Journal of clinical and diagnostic research

Assessment of Factors Affecting Adolescent Patients’ Compliance with Hawley and Vacuum Formed Retainers

Behnam Mirzakouchaki, Sajjad Shirazi, Reza Sharghi, Samaneh Shirazi

Introduction: Success of orthodontic retention with removable retainers almost entirely depends on patients’ compliance. Aim: This study was carried out to investigate the relationship between adolescent orthodontic patients’ compliance and various clinical and social factors. Materials and Methods: The data were collected from 77 orthodontic patients aged 7-11 years old who had finished the full fixed appliance therapy. Hawley’s retainers were used in 34 patients and 43 patients used Vacuum Formed Retainers (VFRs). The subjects completed a questionnaire including several identifiers allowing the respondents to be classified into subgroups. They were also asked to indicate how long they wore their retainers during the day, by writing the number of hours in the report-card for the next three months. Comparison of the results was performed by one-way ANOVA and independent sample-t tests. Results: No significant differences were found between males and females. Type of the retainer, patients’ grade of study, mothers occupation, clinicians and parents attitudes and filling the report cards had significant effect on mean wear hours per day. When compliance of the patients was assessed according to treatment location, Living place and parents educational degrees and ethnicity, no significant differences could be found. Conclusion: The adolescent patients compliance was greater with VFRs than with Hawley’s retainers. Parental attitude and doctor-patient relationship had a great impact on adolescent patients’ compliance.

An Insight into Health Care Setup in National Capital Region of India using Dimensions of Learning Organizations Questionnaire (DLOQ)- A Cross-Sectional Study

Introduction: Over the past decades India, though being a developing country has progressed in multiple sectors but has not shown a substantial qualitative progress in healthcare. To be able to evaluate learning organization in a healthcare setup would thrust millennium development goals and infuse continuous learning model into health sector. Aim: To assess health care context using the Dimensions of the Learning Organization Questionnaire (DLOQ) in a health care setting in National Capital Region of India. Materials and Methods: DLOQ proforma were distributed among 315 employees at all levels of the hospital. Data was analysed using SPSS software version 19.0 and was subjected to quantitative analysis and non-parametric tests. Results: The Kruskal-Wallis test indicated a significant difference between the means of the different professions where as Mann-Whitney tests compared the relation between each of the profession and a significant difference (p < 0.05) was noted, except dimension “systems connection”. Conclusion: The results provided sufficient inputs about the multidimensional learning organization capacity of a health care setting in a rapidly developing country.

Efficacy of Different Methods for Removing Root Canal Filling Material in Retreatment - An In-vitro Study

Swetha Kasam, Annapoorna Ballagere Mariswamy

Accuracy of Mri in Prediction of Tumour Thickness and Nodal Stage in Oral Tongue and Gingivobuccal Cancer With Clinical Correlation and Staging

Introduction: Squamous cell carcinoma of lower gingivo-buccal complex and tongue are the most common cancer in the Indian sub-continent. The value of imaging in the staging of Oral Squamous Cell Carcinoma (OSCC) is in judging operability, assessment of the prognostic characteristics and dimensions of the primary tumour, depth of tumour invasion, the presence of cervical metastasis and detection of bone infiltration. Aim: This study evaluated squamous cell carcinomas of the oral cavity (tongue and gingivo-buccal complex) on the basis of their appearance, soft tissue extent, depth of tumour invasion and staging. Further, this study assessed the accuracy of MRI in the detection of cervical lymph nodal metastasis on the basis of ADC values on diffusion weighted MR sequence. Materials and Methods: T1- and T2-weighted MR, diffusion-weighted sequences and post contrast T1W sequences were performed in various planes on biopsy proven squamous cell carcinomas (61 cases) involving tongue and/or gingivo-buccal region. Depth of tumour invasion was calculated on axial images of post contrast T1W images. The Apparent Diffusion Coefficient (ADC) was measured by using two b factors (500 and 1000 s/mm2). MRI findings were compared clinically and histopathologically. Results: Average depth of invasion calculated on MRI was 8.47mm and by histopathology was 6.85mm. Pearson's correlation coefficient was 0.988. Shrinkage factor was 0.8. A 71% of patients with depth of invasion greater than 9mm showed evidence of cervical lymph nodal metastasis at one or another levels. Cut-off value to discriminate between malignant and benign lymph nodes was 1.038 x10-3 mm2/s in the present study. Conclusion: Depth of tumour invasion in oral malignancies can be measured reliably on MRI which helps in predicting cervical lymph node metastasis. Benign or malignant cervical lymph nodes can be differentiated on diffusion-weighted imaging of MRI on the basis of their ADC values.

Evaluation of Hand Written and Computerized Out-Patient Prescriptions in Urban Part of Central Gujarat

Anuradha Joshi, Jatin Buch, Nitin Kothari, Nishal Shah

Introduction: Prescription order is an important therapeutic transaction between physician and patient. A good quality prescription is an extremely important factor for minimizing errors in dispensing medication and it should be adherent to guidelines for prescription writing for benefit of the patient. Aim: To evaluate frequency and type of prescription errors in outpatient prescriptions and find whether prescription writing abides with WHO standards of prescription writing. Materials and Methods: A cross-sectional observational study was conducted at Anand city. Allopathic private practitioners practising at Anand city of different specialities were included in study. Collection of prescriptions was started a month after the consent to minimize bias in prescription writing. The prescriptions were collected from local pharmacy stores of Anand city over a period of six months. Prescriptions were analysed for errors in standard information, according to WHO guide to good prescribing. Statistical Analysis: Descriptive analysis was performed to estimate frequency of errors, data were expressed as numbers and percentage. Results: Total 749 (549 handwritten and 200 computerised) prescriptions were collected. Abundant omission errors were identified in handwritten prescriptions e.g., OPD number was mentioned in 6.19%, patient’s age was mentioned in 25.50%, gender in 17.30%, address in 9.29% and weight of patient mentioned in 11.29%, while in drug items only 2.97% drugs were prescribed by generic name. Route and Dosage form was mentioned in 77.35%-78.15%, dose mentioned in 47.25%, unit in 13.91%, regimens were mentioned in 72.93% while signa (direction for drug use) in 62.35%. Total 4384 errors out of 549 handwritten prescriptions and 501 errors out of 200 computerized prescriptions were found in clinicians and patient details. While in drug item details, total number of errors identified were 5015 and 621 in handwritten and computerized prescriptions respectively. Conclusion: As compared to handwritten prescriptions, computerized prescriptions appeared to be associated with relatively lower rates of error. Since out-patient prescription errors are abundant and often occur in handwritten prescriptions, prescribers need to adapt themselves to computerized prescription order entry in their daily practice.

Preventive and Protective Effect of Nishamalaki in STZ Induced Diabetic Complications in Wistar Rats

Introduction: Diabetes is a metabolic disease of vital health importance because of the complications associated with it. Clinical trials and animal studies have demonstrated the anti-hyperglycaemic effect of Nishamalaki. Present study was planned to evaluate the protective potential of Nishamalaki on diabetic complication in rats. Aim: To study the Nephro-protective effect and to assess the protective potential on retinal changes of Nishamalaki in diabetic wistar rats. Materials and Methods: Diabetes induced with 60 mg/kg of Streptozotocin and 110 mg/kg Nicotinamide IP. Nishamalaki, a combination of Curcuma longa and Emblica officinalis administered orally with honey. Rats divided into six groups, control and diabetic rats with blood glucose above 250 mg/dl were divided into 5 groups. After 8 weeks test animals were treated with Nishamalaki, Enalapril and control with saline for 30 days. Biochemical parameters measured like Serum BSL, BUN and Creatinine and rats were observed for development of cataract. Rats sacrificed and kidney samples were taken to examine histopathological changes. Results: Blood Urea Nitrogen and Creatinine values were significantly (p<0.01) reduced in Nishamalaki group than control group. Nishamalaki showed the protective effect on kidney pathology as seen on histopathology by near normal glomerular and tubular structures. Control group showed shrunken glomerulus and tubular vacuolations. In Nishamalaki group immature sub capsular cataract with mild lenticular opacity were seen compared to the mature cataract with significant lenticular opacity and corneal vascularisation in control group. Conclusion: Nishamalaki showed protective effect on development of Nephrotoxicity and it has also delayed the progression of cataract in rats.

Evaluation of Antibacterial Efficacy of MTA with and without Additives Like Silver Zeolite and Chlorhexidine

Introduction: Microorganisms, predominantly Enterococcus faecalis are found responsible in the progression of pulpal, periradicular diseases and in endodontic failures. Unsuccessful conventional treatment might necessitate the need for a surgical approach; where in retrograde restorative materials are used to seal the apex. Among the root end filling materials, Mineral Trioxide Aggregate (MTA) is considered biocompatible and is most commonly used in clinical applications but it has limited antibacterial activity. Metallic silver and chlorhexidine have been added into various dental materials to enhance the antibacterial activity. Aim: This study aimed to compare the antibacterial effect of MTA, MTA mixed with silver zeolite and MTA mixed with chlorhexidine against Enterococcus faecalis. Materials and Methods: Test materials used in the study were divided into three groups namely Group 1- MTA , Group 2-MTA + Silver Zeolite , Group 3-MTA + Chlorhexidine. Direct contact test was done by placing a standardized suspension of Enterococcus faecalis on the test materials in a 96 well microtiter plate. The bacterial growth was measured spectrophotometrically using ELISA reader at intervals of one, three and seven days. Statistical Analysis: Data was collected by recording the optical density and analyzed using two-way ANOVA and Tukey’s multiple post hoc test followed by paired-t test. Results and Conclusion: All test groups showed antibacterial activity against Enterococcus faecalis at day one, three and seven. MTA with silver zeolite showed the maximum antibacterial activity followed by MTA with 2% chlorhexidine. The least antibacterial effect was shown by MTA mixed with sterile water.

Surveillance of Anaemia: Mapping and Grading the High Risk Territories and Populations

Sairam Challa, Pallavi Amirapu

Introduction: Surveillance of anaemia is an ongoing process for assessing iron status and anaemia prevalence among individuals and the communities they live in. Measuring blood haemoglobin levels is the commonest method espoused worldwide for screening individuals and populations for anaemia and iron deficiency. World Health Organization (WHO) proposed a classification of public health significance of anaemia in populations on the basis of prevalence estimated from blood levels of haemoglobin. India falls under “Severe public health problem” category. An attempt has been made to categorise “Severe public health problem” into grades of severity that will help in prioritising the states and districts for targeted action. Aim: To adapt the “WHO Classification of anaemia as a problem of public health significance” and to use the same to identify and map high risk population groups in the southern states of India. Materials and Methods: The category of ‘Severe Public Health Problem’ has been graded based on prevalence of anaemia. Secondary data published in the District Level Household and Facility Survey - 4 is analysed for five states and 1 UT (Union Territory) of southern part of India. Choropleth Mapping was done to visually depict the intensity of anaemia problem across the geographic territories. Results: Children from 6 months to 59 months were having highest prevalence of both, anaemia (68%) and severe anaemia (10%). This was followed by pregnant women aged 15 to 49 years and Girl Child 6 to 9 years. Four of the Southern states of India including Andhra Pradesh, Karnataka, Telangana and Tamil Nadu fall in the Grade 2 SPHP (Severe Public Health Problem) Conclusion: The sixteen districts fall under Grade 3 Severe Public Health Problem in the states of Andhra Pradesh, Karnataka and Telangana, require special focus for identifying and addressing the determinants of such high prevalence of Anaemia. These populations and territories require priority in the Government of India’s Rashtriya Bal Swasthya Karyakram (RBSK) in the National Health Mission to address iron deficiency anaemia. The problem needs to be addressed through dietary diversification and improved access to foods that have high levels of bioavailable iron, including animal products apart from iron supplementation.

Effects of Yoga on Physiological Indices, Anxiety and Social Functioning in Multiple Sclerosis Patients: A Randomized Trial

Ali Hasanpour-Dehkordi, Nahid Jivad, Kamal Solati

Introduction: Multiple sclerosis (MS) as a chronic disease could affect patients’ various domains of life. Aim: This study was conducted to study the effect of yoga on the physiological indices, anxiety and social functioning of patients with MS in southwest, Iran. Materials and Methods: In this clinical trial study, 60 MS patients were enrolled according to inclusion criteria and randomly assigned to two groups of 30 each. Prior to and after intervention, the patients’ vital signs were measured. For case group yoga exercises were performed three sessions a week for 12 weeks while control group performed no exercise. The data were gathered by questionnaire and analysed by descriptive and analytical statistics in SPSS. Results: Prior to intervention, there was no significant difference in fatigue severity and pain between the two groups but the mean fatigue severity and pain in case group decreased compared to the control group after the intervention. Prior to intervention, there was no significant difference in mean physiological indices between the two groups but the mean physiological indices in case group decreased significantly after the intervention (p<0.05). Conclusion: Yoga is likely to increase self-efficacy of MS patients through enhancing physical activity, increasing the strength of lower limbs and balance, and decreasing fatigue and pain, and finally to promote social functioning and to relieve stress and anxiety in these patients.

A Case Report of Childhood Recurrent Autoimmune Pancreatitis: A Rare Emerging Entity

Mohammed Y Hasosah, Lojain Masawa, Ajwan Jan, Khalid Al Saleem

Autoimmune pancreatitis (AIP) is a rare entity in the paediatric population and its aetiology is unknown. Here, we report a 10-year-old girl with recurrent abdominal pain. A diagnosis of AIP was made based on elevated pancreatic enzymes, elevated IgG 4 and image findings. She responded to corticosteroid treatment. AIP should be considered in the differential diagnosis of recurrent pancreatitis. Correct diagnosis can help avert the consequences of progressive disease and unnecessary surgery.

Comparison of Albumin, Hydroxyethyl Starch and Ringer Lactate Solution as Priming Fluid for Cardiopulmonary Bypass in Paediatric Cardiac Surgery

Jigar Patel, Mrugesh Prajapaajapati, Atul Solanki, Himani Pandya

Introduction: In paediatric cardiac surgery, there is still not any information with regard to the best choice of priming fluids for Cardiopulmonary Bypass (CPB). Albumin, Hydroxyethyl Starch (HES) & ringer lactate equally used, but each has its advantages & disadvantages. Albumin & HES had better fluid balance which affect outcome in paediatric cardiac surgery significantly. Aim: To compare priming solution containing albumin, hydroxyethyl starch and ringer lactate during elective open-heart surgery in paediatrics aged up to 3 years. Materials and Methods: All patients were managed by standardized institution protocol and were randomly distributed into three groups based on the priming solution which is used in the CPB Circuit and having 35 patients in each group. Group A: Receive albumin 10 ml/kg in priming solution, Group B: Receive Hydroxyethyl starch (HES130/0.4) 6% 20ml/kg in priming solution, Group C: Receive ringer lactate priming solution. Primary outcome variable included perioperative haemoglobin, total protein, colloid osmotic pressure, platelets, fluid balance, urine output, post-operative blood loss, blood products usage, renal & liver function, extubation time, ICU stay & outcome. Results: Patients receiving albumin had higher perioperative platelet count, total protein level & colloid osmotic pressure, lesser post-operative blood loss & blood products requirement. Patients receiving HES had lower level of platelets postoperatively than ringer lactate group but not associated with increase blood loss. HES did not affect renal function & haemostasis in this dose. Patients receiving ringer lactate had positive fluid balance intraoperatively. All three groups have similar effect on renal & liver function, urine output, time to extubation, ICU stay & outcome. Conclusion: We conclude that albumin is expensive but better prime as maintain haemostasis, colloid oncotic pressure & reduced blood product requirement. HES will not hamper haemostasis & renal function in lower dose & better than crystalloid as maintain negative fluid balance. Patient outcome & ICU stay was similarly affected by priming solutions.

Expression of Cytokeratin-19 and Thyroperoxidase in Relation to Morphological Features in Non-Neoplastic and Neoplastic Lesions of Thyroid

Introduction: Thyroperoxidase (TPO) is a protein involved in thyroid hormone synthesis. TPO gene suppression and mutation were involved in thyroid tumours. CK-19 plays important role in the structural integrity of epithelial cells. Reduced TPO expression with increased CK-19 immunoreactivity has been implicated as a marker for differentiating non neoplastic and neoplastic thyroid lesions. Aim: To study the histopathological features of thyroid lesions and to evaluate the diagnostic role of thyroperoxidase and CK-19 in non-neoplastic and neoplastic thyroid lesions. Materials and Methods: Prospective observational study of 65 thyroid specimens was studied for detailed histopathological examination and Expression of Immunohistochemical Markers Cytokeratin-19 (CK-19) and Thyroperoxidase. Results: TPO IHC marker was expressed by non-neoplastic and benign lesions of thyroid but not in malignancy. CK-19 was expressed 100% in papillary carcinoma of thyroid and its variants, focal and weak staining noted in goitre and hyperplastic areas. Conclusion: Most of the non-neoplastic and neoplastic lesions were diagnosed based on histopathological features. When the histopathological diagnosis are equivocal, immunohistochemical markers aids in diagnosing malignancy. Diffuse and strong TPO expression indicates non-neoplastic thyroid lesions whereas diffused and strong CK-19 expression indicates thyroid malignancy.

Ventilator-Associated Pneumonia: Incidence, Risk Factors and Outcome in Paediatric Intensive Care Units at Cairo University Hospital

Yasmine S. Galal, Meray Rene L. Youssef, Sally K. Ibrahiem

Introduction: Ventilator-Associated Pneumonia (VAP) is a major cause of hospital morbidity, mortality and increased health care costs. Although the epidemiology, pathogenesis and outcome of VAP are well described in adults; few data exist regarding VAP in paediatric patients, especially in developing countries. Aim: To determine the incidence, risk factors and outcome of VAP in two Paediatric Intensive Care Units (PICUs) at Cairo University Hospital. Materials and Methods: A total of 427 patients who received Mechanical Ventilation (MV) were included in this prospective study during the period from September 2014 till September 2015. Patients were observed daily till VAP occurrence, discharge from the unit or death, whichever came first. Demographic, clinical characteristics, laboratory results, radiographic and microbiological reports were recorded for all patients. Results: Nearly 31% patients developed VAP among the entire cohort. The incidence density was 21.3 per 1000 ventilator days. The most frequently isolated organisms from VAP patients were Pseudomonas aeruginosa (47.7%), Acinetobacter (18.2%) and Methicillin-resistant Staphylococcus aureus (MRSA) (14.4%). VAP patients were significantly younger than non-VAP ones. The incidence of VAP in comatose patients and those with MOSF was significantly higher. Prior antibiotic use for > 48 h before MV, supine body positioning and reintubation were significantly associated with VAP. On multiple logistic regression analysis, MOSF; prior antibiotic use > 48h; reintubation; coma; and age remained independent predictors of VAP. Mortality rate among the VAP group was significantly higher compared to the non-VAP one (68.2% vs. 48.5%, p<0.001). Survival curve analysis showed a shorter median survival time in VAP patients. Conclusion: Identification of risk factors and outcome of VAP in PICUs may help in reducing the incidence and improving patients’ outcomes. The incidence of VAP in this study was relatively high. The most prominent risk factors for occurrence of VAP were MOSF, prior antibiotic use for > 48 h before MV, reintubation, coma and age. Proper use of antibiotics before MV in PICUs is essential. Also, adequate training of nurses and strict supervision of infection control protocols are crucial. Lack of a gold standard for the diagnosis of VAP and difficulty in sampling procedures were among the study limitations.

Skeletal Maturation and Mineralisation of Children with Moderate to Severe Spastic Quadriplegia

Indar Kumar Sharawat, Sadasivan Sitaraman

Introduction: Diminished bone mineral density and delayed skeletal maturation are common in children with spastic quadriplegia. Aim: The purpose of our study was to evaluate the Bone Mineral Density (BMD) of children with moderate to severe spastic quadriplegia and its relationship with other variables like nutrition and growth. Materials and Methods: This was a hospital based, cross- sectional, case-control study. Forty-two (28 males, 14 females) children with spastic quadriplegia and 42 (24 males, 18 females) healthy children were included in the study. BMD of cases and control were measured by Dual Energy X-ray Absorptiometry (DEXA). Radiographs of left hand and wrist of cases and controls were taken and bone age was determined. Results: BMD values of upper extremity, lower extremity, thoraco-lumbar spine and pelvis in cases were lower than those of controls (p <0.0001 ). In children with non severe malnutrition, 75% of the cases had lower bone age than chronological age, whereas all cases with severe malnutrition had lower bone age than chronological age. Step wise regression analysis showed that nutritional status independently contributed to lower BMD values but the BMD values did not correlate significantly with the use of anticonvulsant drugs and presence of physical therapy. Conclusion: Decreased BMD and delayed bone age is prevalent in children with spastic quadriplegia and nutritional status is an important contributing factor.

A Prospective Study of the Clinical Profile, Outcome and Evaluation of D-dimer in Cerebral Venous Thrombosis

Introduction: Cerebral Venous Thrombosis (CVT) is a well known disease with diverse clinical presentation and causes. With advances in neuroimaging and changing lifestyles, the clinical profile and causes of CVT are changing. D-dimer has been studied in early diagnosis of CVT with variable results. This prospective study was carried out to assess the clinical profile of CVT and role of D-dimer in diagnosis of CVT. Aim: To study various aspects of CVT and role of D-dimer. Materials and Methods: The study period was September 2012 to July 2014 and included 80 imaging proven patients of CVT. We also included 39 controls for assessing D-dimer. Data was collected according to a preformed format. D-dimer was assessed by a rapid semi-quantitative latex agglutination assay. Discharged patients were followed up to six months. Results: Of the total 44 were women and 36 were men (F: M=1.2:1). The mean age of the patients was 29.5±9.68 years. Most common clinical features were headache 77 (96.25%), papilloedema (67.5%) and seizures 51 (63.75%). Pregnancy was the most common cause of CVT. Superior sagittal and transverse sinuses were the most common sinuses to be affected. The sensitivity and specificity of D-dimer for diagnosing CVT was 84.62% and 80% respectively. The risk factors for poor prognosis were altered sensorium, presence of sepsis, increased sinus involvement and deep sinus thrombosis. Conclusion: CVT affects both sexes equally. Puerperium still contributes to majority of the cases. Iron deficiency anaemia needs to be evaluated as a contributing factor for incidence of CVT. D-dimer is not useful in puerperal female with CVT. Positive D-dimer will strengthen the suspicion of CVT in patients with acute headache followed by a neurological deficit.

Dengue: Lessons of an Outbreak

Oves Siddiqui, Anita Chakravarti, Kumar S. Abhishek

Introduction: Since 1967 there have been many outbreaks of dengue in Delhi. In the year 2015 Delhi has suffered it’s one of the worst dengue outbreaks, with more than 15000 dengue confirmed cases and the highest number of deaths (60) in recent years. Aim: To determine the status of Dengue cases as compared to previous six years, the ratio of primary and secondary dengue cases and to review the effectiveness of the one test strategy (either NS1 antigen or IgM antibody) for the confirmation of Dengue. Materials and Methods: A cross-sectional study was performed in the year 2015. A total of 7177 serum samples were tested for the confirmation of suspected cases of dengue at our institute. We performed dengue NS1 antigen and dengue IgM antibody ELISA tests for the confirmation of dengue cases in acute and convalescent fever cases respectively. Hundred random samples negative for NS1 antigen were tested for IgM antibody and 100 random samples negative for IgM antibody were tested for NS1 antigen. For determination of ratio of primary and secondary dengue cases, IgG Avidity ELISA was performed on random 76 dengue positive samples. Results: Out of 7177 samples tested, 2358 were positive either by NS1 antigen or for IgM antibody from January to December. Percentage positivity rates for IgM antibody detection and NS1 antigen detection tests were 24.8% (626) and 37.1% (1732) respectively. Out of 100 NS1 negative samples 8 were positive for IgM antibody and out of 100 IgM negative samples 6 were positive for NS1 antigen. Among the 76 samples tested for dengue IgG Avidity ELISA 52 (68.4%) were found to be of secondary dengue. Conclusion: Number of dengue cases is constantly rising in Delhi since 2011 and 2014. IgM antibody detection and NS1 antigen detection both the tests should be performed for each patient. Due to the increased prevalence of past infection of dengue, percentage of secondary dengue cases is also increasing in Delhi.

Minocycline Ointment as a Local Drug Delivery in the Treatment of Generalized Chronic Periodontitis - A Clinical Study

Sara Abbas, Jaideep Mahendra, Geetha Ari

Introduction: The primary goal in periodontal therapy includes removal of the etiological factors by mechanical periodontal treatment, which sometimes fail to eliminate the anaerobic infection at the base of the pocket and requires adjuvant chemical therapy. Aim: The aim of the study was to evaluate the effectiveness of 2% minocycline ointment when used as an adjunct to periodontal flap surgery and post-operative maintenance period for the treatment of generalized chronic periodontitis. Materials and Methods: The study included 30 subjects comprising of 60 posterior sextants in a split mouth design in which 30 sextants were treated as experimental and 30 sextants as control with a probing pocket depth=6mm. In Group A (experimental group) 30 sextants were treated with open flap debridement followed by the application of minocycline ointment as a local drug delivery. In Group B (control group) 30 sextants were treated with open flap debridement alone. Minocycline hydrochloride ointment was applied on the 0 day and 3rd month. The clinical parameters such as plaque index, probing pocket depth, clinical attachment level and gingival bleeding index were recorded at 0 day, 3rd month and 6th month in both the groups. Paired and unpaired t-test were used to compare the means of the two groups. Results: When Group A and Group B were compared, Group A showed significantly greater reduction in gingival bleeding index, probing pocket depth and gain in clinical attachment level than Group B, from 0 day to 3 months and from 0 day to 6 months. Group A showed significant reduction in plaque index than Group B when they were compared at 6 months. Conclusion: The results demonstrate that there was significant reduction in the clinical parameters with improvement in the periodontal status on application of minocycline ointment as an adjunct to periodontal flap surgery in generalized chronic periodontitis.

Comparison of K-loop Molar Distalization with that of Pendulum Appliance - A Prospective Comparative Study

Nagam Reddy Shashidhar, S.Rama Koteswara Reddy, Madhukar Reddy Rachala

Introduction: Molar distalization is the non extraction method of managing Class II malocclusions. Aim: The purpose of this study was to evaluate the skeletal and dentoalveolar effects of maxillary molar distalization with K-loop appliance, and to compare these effects with that of pendulum group. Materials and Methods: Class I and dental Class II malocclusions were divided into two groups of 15 each: In Group 1 (nine females and six males; mean age, 16.0±2.6 years) patients were treated with K-Loop molar distalization supported palatally by Nance button, while in Group 2 (seven females and eight males; mean age, 15.4±4.7 years), the patients were treated with conventional pendulum appliance. Standardized lateral cephalograms were taken at the beginning of treatment (T0) and at the end of molar distalization (T1) and the changes were statistically analyzed with paired t-test. Results: The results showed no statistically significant difference in the amount of molar distalization in either of the appliance groups: the mean amount of molar distal movement of 5.1±0.8 mm and 4.93±1.68 mm was observed in the Group 1 and 2 respectively. The incisors moved mesially by 1.3±0.63 mm in Group 1 and 1.57±0.58 mm in Group 2. Conclusion: K-Loop molar distalizing appliance has similar skeletal and dentoalveolar effects as that of pendulum appliance, with the advantages of simple yet efficient to control the moment-force ratio to produce all types of tooth movements and also requires minimal patient co-operation.

CT Evaluation of Acute Pancreatitis and its Prognostic Correlation with CT Severity Index

Sameer Raghuwanshi, Rajesh Gupta, Mahendra Mohan Vyas, Rakesh Sharma
Introduction: Pancreatitis is one of most complex and clinically challenging of all abdominal disorders. USG and abdominal CT are the most commonly used diagnostic imaging modalities for the evaluation of pancreas. Computed Tomography (CT) is highly accurate and sensitive than USG in both diagnosing as well as demonstrating the extent. Early assessment of the cause and severity of acute pancreatitis is of utmost importance for prompt treatment and close monitoring of patient with severe disease. CT is the imaging method of choice for assessing the extent of acute pancreatitis and for evaluating complications. Aim: To assess prognostic correlation and clinical outcome of acute pancreatitis on the basis of CT severity index. Materials and Methods: A prospective study of 50 cases was carried out in the Department of Radio Diagnosis, with complaint suggestive of acute pancreatitis on the basis of clinical/laboratory/ultrasonography findings were evaluated in Siemens somatom 40 slice ct . The severity of pancreatitis was scored using CT severity index, modified severity index and revised Atlanta classification and classified into mild, moderate, severe categories. Clinical follow-up of the patients was done in terms of the following parameters: Length of hospital stay, Need for surgery or percutaneous intervention, Evidence of infection in any organ system, Occurrence of organ failure- respiratory, cardiovascular, renal, hepatic and haematological system, death. The clinical outcome was compared with the currently accepted Balthazar’s CTSI and Modified Mortele’s CTSI and revised Atlanta classification in all the cases. Results: Gall stone disease was most common aetiological factor seen in 40%, cases it was more common in females than males. Alcohol was second most common aetiological factor seen in 38% cases and was noted only in males. Pleural effusion was the most common extra-pancreatic complication seen in 46% cases. Balthazar grade C was the most common (40%) followed by grade D and E (25% each). Acute peri-pancreatic collection was the most common findings seen in 72% cases. Majority of the cases (42%) were categorized as mild pancreatitis according Balthazar CTSI score. Majority of the cases (44%) were categorized as severe pancreatitis according modified CTSI. Majority of the cases were categorized as mild pancreatitis according revised Atlanta classification. Organ system failure, death were more seen in severe grade in modified CTSI and revised Atlanta classification. Conclusion: Modified CT severity index makes the score easier to calculate and reduces the inter-observer variation. Scores obtained with the modified Mortele index, show a stronger statistical correlation for all clinical outcome parameters in all the patients better than the Balthazar index.

Differences in Bacterial Colonization and Biofilm Formation Property of Uropathogens between the Two most Commonly used Indwelling Urinary Catheters

Amit Verma, Deepa Bhani, Vinay Tomar, Rekha Bachhiwal, Shersingh Yadav
Introduction: Catheter Associated Urinary Tract Infections (CAUTI) are one of the most common cause of nosocomial infections. Many bacterial species show biofilm production, which provides survival benefit to them by providing protection from environmental stresses and causing decreased susceptibility to antimicrobial agents. Two most common types of catheters used in our setup are pure silicone catheter and silicone coated latex catheter. The advantage of pure silicone catheter for long term catheterization is well established. But there is still a controversy about any advantage of the silicone catheter regarding bacterial colonization rates and their biofilm production property. Aims: The aim of our study was to compare the bacterial colonization and the biofilm formation property of the colonizing bacteria in patients with indwelling pure silicone and silicone coated latex catheters. Materials and Methods: This prospective observational study was conducted in the Urology Department of our institute. Patients who needed catheterization for more than 5 days during the period July 2015 to January 2016 and had sterile precatheterisation urine were included in the study. Patients were grouped into 2 groups of 50 patients each, Group A with the pure silicone catheter and Group B with the silicone coated latex catheter. Urine culture was done on the 6th day of indwelling urinary catheter drainage. If growth was detected, then that bacterium was tested for biofilm production property by tissue culture plate method. Statistical Analysis: Statistical analyses were performed using the Statistical Package for the Social Science Version 22 (SPSS-22). Results: After 5 days of indwelling catheterization, the pure silicone catheter had significantly less bacterial colonization than the silicone coated latex catheter (p-value=0.03) and the biofilm forming property of colonizing bacteria was also significantly less in the pure silicone catheter as compared to the silicone coated latex catheter (p-value=0.02). There were no significant differences in the colonizing bacteria in the 2 groups. In both the groups the most common bacteria were Escherichia coli. Conclusion: The pure silicone catheter is advantageous over the silicone coated latex catheter in terms of incidence of bacterial colonization as well as the biofilm formation and hence in the management of CAUTI.

En-Plaque Central Nervous System Tuberculoma - An Uncommon Entity: Clinico-Radiological Profile in a Cohort from a Tertiary Referral Centre

Praveen kumar Srikanteswara, Praveen kumar Pampapati, Kalpana Ramesh Yelsangikar
Introduction: Case reports pertaining to Magnetic Resonance Imaging (MRI) diagnosis of en-plaque tuberculoma are limited. To the best of our knowledge, descriptions about en-plaque tuberculoma are limited to few isolated case reports. This paper comprehensively depicts the clinical and radiological features in such patients and may serve not to miss this uncommon manifestation of a common central nervous system infection. Materials and Methods: A descriptive documentation of the patient cohort with a detailed history and neurological examination were carried out in all the patients. All underwent MRI Brain which revealed en-plaque tuberculoma. Relevant investigations including Cerebrospinal Fluid (CSF) were done in all patients. CSF Polymerase Chain Reaction (PCR) was done in all. Results: Eight adult patients (two women and six men) with MRI showing en-plaque CNS tuberculoma were seen during a period of five years. None had suffered from TB in the past nor had history of contact with tuberculosis. All patients demonstrated extra axial dural based lesions and none had cerebral ooedema, parenchymal lesions, mass effect or midline shift. The lesions were located in bilateral corresponding regions in two patients and the rest six had unilateral lesions. Seven patients had lesions located in the supratentorial compartment; one had lesion extending to the infratentorium along the tentorium cerebelli. Various patterns of enhancement were noted in our patients: thin peripheral (n=3), homogenous (n=3), varied enhancement (n=1) and open ring enhancement (n=1). CSF Polymerase Chain Reaction (PCR) was tested positive for tuberculosis in all of our patients. Conclusion: While MRI provides an understanding of the topography of the lesion, PCR helped in establishing the diagnosis of tuberculosis in our patients. Awareness about en-plaque tuberculomas can heighten the index of suspicion and can thus prevent aggressive surgical resections and thereby reduce mortality and morbidity.

Standardized Patient’s Views About their Role in the Teaching-Learning Process of Undergraduate Basic Science Medical Students

Pathiyil Ravi Shankar, Neelam Rekha Dwivedi
Introduction: Standardized Patients (SPs) are widely used in medical education. SPs have a number of advantages but also have certain limitations. At the institution, SPs have been used since January 2013 for both teaching-learning and assessment during the basic science years of the undergraduate medical program. Aim: The present study was conducted to investigate the perception of SPs about various aspects of the program and obtain suggestions for further improvement. Materials and Methods: A Focus Group Discussion (FGD) was conducted with a group of five SPs during the second week of November 2015. Respondents were explained the aims and objectives of the study and invited to participate. Written informed consent was obtained. The FGD was conducted using a discussion guide and was audio recorded. Various aspects of the SP program at the institution were discussed. Motivation/s for joining the program and suggestions for further improvement were obtained. Transcripts were created after listening to the recordings and were read through multiple times. Similar responses were coded. Items with similar codes were grouped together into themes. Results: Three respondents were female while two were male. The major advantage of SPs was their flexibility and ability to present a standardized response to the student. Students become familiar and comfortable with SPs. However, as a SP is simulating an illness s/he may not always be able to do complete justice to the role. The process used by SPs to prepare themselves to portray various diseases was highlighted. The use of SPs both during teaching-learning and assessment was also discussed. Some SPs are trained to provide feedback to students. Most SPs joined the program based on invitations from their friends who were already SPs. Challenges in recruiting SPs in a small island were discussed. Suggestions for further improvement were obtained. Conclusion: The present study obtained the perception of SPs regarding various aspects of the SP program at the institution. The overall opinion of SPs was positive.

Evaluation of Autonomic Dysfunction in Obese and Non-Obese Hypertensive Subjects

Amjad Ali, Jyoti Ganai, Shobitha Muthukrishnan, Sunil Kohli
Introduction: Obesity and more specifically, visceral obesity, has been consistently associated with hypertension and increased cardiovascular risk. Epidemiological studies indicate that at least two-third of the prevalence of hypertension can be directly attributed to obesity. Studies also suggest that hypertensive patients have impaired cardiac autonomic function. Aim: The objective of the study was to examine any added effects of obesity on cardiac autonomic dysfunction in hypertensive patients. Materials and Methods: Hypertensive subjects (n=45) between 35-60 years of age were divided into two groups; Group A (n=30) consisted of non-obese hypertensive subjects and Group B (n=15) consisted of obese (BMI=30kg/m2) hypertensive subjects. Cardiac autonomic function was assessed using four tests – Heart rate response to immediate standing (30:15 ratio), standing to lying ratio (S/L ratio), Blood pressure response to immediate standing and Cold Pressor Test (CPT). Results: There were no significant differences for autonomic function tests between obese and non-obese hypertensive subjects (p >0.05). Conclusion: The results showed that there are no significant differences in the cardiac autonomic function responses between obese and non-obese hypertensive subjects.

A Comparative Study to Assess the Determinants and Outcomes of Sepsis Treated in Medical Wards and ICU in an Indian Teaching Hospital

Prasanta Kumar Bhattacharya, Debdutta Gautom, Neena Nath, Hiranya Saikia
Introduction: Sepsis is the primary cause of death from infection worldwide. In resource-limited countries, increasing number of sepsis is managed in non-ICU settings, in Medical Wards (MW). Aim: To compare the burden, aetiology and short term outcome of sepsis treated in MW with ICU. Materials and Methods: Prospective, observational, analytical study in sepsis patients in general MW and medical ICU in a tertiary care hospital. Two hundred forty five sepsis patients (MW=150, ICU=95), =18 years, selected randomly, were studied to compare aetiology, co-morbidities, clinical & microbiological profile and short-term outcome between MW and ICU sepsis. Sepsis following surgery, trauma, those transferred to/from ICU, those with other life threatening diseases were excluded. Chi-square test/Fisher’s-exact test was used for comparing ratios. A ‘p-value’ <0.05 was considered statistically significant. Results: Sepsis was more common in elderly males, both in MW and ICU (median age: 56.7, 59.2 years; male: female ratios = 1.34:1, 1.63:1 respectively). Frequency of presenting symptoms, co-morbidities and sources of sepsis were similar in both groups (p>0.05). Frequency of positive microbiological culture, pattern of microbial flora and antimicrobial resistance patterns were similar in both groups (p>0.05). Number of antibiotics used was significantly higher in ICU compared to MW (p<0.01); multi-organ dysfunction and mortality were significantly higher in ICU settings (55.8% vs. 38.7%, p=0.04; 48.4% vs. 32.6%, p=0.041 respectively). While sepsis and severe sepsis were significantly higher in MW (34.6% vs. 22.1 %, p=0.03; 47.3% vs. 26.3%, p<0.01 respectively), septic shock was significantly higher in ICU (51.6% vs. 18.0%, p<0.01). Mortality in both settings was highest in septic shock (55.5% and 61.2%, p>0.05) and multi-organ dysfunction (55.1% and 64.2%, p>0.05). Duration of hospital stay was significantly shorter in MW than ICU (7.3 vs. 11.0 days, p<0.01). Conclusion: Our study aimed to identify determinants and outcome of sepsis in MW and compare with ICU settings. Antibiotic usage in the two settings differed: concurrent use of =3 antibiotics, and carbapenems & linezolid usage were significantly higher in ICU compared to MW. Sepsis in MW had significantly lower incidence of multi-organ failure, lower mortality and shorter hospital stay compared to ICU.

Study of Aplastic Anaemia with Cyclosporine in Resource Poor Setting
Introduction: Aplastic Anaemia (AA) is a syndrome characterized by peripheral pancytopenia with hypo-cellular marrow. Acquired idiopathic AA is the most common variety, probably of an autoimmune aetiology. Bone Marrow Transplantation (BMT) is the treatment of choice but cost is the limiting factor. Antithymocyte Globulin and Cyclosporine-A is an alternative to BMT. Cyclosporine alone has been tried as a single agent in resource poor setting. Aim: The study was conducted with the aim to observe the treatment response in aplastic anaemia to Cycloserine-A. Materials and Methods: Patients who were diagnosed as AA and opted for Cyclosporine with informed consent were included in the study. All the subjects were started on 5mg/kg of Cyclosporine and were followed up for three months to see the treatment response. This study had the approval from IEC. Results: Twenty patients were enrolled in the study. Age of the patients ranged from 10 to 65 years. Maximum number (10/20) of patients was in the 2nd decade. Most of the patients presented with mucosal bleeds and breathlessness on exertion; the predominant sign was pallor. Eleven patients had severe AA, eight had non severe and one had very severe anaemia. Out of 20, three patients were lost to follow-up and one patient discontinued therapy due to renal dysfunction; finally sixteen patients’ data was analysed. Out of 16 patients, 9 responded and 7 did not respond. Complete response was observed in three patients, partial response in six patients. Seven patients had drug toxicity in the form of acute renal failure and gum hypertrophy. Conclusion: Cyclosporine seems to be a reasonable therapeutic option with good response rate and minimal side effects.

Indications and Visual Outcome of Penetrating Keratoplasty in Tertiary Eye Care Institute in Uttarakhand
Introduction: Corneal blindness forms significant proportion of visual blindness in developing countries and penetrating keratoplasty (PK) can restore vision for this. The prognosis of PK is dependent on the corneal diseases responsible for corneal blindness. Aim: To evaluate the indications and visual outcome of PK in tertiary eye care institute in Uttarakhand. Materials and Methods: Data was reviewed from the medical records of 145 PK done in Department of Ophthalmology, Himalayan Institute of Medical Sciences from January 2012 to October 2014. Analysis of data was done for evaluation of the indications and visual outcome by Paired student’s t-test for hypothesis testing of grouped values of preoperative and last follow-up best corrected visual acuity in cases of optical and therapeutic grafts. A p-value < 0.05 was considered statistically significant. Results: In this study data of 145 eyes of 138 patients was reviewed. The most common indication for keratoplasty was corneal scarring including adherent leucoma 48 (33.10%). Therapeutic keratoplasty was done for 33 cases with maximum 30(20.68%) cases of infectious keratitis. One case of tectonic graft was included in therapeutic keratoplasty group for analysis. There was statistically significant difference (p=.0001) in best corrected visual acuity improvement from 1.39 logMAR+ 0.022(SD) preoperatively to 0.367 logMAR+0.44(SD) postoperatively and 1.4 logMAR+.000(SD) preoperatively to 0.16 logMAR+0.57(SD) postoperatively for optical and therapeutic grafts respectively. Conclusion: Infective keratitis either active or healed was the major indication for keratoplasty. Poor prognosis indications were most common in this part of the country. The visual outcome following corneal transplantation was encouraging particularly in cases of optical keratoplasty.

Perspectives and Challenges of Hmis Officials in the Implementation of Health Management Information System (Hmis ) with Reference to Maternal Health Services in Assam

Janmejaya Samal, Ranjit Kumar Dehury
Introduction: Health Management Information System (HMIS) is one of the important components of National Rural Health Mission (NRHM). The web portal of HMIS was launched by the Ministry of Health and Family Welfare (MOHFW), Govt. of India (GOI) in 21st Oct. 2008 to enable capturing of public health data from both public and private institutions in rural and urban areas across the country. Aim: The aim of the study was to assess the quality perspectives and challenges among HMIS officials in implementing HMIS at their respective levels, i.e. district and block level. Materials and Methods: We conducted a pilot qualitative study in two districts of Assam. HMIS officials working at district and block level were interviewed in-depth with the help of a semi-structured interview schedule which lasted from May to July 2014. Results: Both HMIS and MCTS (Mother and Child Tracking System) formats were considered useful, by the HMIS officials, for data collection, planning at various levels, tracking maternal and neonatal deaths, institutional deliveries. HMIS officials reported that MCTS is useful for monitoring individual health status especially the status of the mother and child and HMIS being helpful as a health facility monitoring tool. Conclusion: The study used a small sample size, hence similar type of studies are required with large sample size to understand the perspectives and challenges of HMIS officials in the implementation of HMIS.

Molecular Characterisation of nfsA Gene in Nitrofurantoin Resistant Uropathogens

DhivyaLakshmi Shanmugam, Shamsadh Begum Esak, Anbumani Narayanaswamy
Introduction: Majority of Urinary Tract Infections (UTI’s) are lower UTI’s which constitute the real burden in the primary care setting and are usually treated empirically. Nitrofurantoin is an underused antimicrobial for empiric therapy for community-acquired and nosocomial lower UTIs. Nitrofurantoin has a wide spectrum of action against Escherichia coli, Klebsiella pneumonia and Enterococci, which are the frequent causes of nosocomial lower UTIs and also against multidrug-resistant gram-negative organisms including extended spectrum beta lactamase (ESBL) producers, Amp-C producers and Carbapenamase producers. Aim: The study was conducted to describe the resistance pattern of nitrofurantoin and to identify the genes responsible for nitrofurantoin resistance (i.e.) nfsA and the type of mutations involved. Settings and Design: This study was conducted in a tertiary care hospital for a period of six months which caters to a total of 1200 beds. Materials and Methods: A total of 115 clinical strains of Escherichia coli and Klebsiella pneumoniae including ESBL and Carbapenemase producing isolates were analysed for susceptibility to commonly used antimicrobials. Results: ESBL producers 65% and 51% of carbapenems resistant strains were susceptible to nitrofurantoin by minimal inhibitory concentration. MIC to nitrofurantoin was determined by E-strip method. Nitroreductase nfsA gene was detected by PCR in 64 of 70 E.coli isolates with reduced susceptibility to nitrofurantoin. Gene sequencing was done using BLAST algorithm and substitution (N=12) and insertion mutation (N=1) were observed in the resistant strains. Conclusion: Nitrofurantoin being an oral antibiotic, its usage in ESBL producers and carbapenamase producers is still warranted. Surprisingly, resistance to nitrofurantoin remains minimal even after extensive use and may be related to the fact that it has multiple mechanisms of action hence may require organisms to develop more than a single mutation to concur resistance.

Morphological Spectrum of Basal Cell Carcinoma in Southern Karnataka
Introduction: Basal Cell Carcinoma (BCC) is the most common skin cancer worldwide, which appears over sun-exposed skin as slow-growing, locally invasive lesion that rarely metastasizes. Many phenotypic presentations are possible. BCCs are more common in males and tend to occur in older people. Majority is found on the head and neck. Many histopathological subtypes have been defined including nodular, micronodular, cystic, superficial, pigmented, adenoid, infiltrating, sclerosing, keratotic, infundibulocystic, metatypical, basosquamous and fibroepitheliomatous. Mixed patterns are common. Aim: The aim was to study morphological spectrum of BCC in a tertiary care hospital in southern Karnataka. Materials and Methods: This was a retrospective analysis of 100 cases of BCCs reported in the Department of Pathology over a 9-year period from 2006 to 2014. Results: The mean age of presentation was 62 years. There was slight female preponderance (56%). The most common location was face (65%) and the most common presentation was ulceration (45%). Of the 100 BCCs, 50% were nodular, 13% infiltrating, 6% basosquamous, 4% superficial, 3% keratotic, 3% multinodular and 1% mixed. Conclusion: BCC, besides being the commonest cutaneous cancer, is also known for its numerous histological patterns which are shown to have prognostic implications. This study reveals the frequency of the various histological patterns of BCC in southern Karnataka, where it has been rarely studied before.

Anaemia in Systemic Lupus Erythematosus Based on Iron Studies and Soluble Transferrin Receptor Levels
Introduction: Haematological alterations such as anaemia, neutropenia and thrombocytopenia are frequent in Systemic Lupus Erythematosus (SLE). Ferritin being an acute phase reactant can be falsely elevated in lupus cases. Aim: To evaluate the haematological alterations and to re-categorise the types of anemia by soluble transferrin receptor levels in diagnosed cases of SLE. Materials and Methods: A sample of 30 newly diagnosed ANA positive SLE patients was taken. Complete blood counts, ESR, reticulocyte count, coagulation studies, diluted Russel Viper Venom Test (dRVVT), mixing studies, serological tests, high sensitivity CRP along with iron profile, transferrin saturation, soluble transferrin receptor (sol TFR) levels, anti-beta2 glycoprotein1, direct and indirect Coomb’s test were estimated in cases diagnosed as SLE. Clinical symptoms were co-related with and Systemic Lupus Erythaematosus Disease Activity Index (SLEDAI) was estimated. Results: Anaemia was the most prevalent haematological alteration followed by thrombocytopenia. Further sub typing of anaemia was done by serum ferritin levels and using sol TFR assays. Ferritin is an acute phase reactant; it underestimated iron deficiency in patients of SLE. When sol TFR was used; patients with pure Anaemia of Chronic Disease (ACD) reduced from 68% to 26%, those with pure IDA reduced from 32% to 16% and a group with co-existing IDA & ACD (58%) was defined {Agreement=53%, p=0.09} by sol TFR which co-related with clinical response to Iron therapy in these patients. CRP was significantly raised in association with disease activity. Fever (p<0.0001), arthritis (p<0.03) were significantly related and CRP was elevated (p<0.04) in cases with high SLEDAI (severe flare). Conclusion: Thus, in SLE, anaemia is the most frequent hematological alteration; iron deficiencies supercede in contrast to ACD and further autoimmune haemolytic anaemia. Sol TFR emerged as a better parameter to detect iron deficiency in patients of non- haemolytic anaemia in contrast to iron profile and ferritin levels.

Expression of CD1a by Langerhan’s Cells in Oral Lichen Planus - A Retrospective Analysis
ntroduction: Langerhan’s Cells (LCs) are dendritic cells of the oral epithelium which play a role in a series of oral lesions from gingivitis to oral cancer. Oral Lichen Planus (OLP) is an oral mucosal T-lymphocyte mediated immunologic reaction to an unidentified putative antigen or allergen. Aim: The aim of this study was to quantify the presence of immature LCs in OLP comparing them with normal epithelium. Materials and Methods: A retrospective study using 30 of OLP cases were conducted. Immunohistochemistry was performed using polyclonal anti-CD1a antibodies to identify LCs in 10 cases of normal tissue and 30 samples of OLP. The distribution of LCs among lesional tissue and normal mucosa was analysed using Mann-Whitney U test . Results: LC population in OLP was significantly higher when compared to the normal epithelium (p<0.001). Conclusion: The increase in LCs indicates the active role played during the antigen detection in OLP and subsequent presentation to T-lymphocytes.

Predictors of Mortality in Paediatric Myocarditis

Shahla Abrar, Mohammed Junaid Ansari, Mahima Mittal, K.P. Kushwaha
Introduction: Paediatric myocarditis can present as mild flu like symptoms to fulminent form. Early identification of the severity of illness and prioritization of intensive care is helpful especially in developing countries with limited resources. Aim: To know the factors at admission that can predict mortality in paediatric myocarditis. Materials and Methods: This was an observational study which enrolled children who presented with fever of acute onset (less than 15 days in duration), and were diagnosed as suspected myocarditis on the basis of clinical features, Troponin I and echocardiography, according to Expanded criteria for myocarditis in Paediatric ward at our institute over a period from August 2014 to December 2015. Their clinical features, cardiac biomarkers and echocardiography findings were compared between survivors and non-survivors. Statistical Analysis: All statistical analysis was done using graphpad Prism 5 and SPSS statistical software. A Fisher exact p-value <0·05 was regarded as significant. Multivariate Logistic Regression was carried out to quantify the relationship between cardiac death and other predictor variables. The logistic coefficients for the predictor variables and their exponents, that is, log odds were calculated. Statistical significance of these predictor variables was interpreted by p-values. Results: A 17.7% (n=11/62) patients of paediatric myocarditis died in this study. New York Heart Association (NYHA) class IV dyspnea (p=0.0115) and hypotension (p=0.0174) were more in patients who did not survive. The mean value of Troponin I was more in the non-survivor group (0.958 ± 1.13ng/ml); (p=0.0074). More number of patients who died had Brain Natriuretic Peptide (BNP) levels increased in their plasma (p=0.0087) with higher mean value (p=0.0175). LV ejection fraction was decreased markedly in non survivor group with mean value of 37±8.09 % as compared to survivor group with mean value of 46.6±10.5%, (p=0.0115). On multivariate analysis, NYHA class IV dyspnea (p=0.0113), BNP (p=0.015) and ejection fraction (p = 0.0284) independently are the predictors of mortality in our study group. Conclusion: Children with myocarditis having hypotension, raised Troponin I, BNP and decreased ejection fraction are more prone to die. NYHA IV dyspnea, higher levels of BNP and decreased EF are independently related to worst outcome.

Fertility Desires and Intentions among People Living with HIV/AIDS (PLWHA) in Southern India
Introduction: The desire of people living with HIV/AIDS (PLWHA) to have children can have significant public health implications. Combination Antiretroviral Therapy (cART) has increased the life expectancy of PLWHA as a result of which they may consider child bearing. There are hardly any studies from India addressing the fertility desires among PLWHA. Aim: This study was done to assess the fertility desires of PLWHA in Southern India. Materials and Methods: It was a cross-sectional study conducted among 230 HIV-positive men and women who presented to Kasturba Medical College (KMC), Mangalore, India. Study was conducted between October 2012 and October 2014. Statistical analysis was performed using SPSS software version 11.5. Chi-square test, Fisher's exact test and student t-test was used to find out the association of various factors affecting fertility desire. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of our study population was 36.3±5.5 years. The mean age of males was 37.3±6 years and for female 34.9±5 years. In our study 132 (57.4%) were males. Majority were literate 229 (99%). Majority of patients were employed 166 (72%). In our study 195 (84.7%) were on cART. Out of 230 PLWHA 39 (16.95%) were unmarried and 151(65.5%) married PLHIV were living with partners at the time of study. In our study 77 (33.5%) patients had fertility desire. Age, gender, marital status, number of children, partner’s fertility desire and HIV status of partner had an association with fertility desire. Conclusion: Providing universal access to cART is the main aim of national programs. It is high time that these programs focus on fertility issues of PLWHA. Reproductive rights of PLWHA need to be respected. Physicians and HIV counselors should proactively discuss and address reproductive issues of PLWHA.

Therapeutic effect of 0.1% Tacrolimus Eye Ointment in Allergic Ocular Diseases
Introduction: Allergic Ocular Diseases (AODs) like Atopic Keratoconjunctivitis (AKC) and Vernal Keratoconjunctivitis (VKC) are chronic forms of ocular allergy that can cause severe visual complications. Pathogenesis of AODs is uncertain and treatment has been a challenge for ophthalmologists. Tacrolimus, a 23-member cyclic macrolide lactone derived from [streptomyces tsukubaensis] now in ointment form has been successfully used in AODs. Aim: To study the therapeutic effect of 0.1% Tacrolimus eye ointment in patients with Allergic Ocular Diseases (AODs). Materials and Methods: This prospective observational study was conducted on 36 patients with severe AOD and moderate cases not responding to conventional treatment. They were treated with 0.1% tacrolimus eye ointment twice daily for minimum three months in addition to conventional treatment and observed for a period of 6 months. Symptoms and signs after treatment were evaluated. Grades of clinical signs were assessed based on slit lamp clinical photographs; development of possible complications was assessed and analysed by Wilcoxon signed rank test. Results: Mean age of patients was 9.3±4.3 years and mean duration of AODs was 3.1±1.8 years. The scores on both the four point scales for signs and symptoms decreased significantly (p<0.0001) after 1 month of 0.1% Tacrolimus eye ointment treatment. Itching was the first symptom to show dramatic relief and conjunctival hyperaemia was the first sign to show improvement. 88.88% of patients were successfully weaned off topical steroids in 6 months into Tacrolimus treatment. Even in patients unresponsive to 0.1% topical Cyclosporine, symptoms and signs scores decreased significantly (p<0.0001). The most common adverse reaction was a transient burning sensation (36.11%). Conclusion: Topical 0.1% Tacrolimus eye ointment was found to be a safe and effective treatment in cases of AODs and also worked as steroid sparing and replacing agent. It was also found effective in patient’s refractory to topical Cyclosporine.

Detection of Porphyromonas gingivalis fimA Type I Genotype in Gingivitis by Real–Time PCR–A Pilot Study

Mahalakshmi Krishnan, Padma Krishnan, S.C. Chandrasekaran
Introduction: Published literature till date reveals a high prevalence of Porphyromonas gingivalis fimA type I genotype among healthy subjects. Quite a few studies have reported its prevalence also in periodontitis patients. Nevertheless incidence of this genotype in gingivitis is lacking in adult population. Aim: The present study was chosen to detect P. gingivalis fimA type I genotype among chronic gingivitis patients. Materials and Methods: A total of 46 subgingival plaque samples collected from chronic marginal gingivitis (n=23) and chronic periodontitis subjects (control group) (n=23) were subjected to Real-Time Polymerase Chain Reaction to detect the P. gingivalis fimA type I gene. Statistical analysis was performed using chi-square test. Results: Prevalence of P. gingivalis fimA type I gene among chronic periodontitis and chronic gingivitis patients were 8.7% and 30.4% respectively. P. gingivalis fimA type I genotype prevalence was found to be statistically insignificant between the two study groups (p=0.135). Conclusion: The avirulent P. gingivalis fimA type I genotype, occurred in high prevalence among chronic gingivitis patients, while its presence was low in chronic periodontitis patients. Presence of this avirulent genotype in chronic marginal gingivitis signifies its reversible condition.

Effects of Preheated Composite on Micro leakage-An in-vitro Study

Joshua Ng Chor Yang, James David Raj, Herald Sherlin
Introduction: Resin composites have been the pinnacle of direct esthetic restorations ever since its discovery. However, it comes with its own disadvantages. Post-operative sensitivity and marginal discoloration frequently occur due to polymerization shrinkage and micro leakage, which is the major cause of failure in resin composite restorations. Aim: To evaluate the effects of preheated composite at different temperatures on microleakage. Materials and Methods: A total of 60 extracted non-carious human premolars were collected and class 1 cavity (1.5x4x 3mm) was prepared in each and were randomly divided into three groups. Group 1 (n=20) was filled with microhybrid resin composite (Heraeus Charisma Smile) at room temperature. Group 2 (n=20) was filled with the same resin composite which was preheated to 50°C and Group 3 (n=20) was filled with resin composite preheated to 60°C. Teeth were subjected to a thermocycling regime (500X, 5 - 55°C), followed by a dye infiltration by immersing in basic fuschin for 24 hours. The tooth was sectioned longitudinally and the extent or absence of micro-leakage was determined by the amount of dye penetration along the resin composite-tooth interface using a confocal microscope. Results: There was minor micro-leakage detected at the occlusal margin of the control tooth specimen. The sample with preheated composite restoration at 50°C showed an intact tooth-restoration interface with no micro leakage. However, the preheated composite at 60°C showed large amount of microleakage. Conclusion: Under the current limitation of the study, preheated composite at 50°C showed the least micro-leakage.

Quality of Life in Infertile Menopausal Women; Development and Psychometric of an Instrument

Ashraf Direkvand-Moghadam, Ali Delpisheh, Ali Montazeri, Kourosh Sayehmiri
Introduction: So far few studies have been designed to evaluate the quality of life instrument in infertile women. Aim: The present study was decided to design a valid and reliable instrument to assess quality of life in Iranian infertile women in postmenopausal period. Materials and Methods: Both quantitative and qualitative research methods were applied. The process was divided into three main stages including: instrument development, instrument validity and instrument reliability. Instrument development used three main steps, including determining content domain, item generation and instrument construction. Instrument was validated using face validity, content validity and factor analysis. Both internal consistency and test–retest reliability methods were used to confirm the reliability of the questionnaire. Results: During content development, domain step obtained 83 items in all demission of life in infertile women. In the qualitative and quantitative face validity, 25 items had item impact less than 1.5 and were excluded from the questionnaire. In the content validity section, 17 items failure to obtain necessary score based on Lawshe formula, so were excluded from the questionnaire. Overall, 8 factors were extracted by factor analysis test. However, 67.38% of the total variance was explained by 4 factors, other 4 next factors explained the remaining 32.62% of the total variance. Totally, 34.01% of rotation variance was explained by first factor and 24.37% by second factor. In questionnaire internal consistency, 8 items had Cronbach’s alpha 0.942. Conclusion: Therefore, we recommend the use of present questionnaire as a valid tool to evaluate the quality of life in infertile women during postmenopausal period.

Transdermal Buprenorphine Patches for Postoperative Pain Control in Abdominal Surgery
Introduction: Buprenorphine is a semi-synthetic derivative of thebaine; its low concentration is sufficient to provide effective pain relief. Aim: To evaluate the efficacy of transdermal buprenorphine patch in postoperative pain management. Materials and Methods: After ethical approval and taking informed consent from the patients, they were randomized into three groups (n=30 in each group) using a computer generated random number table. Group A: placebo patch; Group B: buprenorphine (10mg) patch and Group C: buprenorphine (20mg) patch. Haemodynamic and analgesic effects were compared by using analysis of variance (ANOVA) followed by Turkey’s post hoc test. The proportion of side effects was compared using the Chi-square test. Results: Haemodynamic changes were not statistically different in all the three groups A, B and C, whereas at the end of surgery VAS score of Group A subjects was significantly higher (4.93+0.98) as compared to Group B (1.73+0.64) and Group C (1.40+0.50). On 2nd postoperative day, no pain was reported by the Group C patients and on 4th day after surgery, no pain was reported by Group B patients. Conclusion: The transdermal buprenorphine patch (20mg) was effective in attenuating postoperative pain, maintaining haemodynamic stability requiring no rescue analgesia, with fewer postoperative rescue analgesic requirements in low dose of buprenorphine patch (10mg) group.

Clinical Study of Endometrial Polyp and Role of Diagnostic Hysteroscopy and Blind Avulsion of Polyp
Introduction: Endometrial polyp is one of the common causes of Abnormal Uterine Bleeding (AUB) in the reproductive age group as well as postmenopausal age group. Aim: To study the clinical features of endometrial polyp and the safety and feasibility of blind polypectomy following diagnostic hysteroscopy. Materials and Methods: Total of 256 women who were diagnosed to have endometrial polyp by transvaginal ultrasound and underwent diagnostic hysteroscopy and blind polypectomy by simple avulsion in the period of January 2008 to December 2014 were included in our study. Polyp was confirmed by the histopathology. Results: The prevalence of polyp among women who underwent diagnostic hysteroscopy and blind polypectomy was more common in the age group of 40-49years. Polyps manifested as AUB in 45.6% of our study population. The mean size of the polyp was not significantly different between premenopausal and postmenopausal women and single and multiple polyps. Histopathological study of the polyp showed two malignant polyps in our study population. Premalignant lesions i.e., endometrial hyperplasia without atypia and with atypia was found in 33 women. There was one uterine perforation, one cervical tear; one false passage and one patient had mild bleeding after the procedure. In our study, in the mean follow-up period of 37.57±28.12 months, 3.9% (7 women) had recurrence. In the follow-up period of 16.56±18.96 months, 78.9% women didn’t have recurrence. Conclusion: Diagnostic hysteroscopy and blind polypectomy has low complication rate and recurrence rate and technically feasible for the practicing gynaecologists which dont need much training and is cost-effective also.

An in vitro Comparative Evaluation of Three Remineralizing Agents using Confocal Microscopy
Introduction: The caries process has been thought to be irreversible, resulting in the permanent loss of tooth substance and eventually the development of a cavity. Recent approaches focused on application of remineralizing agents to incipient carious lesions, aim at controlling demineralization and promoting remineralization. Remineralizing agents create a supersaturated environment around the lesion; thus, preventing mineral loss and forces calcium and phosphate ions in the vacant areas. Aim: To compare and evaluate the remineralization potential of Fluoride Varnish, CPP-ACP Paste (Casein Phosphopeptide-Amorphous Calcium Phosphate) and fTCP Paste (functionalized Tricalcium Phosphate) using confocal microscope. Materials and Methods: Two windows of 3X3mm were created on the labial cervical and incisal thirds in 60 permanent maxillary central incisors. The teeth were demineralized to create artificial caries and divided into three groups of 20 each. Group I specimens were coated with Fluoride Varnish once whereas those in CPP-ACP paste group and fTCP group were brushed for 2 minutes, twice daily for 20 and 40 days. The specimens were stored in artificial saliva during the study period and were later sectioned and observed under confocal microscope. Data obtained was statistically analyzed using Fischer’s exact test, ANOVA and post-hoc Bonferroni’s test. Results: Fluoride Varnish, CPP-ACP Paste and fTCP Paste showed remineralization of artificial carious lesions at both the time intervals. Fluoride varnish showed the highest remineralization followed by CPP-ACP Paste and fTCP Paste. A statistically significant increase in remineralization potential of CPP-ACP Paste and fTCP Paste was observed at the end of 40 days as compared to 20 days. Conclusion: Fluoride varnish showed the greatest remineralization potential of artificial carious lesions followed by CPP-ACP Paste and fTCP Paste respectively.

Effect of Calcium Hydroxide, Chlorhexidine Digluconate and Camphorated Monochlorophenol on the Sealing Ability of Biodentine Apical Plug
Introduction: Teeth with immature apex are managed by establishing an apical plug using various materials and techniques. However, the use of previously placed intracanal medicament may affect the sealing ability of permanent filling material used as an apical plug. Aim: To evaluate the effect of removal of previously placed Calcium Hydroxide, Chlorhexidine Digluconate and Camphorated Monochlorophenol as an intracanal medicament on the sealing ability of the Biodentine as an apical plug. Materials and Methods: A total of 72 recently extracted human permanent teeth with single root were selected and stored in saline at room temperature. The crown portion of each tooth was removed at the level of cemento enamel junction; 14mm root length was taken as standard length. All the roots were submerged in 20% sulphuric acid up to 3 mm from the apex, for four days for root resorption. One sample was cut longitudinally to look for root resorption under stereo microscope. The canal preparation was done; the roots were kept in moist gauze after instrumentation. A total of 71 roots were randomly divided into three groups. GROUP 1:Calcium hydroxide paste, GROUP 2: Chlorhexidine digluconate, GROUP 3: Camphorated Monochlorophenol (CMCP). The medicaments were removed with stainless steel hand files and 0.5% sodium hypochlorite irrigation. After removal of medicament Biodentine was placed in apical third of resorbed roots and the remaining portion of the canals was filled with gutta-percha. All the 71 roots were analysed with fluid filtration method for evaluating microleakage. Results: Comparing all the three groups statistically there was no significant difference. The mean values were found more for group 1 followed by group 2 & 3. Conclusion: All the groups showed microleakage. Calcium hydroxide showed the maximum microleakage followed by Chlorhexidine digluconate and least with CMCP.

Comparison of Oxidative Stress Markers and Serum Cortisol between Normal Labor and Selective Cesarean Section Born Neonates
Introduction: An imbalance between antioxidant and oxidant-generating systems in newborns can cause oxidative damage. The effect of modes of delivery on oxidative stress in neonates is not fully investigated. Aim: This study was aimed to examine the effects of modes of delivery on oxidative stress markers and cortisol in newborns. Materials and Methods: In this study 60 term neonates {30 born via Normal Delivery (ND) and 30 born via elective Caesarean Delivery (CS)} at birth were enrolled. Glutathione Peroxidase (GPx), Catalase (CAT) and Superoxide Dismutase (SOD) activities were determined in umbilical cord blood in all neonates. Moreover serum cortisol, uric acid and Total Antioxidant Capacity (TAC) were measured. Results: GPx and SOD activities in cesarean born neonates were significantly higher than those of control subjects (p<0.05). TAC and CAT were not significantly different between the two groups. Serum cortisol was lower in caesarean born subjects as compared to normal born neonates. On the other hand uric acid concentration was higher in caesarean born neonates. Conclusion: The obtained data indicated that babies born via caesarean section might be predisposed to pathological conditions due to altered antioxidant levels.

Prospective Randomized Study of Oral Diazepam and Baclofen on Spasticity in Cerebral Palsy

Vinay Goyal, Nonica Laisram, Ranjan Kumar Wadhwa, Shashank Yashwant Kothari
Introduction: Spastic cerebral palsy (CP) is the most common form of CP. Diazepam and Baclofen are the most commonly used oral drugs to manage spasticity. Study was designed to evaluate and compare their effects and safety in CP children. Aim: Study was aimed to assess and compare outcome of oral Diazepam and Baclofen in spastic cerebral palsy children in terms of extent of reduction of spasticity and side effects profile. Materials and Methods: Randomized prospective follow-up study was done for one year after giving Diazepam and Baclofen in weekly incremental doses upto recommended maximum dose to 60 children for three months. Two primary outcome measures were spasticity reduction and adverse effect profile. Spasticity reduction was measured by Modified Ashworth's Scale (MAS) and Range of Motion improvement (ROM). Results: After random allocation, there was no baseline difference between groups. Mean MAS score improved from 1.96±0.4 at baseline to 1.63±0.40 and 1.41± 0.36 at 1 month and 3 months for Diazepam and from 1.84±0.64 to 1.57±0.59 and 1.31± 0.48 respectively for Baclofen. Within the group reduction was significant with p-value = 0.0001. Intergroup comparison showed no statistically significant difference with p-value of 0.48 and 0.22 at 1 and 3 months. Baseline ROM showed significant improvement at 1 and 3 months with p value of 0.004 and 0.001 for Diazepam and 0.01 and 0.000 for Baclofen respectively with no statistically significant difference among two groups. Drowsiness was most common observed side effect in both the groups. Conclusion : Patients showed significant improvement in spasticity as measured by Mean MAS score and range of motion in Diazepam as well as Baclofen group. Both drugs were found safe for use in children. Study couldn't establish any difference between the two drugs. However studies with bigger sample size and longer follow- up assessing functional improvement in patients will be required in near future.

Anthropometric Predictors of Bio-Impedance Analysis (BIA) Phase Angle in Healthy Adults

Nazeem Ishrat Siddiqui, Sarfaraz Alam Khan, Mohammad Shoeb, Sukhwant Bose
Introduction: Phase Angle (PhA) is a ratio of whole body reactance and resistance obtained from Bioelectrical Impedance Analysis (BIA). It indicates cellular health and integrity and is considered as prognostic tool in medical disorders. In spite of prognostic potentials of PhA, it has limited usefulness in clinical practice and in population studies because of non-availability of normal population reference limits for comparison. Moreover, it is influenced by various factors like age, sex, race and body composition (i.e. body fat, muscle mass, visceral fat, body cell mass, total body water, etc). Aim: The aim of this study was to evaluate predictors of phase angle which will be useful in formulation of reference values for Indian population. Materials and Methods: BIA was performed by Tanita Body Composition Analyser on healthy adults aged 17-24 years. The inbuilt software measured the phase angle by the formula: Phase angle (PhA) = Reactance (xc)/Resistance (R)* (180/p). Phase angle values were compared across categories of age, sex, weight, height, Body Mass Index (BMI), total fat, visceral fat and muscle mass. Results: Mean value of phase angle was found to be 5.65. Phase angle was significantly (p< 0.001) higher in male than in female. Phase angle was significantly predicted from height (p< 0.001), weight (p< 0.002), muscle mass (p< 0.002) and visceral fat (p< 0.02) in multiple regression models. Conclusion: Phase angle differs across anthropometric and body composition categories. Thus height, weight and muscle mass should also be taken into consideration while deriving population specific reference limits of phase angle.

Comparative Evaluation of Ciprofloxacin Levels in GCF and Plasma of Chronic Periodontitis Patients: Quasi Experimental Study
Introduction: For any antimicrobial approach to be successful in periodontal therapy, it is important that the antimicrobial agent targets the sub-gingival biofilm by attaining sufficient concentration at the sub-gingival site. Aim: The purpose of the present study was to determine and compare the concentrations of ciprofloxacin present in Gingival Crevicular Fluid (GCF) and plasma after its systemic administration. Materials and Methods: A total of 20 subjects, in the age group of 30-60 years satisfying the inclusion and exclusion criteria, were chosen from the outpatient Department of Periodontology, Government Dental College and Hospital, Hyderabad and consent was obtained. Subjects were put on oral ciprofloxacin therapy (Baycip, Bayer Corporation) of 500mg twice daily doses for five days to establish steady state tissue levels of the agent. GCF and serum samples were collected at the 72nd hour after the first dose of ciprofloxacin and were compared using unpaired t test. Results: The mean gingival index value of the subjects was 1.8 ± 0.59 and the mean probing depth of the subjects taken in the study was 5.724 ± 0.47mm. The results of this study showed that ciprofloxacin concentrations were significantly higher (p<0.001) in GCF than in plasma. Conclusion: Results from the present study and those from the earlier studies clearly indicate the ciprofloxacin’s ability to reach and concentrate in infected periodontal sites via GCF. This property of ciprofloxacin may be useful for eradication of periodontal pathogens, thus improving the outcome of periodontal therapy.

Assessment of Skeletal Maturation in Concordance to Statural Height and Body Weight in 12–Year–Old Children – A Cross–Sectional Study
Introduction: To analyse the importance of bodily characteristics of growing children and its correlation towards skeletal maturity. This further aids orthodontists in proper treatment planning. Aim: The purpose of this study was to assess the correlation between cervical vertebrae maturation, statural height and body weight as measured in 12 -year-old children. Materials and Methods: Lateral cephalograms were taken as a part of treatment records in 94 children along with their statural height and body weight. The Cervical Vertebrae Maturation Index (CVMI) was used to trace the C2, C3 and C4 vertebrae respectively and the data were then correlated to the chart provided by the Indian Council for Medical Research (ICMR). Results: The overall sample showed a statistically significant correlation between CVMI and height (p=0.047). Girls showed significant correlation in their mean heights to the CVMI staging (p=0.012) while the boys exhibited a maximal mean height value in Cervical Stage (CS) 5 followed by CS3. There was no significant correlation between weight and CVMI. The mean CVMI stage seen in boys and girls were CS2 and CS3 respectively. Conclusion: There exists a definitive correlation between height and CVMI stages in growing children. Girls showed an advanced level of skeletal maturity in comparison to boys. CVMI staging should be used along with statural height and body weight when considering growth modification procedures.

A Retrospective Study of the Treatment Outcome of Drug Therapies used in Heart Failure Patients with Associated Co-morbidities in a Tertiary Care Hospital
Introduction: Heart failure is one of the most common heart problems seen in the Indian population. There are various drugs used to prevent further progression of the disease. In India, there are few studies in relation to treatment outcome in a tertiary care hospital. Aim: To study the treatment outcome of drug therapies used in heart failure patients with associated co-morbidities in a tertiary care hospital. Materials and Methods: This was an observational study conducted on 250 patients with heart failure. Details collected using the proforma were demography (age, gender); medical history; medication history for heart failure patients on admission and discharge; ejection fraction; median length of stay in hospital; number of readmissions & in-hospital mortality. Results: One hundred and twenty eight patients categorized into LVSD group (ejection fraction <40%) and 122 patients in PSF group (ejection fraction > 40%). Medical history of coronary artery disease (54%) was significantly higher in LVSD group (p<0.05) and anaemia (19%) was significantly higher in PSF group (p<0.05). On admission, inotropes (30%), digoxin (59%) and statins (54%) were prescribed more in LVSD patients (p<0.05) while calcium channel blockers (20%) were prescribed more in PSF group (p<0.05). At discharge, patients with LVSD were receiving ACE inhibitors (51%), beta blockers (30%), digoxin (67%) and statins (59%) (p<0.05) while calcium channel blockers (20%) was prescribed more in PSF group. The median length of stay was slightly higher in patients with PSF (7 days) as compared to LVSD (6 days). In-hospital mortality was lower in patients with PSF (6%) than patients with LVSD (20%). The percentage of readmissions within one month was slightly higher in patients with PSF (15%) compared to LVSD (14%). Conclusion: Length of stay in hospital was 6-7 days in heart failure patients. In hospital mortality in LVSD patients (20%) was higher compared to PSF patients (6%). A 15% heart failure patient were readmitted within 1month of discharge.

Enigmatic Weak D antigen: An Experience in a Tertiary Care Hospital of East Delhi
Introduction: The Rh blood group system is one of the most polymorphic and immunogenic blood group systems in humans. The expression of Rh blood group antigen is complex, among that Rh-D antigen is the most important antigen because of its immunogenicity. It is easy to detect D antigen in most of the cases. Sometimes, variable expression of Rh-D antigen leads to presence of weak forms. Weak D reacts variably with anti D sera and poses a problem in blood banking. Molecular genetics of Rh-D revealed that weak D antigen is a Rh-D phenotype that possesses less numbers of complete D antigens on the surface of red blood cells. Aim: Present study was carried out to study weak D positivity in a tertiary neuropsychiatry hospital of East Delhi for compatibility testing in blood transfusion, to assess the implications and need of weak D testing and for population genetics study. This study tried to observe pattern of weak D antigen in four broadly classified religious communities also (Hindus, Muslims, Sikhs and Christians). Materials and Methods: This was a two years prospective hospital based study including patients as well as donors. All patients were tested for Rh-D factor by commercially available monoclonal anti-D sera. The individuals who were found negative with anti-D were further investigated for weak D antigen by using indirect antiglobulin test (IAT) by tube as well as gel card technique. Results: The results were compiled by using SPSS software version 21.0 and Microsoft excel. Among 3619 cases, 3502 (96.7%) were Rh-D factor positive while 117(3.2%) were Rh D factor negative. Among these 117 Rh-D negative cases, 9 (7.6% out of total Rh-D negatives and 0.25% out of total samples) were weak D positive and 108(2.98%) were actually D negative individuals after IAT. Weak D positivity showed a slight predominance in females (55.5%). As per broad religious communities, weak D antigen was found in Hindus only and not observed in Muslims, Sikhs and Christians. In weak D positive individuals, B phenotype (0.43%) was found to be most common followed by A (0.26%) and O (0.2%). Conclusion: Considerably high frequency of weak D antigen was noticed in study samples of this hospital. With this data based information, it is felt worthwhile to perform weak D testing routinely of those individuals who are negative with saline anti-D to prevent possibility of haemolysis and for efficient blood transfusion practices by making compatible blood available.

Total Thyroidectomy for Benign Thyroid Diseases: What is the Price to be Paid?
Introduction: Total thyroidectomy has been used to treat patients with malignant thyroid disease. But for patients with benign thyroid disease, the safety and efficacy of total thyroidectomy is a matter of debate. Subtotal thyroidectomy that was previously the treatment of choice for benign thyroid disease has been associated with high recurrence rates. The risk of permanent complications is greatly increased in patients who undergo surgery for recurrence of benign thyroid disease. Total thyroidectomy is an operation that can be safely performed, with low incidence of permanent complications, which allows one to broaden its indications in various benign thyroid diseases, thus avoiding future recurrences and reoperations. Aim: To assess the benefits of total thyroidectomy for benign thyroid diseases. Materials and Methods: This randomized prospective study was conducted between Feb 2013 and Nov 2014 in the Department of General Surgery at Bangalore Medical College and Research Institute. It included 116 patients undergoing total thyroidectomy procedure for benign thyroid disease. All cases were followed-up for a period of 6 months for incidence of RLN palsy, hypoparathyroidism, disease recurrence and number of incidental malignancies detected on postoperative histological analyses of the thyroid specimens. Results: Most of the patients were in the third decade of their lives. The female to male ratio was 6.7:1. Total thyroidectomy was done for 116 benign thyroid diseases with multinodular goiter as the most common diagnosis. The incidence of postoperative hypocalcaemia was 16.37% (however, only 1 patient developed permanent hypocalcaemia) and that of wound infection was 2.58% and seroma formation was 2.58%. None of the patients included in this study had haematoma formation or RLN paralysis. An incidental malignancy was identified in 11.20% patients. Conclusion: Total thyroidectomy shows benefits in eradicating multinodular goiter, alleviating Grave’s opthalmopathy, treating Hashimoto’s thyroiditis and preventing recurrence. It decreases the likelihood of future operations for recurrent disease or completion thyroidectomy for incidental thyroid cancer thus decreasing the associated risks of increased morbidity associated with second operation. Therefore, for benign thyroid diseases requiring surgical management total thyroidectomy can be considered the treatment of choice.

The Ultrasonographic Determination of the Position of the Mental Foramen and its Relation to the Mandibular Premolar Teeth

Abdullah Ebrahim Laher, Feroza Motara, Muhammed Moolla
Introduction: The position of the mental foramen has been well researched in cadaver specimens, radiographically as well as intraoperatively. To our knowledge, this landmark study is the first to make use of ultrasonography in a study population to determine the position of the mental foramen in relation to the mandibular premolar teeth. Ultrasonography has great potential to further revolutionize the practice of medicine and dento-maxillofacial surgery. Aim: To make use of ultrasound to determine the position of the mental foramen and its relation to the mandibular premolar teeth. Materials and Methods: One hundred Black and Caucasian subjects were enrolled. A high frequency (8MHz) transducer (PLF.805ST) of a diagnostic ultrasound system (model SSA-510A) was applied above the inferior border of the mandible, just lateral to the mentum. With the marker of the transducer pointing cranially, the position of the mental foramen in relation to the closest mandibular premolar tooth was determined. The position was compared across race, sex and age groups. Results: All mental foramina (100%) were visualised. Overall the most frequent position of the mental foramen was in line with the long axis of the second premolar on the right (44%) and between the first and second premolars on the left (44%). There were no statistical differences (p >0.05) between race groups, sex and age groups with regard to the position of the mental foramen in relation to the mandibular premolars. However, in Blacks, the most frequent position of the mental foramen was in line with the long axis of the second premolar and in Caucasians the most common position was between the first and second premolars. The most frequent position of the mental foramen in females was in line with the long axis of the second premolar on the right and between the first and second premolars on the left. In males, the most frequent position of the mental foramen was in line with the long axis of the second premolar bilaterally. The most common position of the mental foramen in the age group category 18-30 years was between the first and second premolars. In patients aged 31-60 years the most frequent position was in line with the long axis of the second premolar. Conclusion: Ultrasound is a sensitive modality to locate the mental foramen. There are differences in the most common position of the mental foramen with regard to the long axis of the premolar teeth. Ultrasonography has the potential to revolutionize the practice of dento-maxillofacial surgery.

Estimation of Salivary and Serum Biomarkers in Diabetic and Non Diabetic Patients - A Comparative Study

Amit Ladgotra, Pradhuman Verma, Seeth Aramaiah Sunder Raj
Introduction: Blood is the gold standard body fluid for diagnosis of Diabetes Mellitus (DM) but saliva offers an alternative to serum as a biological fluid for diagnostic purposes because it contains serum constituents. Aim: The study was conducted to estimate and compare serum and salivary glucose, amylase, proteins, calcium and phosphorus levels in DM and healthy subjects and to evaluate whether saliva can be used as a diagnostic fluid in DM patients. Materials and Methods: Study consisted of 120 subjects from OPD of Surendera Dental College, Sriganganagar, Rajasthan, India. The study groups were divided into Group I-60 DM patients (Type I & II) and Group II-60 healthy subjects. The saliva and serum samples were collected from each subject and levels of different biochemical parameters were estimated. Results: Mean serum level of glucose (211.50 ± 43.82), amylase (79.86 ± 16.23), total proteins (6.65 ± 0.84), calcium (7.17 ± 0.91) and phosphorus (3.68±0.65) as observed in Group I while in Group II, glucose (88.81±11.29), amylase (77.67±14.88), total proteins (6.35±0.76), calcium (7.52±0.97) and phosphorus (3.96 ± 0.91) were noted. Mean salivary level of glucose (14.10±6.99), amylase (1671.42±569.86), total proteins (1.33±1.11), calcium (10.06±2.76) and phosphorus (13.75±4.45) as observed in Group I while in Group II, glucose (5.87± 2.42), amylase (1397.59 ±415.97), total proteins (1.36±0.81), calcium (7.73±2.78) and phosphorus (8.39 ± 1.95) were noted. On comparing values in saliva and serum, among two groups, an insignificant difference (p>0.005) was found between few of them. Conclusion: Values regarding blood and salivary biochemical parameters were distinctly different between two groups suggesting salivary parameters can be used as a diagnostic alternative to blood parameters for diabetes mellitus .

Buccal Micronucleus Cytome Assay in Sickle Cell Disease
Introduction: Sickle Cell Anaemia (SCA) is a commonly inherited blood disorder preceded by episodes of pain, chronic haemolytic anaemia and severe infections. The underlying phenomenon which causes this disease is the point mutation in the haemoglobin beta gene (Hbß) found on chromosome 11 p. Increased oxidative stress leads to DNA damage. DNA damage occurring in such conditions can be studied by the buccal micronucleus cytome assay, which is a minimally invasive method for studying chromosomal instability, cell death and regenerative potential of human buccal tissue. Aim: To evaluate genomic instability in patients with sickle cell disease by buccal micronucleus cytome assay. Materials and Methods: The study included 40 sickle cell anemia patients (Group A) and 40 age and sex matched controls (Group B). Buccal swabs were collected and stained with Papanicolaou (PAP). Number of cells with micronucleus, binuclei, nuclear bud, pyknosis and karyolysis were counted in two groups as parameters for the evaluation of genome stability. Results: All the analysis was done using t-test. A p-value of <0.001 was considered statistically significant. There was a statistically significant increase in micronuclei number in SCA patients when compared with controls. Karyolytic (un-nucleated) cell number in Group A was more than to those of the controls. Conclusion: The results might suggest that patients with sickle cell anaemia have genome instability which is represented by the presence of micronuclei in the somatic cells. Presence of apoptotic cells might only indicate the bodily damage to the tissue as a result of the disease.

Assessment of Oral Health Knowledge, Attitude and Self-Care Practice Among Adolescents - A State Wise Cross- Sectional Study in Manipur, North Eastern India
Introduction: The World Health Organization global strategy of promoting oral health have shown vast improvements in developed countries but the scenario is glum among underprivileged communities due to lacunae in implementation of these promotional programs. Manipur, a North Eastern state in India, is one such marginalized area. Aim: The study aimed to evaluate Knowledge, Attitude and Practice (KAP) towards oral health in 15-18 year adolescents residing in Manipur together with the association of these variables to sociodemographic factors. Materials and Methods: This cross-sectional study included 810 healthy adolescents drawn from various primary health care centers spanning in all the nine districts of Manipur. A closed ended questionnaire for the purpose of collecting data was used in the survey. Results: Of the total participants 90.9% had high knowledge, 79.8% had favorable attitude and 70.4% had adequate practice towards oral health. Education of the parents and respondents was the only factor significantly associated with all three variables, knowledge, attitude and practice. Significant and positive linear correlation between knowledge-attitude (r=0.369, p<0.01) knowledge-practice (r=0.405, p<0.01) and attitude-practice (r =0.353, p<0.01), were observed. Conclusion: An overwhelming majority of the respondents had high knowledge, favorable attitude and sound practice with respect to oral health. A positive linear correlation exists between the knowledge, attitude and practice. Evidence based reinforcement programs should be introduced to further reduce the gap between knowledge, attitude and practice. The study will also serve as a reference value for use in future evaluation to help measure the effectiveness of the planned activities. Future research needs to focus on establishing the dental caries prevalence and oral hygiene status of Manipuri youth.

The Effect of Some Polymorphisms in Vitamin D Receptor Gene in Menopausal Women with Osteoporosis

Morteza Dehghan, Razieh Pourahmad-Jaktaji
Introduction: Vitamin D receptor gene is one of candidate genes related to osteoporosis expansion. The association of ApaI, TaqI, BsmI polymorphisms in vitamin D receptor gene with bone metabolism and density has been area of intrest in many studies. Aim: This study was conducted to further investigate the association between the ApaI, TaqI, BsmI polymorphisms and bone density. This study was analytical study. Centers for bone density measurement in southwestern Iran. Materials and Methods: In this analytical study, 200 participants aged 45- and above 45-year-old women referring the centers of bone density measurement participated. The bone density of femoral neck and lumbar vertebrae was measured using dual-energy X-ray absorptiometry method. Based on t-score, the participants were assigned into patients (n=130) and healthy individuals (n=70). Different genotypes of ApaI (AA/Aa/aa), TaqI (TT/Tt/tt), and BsmI (BB/Bb/bb) were determined by PCR-RFLP. The data on bone density and PCR-RFLP were analysed by chi-square and ANOVA. Also, triad combination of the genotypes was statistically analysed. For each genotype combination, chi-square was run between the patients and control group and p-value was calculated. Results: No significant association was seen between ApaI polymorphism and bone density (p>0.05). TaqI and BsmI polymorphisms had a significant association with femoral neck’s bone density (p<0.05), but these polymorphisms were not significantly associated with lumbar vertebrae’s (p>0.05). Patients with homozygous dominant TT genotype had the least bone density in femoral neck compared to other genotypes. Lumbar vertebrae’s bone density was similar in three TaqI genotypes. The patients with homozygous recessive bb genotype had the least bone density in femoral neck and lumbar vertebrae compared to other genotypes. Conclusion: TaqI and BsmI polymorphisms could be desirable markers in diagnosis of women at risk of osteoporosis in the studied region in Iran. Therefore, these women will receive suitable medical treatment at proper time.

Comparison of Dental Caries Experience in Children Suffering From Epilepsy with and without Administration of Long Term Liquid Oral Medication
Introduction: Sucrose is added as sweetening agent in liquid oral medication (LOM) to mask the acrid taste of medicines which may be potentially cariogenic. Many children under long term LOM therapy for treatment of epilepsy may be susceptible to dental caries. Aim: To assess and compare dental caries experience in children under long term liquid oral medication with those not under such medication among 2-12 years old children suffering from epilepsy. Materials and Methods: A cross-sectional study was undertaken on a total of 84 children aged 2–12 years, who were suffering from epilepsy receiving liquid oral medication for more than 3 months were selected (study group) and for comparison 106 children of similar age group and disease but on other forms of medication were included as control group. Dental caries was assessed using DMFT/DMFS (Decayed, Missing, Fillled Teeth / Surfaces), dmft/dft and dmfs/dfs indices. One-way ANOVA and t-test were used with p-value fixed at 0.05. Univariate logistic regression was applied. Results: Children on LOM were at increased risk of dental caries than those with other forms of medications (OR: 2.55, 95% CI (2.37-4.15) p=0.000, HS). Caries prevalence was high in the study group (76.1%) when compared to control group (55.6%). Conclusion: Long term use of liquid medicines containing sucrose is a risk factor for dental caries among children with epilepsy.

Histopathological Trends of Testicular Neoplasm: An Experience over a Decade in a Tertiary Care Centre in the Malwa Belt of Central India
Introduction: Testicular and para-testicular neoplasm are rare type of tumours affecting adolescents and young adults, reflected by the paucity of published data in India. Aim: This study was undertaken to estimate the epidemiological characteristics and histological types and subtypes of testicular neoplasm according to the WHO classification in our patient group. Identification of histopathological pattern of testicular tumour is immensely important for improved management protocols. Materials and Methods: This was a retrospective study done over a period of ten years from 2004 to 2014 in a tertiary care centre. All relevant clinical data including patient’s age, laterality, history of risk factors and serum tumour markers were collected from records. Histopathological slides were retrieved and reviewed for tumour and its subtype and classified according to WHO classification (2004). Results: A total of 37 cases of testicular and paratesticular neoplasm were encountered in our study with a mean age of 38.1 years. Right testis was affected in 70.3% of cases. The most common clinical presentation was scrotal swelling with heaviness. Germ cell tumour was the most common type accounting for 77.1% followed by lymphomas (17.1%). Germ cell tumours were categorized into seminomatous (48.2%) and non-seminomatous tumours (51.8%). The most common subtype of non-seminomatous tumours was mixed germ cell tumour accounting for 85.8%. Conclusion: The incidence of testicular neoplasm among general population in Asian countries is low, as reflected in the very few studies that have been performed and published in literature. Epidemiological and histomorphological spectrum of our study was comparable to most of the countries except for some African and Western countries.

Evaluation of Effect of Brushite-Calcite and Two Indigenous Herbs in Removal of Fluoride from Water
Introduction: The acceptable concentration of fluoride in drinking water is 1.5mg/l. Excess fluoride in drinking water causes fluorosis. Fluorosis is an important public health problem in India. Several treatment technologies suggested in the past for removing excess fluoride generated and causes various chemical byproductswhich are hazardous to public. In recent years, there has been a resurgence of interest to use natural materials due to cost and associated health and environmental concerns of synthetic organic polymers and inorganic chemicals. Aim: The aim of this study was to evaluate and compare the defluoridating capability of the brushite-calcite with that of two indigenous herbs, tulsi and wheat grass. Materials and Methods: One gram of brushite-calcite combination, tulsi and wheat grass were separately added to 10 containers, each containing 1.0 l of prepared distilled water with a fluoride concentration of 5ppm and naturally fluoridated water at 2ppm. Half of the samples were boiled for one minute in a domestic electric kettle for one minute and allowed to cool. The remaining half of the samples was left un-boiled. Fluoride concentration in all the samples was assessed at the end of 30 minutes and 24 hours using fluoride ion selective electrode method. Data was analyzed using unpaired t-test and one-way ANOVA. Results: For water with 2ppm and 5ppm fluoride, brushite-calcite had shown highest de-fluoridation capacity (p=0.001) at the end of both 30 minutes and 24 hours in boiled samples whereas tulsi (p=0.001) was most effective in un-boiled samples. Conclusion: The results of the study suggest that tulsi can be used for domestic water defluoridation as it is economic, safe and effective.

Evaluation of Tlr2 and 4 in Chronic Periodontitis
Introduction: Periodontal disease is the major cause of adult tooth loss and is commonly characterized by a chronic inflammation caused by infection due to oral bacteria. Members of Toll-Like Receptor (TLR) family recognize conserved microbial structures, such as bacterial lipopolysaccharides and activate signalling pathways that result in immune responses against microbial infections. Aim: The aim of the present study was to assess the mRNA expression of Toll-Like Receptor 2 and 4 in tissues with or without chronic periodontitis. Materials and Methods: Gingival tissue samples were collected from controls (30 subjects with healthy periodontal tissues) and experimental group (30 subjects with chronic periodontitis). Total RNA was extracted and RT-PCR was done for evaluation of TLR-2 and TLR-4. Mann Whitney U-test, Pearson Chi-square Test was used for statistics. Results: The results showed that there is a significant (p-value= 0.004) association between TLR-4 and the experimental group comprising of chronic periodontitis patients in comparison to the insignificant (p-value= 0.085) TLR-2 expression. Conclusion: This study concludes that TLR-2 and TLR-4 expressed in the gingival tissues recognize different bacterial cell wall components thus helping us to associate its potential in diagnosing periodontal disease. Hence, in the future, these scientific findings can pave the way in using TLR as a diagnostic biomarker for periodontal disease.

Comparison of the Antimicrobial Efficacy of Octenidine Dihydrochloride and Chlorhexidine with and Without Passive Ultrasonic Irrigation - An Invitro Study

Bastin Cherian, Paras Mull Gehlot, Mysore Krishnaswamy Manjunath

Clinicopathological Study of Non-Infectious Erythaematous Papulosquamous Skin Diseases

Sushma Hosamane, Muktha Pai, Thoppil Reba Philipose, Umaru Nayarmoole
Introduction: Papulosquamous diseases are characterized by scaly papules and plaques with similar clinical picture which amounts to confusion and hence, a definitive histopathological diagnosis goes a long way in treatment of such diseases. Aim: The aim of the study was to study the histomorphology of non-infectious, erythaematous, papulosquamous lesions of skin with clinicopathological correlation. Materials and Methods: Skin biopsies from 150 clinically diagnosed/suspected non-infectious erythaematous, papulosquamous skin diseases were received in the Department of Pathology. The specimens obtained were subjected to formalin fixation and paraffin embedding, stained with haematoxylin and eosin and studied. The lesions were classified as psoriasis, lichen planus, lichen nitidus, lichen striatus, pityriasis rosea and pityriasis rubra pilaris and clinicopathological correlation was done. Results: Papulosquamous lesions were common in the elderly. Males were commonly affected except in pityriasis rosea. Among the 150 cases studied, 72 cases (48%) were histopathologically confirmed to be papulosquamous lesions. Psoriasis was the most common lesion. Conclusion: Key histopathological features and clinicopathological correlation gives a conclusive diagnosis. The importance of specific histomorphological diagnosis lies in distinguishing these lesions as the treatment and prognosis varies widely.

Cadaveric Study on Morphology of Dorsal Interossei of Hand and its Anatomical Variation
Introduction: The dorsal interossei are the abductors of the fingers and the knowledge of its variation help the surgeon in treatment of fractures, claw hand and compartment syndromes. Aim: To note the origin, insertion, pattern of muscle fibres and tendon length of all the dorsal interossei of hand. Materials and Methods: Routinely dissected 30 formalin fixed hand in the Department of Anatomy, KMC, Manipal, were observed for origin, insertion and tendon length and muscle pattern of dorsal interossei. Results: Out of 30 hands, presence of supernumerary muscle was observed in three hands. Presence of three heads of dorsal interossei was noted in one hand. Conclusion: The finding of present study is of importance to surgeons and orthopaedicians during conservative and surgical management of hand deformity. Adequate knowledge of these muscular variations is also important in treatment of fractures, stiff hand, claw hand or tendon transfer.

Diagnostic and Prognostic Significance of Various Histopathological Features in Extrahepatic Biliary Atresia
Introduction: Extrahepatic biliary atresia is a progressive disorder characterised by fibroinflammatory obliteration or stenosis of the extrahepatic biliary tree leading to obstruction of bile flow and cholestatic jaundice. It is the most common cause for cholestasis in newborn. Histopathological criteria for diagnosing biliary atresia from liver biopsy have not been clearly defined. Aim: This study was undertaken to analyse the significance of the various histopathological features in diagnosis and prognosis of extrahepatic biliary atresia from liver biopsy specimens. Materials and Methods: This was a retrospective study of 43 cases of extra-hepatic biliary atresia diagnosed and treated at a tertiary care hospital between January 2010 to December 2014. Formalin fixed paraffin embedded liver biopsy tissues were processed by standard technique and the slides were stained with haematoxylin and eosin. All the slides were reviewed and graded by a semi-quantitative scoring system. Features such as increased age at kasai’s portoenterostomy, portal fibrosis, bile duct proliferation, cholestasis, portal inflammation and duct plate malformation were studied. Statistical analysis was worked out using SPSS 17.0 (statistical package for the social science software). Chi-square test was used to find association between various parameters with respect to mortality and Kaplan-Meier estimator was used for survival analysis of the population under study. Results: In this study comprising of 43 cases, only 6 cases (13.95%) were alive at the end of 6 months follow-up. Twenty patients who died and the 17 cases with poor survival had greater degrees of fibrosis, bile duct proliferation and cholestasis. Majority of the cases with duct plate malformation expired inspite of earlier surgical intervention. Thus proving the association of fibrosis, bile duct proliferation, cholestasis and duct plate malformation with the survival and prognosis of biliary atresia cases. Age at surgery did not show any correlation with prognosis as cases operated even at <60 days had poor survival. Conclusion: From this study it can be concluded that in extrahepatic biliary atresia patients, presence of duct plate malformation, greater degrees of fibrosis, bile duct proliferation and cholestasis were strongly associated with poor prognosis.

Evaluation of Antifungal Efficacy of Ethanolic Crude Lawsone and Listerine Mouthwash in Uncontrolled Diabetics and Denture Wearers - A Randomized Clinical Trial
Introduction: Lawsonia Inermis (LI) is a shrub cultivated throughout India. Many in vitro studies have been done on antifungal activity of LI, although none of the studies have been conducted invivo. Aim: To evaluate the antifungal efficacy of ethanolic extract of crude lawsone in comparison with listerine mouth wash in known diabetics and wearing dentures. Materials and Methods: A total of 60 subjects were taken and randomly divided into two groups of 30 each. Group 1 received crude lawsone mouthwash and Group 2 received listerine mouth wash. Oral rinse technique was performed. Each subject was given distilled water at baseline and Colony Forming Units (CFU) of candidal species was determined. Post therapeutic samples were then collected 1hr and 1week following drug usage and they were further advised to use given mouth washes twice daily with volume of 5ml/rinse for 30 seconds and CFU was evaluated. Results: Crude lawsone mouthwash showed superior antifungal activity when compared to listerine mouthwash. On individual comparison of both mouth washes at baseline, 1hr and 1week highly significant results were obtained using inferential statistics. The inter group comparison was done using independent t-test where lawsone was considered to be more effective in reducing CFU, at 1hr and 1week of using the mouth wash (p<0.01). Subjective symptoms like taste and smell were determined by chi square test where good taste was felt for lawsone and olfactory satisfaction was good with listerine (p<0.01). Burning sensation was found to be more with listerine mouth wash. Conclusion: The present study revealed superior antifungal activity with ethanolic extract of crude lawsone mouth wash compared with listerine mouthwash.

An Evaluation of the Stress Distribution in Screw Retained Implants of Different Crown Implant Ratios in Different Bone Densities Under Various Loads-A FEM Study
Introduction: Studies on stress distribution around screw retained implants in different bone densities are limited. In clinical situations crowns of different heights are placed on the implants and the effect of varying crown implant ratio on the bone is not understood properly. Aim: To evaluate and compare the stress distribution in different screw retained implants for different crown–implant ratios in different bone densities under various occlusal loads using three dimensional finite element analyses. Materials and Methods: In this invitro study the stress distribution was evaluated and compared between two different crown heights (7.5mm, 10mm) retained on implants by using different screw materials (commercially pure titanium, titanium alloy) in two different densities of bone D2, D3 under various load (100N, 200N) applications by using finite element analysis. Results: For crown height of 7.5mm, in D2 bone density when vertical load of 200N was applied, the maximum stress concentration was 1780N/cm2, for oblique load of 100N it was 2936N/cm2 respectively and in D3 bone density when vertical load of 200N was applied, the maximum stress concentration was 1820N/cm2, for oblique load of 100N it was 3477N/cm2 respectively. When the crown height is increased to 10mm, the maximum stress concentration in D2 bone was 1875N/cm2 for vertical load, 4015N/cm2 for oblique load and in D3 bone the maximum stress concentration was 2123N/cm2 for vertical load and 4236N/ cm2 for oblique load. In case of titanium screws for crown height of 7.5 mm, when vertical load was applied, stress concentration was 1603 N/cm2 where as for titanium alloy screw it was 1820N/cm2. In case of 10mm crown height stress concentration was 1904N/cm2 for titanium screw and 2123N/cm2 for titanium alloy screw. In case of oblique loading for 7.5mm crown height stress concentration was 3155N/cm2 for titanium screw 3477N/cm2 for titanium alloy screw. For 10mm crown height stress concentration was 4236N/cm2 for titanium screw, 4663N/cm2 for titanium alloy screw. Conclusion: Stress concentration was less and stress distribution was better in D2 bone density than in D3 bone density. Stress concentration was less and stress distribution was better in commercially pure titanium screw than in titanium alloy screw. With the increase in the height of crown (i.e., from 7.5mm to 10mm) stress concentration and stress distribution also increased.

A Therapeutic Effects of Atorvastatin on Genetic Damage in Coronary Artery Disease
Introduction: Coronary Artery Disease (CAD) a multifactorial chronic heart disease and the most frequent cause of death and disabling symptoms worldwide, occurs due to the formation of atheromatous lipid rich plaques in the arteries. Statins, which inhibit cholesterol biosynthesis, have both pleiotropic and Low-Density Lipoprotein (LDL)-lowering properties. Atorvastatin is one of the choices for the primary and secondary prevention of cardiovascular disease and management of hypercholesterolaemia. However, there is a paucity of data regarding the changes in the DNA damage in patients with coronary atherosclerosis after statin use. Aim: The aim of the present study was to evaluate atorvastatin treatment efficacy on lipid profiles and DNA damage in CAD patients. Materials and Methods: The current observational study was conducted on 180 CAD patients between November 2011 to December 2013 at Durgabai Deshmukh Hospital and Research Centre, Vidya Nagar, Hyderabad, India. Atorvastatin administered and blood samples were collected at index hospitalization and after 6 months statin therapy and lipid profiles and DNA damage was compared with 200 healthy control. Results: Lipid profiles and DNA damage were found to be significantly high (p < 0.01) in CAD patients before atorvastatin therapy compared to after 6 months statin therapy and healthy controls. Conclusion: The study suggests that atorvastatin might help in regression of lipid profile as well as DNA damage of CAD patients.

Effect of Lump Size and Nodal Status on Prognosis in Invasive Breast Cancer: Experience from Rural India

Monique Garg, Nitin Nagpal, Darshan Singh Sidhu, Amandeep Singh
Introduction: Breast cancer is now the leading cause of cancer among Indian women. Usually large tumour size and axillary lymph node involvement are linked with adverse outcome and this notion forms the basis of screening programs i.e. early detection. Aim: The present study was carried out to analyse relationship between tumour size, lymph node status and there relation with outcome after treatment. Materials and Methods: Fifty patients with cytology-proven invasive breast tumours were evaluated for size, clinical and pathologic characteristics of tumour, axillary lymph node status and outcome data recorded on sequential follow-up. Results: Mean age of all participated patients was 52.24±10 years. Most common tumour location was in the upper outer quadrant with mean size of primary tumour being 3.31±1.80cm. On pathology number of lymph nodes examined ranged from 10 to 24 and 72% of patients recorded presence of disease in axilla. Significant positive correlation (p<0.013; r2=0.026) between tumour size and axillary lymph node involvement on linear regression. Also an indicative correlation between size and grade of tumour and axillary lymph node status was found with survival from the disease. Conclusion: The present study highlights that the size of the primary tumour and the number of positive lymph nodes have an inverse linear relationship with prognosis. Despite advances in diagnostic modalities, evolution of newer markers and genetic typing both size of tumour as T and axillary lymphadenopathy as N form an integral part of TNM staging and are of paramount importance for their role in treatment decisions and illustrate prognosis in patients with invasive breast cancer.

Incidence of Foramen of Huschke in South Andhra Population of India

P. Sharmila Bhanu, K. Devi Sankar
Introduction: Foramen of Huschke (FH) is an opening present in anteroinferior wall of External Acoustic Meatus (EAM) on the tympanic plate of temporal bone. The developing tympanic ring normally gets closed by the age of 5 years, if not, leads to the persistence of FH, shows a communication between the EAM and mandibular fossa of temporal bone. Aim: The aim of the present study was to report on the incidence of FH in adult skulls and individual temporal bones, belonging to South Coastal Andhra population. Materials and Methods: Ninety three skulls and 34 temporal bones (18 right and 16 left) obtained from the Department of Anatomy and ENT respectively, irrespective of their sex were utilized. This Tympanic Plates (TP) was observed for the occurrence of FH. Results: Incidence of FH was found in 18 (16.22%) on right and 24 (22.02%) on left side. Bilateral FH was seen in 13 (13.98%) and multiple FH was 13 (5.91%). Mostly it was situated on left than the right side. Conclusion: This study revealed that about 38% of South Coastal Andhra crania have FH. The presence of FH may render external and middle ear structures vulnerable to injury during arthroscopy of the Temporomandibular Joint (TMJ). Since FH can result in TMJ herniation and salivary gland fistulisation through the anterior wall of the bony EAM, surgeons working in this area must be cautious during surgical procedures. Also, data obtained from different populations, as observed from our study can be useful in racial and anthropological studies.

An Innovative Method of Assessing the Mechanical Axis Deviation in the Lower Limb in Standing Position

Jagannath Kamath, Raja Shekar Danda, Nikil Jayasheelan, Rohit Singh
Introduction: Various methods of measuring mechanical axis deviation of lower limb have been described including radiographic and CT scanogram, intraoperative fluoroscopy with the use of an electrocautery cord. These methods determine the mechanical axis in a supine, non-weight bearing position. Although long cassette standing radiographic view is used for the purpose but is not available at most centres. A dynamic method of determining the mechanical axis in a weight bearing position was devised in this study. Aim: The aim of the study was to describe a simpler and newer method in quantifying the mechanical axis deviation in places where full length cassettes for standing X rays are not available. Materials and Methods: A pilot study was conducted on 15 patients. The deviation from the mechanical axis was measured using a manually operated, hydraulic mechanism based, elevating scissor lift table. Patient was asked to stand erect over the elevating lift table with both patellae facing forward and C-arm image intensifier was positioned horizontally. Radiological markers were tied to a radio-opaque thread and placed at the centre of head of the femur and another at the centre of the tibio-talar joint. C-arm views of the hip, ankle and knee joint were taken to confirm the correct position of the marker by varying the height of the lift table. Results: The mechanical axis deviation values were recorded by measuring distance between the centre of the knee and radio-opaque thread in cm. This was measured in each case both clinically and from the image on the monitor. The two values were found to be statistically same. Pain was measured on VAS. Mechanical axis deviation values and VAS score were found to be positively significantly correlated. Conclusion: This technique is dynamic, unique and accurate as compared to other methods for assessing mechanical axis deviation in a weight bearing position.

Detection of Respiratory Syncytial Virus using Direct Fluorescent Antibody Assay in Paediatric Patients with Acute Respiratory Tract Infection

Roopa Bhandary, Rekha Boloor
Introduction: Severe Respiratory Syncytial Virus (RSV) pulmonary disease manifesting as bronchiolitis and pneumonia continues to play a major role in the childhood mortality and morbidity. Hence the present study was undertaken to evaluate the prevalence of RSV among hospitalized children presenting with Acute Respiratory Tract Infection (ARTI) and its correlation with risk factors. Aim: To determine the occurrence of RSV related respiratory tract infection in paediatric patients and to access the risk factors and clinical features associated. Materials and Methods: RSV antigen detection was performed by Direct Fluorescent Antibody (DFA) staining on 100 nasopharyngeal aspirate collected from hospitalized children below 5 years of age with a diagnosis of ARTI. Results: Out of the 100 samples tested for RSV with DFA, 22 (22%) were found RSV positive with a mean age of 12 months and a male to female ratio of (1.75:1). Clinical features significantly associated with RSV were wheezing and breathlessness. Congenital heart disease (CHD) and prematurity were the risk factors significantly associated with RSV infection. Conclusion: RSV infection is a significant cause of morbidity among children presenting with ARTI. In resource limited countries DFA can be used as an important tool for rapid detection of RSV and can potentially eliminate prolonged hospitalization and unnecessary use of antibiotics.

Comparative Evaluation of Preemptive Analgesic Effect of Injected Intramuscular Diclofenac and Ketorolac after Third Molar Surgery- A Randomized Controlled Trial

Deepthi Mony, Deepak Kulkarni, Lakshmi Shetty
Introduction: Analgesia pre-emptively administered effectively aid in management of pain. Pre-emptive analgesia is anti-nociceptive treatment which prevents altered central sensitization of afferent inputs. Aim: To compare and evaluate the pre-emptive analgesic efficacy of preoperatively administered ketorolac and diclofenac for controlling postoperative pain after third molar surgery. Materials and Methods: A total of 50 patients with symmetrically impacted third molars were divided into two groups, 30mg intramuscular injection of ketorolac and 75 mg diclofenac sodium were used in the respective groups. The visual analogue scale was used to assess post operative pain for three days and the patients were also evaluated for the number of rescue analgesia. Results: The data was statistically evaluated with paired ttest. The maximum time taken for pain perception for Group A Ketoralac was 5.48 hrs and Group B Diclofenac sodium was 4.9 hrs and p=0.235 which was not significant. The mean number of tablets taken by the patients in the first three post operative days was 3.24 in Group A i.e., Ketorolac and 4.04 in Group B i.e., Diclofenac sodium. The values were compared using the paired t test. The p value = 0.004, which was significant. Conclusion: Ketoralac showed better pre-emptive analgesic effect for post-operative pain management after third molar extraction. The immediate post-operative pain free period provided by both ketorolac and diclofenac by intramuscular route was same.

Serum Proteins Alteration in Association with Body Mass Index in Human Volunteers

M. Madhuvanthi, G.V. Lathadevi
Introduction: Serum proteins are an important indicator of the nutritional status in an individual. There is a worldwide prevalence of both undernourishment and obesity. It has been suggested that low Body Mass Index (BMI) is associated with a decrease in serum protein levels predisposing them to other illnesses. Overweight and obese individuals carry risk for various other non-communicable diseases. Aim: To compare the serum protein levels in underweight, overweight and obese individuals with that of normal body mass index individuals. Materials and Methods: This prospective study was conducted in subjects who attended the master health checkup clinic of PSG hospitals. Subjects in the age group of 20-50 years were selected. Their serum proteins and BMI was measured. Twenty subjects each of underweight, normal, overweight and obese individuals were selected, categorized and compared. Results: The serum protein level of normal individuals (Group I) was compared with underweight (Group II), overweight (Group III) and obese subjects (Group IV) by one-way ANOVA analysis. The mean serum total proteins in gm/dl in group I controls was 7.555±0.37 compared to Group II (underweight) which was 7.295±0.419. Low BMI was found to be associated with a decrease in serum protein level which was not statistically significant. Elevated BMI as in overweight and obese subjects showed no significant alterations in serum protein levels with p >0.05 and the changes were found to be independent of the body mass index. Conclusion: Underweight individuals showed a decrease in serum protein levels whereas there were no significant changes in the serum protein levels in overweight and obese individuals.

Supraclavicular Brachial Plexus Block With or Without Dexamethasone as an Adjuvant to 0.5% Levobupivacaine: A Comparative Study

Ritu Baloda, Jatinder Paul Singh Bhupapal, Parmod Kumar, Gurjit Singh Gandhi
Introduction: Brachial plexus block is an excellent method for attaining optimal operating conditions by producing complete muscular relaxation, maintaining stable intraoperative haemodynamics and the associated sympathetic block. In addition, they provide extended postoperative analgesia with minimal side effects. Different adjuvants have been described in literature to hasten the onset and prolong the duration of block. The present study was conducted to study the effect of adding dexamethasone to levobupivacaine in supraclavicular brachial plexus block. Aim: To observe the effect of dexamethasone on onset and duration of anaesthesia, when used as an adjuvant to levobupivacaine in supraclavicular brachial plexus block. Materials and Methods: A total of 60 patients in the age group of 18-65 years belonging to ASA physical status I or II were included in the study. They are randomly allocated in two groups and each group included 30 patients. In group 1, patients received 30ml of 0.5% isobaric levobupivacaine with 2ml of isotonic sodium chloride. In group 2 patients received 8mg (2ml) dexamethasone in addition to 30ml of 0.5% isobaric levobupivacaine. Results: The results showed that the onset of sensory and motor block were faster in group 2(p<0.05). The duration of sensory and motor block were significantly longer in group 2 (p<0.05). VAS score at 12 hours were significantly lower in group 2 (p<0.05). None of the patients had bradycardia, hypotension or any other side effects. Conclusion: Dexamethasone added to levobupivacaine for supraclavicular brachial plexus block reduces the time to onset of sensory and motor blockage and prolongs the duration of analgesia.

Association of Intrauterine Device (IUD) and Cervical Neoplasia - A Study in a Poor Nigerian Population
Introduction: Intrauterine Device (IUD) is a contraceptive method used by women of reproductive age group. However, there are conflicting reports on the association between IUD and cervical neoplasia. These controversies may further hamper the poor uptake of modern contraception in Nigeria. Aim: This study was therefore aimed at evaluating the association between IUD and cervical neoplasia. Materials and Methods: This was a case control study in which Pap smear results of 156 participants on IUD were compared with those of 156 non-users of modern contraception. The participants who were found to have abnormal cervical smear cytology results were further subjected to colposcopy. Biopsy specimens for histology were collected from the participants with obvious cervical lesions or those with suspicious lesions on colposcopy. The results were analysed with descriptive and inferential statistics at 95% level of confidence. Results: Seven (4.5%) and 2(1.3%) of participants using IUD had Cervical Intraepithelial Neoplasia (CIN) 1 and CIN 2 respectively. Also, 5(3.2%) and 1(0.6%) of non-users of modern contraception had CIN 1 and CIN 2 respectively. The prevalence of cervical neoplasia among all the participants was 4.8%. Although, the proportion of women who had CIN was more among participants using IUD than non-users of modern contraception, the difference was not statistically significant. Conclusion: There was no significant association between IUD and cervical neoplasia in this study.

Changing Trends of Skin Cancer: A Tertiary Care Hospital Study in Malwa Region of Punjab
Introduction: Skin cancer constitutes a small but significant proportion of patients with cancer. Although the presence of eumelanin in dark skin is protective against the development of skin cancer, it is increasingly being diagnosed in the Indian population. Aim: To study the profile of skin cancer patients presenting to a tertiary hospital in Malwa area of Punjab, India. Materials and Methods: Retrospective study was done to analyse the profile of skin cancer patients who attended the institution over one year from 1st December 2013 to 30th November 2014. A comprehensive review of aetiology and related risk factors was done to correlate the environmental factors with high skin cancer prevalence in this region. Results: Skin cancer constituted (3.18%) 84 out of 2638 patients registered with cancer of all types. The age of the patients was 62±14.2 years and ranged from 27 to 92 yrs. Basal cell carcinoma (BCC) was the most common histological type(46/84, 54.76%) followed by squamous cell carcinoma (SCC) (31/84, 36.91%) and malignant melanoma (MM) (7/84, 8.33%). Male: female ratio was found to be 0.79:1. BCC showed higher female preponderance (p<0.05). Head and Neck was the commonest site involved (p<0.05). Majority (88%) of patients were from rural area. 92% of patients were directly into the profession of agriculture with history of prolonged exposure to sunlight. Conclusion: Skin cancer constitutes a small but significant proportion of patients with cancers. This study highlights a paradoxically increasing trend of BCC and female preponderance. Head and neck is the most common site involved. Exposure to Ultra Violet B (UVB) radiation and higher levels of arsenic in drinking water has been reported to be associated with skin cancers. Limited studies show that levels of arsenic and pesticides were higher in the samples of drinking water in Malwa area of Punjab. Therefore a multipronged strategy to provide safe drinking water supply and discouraging the indiscriminate use of pesticides is recommended.

Factors Contributing Towards Poor Asthma Control in Patients on Regular Medication

Siddharth Gosavi, Pratibha Nadig, Alamelu Haran
Introduction: In-spite of the availability of effective medications, it is observed that patients with bronchial asthma on treatment are poorly controlled. An objective evaluation of asthma control especially with respect to inflammation and the factors contributing towards poor control is crucial in obtaining relief of symptoms. Aim: 1) To measure the asthma control using modified Mini Asthma Quality Of Life Questionnaire (MAQOL) and sputum eosinophil count; 2) To identify the role of factors viz. age, duration of asthma, severity, compliance, technique of inhalation and knowledge of asthma action plan on asthma control. Materials and Methods: Total 50 asthmatic patients on regular medication were included in the study after obtaining written informed consent. The asthma-control was evaluated based on history, clinical symptoms, need for short-acting bronchodilators, FEVs1 and sputum eosinophil count with the help of modified MAQOL. A global score of <80% was considered as poor control. The proportion of patients under each factor, in poorly-controlled group (PC) was compared with the well-controlled group (WC). The results were analysed using descriptive statistics and unpaired student’s t-test. Results: Of the total, 33 (66%) patients were in PC category with a mean global asthma score of 58.46 ± 2.881 vs 85.2 ± 1.19 in the WC group (34%) (p<0.05). The mean age in PC was 41.41 ± 2.413 vs 29.00 ± 2.157(p<0.05) in the WC. The mean duration of asthma was 16.76 ± 2.761 in PC vs 7.882 ± 2.065 years in WC (p<0.05). The severity score was 7.265 ± 0.4434 in PC vs 6.706 ± 0.64 in WC. Eight patients in PC and six in WC were unaware of the treatment plan. One in PC group and three in WC were unaware of technique of inhalation. One in PC group and three in WC were non–compliant. Mean sputum eosinophil count was 7.441 ± 1.081 in PC vs 5.176 ± 1.201 in WC. Conclusion: MAQOL is useful in evaluating asthma-control. Sputum eosinophil count correlates with asthma-control. Duration of asthma, age and severity contributed significantly to the poor control of asthma. There is a need for an objective monitoring in asthma and the treatment strategies need to be modified accordingly

A Study on the Impact of Hyperhidrosis on the Quality of Life among College Students
Introduction: Hyperhidrosis (HH) is a condition characterized by excessive sweating or perspiration. The general population, especially in developing countries like India are seldom aware of this condition and sparsely seek medical attention. The tropical climate and the environment also influence this condition to a greater extent. This can be a hindrance in their professional and social life. Though, it is a widely explored topic, studies on hyperhidrosis from India are rare. Aim: The current study was aimed at estimating the prevalence of hyperhidrosis among college students subjectively and to assess the quality of life using Dermatology Life Quality Index (DLQI). Materials and Methods: Five hundred students with age ranging from 17 to 21 years of both genders were included in this study using convenient sampling method. After explaining the study and getting written consent, the students were requested to respond to two questionnaires, one for the subjective diagnosis of hyperhidrosis using a standardized questionnaire developed by North Jersey Thoracic Surgical Associates and the other to assess the quality of life using DLQI. Based on the subjective prevalence scores, the students were divided into 3 groups as “Not bothersome” group, “Somewhat bothersome group” and “Extremely bothersome” group. The DLQI scores of these three groups were compared by ANOVA using SPSS 21.0. Results: The study revealed that overall, 38% of the students were suffering from somewhat bothersome to extremely bothersome hyperhidrosis. Gender analysis showed that male students were affected more (58%), especially with palmar hyperhidrosis and were significantly requiring treatment when compared to female students. Analysis of DLQI scores using ANOVA revealed the fact that overall quality of life was significantly affected in almost 35% of students to the extent that they require appropriate treatment and care. Conclusion: This study brings into light the higher prevalence of hyperhidrosis and also its impact on the quality of life among college students in this tropical region.

Cadaveric Study of Berretini Communications in North Indian Population

Neelamjit Kaur, Rajan Kumar Singla, Jagdev Singh Kullar
Introduction: Intercommunication between peripheral nerves deserves special attention in view of their clinical significance. Superficial palmar communication between the median nerve and ulnar nerve is referred to as Berrettini Anastomosis. The presence or absence of this communicating branch varies between individuals. Earlier, incidence of Berretini communication reported varied significantly (4-94%). Aim: The aim of this study was to find out the frequency with which Berretini communication is found in North Indians. Materials and Methods: The present study was conducted on 60 upper limbs of 30 cadavers at the Government Medical College, Amritsar. The whole course of the median nerve and the ulnar nerve was exposed. Communicating rami in the hand were identified, cleaned and photographed. Results: In all the six (10%) variant limbs, the communicating branch originated from lateral common palmar digital branch of ulnar nerve and joined medial common palmar digital branch of median nerve. Single communication with oblique course was seen in all the variants. Further, its ontogeny and clinical implications have been discussed in detail. Conclusion: The Berretini anastomosis was seen in 10% upper limbs of the present study. Damage to the communicating branch or the severing of the branch might result in sensory loss which may be difficult to diagnose owing to the large number of variations in the origin of the communicating branch. The patterns of sensory impairment may vary depending upon the branch of median and ulnar nerve it is seen connecting.

Evaluation of a New Self-Reported Tool for Periodontitis Screening

Antonio Renatus, Tanja Kottmann, Fabian Schwarzenberger, Holger Jentsch
Introduction: Periodontitis is still highly prevalent in industrial population whereas at the same time appropriate screening programs are missing. Aim: To evaluate, a self-reported questionnaire about periodontal risk factors in combination with the Periodontal Screening Index (PSI) to identify an existing need for periodontal treatment combined with the early recognition of high-risk patients. Materials and Methods: Total 200 patients took part in the questionnaire based study and were examined using the PSI. Thereafter the participants were divided into two groups, subjects with periodontitis (Group 1; PSI 0-2) and subjects without periodontitis (Group 2; PSI 3-4). The answers were evaluated using a point system ranging from 0 to 8, based on known periodontal risk factors and their assumed degree of influence. Receiver-Operating Characteristic (ROC) curve analysis were applied to examine the overall discriminatory power, sensitivity, specificity and corresponding cut-off points of the self-reported periodontal disease scale. Results: There was a significant difference between Group 1 and 2 concerning the majority of the inquired items (12 of 16, p<0.05). The distribution of the individual total score exhibited a high statistical significance (p<0.001) of robustness in terms of differing definitions of periodontitis. The Area Under the Curve (AUC) was 0.912 with a sensitivity of 86% and a specificity of 76%. Conclusion: The questionnaire produced a reliable assessment of the individual risk (total score) and the need for periodontal treatment as well as the differentiation between gingivitis and periodontitis. Clinical relevance: Patient-based data (clinical variables and periodontal risk factors of periodontitis) were adequate to make a preliminary assessment of a possible need for periodontal treatment.

Clinical Evaluation of Proclination of Lower Anterior Teeth during Alignment using a Single Width Bracket-A Pilot Study
Introduction: The pre-adjusted brackets are available in various prescriptions and sizes; nevertheless there are still many controversies as to which pre-adjusted edgewise bracket offers the maximum clinical efficiency. Aim: This study was conducted to determine and compare the amount of lower incisor proclination during de-crowding if any of the Mini-Uni Twin Brackets with that of the standard double width brackets. Materials and Methods: A total of 20 patients i.e., 10 patients in each group both males and females were randomly selected for the study from subjects seeking treatment, the selected samples were grouped as follows. Group I – Double Width Brackets (3M Unitek Gemini Series) 0.018” slot with Roth prescription. Group II – Mini Uni-Twin Bracket (3M Unitek) 0.018” slot with Roth prescription. Results: The Mini-Uni Twin Brackets had statistically significant (p = 0.01) amount of proclination of the lower anteriors (0.8o± 0.3o) after de-crowding as compared to the standard Double Width Brackets and since the mean change in the Incisor Mandibular Plane Angle (IMPA) was lesser than 1o, its clinical significance could be questionable. Conclusion: The Mini Uni Twin brackets are comparatively efficient in the lower anterior decrowding but further comparative clinical studies need to be performed on these Mini Uni Twin brackets, with an increase in the sample size and also the number of parameters to prove its total clinical efficiency

A Study of the Extended Lipid Profile including Oxidized LDL, Small Dense LDL, Lipoprotein (a) and Apolipoproteins in the Assessment of Cardiovascular Risk in Hypothyroid Patients

Sanjiv Kumar Bansal, Rakhee Yadav
Introduction: Hypothyroidism is one of the most common metabolic disorders associated with dyslipidemia which poses a higher risk of Coronary Artery Disease (CAD) in such patients. Biochemical markers which can pick up the risk promptly are becoming imperative now-a-days and thus the assessment beyond the conventional lipid profile is the need of the hour. Aims: To assess the association of non-conventional lipid parameters like small dense Low Density Lipoprotein (sd LDL), oxidized Low Density Lipoprotein (ox LDL), Apolipoprotein A (Apo A1), Apolipoprotein B (Apo B) and Lipoprotein (a) {Lp(a)} in hypothyroid patients and compare their values with the conventional lipid parameters such as Total Cholesterol (TC), Triglyceride (TG), Low-Density Lipoprotein Cholesterol (LDL-C) and High-Density Lipoprotein Cholesterol (HDL-C). Materials and Methods: One hundred and thirty clinically proven patients of hypothyroidism aged 20-60 years and equal number of age and gender matched healthy individuals were included in this case control study. Serum sd LDL, ox LDL, Apo A1, Apo B, Lp (a), lipid profile, Thyroid Stimulating Hormone (TSH), Free Triiodothyronine (FT3 ) and Free Tetraiodothyronine (FT4 ) levels were measured in both the groups. The data was recorded and analysed on SPSS system. The results of cases and controls were compared by student t-test and one-way ANOVA. All the parameters were correlated with TSH by Pearson’s correlation. Results: We found significantly high levels of sd LDL, ox LDL, Apo B, Lp (a), TC, TG, LDL-C in cases as compared to the controls. Ox LDL has shown maximum correlation with serum TSH (p<0.0001, r=0.801) followed by sd LDL (p<0.0001, r=0.792), Apo B (p<0.001, r=0.783) and LDL-C (p<0.001, r=0.741). Moreover, ox LDL and sd LDL were found to be increased in normolipidemic hypothyroid patients thereby giving a strong supportive evidence that estimation of these parameters can become fundamental in prompt identification of the high risk patients of CAD in hypothyroid population. Conclusion: Non-conventional lipid parameters appear to be better markers for the assessment of cardiovascular risk in hypothyroidism and might help in the designing of the effective treatment protocols and areas of intervention by the clinicians as well as researchers.

Correction: 2016 May: 10(5): OD29-OD30
Mohan Varadanayakanahalli Bhojaraja, Pradeep Kumar Reddy Kistampally, Karthik S Udupa, Joseph Thomas, Kanthilatha Pai, Subcutaneous Panniculitis-Like T-Cell Lymphoma: A Rare Tumour. (Published in Journal of Cilinical and Diagnostic Research). 2016 May: 10(5): OD29-OD30 In this article, one deserving Author was missed, her name has now been added in the author list (5th Author).

Rare Undifferentiated Tumour of Thyroid: Primary Thyroid Fibrosarcoma
Primary thyroid fibrosarcoma cases are very rare. Although it is a known fact that soft tissue sarcomas show slow growth, there have been some cases in literature similar to our case in which there was a fast-growing tumour tissue causing breathing and swallowing difficulties due to painless pressure. For diagnosis, there is no specific clinical or radiological finding. We report a 67-year-old male with a mobile fast-growing mass covering almost all over the neck that appeared 2 months prior to the admission. Laboratory findings showed that the patient was euthyroid. Fine needle aspiration biopsy results are consistent with suspicion of a mesenchymal, histiocytic, epithelial or lymphoid tissue origined malignancy. Patient was taken into surgical operation. The thyroid tissue invaded the main vascular structure, trachea and esophagus. Due to this situation R1 resection was applied. Immunohistopathological examination showed a conventional type of fibrosarcoma. After the surgery, radiotherapy and chemotherapy had been planned and applied. Patients died before the radiotherapy sessions ended. It should be kept in mind that a rapid growth in thyroid tissue can be thyroid fibrosarcoma, there could be a rapid clinical course and poor prognosis after operation.

Extramedullary Haematopoiesis in a Case of Pilomatricoma

Bembem Khuraijam, Parul Sobti, Darilin Shangpliang, Nita Khurana
Pilomatricoma is a benign follicular skin appendage tumour. It usually occurs as solitary lesion and is most commonly seen in the face and upper extremeties. Here we report a rare case of extramedullary haematopoiesis (EMH) in pilomatricoma in a 38-year-old lady.

Unusual Variation in the Branching Pattern of the Celiac Trunk and Its Embryological and Clinical Perspective

Shilpi Agarwal, Babita Pangtey, Neelam Vasudevava
Knowledge of variations in the branching pattern of Celiac Trunk (CT) is important for surgeries of stomach, duodenum, pancreas and hepatobiliary region, for abdominal aortic aneurysm, for liver transplant and chaemoembolization of hepatic tumours. An unusual variation in the branching pattern of CT was observed in 50-year-old male cadaver of Indian origin. CT divided into six branches out of which right & left inferior phrenic arteries originated as first two branches and left gastric artery as the third branch. CT ended into three terminal branches as common hepatic artery, splenic artery & dorsal pancreatic artery. Right gastric artery originated from left hepatic artery instead of common hepatic artery. A variant hepatic artery to the left lobe of liver was also observed which originated from right gastric artery. Anatomical variations in the branching pattern of CT are due to developmental changes in ventral splanchnic artery.

Deep Soft Tissue Leiomyoma of Forearm: A Case Report and Review of Literature

Babulreddy Bommireddy, Vijay Gurram
Leiomyomas are benign tumours of smooth-muscle origin representing 4.4% of all benign soft-tissue neoplasms. They are classified as cutaneous, vascular and leiomyomas of deep soft tissues. Leiomyomas rarely occur in extremities and are more common in the lower limb than in the upper extremity. Deep soft tissue leiomyomas are even rare with a very few reported cases so far in the literature. A 25-year-old female presented to us with an atraumatic slowly enlarging mass in the right forearm from 6 months with mild erosion of cortex of radius. She was otherwise healthy, MRI revealed a soft tissue lesion involving the interosseous space, isointense on T1, slightly hyperintense on T2 and hyperintense on STIR images. The tumour was excised intoto. The case is presented due to its rarity and the risk of tumor misdiagnosis. It should be considered in the differential diagnosis of any solitary painful slow growing mass of the extremities. If adequate margins are obtained recurrence of this tumour is very rare.

Benign Fibrous Histiocytoma of Mandible: Report of A Case and Updated Review
Introduction: The pre-adjusted brackets are available in various prescriptions and sizes; nevertheless there are still many controversies as to which pre-adjusted edgewise bracket offers the maximum clinical efficiency. Aim: This study was conducted to determine and compare the amount of lower incisor proclination during de-crowding if any of the Mini-Uni Twin Brackets with that of the standard double width brackets. Materials and Methods: A total of 20 patients i.e., 10 patients in each group both males and females were randomly selected for the study from subjects seeking treatment, the selected samples were grouped as follows. Group I – Double Width Brackets (3M Unitek Gemini Series) 0.018” slot with Roth prescription. Group II – Mini Uni-Twin Bracket (3M Unitek) 0.018” slot with Roth prescription. Results: The Mini-Uni Twin Brackets had statistically significant (p = 0.01) amount of proclination of the lower anteriors (0.8o± 0.3o) after de-crowding as compared to the standard Double Width Brackets and since the mean change in the Incisor Mandibular Plane Angle (IMPA) was lesser than 1o, its clinical significance could be questionable. Conclusion: The Mini Uni Twin brackets are comparatively efficient in the lower anterior decrowding but further comparative clinical studies need to be performed on these Mini Uni Twin brackets, with an increase in the sample size and also the number of parameters to prove its total clinical efficiency.

Fetal MR Imaging Analysis of Sirenomelia with Clinico Radiographic Correlation: A Case Report

Madhavi Nori, Raghavendra G. Prasad, Arvind K Reddy, Sandeep Reddy Cheguri
Sirenomelia is a social curiosity, a medical and diagnostic challenge prenatally compounded by varied diagnostic difficulties. Prenatal diagnosis of sirenomelia was and continues to be a challenge although von klippel et al., described a case at 10 weeks of gestational age. However, they needed a second imaging at 12th week for confirmation. First trimester or early second trimester anatomic survey on ultrasound and MRI is accurate for the diagnosis thereby avoiding unnecessary complex pregnancy. We report a case of second trimester diagnosed sirenomelia, with detailed analysis of image findings on ultrasound and fetal MRI.

Intracranial Tuberculoma Presenting as Atypical Eclampsia: A Case Report
Occurrence of eclampsia before 20 weeks of pregnancy and after 48 hours of delivery in the absence of typical signs of hypertension and or proteinuria is termed as atypical eclampsia. Atypical or non-classic eclampsia will have some symptoms of eclampsia but without the usual proteinuria or hypertension. All patients with atypical onset should undergo neurological evaluation to rule out neurologic causes of seizures.Cerebral tuberculosis is a rare and serious form of disease secondary to haematogenous spread of Mycobacterium tuberculosis. Here we present a case of cerebral tuberculoma with seizures in late pregnancy mimicking eclampsia.

A Rare Case Report of Inguinal Hernia with Persistent Mullerian Duct and Klinefelter Syndrome

Darpan Dadheech, Prabha Om, Sharma Ankit shridatt, Ankur Patni, Naveen Verma
Inguinal hernia in male is a common problem but having female reproductive organs in hernial sac is rare. It occur because of failure of mullerian duct to regress in a male fetus during embryonic development, result in a syndrome known as Persistent Mullerian Duct Syndrome (PMDS), which is a rare entity of male pseudohermaphroditism. We hereby present a case of 21-year-old male patient reported with complains of cryptorchidism and inguinal hernia. Generally diagnosis of PMDS was established during investigation like ultrasonography, MRI for localization of undescended testis and during surgical exploration for inguinal hernia or cryptorchidism. Our patient was operated by bilateral inguinal incision; hernial sac contained adult size uterus fallopian tube and upper 2/3rd of vagina. On karyotyping it was found that he was a case of klinefelter syndrome also. Association of PMDS with klinefelter syndrome is very rare.

Classical Cases of Lymphangioma – As Multiple Vesicular Eruptions

Anju Devi, Anjali Narwal, Achla Bharti Yadav, Virender Singh, Ambika Gupta
Lymphangiomas are uncommon congenital hamartomas of the lymphatic system, usually diagnosed in infancy and early childhood. They are rarely situated in oral cavity and most commonly identified on the anterior two-thirds of the tongue. Though rarely seen in the oral cavity, lymphangiomas are the entities which should be taken into consideration by the clinician while examining vesicular lesions of the oral cavity. Early recognition is of utmost importance for the initiation of proper treatment and to avoid serious complications. We hereby report two classical cases of lymphangioma of the buccal mucosa with multiple vesicular eruptions, a rare site.

Parathyroid Adenoma Completely Impacted within the Thyroid Gland: A Case Report

Sayed Mahmoud Mirhosaini, Soroush Amani, Rana Fereidani
Ectopic parathyroid adenoma can be seen in various locations. Sometimes ultrasound and even fine needle aspiration studies cannot distinguish this lesion from thyroid lesions. A 29-year-old woman with a prominent nodule of left thyroid lobe was referred to surgical department. Thyroid function test were normal. She had no family history of parathyroid disease, other endocrine disease, and any other malignancies and had received no radiation. Ultrasonography revealed a solid and hypoechoic mass, 25x20 mm in size, with a regular shape and contour without calcification in the inferior of left lobe of the thyroid gland. For definite diagnosis, immunohistochemistry study of the lesion with three markers was done. Finally, PTH marker was positive in cytoplasms of cells so parathyroid adenoma was confirmed. Fine needle aspiration of the nodule was suspicious for follicular neoplasm; however, postoperative histopathology and immunohistochemistry revealed a parathyroid adenoma. Ultrasonography may be helpful to identify localized thyroid lesions especially in parathyroid adenoma.

Systemic Sclerosis with Multiple Pulmonary Manifestations
Systemic sclerosis (SSc) is a chronic autoimmune multisystem disorder characterized by endothelial dysfunction and fibroblast dysfunction, which results in progressive fibrosis of the skin and internal organs more frequently the lungs and gastro intestinal tract. Pulmonary involvement is common in the course of SSc, with Interstitial Lung Disease (ILD) and Pulmonary Arterial Hypertension (PAH) being the leading causes of death. Here we report, case of an elderly female patient presenting with Diffuse SSc with multiple uncommon pulmonary manifestations like ILD with Usual Interstitial Pneumonia (UIP) pattern (usually less common), PAH and right sided pleural effusion.

Anaesthetic Management of Caesarean Section in a Term Pregnancy with Ventricular Septal Defect and Pulmonary Hypertension with Severe Pulmonary Stenosis

Rohan Bhatia, Nidhi Kaeley, Ruby Bhatia
Pregnancy with pulmonary hypertension – WHO risk class IV cardiac disease is associated with significant haemodynamic burden due to cardiocirculatory changes which is a significant indirect cause of maternal mortality. We report a very rare case – primigravida term pregnancy with pulmonary hypertension, large ventricular septal defect (2.4 cm2), bidirectional shunt mainly left to right with severe pulmonary stenosis with peak gradient of 144mmHg. Caesarean section was done under general anaesthesia with successful maternal and neonatal outcome.

Video Assisted Thoracoscopic Surgery (VATS) for Excision of an Ectopic Anterior Mediastinal Intra-Thymic Parathyroid Adenoma
Ectopic anterior mediastinal parathyroid adenoma is a rare cause of Primary Hyperparathyroidism (PHPT). Imaging studies such as Technetium-99m (99mTc) sestamibi parathyroid scan along with a Single Photon Emission Computerized Tomogram (SPECT), and contrast enhanced Computerized Tomogram (CT) of the neck and thorax can precisely localize the ectopic mediastinal parathyroid adenoma. We report a 40-year-old gentleman who presented with persistent pain in the right shoulder following trivial trauma. His biochemical investigations showed an elevated serum calcium of 11.6mg% (Normal: 8.3-10.4 mg%) along with an elevated iPTH of 1443 pg/ml (normal: 8-70 pg/ml) which were suggestive of primary hyperparathyroidism. The localization studies revealed an ectopic cystic parathyroid adenoma in the anterior mediastinum that was not accessible from the neck. He underwent a Video Assisted Thoracoscopic (VAT) excision procedure with normalization of serum calcium and an uncomplicated recovery. The VAT approach is a successful minimally invasive technique for mediastinal parathyroidectomy.

An Approach with Hybrid Segmental Mechanics

Harsh Ashok Mishra, Raj Kumar Maurya
Present case report provides an insight into the hybrid segmental mechanics with treatment of 13-year-old male, considering the side effects of sole continuous arch wire sliding mechanics. Patient was diagnosed as a case of skeletal class I jaw relationship, low mandibular plane angle, class II molar relation on right and class I molar relation on left side, anterior cross bite, crowding of 12mm in upper, 5mm in lower arch. He also had proclined upper and lower anteriors by 2mm, convex profile and incompetent lips. Total treatment duration was 20 months, during which segmental canine retraction was performed with TMA (Titanium, Molybdenum, Aluminum) ‘T’ loop retraction spring followed by consolidation of spaces with continuous arch mechanics. Most of the treatment objectives were met with good intraoral and facial results within reasonable framework of time. This approach used traditional twin brackets, which offered the versatility to use continuous arch-wire mechanics, segmental mechanics and hybrid sectional mechanics.

Successful Resuscitation of a Cardiac Arrest following Slit Neck and Carotid Artery Injury: A Case Report

Sayyed Ehtesham Hussain Naqvi, Eram Ali, Mohammed Haneef Beg, Saurav Varshney
Carotid artery injuries constitute a specific and relatively small group of vascular trauma among the traumatic injuries to neck. They have the potential of killing the patients within minutes to hours due to haemodynamic instability if not managed by the specialist team within time. Central Neurologic deficit from cerebral hypoxia either resulting primarily from trauma or secondarily from surgery is a major concern. We hereby present a case of a 22-year-old man who presented to emergency department with alleged assault and vascular trauma to neck in a state of cardiac arrest. On exploration patient had injuries to external and internal carotid arteries and external jugular vein. Combined effort of trauma team lead to successful resuscitation and saved the life of the patient.

Asplenia Syndrome in a Neonate: A Case Report

Kapil Bhalla, Jasbir Singh, Jaivinder Yadav, Suchi Mehra
Asplenia syndrome is a syndrome of right isomerism or attempted bilateral right sidedness. It includes congenital asplenia in association with complex congenital cyanotic heart disease and situs anomalies of the other thoracoabdominal organs. Herein we report a case of asplenia syndrome so as to highlight and refocus attention on the possibility of this rare syndrome that must be considered in a neonate presenting with congenital cyanotic heart disease.

Tufted Angioma of Eyelid in an Adult - A Case Report

Jyoti Verma, Anshul Singh, Vatsala Misra, S. P. Singh
Tufted Angiomas also known as angioblastomas /Angioblastoma of Nagakawa are rare vascular neoplasms localised to the skin and subcutaneous tissues with the upper trunk and neck being most common sites. They are mainly seen in children but a few cases in juveniles and adults have been reported. We hereby report this case, a 40-year-old male who presented with a right lower lid, painless, slowly progressive, firm swelling diagnosed as Tufted Angioma on histopathology and immunohistochemistry.

Aneurysmal Bone Cyst: An Uncommon Secondary Event in Calcaneal Chondroblastoma

Sandip Barman, Preeti Diwaker, Divya Bansal, Neelam Wadhwa, Gurvinder Singh
Chondroblastoma is an uncommon benign bone tumour, involvement of epiphysis of long bones is typical. Chondroblastoma of the calcaneum is uncommon and its association with secondary aneurysmal bone cyst is even rarer. Only two cases of calcaneal chondroblastoma associated with secondary aneurysmal bone cyst have been reported till date. A 22-year-old male presented to the department of orthopaedics with complains of pain and swelling in the left heel since the last 10 months. On clinico-radiological grounds differentials considered were giant cell tumour of bone and aneurysmal bone cyst. In view of the histopathological findings of bone curettage and results of special stain and immunohistochemical marker, final diagnosis of chondroblastoma with secondary aneurysmal bone cyst, left calcaneum was rendered. Although rare, chondroblastoma should always be considered in osteolytic lesions of calcaneum. The identification of secondary aneurysmal bone cyst component is important as it has higher chances of recurrence than usual chondroblastoma.

Sebaceous Gland Carcinoma of the Lower Eyelid Reconstructed with a Composite Flap: A Case Report
Sebaceous gland carcinomas are skin adnexal tumours occurring in the periocular region of elderly females. It is an uncommon malignancy usually involving the upper eyelid and has an indolent course. Mainstay of treatment is surgical excision. Here we present a case of a sebaceous gland carcinoma of the lower eyelid for which wide local excision was done and the lower eyelid reconstructed using a composite flap of nasal chondromucosal graft with a nasolabial flap.

Eosinophilia in an Acutely Limping Child: An Easy Guess of Rare Systemic Aetiology!

Harshita Sharma, Santosh Venketraman Kondekar, Maaz Ahmed, Surbhi Rathi
Painful limping child is often considered due to septic arthritis. Iliopsoas abscess (IPA) is rare in adults and children. The aetiology is often related to tuberculosis of spine. Hereby we report a case of staphylococcal IPA where incidental evaluations led to obvious diagnosis of a rare primary immunodeficiency syndrome called Job syndrome or hyperimmunoglobulin E and Eosinophilia Syndrome (HIES). This was the first case of IPA in a case of immunodeficiency syndrome including HIES.

First Branchial Arch Fistula: A Rarity and a Surgical Challenge

J.S. Rajkumar, Deepa Ganesh, J.R. Anirudh, S. Akbar, Niraj Joshi
Although 2nd Branchial arch fistulae (from incomplete closure of Cervical sinus of His) are well known, 1st arch fistulae are much rarer (<10%) and are usually not tackled comprehensively. We present a case of a rare first branchial arch fistula of the type II Arnot classification, which presented with two external openings of more than 20 years duration. Patient had a successful resection of all the concerned fistulous tract. Review of literature and the surgical challenges of the procedure are presented herewith.

Malignant Peripheral Nerve Sheath Tumor -A Rare Malignancy in Mandible
Malignant Peripheral Nerve Sheath Tumor (MPNST) is biologically an aggressive tumor that is usually found in the extremities, trunk and infrequently found in the head and neck area particularly in the jaws, arising from the cells allied with nerve sheath. Mandibular MPNST may either arise from a preexisting neurofibroma or develop de novo. Because of the greater variability from case to case in overall appearance both clinically and histologically, a case of MPNST of the mandible in a 25-year-old female patient is reported. The lesion was excised and immunohistological studies (S-100 & Neuron specific enolase) were conducted to confirm the neural origin.

Diagnostic Dilemma in a Thyroid Incidentaloma: Second Primary versus Metastatic Nodule?
With the increasing use of 18F-Fluro-Deoxyglucose (FDG) Positron Emission Tomography (PET) the number of thyroid incidentalomas is on the rise. Focal thyroid incidentalomas identified by FDG-PET have been reported to have a high incidence of malignancy. Neuroendocrine tumours of the thyroid are rare entities. The most common neuroendocrine tumour of the thyroid is medullary carcinoma. A thyroid nodule in a patient with a known neuroendocrine tumour must be differentiated from a primary medullary carcinoma which can present a diagnostic challenge to the clinician. A 65-year-old female patient was referred for thyroidectomy for a FNAC diagnosed follicular neoplasm of the left lobe of the thyroid, detected on FDG PET follow up. She was a known case of neuroendocrine tumour of the pancreas with no features suggestive of familial Multiple Endocrine Neoplasia (MEN) syndrome. The patient had undergone Whipple’s procedure elsewhere, 5 years back. Following total thyroidectomy, the final histopathology report was suggestive of a primary neuroendocrine tumour. We present this case to highlight the clinical dilemma in diagnosing a thyroid incidentaloma as a second primary neuroendocrine tumour versus a solitary metastatic nodule in the background of metastatic gastroentero pancreatic neuroendocrine tumour. Although clinically, a metastatic nodule should have been the obvious diagnosis, the histopathological and immunohistochemical features were in favour of a primary non-medullary Neuroendocrine Tumor (NET) of the thyroid.

Giant Intramuscular Nodular Fasciitis Masquerading as Soft Tissue Sarcoma with Neural Involvement - A Case Report
Nodular Fasciitis (NF) is described as a benign reactive proliferation of myofibroblasts that occurs predominantly in the subcutaneous location. Most commonly presents as rapidly growing swelling in the young adults, with usual size of less than 4cm and located commonly in the extremities. We hereby report a case of giant nodular fasciitis of 10cm diameter which presented in an unusual location (gluteal region) and rare plane of origin (intramuscular) with unusual symptom of sciatic nerve involvement. Because of the size, location and neural involvement a clinical diagnosis of soft tissue sarcoma was made. After investigating with trucut biopsy and magnetic resonance imaging, benign nature of the lesion confirmed and treated with complete excision, carefully preserving the sciatic nerve. This case is presented for its rarity in size, location, plane of origin and neural compression. To the best of our knowledge this is the first case of nodular fasciitis of 10cm size and in the gluteal muscles.

Mystery behind Non–Healing Wound at Chin Region – Myiasis due to Neglected Trauma – A Case Report with Review of Literature

Pulkit Khandelwal, Neha Hajira
Myiasis is the infestation of human beings with fly larvae which feed on host’s living or dead tissue. Diagnosis of this condition is made by the presence of larvae in affected body parts. The standard treatment is the mechanical removal of the maggots from the lesion and management of the general systemic condition. This paper report a case of myiasis at the chin region in a 45-year-old male managed by manual removal of larvae after topical application of turpentine oil, surgical debridement of necrotic tissues and antimicrobial therapy.

Dilatation of the Proximal Cystic Duct: Is It a Variant to “Type VI” Choledochal Cyst?

Christos Kaselas, Dimitrios Patoulias, Ioannis Patoulias, Ioannis Spyridakis
Choledochal cysts are rare congenital malformations, comprising of dilatation of the biliary tree of different localization. Classically, classification of choledochal cysts describes five variants of the disease. Type VI choledochal cyst is considered by many authors as the sixth variant of this classification and is described either as a dilatation of the cystic duct or as a cystic duct cyst. We present a rare case of cystic duct dilatation that presented with acute cholangiopancreatitis and a clinical picture consistent of a choledochal cyst in a 10-year-old female patient. Cholecystectomy with excision of the cystic duct was performed. Histopathologic examination did not reveal any findings consistent with choledochal cyst. Based on these findings we speculate that in our case the dilatation of the cystic duct is a variant to type VI choledochal cyst, based on the fact that no cystic-like malformation has been identified in histology. We provide details of the pre-operative work-up and compare them with intraoperative findings in order to increase awareness of the condition.

Adenolipoma of the Breast: A Clinicoradiological Entity and Pathologist's Dilemma!

Dharma Ram, Veda Padama Priya Selvakumar
Breast hamartomas are benign lesions composed of variety of normal breast components arranged in disorganized manner. These are rare and classified as adenolipoma, fibrolipoma, adenofibrolipoma, etc. Clinically these present as painless well-circumscribed, mobile lumps of breast. Incidence and etiology remain obscure due to its rarity. These have been described in women in their 40's or 50's. Mammographically they appear non homogenous mass with circumscribed fatty masses. Histologically they appear as circumscribed masses with variable amount of fat, fibrous and glandular tissue. Here we are presenting adenolipoma in 29-year-old woman with review of literature.

Idiopathic Fatal Pancytopenia: A Case Report

Hema Goyal, Vijai Tilak
Pancytopenia is defined as decrease in red blood cells, white blood cells and platelets. Many disease processes involve the bone marrow primarily or secondarily resulting in pancytopenia. A 55-year-old male presented with generalized body weakness and few episodes of malena for last one year. Physical and systemic examination was unremarkable. CBC report revealed pancytopenia. Other haematological parameters were within normal limit. Stool for occult blood was positive. USG and CECT abdomen showed no abnormality. The patient was evaluated for any evidence of malignancy but no clue was found. Bone marrow examination was done as patient was having pancytopenia. Bone marrow smears, clot sections and bone marrow biopsy was normal. Immunohistochemistry and cytogenetics study was unremarkable. Patient was admitted in hospital for 1 month and his condition rapidly deteriorated. The cause of pancytopenia remained unexplained and therefore it was named as Idiopathic fatal pancytopenia. “Idiopathic Fatal Pancytopenia (IFP)” is an emerging new entity with a grave prognosis. We wish to sensitize the medical community and the scientists to this rapidly fatal condition.

Simple Limbal Epithelial Transplantation in Acid Injury and Severe Dry Eye

Sudesh Kumar Arya, Anubha Bhatti, Amit Raj, Ravi Kant Bamotra
The epithelial cells of cornea constantly undergo renewal and regeneration and the stem cells responsible for renewal resides within basal epithelium at the limbus in palisades of Vogt. Simple limbal epithelial transplantation (SLET) is a simplified technique for limbal stem cell deficiency and it combines the benefits of both conjunctival limbal autografting and cultivated limbal epithelial transplantation by being single-stage and utilizing minimal donor tissue. We will be discussing two cases of ocular surface disorder which were managed successfully by new technique simple limbal epithelial transplantation. Two patients one with unilateral Limbal Stem Cell Deficiency (LSCD) following acid injury and other with bilateral LSCD due to severe dry eye underwent limbal epithelial transplantation using the SLET method after taking prior consent for the procedure. Success was termed complete when a completely epithelialized, avascular and stable corneal surface was seen. The follow up examinations were done on first day, at 1 week, 2 weeks, 4 weeks and at 3 months after the surgery. A completely epithelialised, avascular and stable corneal surface was achieved by 4 weeks in both patients. Simple limbal epithelial transplantation is a new technique which is simple, cheap and easily affordable and it has decreased the dependence on stem cell laboratory.

Resistant Hypertension due to Fibromuscular Dysplasia in a Young Male: A Rare Case Report
Fibromuscular Dysplasia (FMD) is a sporadic non-atherosclerotic disease. FMD has been established in nearly every arterial bed. However, the most frequent arteries affected are the renal and carotid arteries. Disease presentation may vary broadly, depending upon the arterial bed complication and the severity of illness. Hypertension, particularly resistant type, headache and dizziness are the most common presentations. String of beads appearance in angiographic views due to post-stenotic aneurysms is the characteristic view. It is most commonly described in young aged females; but in rare male cases has also been reported. Moreover, balloon angioplasty is standard and effective therapy for FMD. We present a young 28-year-old man who was referred for evaluation of resistant hypertension for nearly 3 years without comprehensive workup. The patient underwent renal artery angiography which confirmed beading narrowing of the right renal artery with significant stenosis at mid portion compatible with FMD; and balloon angioplasty was done. This case highlights that FMD should be kept in mind as a rare cause of resistant hypertension in young males; although it is most common in young females.

Acute Myocardial Infarction Following Blunt Chest Trauma and Coronary Artery Dissection
Blunt chest traumatic coronary artery dissection is an uncommon cause of atherosclerotic and non-atherosclerotic Acute Myocardial Infarction (AMI). Injuries of the coronary artery after blunt chest trauma are caused by different mechanisms such as vascular spasm, dissection and intimal tear or rupture of an existing thrombus formation. Chest pain might be masked by other injuries in patients with multiple traumas in car accident. Present case report is on a 37-year-old male without any specific past medical history who reported to the emergency department of a hospital with chest discomfort and was discharged with the impression of chest wall pain. After three days he experienced severe chest pain and he was admitted with the impression of acute coronary syndrome and underwent coronary angiography which showed Left Anterior Descending (LAD) artery dissection. The possibility of injury of the coronary artery should be kept in mind after blunt trauma to the chest. This condition is sometimes underdiagnosed. Its diagnosis may be difficult because chest pain can be interpreted as being secondary to chest wall contusion or it may be overshadowed by other injuries. Coronary dissection diagnosis after chest trauma requires clinical suspicion and systematic evaluation. Electrocardiography (ECG) should be done for every patient with thoracic trauma as the clinical findings may be misleading.

Sero-Negative Systemic Sclerosis: A Rare Presentation
Systemic Sclerosis is a multisystem disease associated with progressive fibrosis of skin and internal organs. It is diagnosed by presence of characteristic clinical findings and is supported by specific serologic abnormalities. ANA is positive in case of systemic sclerosis in 90 percent of cases. We report a rare case of this rare disease where patient was ANA, Antitopoisomerase I (anti-Scl-70), Anticenteromere antibody negative.

Biofilm in Osteomyelitis caused by a Rare Pathogen, Morganella morganii : A Case Report

Asmita De, Hirak Jyoti Raj, Prasanta Kumar Maiti
Morganella morganii is a member of Enterobacteriaceae family, whose natural habitat is the human gastrointestinal tract. It rarely causes infection alone and is generally encountered in immunosuppressed patients. Osteoarticular pathologies are not commonly observed with Morganella morganii and infections by it have high mortality rate. Biofilm colonization is a causative factor behind the chronicity and/or refractoriness of certain infections. Biofilms colonize on inert medical devices, prosthesis, fibrosed tissues, sinus tracts as well as dead bones as in case of chronic osteomyelitis. Morganella morganii is not a common pathogen to produce biofilm. In this case report, we present a 56-year-old male patient with chronic osteomyelitis of right proximal tibia caused by biofilm producing strain of Morganella morganii, following trauma.

A Rare Case of Tamarind Seed Induced Oral Submucous Fibrosis in a 12-Year-Old Indian Boy
Oral Submucous Fibrosis (OSMF) is a chronic debilitating, potentially malignant disorder of the oral cavity. It is characterized by restricted mouth opening which results due to abnormal accumulation of collagen in the sub-epithelial layers leading to dense fibrous bands in the mouth. The pathogenesis of the disease is believed to be multifactorial. However, literature reports suggest a strong association of OSMF and arecanut chewing habit. The present paper presents a case of OSMF in a 12-year-old boy without arecanut chewing habit, but with a heavy practice of chewing tamarind seeds.

ECMO Rescue Therapy in Diffuse Alveolar Haemorrhage: A Case Report with Review of Literature

Gautam Rawal, Raj Kumar, Sankalp Yadav
Extracorporeal Membrane Oxygenation (ECMO) has evolved as a treatment option for patients having potentially reversible severe respiratory failure who are deteriorating on conventional ventilation. During ECMO, systemic anticoagulation is needed to maintain patency of the circuit. Therefore, ongoing haemorrhage remains a relative contra-indication to ECMO as it can further increase the bleeding. There is only limited evidence available for the use of ECMO in patients with alveolar haemorrhage. Most of these patients did not receive any anticoagulation during ECMO. We describe our experience with a patient who received intravenous anticoagulation during ECMO for refractory hypoxemic respiratory failure due to Diffuse Alveolar Haemorrhage (DAH) associated with Granulomatosis polyangitis (Wegner’s GPA). ECMO sustained life by maintaining gas exchange support and provided the time for the immunotherapy to be effective. We report the successful use of anticoagulation during ECMO in a patient with DAH.

Solitary Fibrous Tumour of the Clavicle: A Rare Case Report
A Solitary Fibrous Tumour (SFT) is the preferred term by most of the pathologists than “haemangiopericytoma”. SFT is a heterogeneous group of benign and malignant neoplasms along a morphologic continuum. Here we report a case of SFT of the clavicle in a 26-year-old male patient, who presented to us with complaints of pain and swelling over the dominant shoulder. No signs of metastasis were noted clinically and radiologically. He underwent surgical resection of swelling. At 6 months after resection and after 22 cycles of radiotherapy, he was noted to have excellent prognosis with satisfactory shoulder function.

Zinsser-Cole-Engman Syndrome: A Rare Case Report
Zinsser-Cole-Engmann syndrome also called Dyskeratosis Congenita (DKC) is a rare genodermatosis first described by Zinsser in 1906. Mutations in DKC1 gene is responsible for DKC. It is usually inherited as an X-linked recessive trait, resulting in a striking male predilection. It is characterized by a triad of reticular skin pigmentation, nail dystrophy and mucosal leukoplakia. Complications include predisposition to malignancy and bone marrow failure. Here, we report a case of DKC in a 9-year-old boy with classic triad of signs. Special investigations like endoscopy, barium swallow and bone-marrow aspiration study confirmed the diagnosis. There is no effective treatment for DKC. Some preventive measures can be adopted and the only long term cure for the haematological abnormalities is allogenic haemopoietic stem cell transplantation.

Scalp Haematoma in Cerebral Palsy Case due to Unknown Cause - A Rare Case Report

Murali Uthamalingam, Dharamjit singh Jitsweer singh
Incidences of cerebral palsy (CP) in children are not quite common even though it is the most common motor disorder in children. Further quality of life in CP cases is not so good in young adult stages and has to face certain problems. However scalp haematoma formation in CP patient without injury to head is rarely been reported. The case is being reported for the first time from Malaysia. We report on a unique case of scalp haematoma in an 18-year-old girl of known CP patient with unknown cause. No history of trauma or fall with any of the focal neurological signs or symptoms was found. Clinical examination showed soft boggy swelling of 8 x 10 cm size, involving most of scalp and upper face. CT - scan showed scalp haematoma with right orbital extraconal lesion. She underwent incision and drainage of scalp lesion; consequently around 100 ml of clotted blood came out. At follow-up she was doing well.

Acute Pancreatitis, Hepatitis and Bone Erosion in Acute Yellow Phosphorous Compound Poisoning – A Rare Complication
We report a case of acute pancreatitis and hepatitis following ingestion of yellow phosphorous. The condition of the patient progressed to encephalopathy and bony erosion of the nasal septum. Fungal mass was observed in both the nasal cavities by endoscopy. Microbiological investigation revealed the identity of the fungus as Aspergillus flavus and Candida tropicalis. Patient improved with fluconazole treatment.

Case Report: Collision Tumour of Colon Leiomyosarcoma and Adenocarcinoma

Victoria M. Kim, Lindsay Goicochea, Sandy H. Fang
The colon is an exceedingly rare site of primary leiomyosarcoma and only a few cases have been published to date. Of the reported cases of collision tumours, collision tumours that specifically occurred in the colon have consisted of combinations of adenoma or adenocarcinoma with lymphomas or neuroendocrine tumours. Here, not only do we report a case of colon leiomyosarcoma, but we report, what is to our knowledge, the first case of collision tumour consisting of colon leiomyosarcoma and adenocarcinoma. Cause, prognosis, and treatment of colon collision tumours vary and are yet to be understood.

Clinicopathological and Immunohistochemical Characteristics of Verruciform Xanthoma of the Lower Gingiva: A Case Report

Masashi Kimura, Hiroyuki Ohto, Akio Shibata, Atsushi Enomoto, Masahiro Umemura
Verruciform xanthoma (VX) is a rare benign lesion and mainly effects the oral mucosa. This slow-growing asymptomatic lesion typically develops along the gingival margin of the masticatory mucosa, followed by the hard palate, tongue, buccal mucosa, floor of the mouth, alveolar mucosa, soft palate and junction between the hard and soft palate. Moreover, this lesion can also affect the skin and genital organs. Clinically, VX generally presents a sessile or pedunculated appearance, forming a papule or single plaque with verrucous or papillomatous mucosal growth. The colour (white, pink, grey, or yellow) depends on the thickness of the overlying epidermis. In fact, the clinical findings of VX are similar to those of verrucous carcinoma and other benign tumours, such as squamous papilloma, verruca vulgaris and mucosal fibroma. For this reason, clinical and histopathological examinations are essential for accurate differential diagnosis. Histologically, VX is characterized by parakeratosis, rete ridges of uniform depth and the accumulation of foam cells, which are also called “xanthoma cells”. Here, we describe the clinicopathological and immunohistochemical findings of a VX located on the lower gingiva of a 64-year-old male patient.

Digital Acrometastasis as Initial Presentation in Carcinoma of Lung A Case Report and Review of Literature
Bony metastases develop in 30% of all the cancers, but out of which only 1% to 3% occurs in the hand. Lung is the most common site for acrometastasis, followed by breast and renal cell cancer. Metastases to the digits are with non-specific presentation. We reported a case of 79-year-old male patient with initial presentation of swelling over left index finger, which was found to be squamous cell carcinoma of finger on histopathological examination. He was subsequently diagnosed as a case of squamous cell carcinoma of lung with acrometastasis.

Benign Recurrent Intrahepatic Cholestasis in a Young Adult

Prabhat kumar, Riyaz Charaniya, Arvind Ahuja, Sakshi Mittal, Ratnakar Sahoo
Benign Recurrent Intrahepatic Cholestasis (BRIC) is a rare genetic disorder characterized by recurrent episodes of cholestatic jaundice. The initial episode of jaundice generally occurs before second decade of life and can persist for several weeks to months before resolving spontaneously. It is a benign disease and even after repeated episodes of jaundice, fibrosis of liver cell does not occur. We had a young adult patient who was having recurrent episodes of cholestatic jaundice with intervening symptom free period for last 20 years. He had first episode of jaundice at the age of eight and since then had several similar episodes. Diagnosis was made by classical clinical presentation and histopathological findings. We intend to report this case due to rarity of this disease in India.

Non-Secretory Myeloma, Diagnosed on Renal Biopsy as Cast Nephropathy
Multiple myeloma is a disorder of plasma cells which can involve kidneys in the form of cast nephropathy. Neoplastic plasma cells produce either complete immunoglobulins or fragments of immunoglobulins leading to a monoclonal spike in the serum and/or Bence Jones proteinuria. Very few patients present as non-secretory myeloma when no immunoglobulins (M spike) are produced or only light chains are secreted which can only be detected in urine. Acute renal failure due to cast nephropathy can rarely be the first presentation of multiple myeloma. We here in report a case in which primary diagnosis of multiple myeloma was made on renal biopsy due to its characteristic histomorphology. The diagnosis was later on supported by presence of neoplastic plasma cells in the aspirate and biopsy of bone marrow.

Surgical Re-entry of an Intentionally Replanted Periodontally Compromised Tooth Treated with Platelet Rich Fibrin (PRF): Hopeless to Hopeful

Haneet Kour Ryana, Rashmi Srinath, Shobha Prakash
Intentional replantation is generally contraindicated in periodontally compromised teeth however, there are reports suggesting that it can be a successful treatment alternative for periodontally involved hopeless teeth. Currently there is dearth of evidence regarding the success of this therapy, especially evidence for the effectiveness of autologous platelet rich fibrin is lacking. We present a case report of a 23-year-old male patient with periodontally hopeless left maxillary central incisor having bone loss extending beyond root apex. The tooth was gently extracted and replanted utilizing root conditioning and combined regenerative therapy (Xenograft, PRF and Type I Collagen Membrane). Surgical re-entry at nine months revealed bone formation in the apical third of the tooth. At one year, 87% radiographic bone gain was accomplished. The improvement in the clinical and radiographic parameters reinforced by the re-entry surgery findings strongly suggest that intentional replantation may be a cost-effective substitute to implants and tooth supported prosthesis in situations where conventional periodontal therapy would yield compromised outcomes.

An Accelerated Multi-Modality Rehabilitation Protocol Combined with Botulinum Toxin-A Injection in Adult Idiopathic Toe Walking: Case Report

Sibel Kibar, Ferdi Yavuz, Birol Balaban
Diagnosis of Adult Idiopathic Toe Walking (AITW) is very rare in clinical practice. High quality studies regarding AITW and its treatment options have not been conducted previously. A 28-year-old male patient complaining of lower leg pain was referred to outpatient rehabilitation clinic. Physical examination revealed a gait abnormality of insufficient heel strike at initial contact. The aetiology was investigated and the patient’s walking parameters were assessed using a computerized gait analysis system. The AITW was diagnosed. Botulinum toxin-A (Dysport®) was injected to the bilateral gastrocnemius muscles. A combined 10-days rehabilitation program was designed, including a daily one-hour physiotherapist supervised exercise program, ankle dorsiflexion exercises using an EMG-biofeedback unit assisted virtual rehabilitation system (Biometrics) and virtual gait training (Rehawalk) every other day. After treatment, the patient was able to heel strike at the initiation of the stance phase of the gait. Ankle dorsiflexion range of motions increased. The most prominent improvement was seen in maximum pressure and heel force. In addition center of pressure evaluations were also improved. To the best of our knowledge this is the first case, of AITW treated with combined botulinum toxin, exercise and virtual rehabilitation systems. This short report demonstrates the rapid effect of this 10-days combined therapy.

A Rare Case of Orbital Apex Syndrome in Herpes Zoster Ophthalmicus

Charudutt Kalamkar, Nishant Radke, Amrita Mukherjee, Snehal Radke
Orbital Apex Syndrome (OAS) is a rare complication of Herpes Zoster Ophthalmicus (HZO). We are reporting a case of 65-year- old male who developed OAS following HZO. Patient presented with vesicular rash in the typical dermatomal distribution, severe periocular congestion and limited ocular motility in all gazes along with loss of vision. Soft tissue inflammation improved within 4 weeks of initiation of treatment while ocular motility slowly improved over 3 months. Patient did not gain vision despite receiving systemic steroids and systemic anti-viral medication. Variable improvement in ocular motility and visual function in our patient points towards multiple mechanisms involved in pathogenesis of this disease, some of which are yet to be Understood

Looped and Tortuous Ulnar Artery – An Erratic Unilateral Vascular Presentation in the Proximal Forearm

Vincent Rodrigues, Mohandas KG Rao, Shivavananda Nayak, Naveen Kumar
Precise and detailed knowledge of possible anatomical variations of the arterial pattern in the upper extremity is vital during reparative surgery in this region. Scientific literatures witnessed several reports on variant origin and branching pattern of ulnar artery. But report on looped and tortuous ulnar artery is lacking in the literature. We report here a unique case of ulnar artery having double loop at its commencement giving it an appearance of sigmoid shape and its undue tortuous course in the forearm. Such an unusual and unpredictable variation of ulnar artery is vulnerable for life threatening hemorrhage during clinical approaches. It could also lead to misinterpretation of CT scans as presence of tumours. Awareness on such exceptional anatomical discrepancy of ulnar artery is important to clinicians, neuroradiologists and radiologists in general.

LBBB with History of Complete Atrioventricular Dissociation Underwent Bipolar Hemiarthroplasty

Anjana Sahu, Indirani H Kumar

The Portal Hypertensive Gastropathy: A Case and Review of Literature

Francesco Massoni, Lidia Ricci, Marcello Pelosi, Serafino Ricci
Upper gastrointestinal bleeding is a cause of high risk for morbidity and mortality. It has been debated in alcoholic cirrhosis, if alcohol exerts an exclusive and causal role upon gastropathy or whether it is linked to cirrhotic portal hypertension. The authors describe an autopsy report regarding mortality caused by gastric bleeding in a 53-year-old patient who suffered from cirrhosis. Literature has evidence of direct, marked damage of alcohol upon the gastric mucosa and there is noteworthy statistical data implying the revaluation of the pathogenesis of the bleeding.

Pyogenic Liver Abscess Caused by Acinetobacter lwoffii: A Case Report

N. Pal singh, Tanu sagar, Kirti Nirmal, I. Rajender kaur
Acinetobacter lwoffii is a gram negative aerobic non-fermenter bacilli. It is considered as an important emerging pathogen after Acinetobacter baumannii in patients with impaired immune system and in nosocomial infections. Here, we present a case of community acquired pyogenic liver Abscess caused by Acinetobacter lwoffii in a diabetic patient.

Herpes Zoster Infection Involving Mandibular Division of Trigeminal Nerve and Ramsay Hunt Syndrome with Meningitis in an Immunocompetent Patient: A Rare Association
Herpes zoster is a unilateral painful vesicular cutaneous eruption caused by the reactivation of the Varicella zoster virus. It commonly affects the older people and immunocompromised individuals. The dermatomes from T3 to L3 are most frequently involved. Its three stages include prodromal stage, active stage and chronic stage. The common complications of the infection include post-herpetic neuralgia, Ramsay Hunt syndrome, Guillain-Barre syndrome, transverse myelitis and encephalomyelitis. This case report summarizes a very rare association of herpes zoster meningitis with the involvement of mandibular division of the trigeminal nerve and facial nerve. The patient improved with intravenous acyclovir and prednisolone treatment.

Cardiac Pseudoaneurysm- A Death Defying Entity

Manoj Mathur, Saryu Gupta
A pseudoaneurysm refers to a contained rupture of the myocardium with a tenuous pericardium walling off the leak. It needs to be differentiated from a true aneurysm by the fact that there is lack of myocardial tissue in the wall of a pseudoaneurysm. The differentiation between the two is pertinent as true aneurysms can be treated medically while pseudoaneurysms require urgent surgical treatment. Untreated pseudoaneurysms carry a high risk of rupture and mortality. We report a case of cardiac pseudoaneurysm developing in a 46-year-old male who had suffered myocardial infarction four months back. The patient now presented with chest pain and dyspnoea. CECT chest revealed a partially thrombosed large pseudoaneurysm arising from the posterior wall of left ventricle. While the clinical diagnosis of this entity is difficult, CECT plays a pivotal role in the non-invasive detection of pseudoaneurysms.

Superior Mesentric Artery Syndrome in a Patient with Subacute Intestinal Obstruction: A Case Report
Superior Mesenteric Artery (SMA) syndrome is one of the rare cause of proximal small bowel obstruction wherein, the third part of the duodenum is compressed between the SMA at its origin and abdominal aorta due to decreased angulations in these two vessels. This decreased angulation exerts a compression effect on third part of the duodenum, resulting in duodenal obstruction which may be complete or partial.There are number of causes which can lead to this entity and will be discussed briefly. Here we report imaging findings of such a rare cause of proximal small bowel obstruction in a young male patient who presented to the emergency surgical department with non specific symptoms of pain abdomen and abdominal fullness. Patient was evaluated under the standard protocol in management of abdominal pain. General physical examination, erect and supine radiograph were taken. On barium meal follow-through examination, there was paucity of contrast agent distal to the second part of duodenum with proximal dilation of stomach, first and second part of duodenum which raised us the possibility of SMA syndrome. Reconstructed CECT abdomen confirmed the decreased angulation between SMA and abdominal aorta and diagnosed it as SMA syndrome. Findings were correlated on duodenojejunostomy anastomotic surgical procedure. Diagnosing and reporting such a case of SMA syndrome is of utmost importance because the clinical presentation being non-specific pertaining to small bowel obstruction which may pose a diagnostic difficulty to the surgeon and with the further delay in diagnosis, patients may end up with chronic symptoms and complications of the disease, repeated hospital visits and electrolyte abnormalities.

Association of Systemic Lupus Erythematosus and Beta Thalassaemia Trait- A Case Report
Systemic Lupus Erythematosus (SLE) is a multisystem chronic inflammatory disease of autoimmune aetiology. It has a predilection for female gender and presence of photosensitive rash over the sun exposed area gives a clue to the diagnosis. Diagnosis in a male patient with atypical manifestations is unusual and difficult. A 25-year-old male presented with fever, fatigue, vomiting, abdominal pain and loss of weight. He had sustained injury on his right arm following which he developed abscess at the trauma site and severe anaemia. Further evaluation revealed pancytopenia and peritonitis. Though peritonitis is rare in SLE, it was considered in the differential diagnosis after ruling out bacterial and tubercular peritonitis. Positive anti-dsDNA and antiSm antibodies confirmed the diagnosis. While evaluating for microcytic anaemia it was found that iron studies were normal and A2 fraction was raised in haemoglobin electrophoresis. The symptoms and laboratory parameters improved remarkably with steroid therapy. Beta thalassaemia trait is rare in patients with SLE, but when they co-exist the manifestations can be severe. High degree of suspicion is required to diagnose SLE in male patients in absence of typical photosensitive rash. Beta thalassaemia trait often does not require any treatment except genetic counseling. However empirical treatment with iron should be avoided.

Rising Trend of Use of Antidepressants Induced Non- Puerperal Lactation: A Case Report

Prerna Kukreti, Wazid Ali, R.C. Jiloha
Non puerperal lactation or galactorrhea is a well known side effect of antipsychotic drugs but has been infrequently described with the use of antidepressants. In past few decades, there have been emerging trend of isolated case reports of selective serotonin reuptake inhibitors induced non puerperal lactation. We report a case of non puerperal lactation following usage of second generation tricyclic antidepressant, nortriptyline and resolution on withdrawing the drug. Literature review has been done for antidepressant induced galactorrhea to understand the current trends, putative mechanism as different from one implicated for antipsychotics and its clinical utility.

A Solid Pseudopapillary Tumour of the Head of Pancreas: A Rare Case Report Diagnosed by Fine Needle Aspiration Cytology

Papillary Cystadenocarcinoma of the Parotid Gland: A Rare Case Report

Ramesh Babu Telugu, Anjana Juanita Job, Marie Therese Manipadam
Papillary cystadenocarcinoma is a rare malignant neoplasm of the salivary gland, characterized by noticeable cystic and solid areas with papillary endophytic projections. These tumours lack features that characterize cystic variants of several more common salivary gland carcinomas. It was first described in 1991 by World Health Organization as a separate entity and cystadenocarcinoma with or without papillary component in the AFIP classification. Most of these tumours occurred in the major salivary glands followed by minor salivary glands. Cystadenocarcinoma is the malignant counterpart of cystadenoma. We report a case of papillary cystadenocarcinoma of parotid. A 40-year-old lady presented with gradually progressive swelling below the right ear associated with occasional pain. Clinical and radiological features suggested benign neoplasm. Right lobe superficial parotidectomy was performed. The histopathologic diagnosis showed papillary cystadenocarinoma of the parotid gland. Histologic confirmation of stromal invasion is required to differentiate it from the benign lesion. Conservative wide local surgical excision is the treatment of choice.

‘Ubiquitous’ Tumour Elsewhere, But Uncommon in the Colon! Can We Ignore this Lesion?

Gabriel Rodrigues
Lipoma, a benign tumour of mature fat cells, can occur anywhere in the body and hence termed ‘ubiquitous tumour’. But it rarely occurs in the colon and can present with complications and mimic malignancy. We present a case of descending colonic lipoma which led to a diagnostic dilemma.

Wine Glass Sign and Empty Delta Sign: A Rare Imaging Presentation of Postpartum Encephalopathy in Dehydration
Rapid correction of hyponatremia is a well-known cause of central pontine and extrapontine myelinolysis. But uncommonly seen and rarely reported in Hypernatraemia. We report a rare case presenting as postpartum psychosis, wherein imaging revealed myelinolysis of corticospinal tracts in wine glass distribution and empty delta sign due to cortical venous thrombosis. At follow-up 3 months later, revealed significant neurological improvement. Concurrance occurrence of this dual pathology is not been described, which in our case was due to high serum sodium levels at presentation and dehydration.

Unusual Origin of a Double Upper Subscapular Nerve from the Suprascapular Nerve and the Posterior Division of the Upper Trunk of the Brachial Plexus: A Case Report
A double upper subscapular nerve on the right side was detected in a male cadaver, with the proximal one arising from the suprascapular nerve and the distal one from the posterior division of the upper trunk of the brachial plexus. Both of them penetrated and supplied the uppermost portion of the right subscapularis muscle. That anatomic variation was associated with a median nerve formed by two lateral roots. The origin and pattern of the upper subscapular nerve displays high variability, however the presented combination of the variable origin of a double upper subscapular nerve has rarely been described in the literature. The knowledge of such an anatomic variation is essential for the surgeon operating in the region especially in instances of brachial plexus’ repair after any traumatic injury. Moreover, the awareness of the precise origin and topography of these nerves is important for the physician attempting to block these nerves or utilizing these nerves as grafts for neurotization of adjacent damaged nerves of the brachial plexus.

Mechanical Ptosis in Neurofibromatosis Type 1 Heralding the Diagnosis of Right Sided Cervical Vagus Nerve Neurofibroma: A Rare Case Report
Neurofibromatosis type 1 (NF1) is an autosomal dominant, multisystem disorder. In NF1, involvement of vagus nerve can occur in the form of neurofibroma. A few cases of neurofibroma of thoracic vagus nerve have been reported while neurofibroma of cervical vagus nerve with NF1 is quite rare. A 19-year-old male came with complaints of decreased vision of both eyes and right sided drooping of eyelid since childhood. He was diagnosed as having NF1 with neurofibroma of right cervical vagus nerve.

Exploring the Management of Radiation Proctitis in Current Clinical Practice

Nupur Bansal, Abhishek Soni, Paramjeet Kaur, Ashok Kumar Chauhan, Vivek Kaushal
Introduction: Radiation proctitis is radiation induced rectal mucositis, occurring as a consequence to radiation therapy of the pelvic organs for various pelvic region malignancies. The management of radiation proctitis is extremely challenging as no recommended guidelines are available and limited number of studies are there in the literature involving the various treatment options. Aim: The aim of the study is the in-depth review of published literature to see the role of various treatment modalities in the management of radiation proctitis. Materials and Methods: An integrative review was undertaken within PubMed, MEDLINE, PMC, GOOGLE SEARCH databases and articles published upto February 2015 were reviewed and analysed. A total of 54 studies were included. Results: Literature suggests that non surgical therapies are the first line of treatment and surgery is reserved for advanced or refractory cases. Endoscopic therapies form the mainstay of treatment in managing the patients of radiation proctitis. Argon plasma coagulation and laser therapies are preferred. Radiofrequency ablation, cryoablation and mesenchymal stem cell therapy are the upcoming modalities. Medical therapy can be tried alone or in conjunction to endoscopic therapies. In the resistant or refractory cases, surgery can be looked for in the form of diversion or resection with or without anastamosis. Conclusion: Though, a number of options are available, still a lot can be explored in this field to improve the morbidity in the patients and to confirm the superiority of one treatment over other.

Test Tube Tooth: The Next Big Thing

Preeti Yadav, Mohammed Tahir, Harsh Yadav, Rakshit Sureka, Aarti Garg
Unlike some vertebrates and fishes, humans do not have the capacity for tooth regeneration after the loss of permanent teeth. Although artificial replacement with removable dentures, fixed prosthesis and implants is possible through advances in the field of prosthetic dentistry, it would be ideal to recreate a third set of natural teeth to replace lost dentition. For many years now, researchers in the field of tissue engineering have been trying to bioengineer dental tissues as well as whole teeth. In order to attain a whole tooth through dental engineering, that has the same or nearly same biological, mechanical and physical properties of a natural tooth, it’s necessary to deal with all the cells and tissues which are concerned with the formation, maintenance and repair of the tooth. In this article we review the steps involved in odontogenesis or organogenesis of a tooth and progress in the bioengineering of a whole tooth.

The Zest for Patient Empowerment

Rangeel Singh Raina, Vijay Thawani
Patient Empowerment (PE) can be considered as an active and self-determining role of patient than a passive recipient of health related services. It encourages the provider–patient relationship to blossom and helps in clearing patients’ doubts, confusion and fears to bring in clarity, relief and assurance. For the active involvement of the patient's in own health management they need to be awakened, motivated, educated and enlightened to enable them to exercise their rights. Active patient involvement in the decision-making achieves favourable health outcome. In an empowerment based approach, the focus is not on defining a particular type of behaviour, but on how the behaviour is defined as a goal to be achieved by a particular individual. As a result of their empowerment process, the patients can better self-manage their illness and their lives. Thus empowerment of the patients will positively help medical uprising of the community by creating an educated, health aware, informed and health conscious mass.

Aptamers in Therapeutics

Abhishek Parashar
Aptamers are single strand DNA or RNA molecules, selected by an iterative process known as Systematic Evolution of Ligands by Exponential Enrichment (SELEX). Due to various advantages of aptamers such as high temperature stability, animal free, cost effective production and its high affinity and selectivity for its target make them attractive alternatives to monoclonal antibody for use in diagnostic and therapeutic purposes. Aptamer has been generated against vesicular endothelial growth factor 165 involved in age related macular degeneracy. Macugen was the first FDA approved aptamer based drug that was commercialized. Later other aptamers were also developed against blood clotting proteins, cancer proteins, antibody E, agents involved in diabetes nephropathy, autoantibodies involved in autoimmune disorders, etc. Aptamers have also been developed against viruses and could work with other antiviral agents in treating infections.

Prevalence of Periodontal Disease in the General Population of India-A Systematic Review

Akhilesh H Shewale, Deepti R Gattani, Nidhi Bhatia, Rupali Mahajan, SP Saravanan
Introduction: Periodontal disease is a chronic inflammatory disease resulting in destruction of tissues and structures surrounding the teeth thus, if left untreated causes loss of teeth and ultimately results in edentulism, posing a great negative impact on individuals’ quality of life. Hence the global epidemiological data suggests periodontal disease to be one of a major burden on oral diseases. To reduce this burden it is necessary to know the true prevalence of the disease according to which proper initiatives can be formulated. India being home to nearly 1.2 billion people and one amongst the rapidly developing country, its population requires being systemically as well as orally healthy to lead a good quality of life. However due to large heterogenecity amongst its residing population in terms of geographical area, culture, education, socioeconomic status, a variety of oral diseases like periodontal diseases are prevalent here. Even though the early studies suggested that the population is highly susceptible to the disease, the true prevalence of periodontal disease has not been found yet due to paucity in literature available. Aim: To systematically review the available literature taken from various parts of India and find the prevalence rate of periodontal disease amongst the general population of India. Materials and Methods: A literature search was performed using PUB MED, COCHRANE and EMBASE databases on August 6, 2015. Following full text assessment a thorough references search was made and potential studies were included. A Quality assessment of retrieved articles from 2nd round was done using a self designed questionnaire and only field survey studies were included in the systematic review. Results: The literature search yielded six studies which had performed field surveys to find the prevalence of periodontal disease in their respective areas. These studies have observed different sets of age groups and the same has been accomplished by using Community Periodontal Index (CPI) or Community Periodontal Index of Treatment Needs (CPITN). It was also found that no prevalence studies have been carried out in few North and North Eastern states and Union Territories of India. Conclusion: Due to non-availability of same age groups in selected studies an overall prevalence rate could not be obtained. However, it was observed that few areas of states like West Bengal, Uttar Pradesh and Assam have reported a prevalence rate of periodontal disease of more than 85% in their general population. The data from the present systematic review calls for a combined initiative from the Government of India and Dental council of India to have a nationwide multicentric prevalence studies to obtain the true prevalence rate of periodontal disease in India and interventions should be provided for the same to maintain the oral health and quality of life of the affected population.

Certainty of S100 from Physiology to Pathology
S100 exists in wide variety of tissues and cell types, originally isolated from brain tissue and they are of low molecular weight proteins. S100 is evenly distributed in cytoplasm and also in nucleoplasm and is involved in both intercellular and extracellular functions. S100 protein is generally expressed in normal and also in pathological conditions. In current review, we discuss: a) update nomenclature of the various S100 proteins, b) expression of S100 in oral diseases (different soft tissue tumors, odontogenic cyst and tumor) for diagnostic value and also to know their histogenesis, c) role of S100 and RAGE receptor in oral squamous cell carcinoma.

Illustrated Imaging Essay on Congenital Heart Diseases: Multimodality Approach Part II: Acyanotic Congenital Heart Disease and Extracardiac Abnormalities

Venkatraman Bhat, Vinay Belaval, Karthik Gadabanahalli, Vimal Raj, Sejal Shah
Acyanotic heart disease constitutes a significant majority of patient who may present with non-cardiac symptoms. Either they are detected incidentally or present with respiratory complaints. Equipped with knowledge of anatomy by echocardiography and radiographic methods described in previous part of this presentation, diagnosis may be confidently attempted. On plain radiography acyanotic congenital heart diseases have variable appearance depending upon severity of disease. Cardiac size, chamber enlargement and pulmonary vascular pattern are key elements. Typically left to right shunts with large volume flow are associated with pulmonary plethora. Plain radiography has an important role in detecting manifestation of pulmonary arterial hypertension. Severe stenosis of pulmonary valve is associated with pulmonary oligemia. Small intra-cardiac shunts and anomalies of coronary arteries generally present with normal cardiac size and pulmonary arterial pattern. Disease spectrum presented in this illustration demands thorough scrutiny of pulmonary, osseous and abdominal abnormalities. This section illustrates some commonly encountered spectrum of acyanotic cardiac disease.

Clinical and Neuroradiological Spectrum of Metronidazole Induced Encephalopathy: Our Experience and the Review of Literature

Ujjawal Roy, Ajay Panwar, Alak Pandit, Susanta Kumar Das, Bhushan joshi
Metronidazole is an antimicrobial agent mainly used in the treatment of several protozoal and anaerobic infections, additionally, is often used in hepatic encephalopathy and Crohn disease. Apart from peripheral neuropathy, metronidazole can also cause symptoms of central nervous system dysfunction like ataxic gait, dysarthria, seizures, and encephalopathy which may result from both short term and chronic use of this drug and is collectively termed as “metronidazole induced encephalopathy”(MIE). Neuroimaging forms the backbone in clinching the diagnosis of this uncommon entity, especially in cases where there is high index of suspicion of intoxication. Although typical sites of involvement include cerebellum, brain stem and corpus callosum, however, lesions of other sites have also been reported. Once diagnosed, resolution of findings on Magnetic Resonance Imaging (MRI) of the Brain along with clinical improvement remains the mainstay of monitoring. Here we review the key clinical features and MRI findings of MIE as reported in medical literature. We also analyze implication of use of this drug in special situations like hepatic encephalopathy and brain abscess and discuss our experience regarding this entity.

Primary Hodgkin’s Lymphoma of the Sternum: Report of a Case and Review of the Literature

Ankur Jain, Naresh Gupta
Sternal masses present a unique diagnostic challenge in clinical practice. A wide array of differential diagnosis of a sternal mass includes osteomyelitis, tuberculosis, eosinophilic granuloma, sarcoma and lymphoma (usually Non-Hodgkin’s) amongst others. Sternum is a rare site of Hodgkin’s lymphoma and is usually misdiagnosed as tuberculosis or eosinophilic granuloma on routine histopathology. This delayed diagnosis culminates in death of patients. We report a 30-year-old lady who presented with swelling in upper part of chest wall since 1 month. Past history was significant for a similar swelling 2 years back, which was diagnosed as hodgkin’s lymphoma and treated with 4 cycles of chemotherapy at another centre (which led to resolution of the swelling). Examination revealed a 6x6.5cm firm swelling originating from the upper part of sternum. There was no lymphadenopathy or organomegaly. Histopathological examination (with immunohistochemistry) of the trucut biopsy from the swelling confirmed the diagnosis of Hodgkin’s lymphoma (nodular sclerosis). Patient was diagnosed as a late relapse of primary sternal Hodgkin’s lymphoma (stage IBE) and was administered 4 cycles of ABVD followed by local radiotherapy to the involved site which led to complete resolution of the disease as assessed by PET scan. We present this unusual case of primary sternal Hodgkin’s lymphoma. Rarity of this entity, with diagnostic challenges encountered and treatment options available are highlighted in the current report. A pubmed search revealed 18 cases of sternal involvement in Hodgkin’s lymphoma which have been tabulated.

Effects of Diaceto-Dipropyl-Disulphide on Plasma Sialic Acid and Renal Tissue Thiol Levels in Alloxan Diabetic Rats
Introduction: Plasma sialic acid levels are elevated in Diabetes Mellitus (DM) patients with proteinuria. Renal damage is mainly caused by free radicals that are excessively generated in DM. Thiols play an important role in the cellular antioxidative defence mechanisms mainly through thiol-disulphide exchange reaction. Diallyl disulphide, a garlic oil principle component, is known for its anti-diabetic properties. Its structural analogue, Diaceto-Dipropyl Disulphide (DADPDS), is a less toxic and more palatable disulphide and possesses similar anti-diabetic actions. Aim: This study was undertaken to assess the usefulness of DADPDS in prevention of de-sialation of Glomerular Basement Membrane (GBM) in alloxan diabetic rats and to assess effect of DADPDS on renal tissue thiol levels. Materials and Methods: Rats were divided into Normal, Diabetic and DADPDS treated diabetic groups. Diabetes was induced by intraperitoneal injection (IP) of alloxan. DADPDS was fed by gastric intubation. Plasma Sialic acid was determined by Ehrlich’s method and renal tissue thiol levels by Nitroprusside reaction method. Results: This study showed a significant decrease (p<0.001) in plasma sialic acid, plasma glucose and renal tissue TBARS levels along with significant increase (p<0.001) in renal tissue thiol levels in DADPDS treated alloxan diabetic rats when compared to diabetic control rats. Conclusion: Hence it may be concluded that DADPDS helps in preventing de-sialation of GBM in alloxan diabetic rats and improves renal tissue antioxidant defence mechanisms, may be through thiol-disulphide exchange reaction and thereby exhibits a possible clinical use in prevention of renal complications like diabetic nephropathy.

Red Lentil Extract: Neuroprotective Effects on Perphenazine Induced Catatonia in Rats
Introduction: Parkinsonism is a neurodegenerative disease that is defined by certain symptoms such as muscle rigidity, impaired movement, catatonia, tremor and disorientation of body. Aim: The aim was to investigate the effect of red lentil extract on perphenazine-induced Catatonia in model of rat. Materials and Methods: This experimental study was done on 48 male albino rats (weight 180–200g) of the Sprague-Dawley strain. Animals were randomly divided into six groups and were pre-treated with a single dose of red lentil extract (200, 400, 800 and 1000 mg/kg), most effective dose of bromocriptine (30mg/kg) and normal saline (5ml/kg) via intraperitoneal (IP) route. perphenazine (5 mg/kg) was after 30 minutes, administered (IP) to induce catatonia. The scoring method of Morpurgo was used to determine the muscular rigidity of animals. Results: The results showed that the 200mg/kg red lentil extract treated group had no significant reduction in catatonic responses after perphenazine administration in comparison with control group while the groups that received 800 and 1000mg/kg of red lentil extract showed significant difference (p<0.05) at all the time points. Conclusion: The results revealed that hydroalcoholic extract of red lentil has protective effect on Catatonia induced by perphenazine in rats. So this extract may be probably beneficial for catatonia in Parkinsonism.

The Long Term Kinetic of Plasma Lipids and Lipoproteins in Tyloxapol Injected Rats

Mehdi Rasouli, Hanieh Tahmouri, Mahboobeh Mosavi-Mehr
Introduction: The level of plasma triglyceride is balanced by the rate of secretion into and clearance from the plasma. Tyloxapol (Triton WR1339) is a nonionic detergent that inhibits lipoprotein lipase and hence clearance of triglyceride from the plasma. Aim: To determine the kinetic of plasma lipids and lipoproteins following injection of tyloxapol over a period of two weeks. Materials and Methods: Fifteen male rats were starved over-night and injected intravenously with tyloxapol (400mg/kg). Blood samples were taken in three steps as, the early (1-6 hours), the middle (1-2 days) and the third (3-9 days) phase. Plasma total cholesterol and triglyceride were measured by enzymatic methods and total phospholipids were analysed as molybdenum blue. Serum lipoproteins were fractionated by electrophoresis on agarose gel (Sebia Inc). Results: The changes of plasma lipids following tyloxapol injection showed three distinctive phases. The early phase lasts at least 6 hours, and the concentrations of triglyceride, total cholesterol and phospholipids increased linearly. The rate of triglyceride secretion was 259.7 + 8.1 mg/h.dl in this phase, which was comparable to the mean rate of 250.6 + 37.0 mg/h.dl or 102.8 + 15.2 mg/h.kg body in starved male rat. During the next 48 hour the lipids continued to accumulate but at a lower rate, and the levels of triglyceride, cholesterol and total phospholipids rose up to about 3200, 586 and 715 mg/dl respectively. In the last phase, the levels of plasma lipids decreased toward the basal levels after 5 days. In serum lipoprotein electrophoresis, the VLDL and LDL increased and HDL fraction disappeared simultaneously during the initial 2 hours of tyloxapol injection. The VLDL fell down toward the normal range, preceded to the reappearance of HDL during 5 days. Conclusion: A single intravenous injection of tyloxapol shows three distinctive phases. In the early phase, triglyceride accumulates linearly and the rate of its increment in plasma is a good estimate of the rate of VLDL secretion from the liver.

Bilateral Clavicle Fractures: A Report of Three Cases

Devendra Lakhotia, Kavin Khatri, Vijay Sharma, Kamran Farooque, Swati Sharma
Bilateral clavicle fractures are uncommonly reported in the literature with the incidence being less than 0.5% of all the clavicle fractures. Bilateral clavicle fractures are caused either by high-energy transfer of compression forces across both shoulder girdles or by a direct trauma to one clavicle followed by that to the other clavicle. These fractures could be missed due to their association with more severe chest injuries or a more symptomatically displaced fracture on one side or due to inadequate chest radiographs. We report three cases of traumatic bilateral clavicle fractures with three modes of injuries in different age groups. All the fractures were treated conservatively with good functional outcomes without any sequelae. Bilateral clavicle fractures should be actively sought by every trauma team with proper clinical examination and chest radiographs including both shoulder joints in high-energy trauma cases or with bilateral shoulder compression injuries.

Endodontic Management of a Three Rooted Maxillary Premolar: A Report of 3 Cases

Melanotic Neuroectodermal Tumor of Infancy

Mridula Goswami, Urvashi Bhushan, Sujata Mohanty

Atypical Response of Gingival Tissue to Extruded Metapex

Puneet Jindal,Navjot Singh Khurana, Ruchi Juneja, Harmesh Sharma, Varun Kumar

Giant Sialolith of Wharton’s Duct Treated Economically in a Poor Patient

Preetkanwal Singh, Sumita Singh, Mayank Vermani, Sunny Garg, Ashok Gupta

Congenital Ichthyosis - Collodion Baby Case Report

A Rare Mimicker in the Placenta

Transposition with Fusion of Maxillary Incisors in Primary Dentition: A Report of a Rare Case

Prevalence of Nosocominal Toxigenic Clostridium difficile in Children Under 5 Years in Hajar Hospital, Shahrekord, Iran

Multiple Myeloma: An Unusual Cause of Extensive Bone Marrow Necrosis

Rashi Sharma, Smeeta Gajendra, Swachi Jain, Sunil Kumar Gupta, Ritesh Sachdev

Revisited:Association of Serum Cholesterol, Triglyceride, High and Low Density Lipoprotein (HDL and LDL) Levels in Chronic Periodontitis Subjects with Risk for Cardiovascular Disease (CVD): A Cross Sectional Study

Pooja Khare, Prashant Gupta, Amit Khare, Pooja Singh

Health System Delay among the Pulmonary Tuberculosis Patients Presenting in the DOTS Centers of Nepal

Wongsa Laohasiriwong, Roshan Kumar Mahato, Rajendra Koju
Introduction: Health system delay is the time for complete diagnosis of the disease after patient approaches a health care provider. Aim: The study aims to identify the characteristics and the determinants of unacceptable health system delay (= 7 days delay from health system) in diagnosis of new pulmonary tuberculosis patients attending in Direct Observation Treatment Short course (DOTS) centers of Nepal. Materials and Methods: An analytical cross-sectional study was conducted by administrating a structured questionnaire interview and reviewing the medical record of the new sputum smear positive pulmonary tuberculosis cases during January–May 2015. The generalized linear model (GLM) was applied to control the clustering effects. Multiple logistic regressions were performed to identify the association between variables with = 7 days of unacceptable health system delay. Results: Of the 374 new sputum smear positive pulmonary tuberculosis cases, the factors that were associated with unacceptable health system delay (time = 7 days) were doing business (adj.OR= 1.61, 95% CI: 1.22-2.11; p-value <0.001) and unemployed (adj.OR= 3.04, 95% CI: 1.53-6.04; p-value <0.001) had chances of health system delay. However, getting support from parents (adj.OR= 0.55, 95% CI: 0.44-0.68; p-value <0.001), consultation with the private practitioners/ pharmacists (adj.OR= 0.24, 95% CI: 0.07-0.81; p-value 0.021), visiting government health facilities (adj.OR= 0.31, 95% CI: 0.13-0.73; p-value 0.008), using X-ray (adj.OR= 0.69, 95% CI: 0.49-0.97; p-value 0.032) and advance technologies for diagnosis of TB (adj.OR= 0.60, 95% CI: 0.39-0.94; p-value 0.024) were found contributing to reduce health system delay while controlling socio-economic, knowledge, presence of symptoms and attitude factors. Conclusion: About a quarter of new TB patients faced health system delay problems. Socioeconomic factors, unemployment, influences the health system delay when controlled for other covariates.

Spectrum of Renal and Urinary Tract Diseases in Kashmiri Children
Introduction: Definite paucity of data pertaining to spectrum of renal and urinary tract diseases in our state and in various parts of India forms the basis of this study. Available data has emphasized more on specific clinical syndromes and chronic renal diseases rather than over all spectrums of renal and urinary tract diseases, that too in adult population. Aim: The present study a retrospective analysis, forms one of the basic data of paediatric nephrology and urology related disorders in our state. Materials and Methods: Retrospective analysis of the case records of all the hospitalized patients with renal and urinary tract diseases between 2012 and 2013 were performed. Case records were analysed and categorized into various groups like; Urinary Tract Infections (UTI), Acute Kidney Injury (AKI), Acute Glomerulonephritis (AGN), Nephrotic Syndrome (NS), haematuria, Polycystic Kidney Disease (PCKD), Posterior Urethral Valve (PUV), Vesicoureteric Reflux (VUR), Chronic Kidney Disease (CKD), Congenital Anomalies of Kidney and Urinary Iract (CAKUT) and others. These groups were divided into subgroups to get more insight about the pattern of these diseases. Results: Out of 28114 patients hospitalized between 2012 and 2013 years, 447 (232 males and 215 females) patients were diagnosed of renal and urinary tract diseases which forms 1.58% the total admitted patients. Among these patients 32.9% (147/447) were diagnosed Acute Kidney Injury (AKI); 24.1% (108/447): Urinary Tract Infection (UTI); 9.6% (43/447): Acute Glomerulonephritis (AGN); 5.6% (25/447): bilateral hydronephrosis with UTI; 4.47% (20/447): nephrotic syndrome (NS); 3.5% (16/447): haematuria; and 4% (18/447) were having CAKUT (Congenital Anomalies Of Kidney And Urinary Tract). In addition to this there were 17 cases of Renal Tubular Acidosis (RTA), 3 cases of Barter syndrome and one case of Liddle syndrome. Conclusion: A substantial number of children are hospitalized with renal and urinary tract diseases with delayed ages of presentation, which at times have suffered irreversible renal damage that could have been prevented or treated if diagnosed earlier. Our study indicates that majority of these renal and urinary tract diseases are preventable and treatable. Henceforth, there is a need to develop a comprehensive service for the children with renal and urinary tract diseases in Jammu & Kashmir (J&K) India.

Detection of Salivary IgA Antibodies Against the HlyE Antigen as a Diagnosis of Typhoid Fever
Introduction: The Salmonella typhi (S. typhi) haemolysin E protein (HlyE) has been shown to be a sensitive and specific antigen for the detection of typhoid fever through the detection of anti-HlyE antibodies in sera. Saliva can also be a useful diagnostic fluid as it also contains antibodies against bacterial pathogens. Aim: This study aims to evaluate the potential detection of salivary anti-HlyE antibodies as a diagnosis of typhoid fever. Materials and Methods: Saliva was collected from acute typhoid patients (n=16) who presented at Hospital Universiti Sains Malaysia with prolonged fever of more than five days and were positive for S. Typhi blood culture. Saliva was also collected from convalescent typhoid patients (n=11), patients with other febrile fevers (n=15), and from healthy individuals (n=25). An ELISA was developed to detect the presence of IgA antibodies against HlyE in the saliva of typhoid patients. Results: The acute typhoid group had a higher mean absorbance value of 1.496 compared to the convalescent typhoid (0.538), other febrile fevers (0.678), and healthy individuals (0.457) group. Conclusion: This study demonstrated the utility of salivary anti-HlyE IgA antibody as a biomarker for the diagnosis of typhoid fever. Follow-up studies with a larger sample size will allow the optimization of the sensitivity and specificity of the assay. This non-invasive method can be useful for mass screening programs.

Assessment of Economic Impact Among In-Patients with Non-Communicable Diseases in a Private Tertiary Care Hospital in Southern India

Nitin Joseph, Shilpa Gupta
Introduction: Non-communicable diseases (NCDs) are currently responsible for tremendous economic impact on households. Aim: This study was done to estimate the direct, indirect and total costs incurred by households of in-patients with non-communicable diseases admitted in a Private tertiary care hospital. Materials and Methods: It was a cross-sectional study conducted in a private tertiary care hospital of Mangalore city in June 2012 by interviewing 30 patients and their attenders using a validated interview schedule. Results: Direct cost constituted 58.6% of the total expenses during the course of stay in the hospital. Mean direct cost was more among patients with cancers (p=0.049). Indirect cost was associated with educational status (p=0.04), occupational status (p<0.001) and socio economic status (ses) (p<0.001) of patients. Total cost was more among patients from upper middle ses households (p=0.012). Direct and indirect cost constituted 5-10% each and total cost > 20% of the annual income of majority of households. Medical insurance scheme was not availed by 26 (86.7%) patients due to ignorance. Conclusion: Economic burden imposed by a single admission among inpatients with NCDs was tremendous on their households. Hence, information on various medical insurance schemes needs to be popularized among people to improve its utilization. Health care providers need to introduce more financial schemes to minimize health care costs among poor households.

Life Course Socioeconomic Transition and its Association with Early Onset Type 2 Diabetes: Protocol for a Sequential Exploratory Mixed Method Study

Sankar Vadassery Uma, V Kutty Raman, Santhosh Kumar Nochikattil
Introduction: The prevalence of early onset type 2 diabetes (Diabetes below the age of 45 years) is increasing worldwide. Transition in socio-economic position–i.e. Life Course Socio-Economic Transition (LSET) - may contribute to the development of early onset T2D through complex processes involving economic and occupational opportunities as well as individual life style choices. Aim: To develop and validate the life course socioeconomic transition questionnaire and to know the association between life courses socioeconomic transition and early onset type 2 diabetes. Materials and Methods: This study follows sequential exploratory mixed method study design. It consists of one qualitative strand followed by two quantitative strands. Qualitative strand consist of in- depth interview among the community dwellers to develop a tool for measuring LSET. Two quantitative strands consist of the validation of the questionnaire by conducting cross-sectional survey among 200 randomly selected community dwellers and a hospital based case control study using the same questionnaire. Results: Those who have a history of lower SEP during his childhood period and enjoying higher SEP during his adulthood period have an increased risk for developing type 2 diabetes at their younger age (18-45 years). Conclusion: This study will help to develop a validated life course socioeconomic transition questionnaire and application of that tool in an epidemiological study.