used to define the basal-like cancers. The “Triple-negative” status cannot be used as a surrogate for the “basal marker expression”.

Chronic Lymphoproliferative Disorders at an Indian Tertiary Cancer Centre — The Panel Sufficiency in the Diagnosis of Chronic Lymphocytic Leukaemia

Background: Flow cytometry has come to occupy the vanguard of the high through put diagnostic techniques that have been used to differentiate between various chronic lymphoproliferative disorders (CLPD). However, economic considerations have created the need for minimal consensus panels that can yield maximum information at reasonable costs. Aims: To collect, analyse and correlate the morphologic, immunophenotypic, and the cytogenetic data from the cases of chronic lymphoproliferative disorders, which were diagnosed at an Indian speciality cancer centre. Methods and Material: The morphology was recorded after staining the samples with the Leishman or the MGG stains. The lineage assignment was done by using three colour flow cytometry with a primary panel of antibodies. For the cytogenetic studies, the short term culture of the sample cells were arrested by using colcemid and they were G-banded by using trypsin and Giemsa stain. FISH studies were conducted by using a CLL-specific diagnostic kit. Results and Conclusions: A total of 66 cases were evaluated, which had a median age of 64.5 years and a sex ratio of 2.3:1. Of these 66 cases, 40 cases were of CLL and 9 cases were of atypical CLL. 17 cases were classified as CLPD and these included 13 cases of Non-Hodgkin’s Lymphoma, two cases of Hairy Cell Leukaemia, one case of Follicular Lymphoma and one case of Prolymphocytic Leukaemia. In immunophenotyping, the lack of expression of CD22 had the highest correlation with a definitive diagnosis of CLL. Cytogenetics demonstrated a classical follicular lymphoma abnormality, t (14; 18) (q32; q21), in one case. A basic minimal panel is sufficient for the routine diagnosis of CLL. However, the stratification of CLPD requires the use of more extensive panels.

The Spectrum of Histopathological Lesions in Scarring Alopecia: A Prospective Study

Mahesh Kumar U., Balasaheb Ramling Yelikar

Introduction: The aim of the article was to study the histopathological features of various lesions of Scarring Alopecia (SA) and to classify Primary SA on the basis of the predominant type of inflammatory cell component. Scarring or cicatricial alopecias are those that are produced as a result of the malformation, damage or destruction of the pilosebaceous follicles, which are replaced by cicatricial tissue, in such a way that they cannot again produce hair. Materials and Methods: This prospective study included 32 biopsy – proven cases of SA, who had attended our hospital. Primary SA was classified according to the North American Hair Research Society. The informed consents of the subjects and the institutional ethical clearance was obtained for the study. The SPSS, version 14 software was used to analyse the data. Frequencies and percentages were used to describe the data. Results: During the study period, 32 cases of scarring alopecia were diagnosed, of which 24 were primary SA and 8 were secondary SA. Among the primary SA, there were 23 cases of lymphocyte associated primary scarring alopecias, of which, 19 of lupus erythematosus, 3 of lichen planopilaris (LPP) and one case of non specific SA. 1 case of neutrophil associated primary scarring (folliculitis decalvans) was also noted and among the secondary SA, there were 4 cases of morphea and 1 case each of lupus vulgaris, congenital absence of skin, burn and sarcoidosis. Conclusion: To conclude, histopathology is a dependable tool for identifying the underlying cause in scarring alopecia, which is helpful for an early diagnosis and treatment.

The Role of Immunohistochemistry in the Analysis of the Spectrum of Small Round Cell Tumours at a Tertiary Care Centre

Context: The term, “Small Round – Cell Tumours” (SRCT) describes a group of highly aggressive malignant neoplasms which are composed predominantly of small and monotonous undifferentiated cells with high nucleocytoplasmic ratios. Immunohistochemistry (IHC) plays a crucial role in catagorizing the small round – cell tumours. Aims: This study was done to analyse the spectrum of small round cell tumours over a period of five years at a tertiary care centre and to study the relevance of immunohistochemistry in making precise diagnoses of the small round cell tumours. Materials and Method: Formalin – fixed, paraffin – embedded sections of tumours which were diagnosed as small round cell tumours on small biopsies and resected specimens were retrieved from the files of the Department of Pathology of Sri Ramachandra Medical College and Research institute, in the period from January 2005 to December 2009. This study was confined to the bone and the soft tissues. Decalcification was performed on the bony tissues before the routine processing was done. The patients belonging to all age groups were included in this study. The small round cell tumours of the bone marrow, the spleen and the lymph node was excluded from our study. Immunohistochemical stains were performed to differentiate and categorise the small round blue cell tumours. The immunomarkers which were utilised in this study included CD45/LCA (the lymphocyte common antigen), CD20, CD3, CD99 (cluster of differentiation 99 also known as MIC2), desmin, EMA (epithelial membrane antigen), CK(cytokeratin), synaptophysin, chromogranin and GFAP (Glial fibrillary acidic protein). Results: Forty three cases of small round cell tumours were analysed, which included 19 cases of NHL (non Hodgkin’s lymphoma), 6 cases of Ewing/PNETs (primitive neuroectodermal tumours), 3 cases of atypical carcinoid, 3 cases of olfactory neuroblastoma, 2 cases each of rhabdomyosarcoma, Wilms tumour, neuroblastoma and synovial sarcoma and 1 case each of small cell osteosarcoma, small (oat) cell carcinoma, medulloblastoma and hepatoblastoma. By using a panel of monoclonal antibodies, we could arrive at a final diagnosis for all the 40 cases in which immunohistochemistry was performed. Conclusions: Our study showed that the use of immunohistochemistry was extremely beneficial. A majority of the small round cell tumours occurred between the ages of 15-45 years and the most common small round cell tumour was Non-Hodgkins lymphoma (extra lymphoreticular).

The Effect of Smoking on the Cardiovascular Autonomic Functions: A Cross Sectional Study

Motilal C Tayade, Nandkumar B Kulkarni

Introduction: Smoking is a worldwide major cause of preventable morbidity and mortality. Smoking affects the cardiovascular system by several mechanisms. The present study was planned to study the effect of smoking on the cardiovascular autonomic functions among smokers. Materials and Methods: Hundred male subjects who were in the age group of 25 to 40 years, who included 50 smokers and 50 non – smokers who formed the control group were selected for the present study. The participant subjects were selected from among the staff members, residents and the patients from the routine OPD. Prior informed written consents were obtained from them after explaining to them, the procedure and the purpose of the study tests. The Cardiovascular Autonomic Function Tests were assessed by using a CANWIN AUTONOMIC ANALYSER which was available in the department. Results and Conclusions: After applying the ‘Z’-test for the difference between the two sample means, it was observed that there was a highly significant difference between the mean values of the para-sympathetic function tests among the smokers and the non – smokers (i.e. p<0.01) The Resting Heart Rate had significantly increased and the Expiration: Inspiration Ratio, the 30:15 Ratio (Response to standing) and the Valsalva Ratio had significantly decreased in the smokers as compared to those in the non – smokers. After applying the ‘Z’-test for the difference between the two sample means, it was observed that there was no significant difference between the mean values of the Postural hypotension test (i.e. p>0.05) and that there was a highly significant difference between the mean values of the Sustained handgrip test in the smokers and the non – smokers (i.e. p<0.01).

Association of Occupational & Prediabetes Statuses with Obesity in middle aged Women

Background: The association between Type 2 Diabetes Mellitus and Obesity is very close. The prediabetes status i.e Impaired Fasting Glucose (IFG) reflects an intermediate condition between normality and diabetes. The socioeconomic position (SEP) is one of the non traditional determinants of type 2 DM. The occupational status, which is a good indicator of the socioeconomic status, also indicates the level and the type of stress that they are exposed to, as well as the individual lifestyle choices. The present work was planned to study the relationship of the prediabetic status with obesity and the occupational status by estimating the Fasting Blood Glucose (FBG) levels. Objectives: To study the association of the occupational status with the fasting blood glucose levels and obesity in middle aged women. Method: The Fasting Blood Glucose levels and the BMI were estimated in 300 asymptomatic middle aged women who had no family history of Type 2 Diabetes Mellitus (D.M.), who had been divided into the Control (I), the Pre – obese (IIa) and the Obese groups (IIb). The occupational status was broadly divided into the categories of housewives and service women. The results was analysed statistically by using the correlation coefficient and the ‘z’ test. Result: The mean FBG levels in the pre – obese and the obese groups were higher than those in the control group. We found significant differences in the FBG levels in the normal weight, the pre – obese as well as in the obese groups among the service women, but no significant correlation was found in the pre – obese and the obese groups. Among the housewives, we found significant differences in the FBG levels of the normal weight and the obese groups, but not in the pre – obese group. Also, no significant correlation was found in the pre – obese and obese groups among the service women. Conclusion: The BMI may be good risk predictor for Type 2 D.M. irrespective of the occupational status, especially in middle aged women.

Effect of Hb% on Cognitive Skills in UG Medical Students

Ilham Jaleel, P Saikumar, PR Devak

Introduction: The cognitive functions in adults can be altered by a number of diseases, nutritional deficiencies, hormonal changes, ageing and drugs. Anaemia, through various possible mechanisms, has been suggested to result in a cognitive deterioration. Aim and Objective: To study the effect of Hb% on cognitive skills of 100 UG medical students of Sree Balaji Medical College and Hospital, Chromepet, Chennai, India. Methodology: One hundred UG medical students who were in the age group of 17 to 19 years were selected and their Hb% estimations were done by using Drabkin’s method. Their cognitive skills were assessed by using the Mini Mental State Examination (MMSE). Correlation between Hb% and their cognitive skills was done. Results: This study showed that there was a significant correlation between the Hb concentration and the cognitive skills in the students.

Frequency of Foetal Anomalies in a Tertiary Care Centre

Rameswarapu Suman Babu, Sujatha Pasula

Objective: The present study was undertaken to explore the incidence of congenital foetal anomalies and the advantages of ultrasonography in detecting the foetal anomalies during the antenatal period. Method: We focused our study on 1000 consecutive pregnancies that came for check up in the second and third trimesters, with major or minor clinically relevant malformations which were detectable by ultrasonography. Results: The analysis revealed that they were 38 foetal anomalies in 37 foetuses. One had multiple anomalies, with the highest incidence of neural tube defects. There was also significant correlation with consanguinity. Conclusion: The overall incidence of congenital foetal anomalies in the present study was 3.8%.This might be probably due to environmental pollution, radiation, exposure to different chemicals and teratogenic drugs.

Improved Diagnosis of Pulmonary Tuberculosis using Bleach Microscopy Method

Preeti B Mindolli, Manjunath P Salmani, Prashant K Parandekar

Background: The bacteriological diagnosis of tuberculosis (TB) is largely dependent on the Ziehl-Neelsen (ZN) microscopy. This method has a low sensitivity, which can be improved by the concentration of the specimen with sodium hypochlorite (NaoCl), followed by centrifugation before doing acid fast staining (AFB). Aim: To study the improvement in the sensitivity of the sputum smear by the bleach method. Setting and Study Design: This study was conducted in BLDEU’s Shri B.M. Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India. Eighty five patients who visited Shri B.M. Patil Medical College, Hospital and Research Centre between January 2012 to December 2012 were investigated. On spot, morning and second on spot samples were collected from each patient. Direct smears were prepared and they were stained with the hot ZN technique and the remaining samples were concentrated by using 5% NaoCl, followed by centrifugation and staining with ZN stain. The improvement in the sensitivity following the bleach method was studied. Statistical Analysis: The Fisher’s exact test was used. Results: A total of two hundred and fifty five specimens from eighty five patients were included in this study; each patient produced three specimens. AFB was detected in twenty five direct smears and in eighty four bleach smears. A statistically significant (p < 0.001) increase in the positivity with the use of the bleach method was detected as compared to that with the use of the direct method. The ZN sensitivity, specificity, positive predictive value (PPV), and the negative predictive value (NPV) were 29%, 99%, 96% and 74% respectively with a 95% confidence interval, with the use of the 5% NaoCl method. Conclusion: The bleach method has advantages over the direct ZN method, as it is simple and as it does not require any additional expertise beyond that which is required for the conventional direct smear microscopy. The materials and the reagents are also affordable and they are available locally.

Wilson’s Disease with Neurological Presentation, without Hepatic Involvement in Two Siblings

Mani Kant Kumar, Vijay Kumar, Praphul Kumar Singh

Wilson’s Disease (WD) is a rare, autosomal, recessive, inborn error of the copper metabolism, which is caused by a mutation in the copper-transporting gene, ATP7B. The presentation is usually neurologic or hepatic, which is seen in 40% of the patients. The diagnosis depends primarily on the clinical features, the biochemical parameters and the presence of the Kayser – Fleischer ring. Here, we are reporting two siblings who were affected by Wilson’s disease, with only neurological manifestations, without any hepatic involvement.

Bilateral Ptosis Due to a Rare Cause-Pachydermoperiostosis

Mahesh M, K V K S N Murthy

Pachydermoperiostosis is a rare hereditary disorder that is characterised by pachydermia (thickening of the facial skin and/or scalp), and periostosis (swelling of the periarticular tissue and a subperiosteal new bone formation). Other associated features are arthralgia, polyarthritis, clubbing, seborrhoea, hyperhidrosis, hypertrophic gastropathy, peptic ulcer and gyanecomastia. Eyelid ptosis which is caused by thickened eyelids (blepharoptosis) is a less common association. We are hereby reporting a patient with a complete form of Pachydermoperiostosis, wherein the presenting feature was bilateral ptosis.

Levator Glandulae Thyroideae, a Fibromusculoglandular Band with Absence of Pyramidal Lobe and Its Innervation: A Case Report

Priti Chaudhary, Zora Singh, Meenakshi khullar, Kamal Arora

Amongst the endocrine glands, thyroid gland is well known for its developmental anomalies, which range from common to rare ones. The presence of levator glandulae thyroideae and its anatomical variations gain importance in the pathologies which are related to thyroid gland and their treatment modalities. Levator glandulae thyroideae is a fibromuscular band. If it is present, it is usually seen on the left side, to connect the pyramidal lobe of thyroid gland and the hyoid bone. But levator glandulae thyroideae which stretches from isthmus to the body of hyoid bone is rare and only very few cases have been reported in the medical literature. During a routine dissection of the thyroid gland in a 55 years old male cadaver, a Levator Glandulae Thyroideae (which was fibromusculoglandular in nature) was seen, with the absence of pyramidal lobe on the left side. It directly came from upper border of isthmus and went upto hyoid bone. It also had innervation from branches of external laryngeal nerve. This was also associated with absence of superior thyroid artery on the same side. The knowledge on various developmental anomalies of the gland and variations in neurovascular relations will help the surgeons in plan thyroid surgeries in a better and safe way.

The Sertoli Cell Only Syndrome and Glaucoma in a Sex – Determining Region Y (SRY) Positive XX Infertile Male

Manish Jain, VeeraMohan v, Isha Chaudhary, Ashutosh Halder

The XX male syndrome is a rare genetic disorder. The phenotype is variable; it ranges from a severe impairment of the external genitalia to a normal male phenotype with infertility. It generally results from an unequal crossing over between the short arms of the sex chromosomes (X and Y). We are reporting a case of a 38-year-old man who presented with infertility and the features of hypogonadism and glaucoma. The examinations revealed normal external male genitalia, soft small testes, gynaecomastia and glaucoma. The semen analysis showed azoospermia. The serum gonadotropins were high, with low Anti Mullerian Hormone (AMH) and Inhibin B levels. The chromosomal analysis demonstrated a 46, XX karyotype. Fluorescent In-Situ Hybridization (FISH) and Polymerase Chain Reaction (PCR) revealed the presence of a Sex-determining Region Y (SRY). Testicular Fine Needle Aspiration Cytology (FNAC) revealed the Sertoli Cell Only Syndrome (SCOS). The presence of only Sertoli Cells in the testes, with glaucoma in the XX male syndrome, to our knowledge, has not been reported in the literature.

A Case of Cerebrospinal Fluid Rhinorrhoea: A Surgical Challenge

Sumitha R, P M Hari, S Ramya Kumar, R Hariprasad

CEREBROSPINAL FLUID rhinorrhoea is defined as the leakage of CEREBROSPINAL FLUID through the nose due to communication between nasal cavity and Sub-arachnoid space. It occurs due to breach in 4 layers – mucosa of the nose and PNS, skull base, Duramater, Subarachnoid membrane. With the advent of nasal endoscope and advancement in technology, Endoscopic Endonasal closure of CEREBROSPINAL FLUID leak has reached tremendous heights due to exact localization and precise placement of graft. In this article, we are publishing a case report of Non-traumatic normal pressure CEREBROSPINAL FLUID leak of more than 1.5cm in size which was successfully closed Endoscopically by multilayered technique.

Bilateral Aberrant Renal Arteries with Abnormal Left Renal Vein: A Case Report

N B S Parimala

Renal arteries are a pair of lateral branches which arise from abdominal aorta, just below the origin of the superior mesenteric artery (sma), at L2 level. The right one is longer, on account of position of aorta and left is a little higher in its origin. Variations in renal arteries are highly common and such variations may differ in number, mode of origin, branching, course and termination. Extra renal arteries (ERA) are broadly divided into two types- The aberrant (polar) ones are those which supply the kidney (poles) without passing through hilum, whereas the accessory (hilar) ones are those which supply the kidney after passing through hilum. The renal veins are of large size, which are located anterior to arteries and they open into inferior vena cava at right angles. The left is thrice in length than right one and it passes in front of abdominal aorta to join inferior vena cava (IVC). In view of constantly increasing renal transplantations and kidney retrieval surgeries, the variations in renal vasculature are valuable. Anomalies of renal veins are rarely encountered. Abnormal renal vessels are of interest to the medical and surgical personnel, because of the wide spectrum of diseases which are associated with kidney, like hydronephrosis, left renal vein hypertension, retro peritoneal tumours and surgeries, particularly renal transplantations.

The Incidence of Nocardiosis at Pulmonary and Extra – Pulmonary Sites

Ayan Kumar Das, Shyamasree Nandy, Mridu Dudeja, Rachna Tiwari, Saba Alam

Nocardiosis is a rare but well-established opportunistic infection. We are presenting two cases of Nocardiosis diagnosed in the microbiology laboratory, one in an immuno-competent elderly patient and the other in a immunocompromised patient with AIDS. The first case was of pulmonary Nocardiosis which was caused by the Nocardia asteroides complex and concomitant infections with Staphylococcus aureus and Blastoschizomyces capitatus. In the second case, Nocardia brasiliensis was isolated from the pus which was extracted from an HIV positive patient, with lymphoadenopathy in the neck, at the upper right clavicular region. Interestingly, in both the cases, the primary identification Was done using 20% H2SO4 as decolourizer for ZN staining method.

A Multivessel Umbilical Cord with a Single Umbilical Artery

Subrat Panda, Vandana Jha, Yookarin Khonglah, Biswajit Dey

Umbilical cord abnormalities are known to be associated with congenital anomalies, chromosomal abnormalities and potential complications during pregnancy. We are reporting a case of a multivessel umbilical cord which comprised two umbilical veins alongwith a single umbilical artery

A Ruputured Left Cornual Pregnancy: A Case Report

Surekha S M, Chamaraja T, Nabakishore Singh N, Bimolchandra Singh N, Neeraja T S

A cornual gestation is one of the most hazardous types of ectopic gestations, which accounts for 2 – 4% of all the ectopic pregnancies and it has a mortality rate which is 6 – 7 times higher than that of the ectopics in general. The diagnosis and the treatment of such a pregnancy is challenging and it constitutes an urgent medical situation. Because of the myometrial stretch ability, they tend to present relatively late, at 7 – 12 weeks of gestation. A significant maternal haemorrhage which can lead to hypovolaemia and shock, can rapidly result from a cornual rupture. We are reporting a case of 28 year old woman who presented to the emergency obstetrical room in a state of hypovolaemic shock. The diagnosis of a ruptured ectopic pregnancy was confirmed in view of the history of 10 weeks of amenorrhoea, with a positive urine pregnancy test. She was shifted for emergency exploratory laparotomy. Intraoperatively, we encountered a left lateral wall ruptured uterus with a 10 week old foetus in the peritoneal cavity, which suggested a left cornual ectopic pregnancy which had ended up as a catastrophic event. A cornual resection and repair was done successfully.

Inflammatory Pseudotumour of the Spleen: A Diagnostic Dilemma

Kalaivani V., VijayaKumar H. M., Girish K. S., Nishchit Hegde

Inflammatory Pseudotumour (IPT) of the spleen is an extremely rare benign lesion of the spleen. It presents as a well-circumscribed mass which is usually solitary and composed of foci of inflammatory cells, mainly plasma cells and lymphocytes in a fibroblastic stroma. We report the case of a 24 year old male who complained of pain in the abdomen, with one episode of vomiting. An ultrasound scan of the abdomen and a contrast enhanced abdominal CT scan showed the presence of a cystic lesion in the spleen. Following a splenectomy, however, it was histologically found to be an IPT of the spleen.

Colletotrichum keratitis: A Rare but Definite Clinical Entity

Shanmuga Vadivoo Natarajan, N. Sasi Rekha, Rewa D. Sharda, Niranjana Mahalingam

Colletotrichum spp. is an emerging pathogen which causes a variety of human infections. Only a few cases of Colletotrichum keratitis have been reported from India. We are reporting three cases of keratitis which were caused by three different species of Colletotrichum. Two of the three patients had a history of trauma and of a previous treatment with topical antibiotics. A direct microscopic examination of the corneas of all the three patients revealed fungal elements and Colletotrichum spp. grew in the culture. Two patients responded to topical anti - fungal therapy and the ulcer regressed, while the third patient failed to respond .The third patient was referred to a higher specialty centre for Keratoplasty.

Rare Case of Ileal Perforation

Ileitis, or inflammation of the ileum, is often caused by Crohn’s disease. However, ileitis may be caused by a wide variety of other diseases. These include infectious diseases, spondyloarthropathies, vasculitides, ischemia, neoplasms, medication-induced, eosinophilic enteritis, and others. Eosinophilic enteritis can present as abdominal pain, protein loosing enteropathy, ulcers, intestinal obstruction, intussusception and perforation.Bowel perforation is an uncommon presentation of eosinophilic enteritis. We report a rare case of ileal perforation due to eosinophilic enteritis in a 57 years old female.

Median Raphe Cysts of the Prepucial Skin, with Triple Histological Linings: A Case Report and Review of the Literature

Anandhi Amaranathan, Sankappa P. Sinhasan, Simon David Dasiah

A median raphe cyst is an uncommon entity. An extensive literature search has revealed only less than 200 reported cases. Among these, only less than 10 have been reported from the Indian subcontinent. Usually, it is located in the midline, anywhere between the urethral meatus and the anus. We are presenting a case of a prepucial median raphe cyst, which occurred at a very uncommon location, which presented with symptoms, which is also a rare scenario. This case has been presented for its rare location, uncommon clinical presentation and an interesting triple lining presentation in histology.

A Pure Epidural Spinal Cavernous Hemangioma — With an Innocuous Face But A Perilous Behaviour!!

Hemalatha A L, Ravikumar T, Neelima P Chamarthy, Kunal Puri

Cavernous hemangiomas occur frequently in the intracranial structures but they are rare in the spine, with an incidence of 0.22 cases/million/year, which account for 5 – 12% of the spinal vascular lesions, 51% of which are extradural. Most of the epidural hemangiomas are secondary extensions from the vertebral lesions. The spinal cavernous hemangiomas which do not involve the vertebrae are referred to as “pure” types. The pure epidural hemangiomas are rare, which account for only 4% of all the epidural lesions. A case of a Pure spinal epidural cavernous hemangioma in a 50 year old male, with the clinical picture of a slowly progressive compressive myelopathy, has been presented here. The imaging studies showed a well-defined, enhancing epidural lesion at the T7 – T8 level, with dorsal cordedema and myelomalacic changes. A radiological diagnosis of a meningioma was considered. Histopathologically, the lesion was diagnosed as a hemangioma. The patient improved dramatically after the excision of the lesion.

Significance of Prophylactic Paratracheal Lymphnode Dissection in A Case of Retrosternal Goitre: A Case Report

An elective or a prophylactic lymph node dissection is the removal of the lymph nodes that are normal on physical examination and on radiographic imaging. This type of dissection is not based on the visible disease in the targeted nodal basins, but on the potential of a radiographically occult tumour which can exist. The pathologic results of an elective lymph node dissection may help in predicting the risk of a future recurrence and, in some solid tumours, guide the delivery of the adjuvant therapy and as in this case, may contribute to a pathological diagnosis. The decision to proceed with an elective node dissection is based on the assessment of the risks and benefits of the procedure. The morbidity of the regional lymph node dissection must be balanced against the potential benefit of the procedure. A thyroid papillary microcarcinoma is defined according to the WHO criteria and Shaha as a thyroid tumour which is smaller than 1–1.5cm. Different terms are currently used to define this thyroid cancer such as small, tiny, minute, minimal or occult papillary carcinomas of the thyroid, impalpable thyroid carcinoma and incidental thyroid papillary cancer. A common clinical scenario is the incidental diagnosis of papillary thyroid microcarcinoma (PTMC) on the histology of the resected thyroid, following the surgery which was done for a presumably benign thyroid disease. PTMC was diagnosed in 7.1% of the patients with a presumably benign thyroid disease. It may be possible that this is an underestimation of the true incidence, because we did not use the serial sectioning technique and maybe because the PTMC which was present was so small that it was grossly not identified and sectioned. Herein, a case which was clinically suspicious and was radiologically and cytologically diagnosed as a case of retrosternal multinodular goitre underwent a near total thyroidectomy and a paratracheal lymphnode dissection. The node was found to have micrometastasis of the follicular variant of a papillary carcinoma and the thyroid, on a retrospective step sectioning, revealed an incidental PTMC. This case has been presented, to highlight the possibility of an incidental PTMC in the thyroid cases which were resected for benign disease and the importance of elective lymphnode dissection in contributing to the diagnosis of PTMC.

Teratocarcinoma In A Non Seminomatous, Mixed Germ Cell Tumour of the Testis-A Rare Entity

Gayathri Malavalli, Shilpa Karra, Bharathi Muniyappa

Mixed Germ Cell Tumours (MGCTs) of the testis are the second most common testicular tumours. In the 10 years retrospective study which was done on testicular neoplasms at our institute, this reported case accounted for 0.4%. We are presenting the case of a 30 year old male with a painless testicular swelling. Abdominal ultrasonography disclosed it as a seminoma and the FNAC report was Mixed Germ Cell tumour of the testis. Histopathology concurred the cytological diagnosis and it additionally revealed the concomitant presence of a Yolk Sac Tumour (YST) and a Teratocarcinoma in a Non-Seminomatous Tumour of the testis. This case attains uniqueness with the very rare presence of the yolk sac tumour with the teratocarcinoma component in Non-Seminomatous Testicular Tumours. The reason behind the reporting of the case was its poor therapeutic response.

Low Density Microfilaraemia as a Causative Agent in a Case of Unexplained Ascitis of Suspicious Nature

Rahul Mannan, Tejinder Singh Bhasin, Mridu Manjari, Vatsala Misra

It is estimated that 120 million people worldwide are affected by filariasis. In the South East and South Asian region, Wuchereria bancrofti is the most prevalent parasite causing filariais in 99.4 % of cases. In the present case the parasite was a cause of unexplained ascitis in a young female whose previous cytological report was suspicious in nature. Extensive physical and radiological assesment was not able to determine the cause of ascitis. Repeat cytological examinantion revealed a few microfilariae of Wuchereria bancrofti. The patient was diagnosed as a case of low density microfilaremia and was put on anti-filarial therapy subsequent to which ascitis of the patient regressed. In this case, the clinical picture did not give a clue regarding the aetiology of the ascites. There was no evidence suggestive of filariasis, such as lymphoedema or hydrocele except mild eosinophilia. Circumstantialtial evidence regarding the aetiology of the effusion in our patient included her recovery following antifilarial therapy. The cytological diagnosis of Mf in this patient avoided further expensive investigations and the patient responded to antifilarial therapy.

Yolk Sac Tumour of the Cryptorchid Testis, with an Unusual Presentation — Diagnosed by Fine Needle Aspiration Cytology

Yolk sac tumour is the most common germ cell tumour in infants and children, with a majority of them arising in the gonads. Rare cases of extra – gonadal germ cell tumours have been described in the literature. We are presenting here, a case of a yolk sac tumour of the cryptorchid testis in a 2 year old child, who initially presented with a mass in the left lobe of the liver, with huge ascites and which posed diagnostic difficulties. The mass was diagnosed as hepatoblastoma on Computed Tomography (CT). Subsequently, CT guided Fine Needle Aspiration Cytology (FNAC) of the liver mass showed the features of a yolk sac tumour. The raised serum Alfa Foetoprotein (AFP) levels corroborated with the cytological diagnosis.

Ofloxacin Induced Hypomania

Siddharth Sarkar, Sudhir Kumar Khandelwal

Flouroquinolones are widely used antibiotics with side effects that involve the central nervous system. Here, we are presenting the case of a patient who developed hypomania after taking ofloxacin. The clinical features included an elevated mood, increased talkativeness, a decreased need for sleep, and drawing up big plans. The episode was circumscribed and resolved after the discontinuation of the antibiotic.

Conjoined Twins: A Rare Case of Thoraco-Omphalopagus

Conjoined twins are a rare entity. Only few cases have been reported in the medical literature. They are a rare and exclusive type of monozygotic twins. They are caused by a faulty division of the embryonic disk. Due to high post-natal morbidity and mortality, an early pre-natal diagnosis is a must. All the monozygotic twins should be carefully screened for conjoinnment and if it is present, the type and the degree of sharing of the foetal organs should be delineated. There are many associated anomalies, of which congenital heart defects are the major prognostic factors. Here, we are reporting a case of thoraco-omphalopagus in which there was sharing of the foetal heart, liver and the intestinal loops.

An Abdominal Flap to Save the Right Forearm and the Hand, Following a High-voltage Electric Burn in a Child: A Case Report

Sharad Khandelwal

High – voltage electric burns are very rare in children. This is a report of a seven years old boy, who presented 20 days after severe burns following a contact with a high – voltage electric line during playing. He was treated for the above at another hospital and was referred for further management. His clinical examination revealed; exposed skull bones, a raw area over the right side of the chest wall and a raw area over the right upper limb, which completely exposed the distal radius and the ulnar bones. After properly explaining the purpose of the operation to his parents and getting their consent, the exposed skull bones were covered with multiple pedicle scalp flaps. A bipedicle abdominal flap was used to cover the exposed right forearm bones and a skin grafting was also provided to the chest wall wound at the same time. The abdominal flap was detached safely after three weeks. He withstood the above operations well and was discharged six weeks after the above operations. The bipedicle abdominal flap helped in saving his right forearm and hand and the reason for the publication of this case is its rarity in children.

A Report of an Indian Boy with a Delayed Diagnosis of Pseudochondroplasia

Ankur Singh,T Abiramalatha,Gaurav Pradhan,Dong- Kyu Jin,Seema Kapoor

The mutations in the Cartilage Oligomeric Matrix Protein (COMP) gene are associated two common and allelic bony dysplasias: Psuedoachondroplasia (PSACH) and Multiple epiphyseal dysplasias-1 (MED-1). The characteristic radiological features of both has been well established in the literature, with areas of overlap between the two in certain forms of mild PSACH and severe MED. MED is also a genotypically and a phenotypically heterogeneous disease. Here, we emphasise the salient radiological features which aid in the diagnosis of PSACH and COMP MED; which may enable a targeted molecular analysis.

Calcific Tendinitis of the Rotator Cuff: A Review

Sushil G Kachewar, Devidas S Kulkarni

Calcifying tendinitis of the rotator cuff is a common disorder; its underlying mechanism still remains unknown. Although details of the clinical presentation(s) and pathological changes which are associated with calcific tendinitis are available, conservative management of this condition remains a topic of debate. About 90% of the patients can be treated non – operatively, but as some are resistant to conservative treatment; newer techniques or surgery should be indicated. Rheumatologists and radiologists have often described this shoulder abnormality, leading to its progressive differentiation from other painful shoulder syndromes. The conservative treatment includes the use of non – steroidal anti – inflammatory agents, roentegen therapy, physical modalities for controlling the pain and for preventing loss of joint mobility, local steroid injections, and open or arthroscopic surgeries. Results of non – operative treatments have also been satisfactory. These include heat, cold, range of motion and pendulum exercises, diathermy, short – wave, and radiation therapy. Rest, immobilization with a sling, and oral non – steroidal and steroid anti – inflammatory medications have also been mentioned. This review aimed at looking at calcific tendinitis of the rotator cuff with a wide vision in the light of modern advances; while at the same time, not disregarding the past experiences.

Neurotheology-Matters of the Mind or Matters that Mind?

Samarth Shukla, Sourya Acharya, Devendra Rajput

Understanding the true nature of an individual, be it a child or an adult, a male or a female, is almost an impossible task. The vast abyss like behaviour of a human mind is virtually unfathomable. Yet, with the advent of neurosciences, it can be said that we, as the medical fraternity, have been in a position to decipher a considerable part of the human mind. This review accepts the fact that religion and theology have extreme reverence and respect. Yet, when it comes to extraordinary beliefs, phenomena, unimaginable feats and emotional deviations of the human mind, especially those which involve deep faiths and beliefs, comprehensive neuroscientific explanations from the emerging data, with the aid of elaborate neuroimaging, have proved to be extremely rational and logical. This review did make an attempt to untangle some facets of spirituality and to make rational explanations of the same. It was an attempt to understand the function of the mind (as an abstract) and the brain, on the spiritual experiences and sudden enlightments, the experience of togetherness with the universe, and to understand the phenomena of trance and an altered state of consciousness, which is better referred as the emerging science of neurotheology.

To Compare Standard Incision and Comma Shaped Incision and Its Influence on Post–Operative Complications in Surgical Removal of Impacted Third Molars

Saravana kumar B, Sarumathi T, Veerabahu M, Uma Raman

Objectives: To compare standard incision and comma shaped incision and its influence on post operative complications in surgical removal of impacted third molar. Methods: This was a cross–over trial. Twenty subjects with bilateral impacted mandibular third molars were recruited for the study. A standard incision was made on one side of the lower jaw and a comma incision was made on the other side to reflect the mucoperiosteal flap, after which the common steps for removal of impacted third molars were followed. The post– operative parameters were recorded immediately on the post –operative days 1, 3 and 7 respectively. Results: The pain scores which were recorded on days 1, 3 and 7 in the surgical area with comma incisions were found to be significantly lower as compared to the pain scores in the area where standard incisions were made. Similarly, swelling was lesser with comma incisions than with standard incisions. There was a significant difference in mouth opening between the two incisions on day 1, but no significance was seen on days 3 and 7. All these findings showed significant statistical differences. Conclusion: The results of the study showed that the new incision design was preferable over the conventional method, considering the lesser degree of post–operative complications. The cross–over design of the study greatly enhanced its statistical power and validity.

The Self—Reported Knowledge, Attitude and the Practices Regarding the Early Detection of Oral Cancer and Precancerous Lesions among the Practising Dentists of Dakshina Kannada — A Pilot Study

Shaila M, Pushparaj Shetty, Audrey Madonna Decruz, Prakash Pai

Introduction: Oral squamous cell carcinoma is one of the leading causes of mortality in India. The screening and the early detection of the premalignant and malignant lesions are the only means for controlling the disease. General dental practitioners can play a great role in this direction. The objective of the present study was to assess the self-reported knowledge, attitude, as well as the practices concerning the early detection of oral cancer among the dentists of Dakshina Kannada, Karnataka, India. Materials and Methods: About 200 clinicians (BDS/MDS) were randomly selected for an 18 itemed questionnaire survey. The aspects which were enquired into were the usage of exfoliative cytology in their clinical practice, the recent attempts which are made by dentists at updating their knowledge on oral cancer, their practical approaches towards the screening for oral premalignant diseases, etc. Results: Over 98% of the dentists reported to have not performed exfoliative cytology in their clinics. However, 85% had attended education programs on oral cancer. About 72% felt the need to be trained and they welcomed the suggestion of conducting practical workshops in this direction. 29.5% conducted biopsies when they encountered suspicious looking lesions, but only 13% counseled such patients for the habit cessation. 86% felt the need for Oral Pathology consultants in their clinics. Conclusion: This pilot survey identified an existing gap in the knowledge and practices among physicians and dentists and this emphasises the need to increase the numbers of oral cancer detection workshops which are held among the professional groups.

The Shear Bond Strengths of Metal and Ceramic Brackets: An in-Vitro Comparative Study

Aim: This study has compared the Shear Bond Strengths (SBSs) of ceramic brackets and metal brackets. Materials and Method: Forty freshly extracted, human maxillary first premolars were selected for bonding. They were equally bonded with ceramic brackets (Transcend series 6000) and metal brackets (Mini Dynalock Straight wire brackets). A no – mix orthodontic adhesive system was used. Their shear bond strengths were measured by using the Instron universal machine. Results: The mean bond strength of the ceramic brackets was 20.68 ± 3.89 Mpa and that of the metal brackets was 12.15 ± 1.32 MPa. Conclusion: The shear bond strength of the ceramic brackets was found to be superior than that of the metal brackets.

Assessment of the Periodontal Status among Kota Stone Workers in Jhalawar, India

Context: Periodontal disease is one of the most prevalent dental diseases which affects the adult population of the world, varying only in degree from mild to severe. Its prevalence, which was reported in various studies which were conducted in different parts of the globe, signifies its need for a control. Aims: To assess the periodontal status among the Kota stone workers in Jhalawar and to provide a baseline data for the planning and evaluation of the oral health care promotion programmes. Settings and Design: A cross-sectional descriptive survey was conducted among the Kota stone workers who were working in the Kota stone factories which were located in the Ricco Industrial Area in Jhalawar, India. Methods and Material: The study population comprised 420 subjects who were in the age group of 21 to 60 years. The data were collected by means of a close ended, self administered questionnaire and clinical examination with the use of the CPI index. Statistical analyses which were used: Chi-square, Student’s t-test, One way Analysis of Variance (ANOVA), and Multiple Logistic Regression. Results: The socio-demographic characteristics, except the gender, were found to be significantly associated with the periodontal status in the study population (P=0.05). Multivariate analysis showed high CPI scores which were associated with males (OR=1.313), the 21-40 year age group (OR=0.548), education upto 10th class (OR=4.776), oral hygiene practices other than toothbrush with toothpaste (OR=0.774) and smoking (OR=3.994). Conclusion: The observations of this study indicate the need for a reorientation of the dental care services, with further emphasis on the preventive care in such a population.

An Epidemiological Study on Supernumerary Teeth: A Survey on 5,000 People

Dara Kalyan Kumar, K Saraswathy Gopal

Background: The formation of dental tissues is a highly delicate and complex phenomenon. Any alteration in this process leads to various dental anomalies which affect the tooth number, size, shape and structure. Supernumerary teeth are one such anomaly which affects the tooth number. Supernumerary teeth can give rise to various complications and pathologies or they may have a familial / syndromic association. They may occur along with other dental anomalies. Thus, such teeth have a definite clinical significance. Aims and Objectives: The aim of the following study was to know the prevalence of the supernumerary teeth and the distribution of the cases according to the age, sex, jaw, region, eruption status, and the position. Materials and Methods: A total of 5000 patients were examined for a period of 1 year’s duration and they were divided into different groups. Group I consisted of individuals who were aged between 5-20 years, Group II consisted of individuals who were aged between 21-40 years, and Group III consisted of individuals who were aged 41 years and above. The dental examination was conducted by using a mouth mirror and a probe, to determine the presence of supernumerary teeth. All the cases with supernumerary teeth were further observed and the details were recorded in a prepared porforma. These cases were also subjected to general physical examinations (to rule out any syndromes) and radiographic examinations. Photographs were also made. Conclusion: Although supernumerary teeth is an unusual anomaly, it is not as rare as was previously reported. The identification of this anomaly could provide a hint towards the possibility of complications, pathologies, other dental anomalies, syndromes and a familial association.

An Analysis of the Vertical Bone Loss in Edentulous Mandibles by Using the Mental Foramen as a Reference: A Radiographic Study

Anjali Sofat, Virat Galhotra, Ramandeep Singh Gambhir, Shushant K. Garg

Objectives: To analyze the amount of vertical bone loss in edentulous mandibles by using the mental foramen as a reference. Method: Ninety subjects who consisted of thirty dentulous (males I MD and females II FD) and sixty edentulous (males I ME and females II FE) subjects were selected and they were subjected to digital panoramic radiography. Among the dentulous subjects, in both the groups, the ratio between the height of the mandible and the distance from the mental foramen and the lower border of the mandible (A/B) were calculated by using inbuilt software. This ratio A/B was applied in the edentulous subjects to measure the original height of the mandible before resorption. The amount of vertical bone loss was then calculated. Results: In the dentulous subjects, the A/B ratio in males was 2.94 and in females, it was 3.09. In the edentulous subjects, the vertical bone loss in males was 3.55mm and in females, it was 6.59mm. Conclusion: The ratio of the distance from the inferior border of the mandible to the superior border of the mandible(A) and the distance from the inferior border of the mandible to the inferior margin of the mental foramen (B) were less in the dentulous males than in the dentulous females. The comparison of the ratios was nonsignificant. The mean bone loss in edentulous females was found to be greater than the mean bone loss in edentulous males on comparison.

The Maternal Socioeconomic Status and the Caries Experience Among 2-6 Years Old Preschool Children of Lucknow City, India

Aim: The aim of the present study was to assess the maternal socioeconomic status and the caries experience among 2-6 years old preschool children of Lucknow city, India. Material and Methods: A sample of 512 preschool going children were selected through a multistage cluster random sampling. Their mothers provided information regarding their demographic data. Their socioeconomic statuses were elicited by using the modified B.G.L. Prasad’s classification for the year 2010. Their mothers’ education, occupations and incomes were also recorded. The dental caries experience was recorded by using the dentition status and the treatment needs (WHO Basic Oral Health Survey 1997). The association between the socioeconomic status and the caries experience was obtained by using the Chi – square test. One way ANOVA was used for the multiple group comparisons. Results: The prevalence of nursing caries was 33.01%. The association between the presence of nursing caries and a lower status of the mother’s education and occupation and socioeconomic position proved to be statistically significant (p<0.001). Conclusion: Instilling positive attitudes in the parents, especially in the mothers, towards the prevention of nursing caries, would reduce its prevalence at this tender age of life.

The Rosai Dorfman Syndrome-The Report of A Rare Case

Snehalatha R, Senthilnathan P, Prathiba Ramani, Sherlin J Herald

Rosai Dorfman syndrome known as Sinus Histiocytosis with Massive Lymphadenopathy (SHML) is an uncommon benign systemic histio-proliferative disease which affects lymph nodes , most often those of the neck (cervical lymphadenopathy). The characteristic histological feature is lymphophagocytosis which is specific for this syndrome. Evidence based survey reveals that many cases that have been reported in india are from medical fraternity other than dental colleagues. As dental professionals we document a rare case of Rosai – Dorfman syndrome , reported to the department of oral and maxillofacial pathology with the cheif complaint of swelling in the neck region.

Pathologic Tooth Migration-Spontaneous Repositioning Following a Non-Surgical Periodontal Therapy: A Case Report

Punit Vaibhav Patel

This case report describes the spontaneous correction of a pathologic tooth migration (PTM) and reduced infra-bony pockets after a nonsurgical periodontal therapy.

Peripheral Adenomatoid Odontogenic Tumour — Is It Really Peripheral?: A Case Report

N. Lavanya, M.R.C. Rajeshwari, R. Bharathi, A. Shaheen

A Peripheral Adenomatoid Odontogenic Tumour (PAOT) is quite a rare entity which has been infrequently reported in the literature. These uncommon clinical variants of an Adenomatoid Odontogenic Tumour (AOT), typically manifest as a soft tissue mass of the gingiva, which mimick a common epulis, but yet have an identical histopathologic presentation as their intraosseous counterpart. These lesions, though they are indolent in nature, have a tendency to cause well defined deep bony pockets. Only fourteen cases have been adequately documented so far. We are reporting a case of a PAOT of the anterior maxillary gingiva, with a periodontal bone defect in a 12 year old girl. The relevant literature has been briefly reviewed, with an insight into the probable origin of PAOTs with bony defects.

“Redefining Smile-A Multidisciplinary Approach”

Prakash Manne, Srujana Zakkula, Jyothi Atla, Suresh Babu Muvva, Anche Sampath

This article presents a case report of a 20 year old female who was very much dissatisfied with her facial appearance and smile.On examination, it was found that there was a Angles class II division 1 malocclusion and a generalised spacing in the anterior teeth, with a retained, deciduous, left maxillary canine and a malposed 15. On radiographic examination, an impacted 18, 23 was noticed. As the part of the treatment plan, the retained deciduous canine and the impacted permanent canine were extracted and an orthodontic correction of the malocclusion was accomplished. The missing canine was planned to be replaced with a fixed partial denture.The short clinical crown height of the abutment teeth was increased by crown lengthening procedures and the pontic space was contoured to receive a ovate pontic by using diode lasers. The missing tooth was restored by using an all ceramic three unit zirconia bridge. This multi–disciplinary approach improved the smile of the patient and it ultimately enhanced her aesthetics and self confidence.

The Possible Role of Fluoxetine in Adenomyosis: An Animal Experiment with Clinical Correlations

Introduction: Fluoxetine is a commonly prescribed drug which is used in the psychiatric practice and adenomyosis is a common medical problem in women of the reproductive age group. Objective: To explore the role of fluoxetine in the causation of adenomyosis. Methods: Female Wistar rats (n=18) were divided into three groups (group I (the control), group II and group III) and they were treated with normal saline and oral fluoxetine (4mg/kg and 8 mg/kg) respectively for 100 days. Periodic serum prolactin measurements and histopathological examinations of the uterine horns of all the rats were done at the end. Comparison of the mean serum prolactin levels between the patients (n=15) who were diagnosed with adenomyosis, the healthy age sex matched controls and the female patients (n=20) who received fluoxetine for more than 3 months, before and after the fluoxetine administration, was done separately. Appropriate (paired or unpaired) t tests were used for the data analysis. Results: Out of the 12 test group rats, 10 rats showed the features of adenomyosis histopathologically, along with significantly (p < 0.05) raised serum prolactin levels. The mean serum prolactin levels of the patients of adenomyosis in comparison to those of the controls and of the patients who were treated with fluoxetine (before and after the fluoxetine administration), were significantly high (p=0.001 in both the cases). Conclusion: Fluoxetine may have some role in the causation of adenomyosis; although for a stronger evidence, the follow-up of the patients who are treated with fluoxetine on a long term basis should be ideal.

A Rare Case of Tubercular Pyo–Pneumothorax Herniating through the Inter–Costal Drainage Site

Peter George, Maroli Roshan, Swapna Ponmaleri Koroth

No Crying Episode after DwPT- A Case of Congenital Hypothyroidism

MM Patil, SS Kalyanshettar, SV Patil, AS Akki, DV Veeresh Babu