Journal of clinical and diagnostic research

Correlation between Sex Chromatin and Female Breast Tumour in Paraffin Sections, Buccal Smears and Peripheral Blood Films

Introduction: Sex chromatin is a plano-convex to triangular DNA mass measuring approximately 1µm in size and lying adjacent to the inner side of nuclear membrane in the somatic cells of the females. There is consistent loss in the sex chromatin percentage in the carcinoma cases in comparison to benign lesions and normal individuals. Aim: To know the correlation between the sex chromatin status in female breast tumors on paraffin sections, buccal smears and peripheral blood films. Materials and Methods: The study was conducted on the paraffin sections prepared from carcinoma breast patients from their lumpectomy and mastectomy specimens. Buccal smears and a peripheral blood films were also prepared from each patient. Discussion: The control group had shown a mean sex chromatin of 54.6±6.73% which was found to be similar to the mean sex chromatin percentage in the fibroadenoma breast cases i.e. 54.91±6.06%. However, the mean sex chromatin in the carcinoma breast cases was markedly reduced i.e. 8.22±6.03%. Maximum no. of fibroadenoma cases (67%) were in the younger age group i.e. 15 to 25 year, while maximum number of carcinoma breast cases (42%) occurred in the 4th and 5th decade. Conclusion: There is a loss of sex chromatin in cases of carcinoma breast and is associated with poor histological markers. A statistically significant correlation was also found between sex chromatin status and microscopic grading in carcinoma breast. The tumors with higher microscopic grade had lower sex chromatin as compared to those with lower microscopic grading.

Piriformis Fossa – An Anatomical and Orthopedics Consideration

O.P. Lakhwani, P.S. Mittal, D.C. Naik

Introduction: Piriformis fossa is an important anatomical landmark having significant clinical value in orthopedic surgery; but its location and anatomical relationship with surrounding structures are not clearly defined. Hence it is necessary to clearly describe it in respect to anatomical and orthopedic aspect. Materials and Methods: Fifty Cadaveric dry femoral bones and Dissection of the four hip specimens were used to study the Piriformis fossa in respect to location and its relationship with surrounding structures. Clinical importance of piriformis fossa was determined in reference to antegrade femoral nail insertion. Observations: Piriformis muscle and so called piriformis fossa are unrelated entities. Piriformis fossa is anatomical site of insertion of obturator externus. In dry cadaveric femora; fossa was not always located in the direction of femoral shaft. It was located in the direction of femoral shaft in 24% cases only. In 68% cases femoral canal was aligned lateral and in 8% cases, it lies medial to the fossa. Conclusion: Piriformis fossa should be named as Trorchanteric fossa or Obturator fossa for better anatomical description. So called Piriformis fossa does not found to be universally corresponding to femoral shaft hence selection of entry site should be based on variable proximal femur and area on femur which corresponds to femoral shaft.

Effectiveness of Progressive Resistance Strength Training Versus Traditional Balance Exercise in Improving Balance Among the Elderly - A Randomised Controlled Trial

Introduction:Falls are important health issues among the elderly people. Most falls in elderly result from abnormal balance control mechanisms. Balance and muscle force generation are directly related, and are associated with age related muscular changes. Studies addressing fall prevention have focused on various group and individualised strength training. However, evidence on strengthening of key muscles necessary for maintaining balance and postural control is lacking. Objectives:To evaluate the effectiveness of individualised progressive resistance strength training (PRT) programme in improving balance for forward limits of stability in elderly with balance impairment, compared to traditional balance exercise (TBE), and combination of both (COMBI). Materials and Methods: This randomised controlled trial included three groups; 18 subjects in each aged = 65 years, from the elderly care centres of Mangalore city in Southern India (between June 2008 and December 2012). Block randomisation technique was used and allocation concealment was done using sequentially arranged sealed opaque envelopes. The TBE group received 8 component traditional balance exercise; 4 times a week for 6 months. The PRT group received resistance training for the key muscles of lower extremities, using DeLormes and Watkins protocol. The COMBI group received PRT and TBE alternately (2 days of PRT and 2 days of TBE per week). Functional reach test (FRT) was used for measurement of forward limits of stability. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 15. Results:For functional reach, PRT group had steady progression from baseline to 6 months (p<0.001). The TBE and COMBI groups showed considerable initial improvement; beyond 3 months, moderate improvement was seen. The changes in scores of FRT were significantly better for PRT than TBE. Conclusion:Individualised PRT intervention targeting the key muscles of lower limbs is more effective than TBE in improving forward limits of stability among non-frail elderly aged = 65 years.

Diagnostic Accuracy of MRCP as Compared to Ultrasound/CT in Patients with Obstructive Jaundice

Amandeep Singh, Ha rka ran Singh Ma nn, Chuni Lal Thukral , Neeti Ra jan Singh

Background:The expanding spectrum of therapeutic options for patients with surgical jaundice makes it necessary for the radiologist to precisely assess the etiology, location, level and extent of disease. Aim:To compare the diagnostic accuracy of Magnetic Resonance Cholangiopancreatography (MRCP) with Ultrasound and Computed Tomography (CT) in evaluation of patients with obstructive jaundice taking direct cholangiographies (ERCP and PTC), hystologic tests and anatomo-pathological findings after surgical intervention as gold standard. Settings anddesign:This prospective study included 50 patients who were referred to the radiology department with clinical features of biliary obstructive disease. Materials and Methods:Initial ultrasonography (USG) evaluation was followed by Computed tomography (CT) and Magnetic Resonance Cholangiopancreatography (MRCP);however in cases of benign pathologies where USG findings were unequivocal Computed tomography (CT )was not done to avoid unnecessary radiation exposure. The results were read by radiologists blinded to other imaging findings. The characteristic Endoscopic Retrograde Cholangiopancreatography (ERCP) features/ histopathological diagnosis / surgical findings (as applicable) were considered as final. Results:Diagnostic accuracy of MRCP (98%) in the diagnosis of benign and malignant diseases was relatively high (98% and 98%) as compared to CT (82.86% and 91.43% in benign and malignant respectively) and USG (88% and 88%). In the diagnosis of benign diseases MRCP was 100% sensitive compared to ultrasound (80.77%), which was more sensitive than CT scan (54.55%).In the diagnosis of malignant diseases, MRCP was more sensitive (95.83%) as compared to CT scan (91.67%), which was more sensitive than ultrasonography (79.17%). conclusion:Ultrasound as a screening modality is useful to confirm or exclude biliary dilatation and to choose patients for MRCP examination. MRCP is an important non invasive imaging investigation in the pre operative evaluation of patients with obstructive jaundice.

Study on Total Antioxidant Status in Relation to Oxidative Stress in Type 2 Diabetes Mellitus

A. Jamuna Rani, S.V Mythili

Background:Diabetes Mellitus is a condition of increased oxidative stress and requiries antioxidants. The sum of endogenous and food derived antioxidants represents the total antioxidant activity of the system. The cooperation among different antioxidants provides greater protection against damage caused by reactive oxygen species or reactive nitrogen species, than any single compound alone. Thus the overall antioxidant capacity may provide more relevant biological information compared to that obtained by the measurement of individual components, as it considers the cumulative effect of all antioxidants present in plasma and body fluids and hence the study. Materials and Method:The study population included healthy volunteers from staff of Sree Balaji Medical College & Hospital (SBMC&H) and Type 2 Diabetic patients attending SBMC&H, Chennai, India. Malondialdehyde levels and total antioxidant status of the case and controls was assessed. Results:A significant decrease in the total antioxidant status among Diabetic patients and significant increase in their malondialdehyde levels in comparison to healthy controls was observed. Conclusion:Type 2 Diabetes Mellitus is a condition in which there is increased oxidative stress as evident by increased Malondialdehyde levels and the condition calls for utilization of antioxidants to combat the oxidants thereby resulting in decreased total antioxidants status.

Role of S-100 Immunostaining in Demonstration of Nerve Changes and Quantification of Dendritic Cells in Leprosy

Anand Mohanraj, Sowmya Srinivasan

Background: A definitive diagnosis of leprosy is based on a demonstration of either acid-fast bacilli or nerve elements within the granulomas. On routine hematoxylin and eosin stains, the nerve fibers are not easily identifiable. In this study, S-100 immunostain is used to highlight the nerve elements and to demonstrate and compare the nerve changes in spectrum of leprosy including reactions. Aim: To demonstrate the nerve changes in spectrum of leprosy using S-100 immunostaining so as to categorize them for the purpose of early diagnosis and treatment. We also want to demonstrate and quantify the dendritic cells in lepromatous spectrum of leprosy using S-100 immunostain. Materials and Methods: Twenty consecutive skin biopsy specimens from patients with histopathological diagnosis of leprosy in the year 2012 were studied. Of these 20 cases, 13 were Borderline Tuberculoid, 1 was of indeterminate leprosy, 1 Borderline Lepromatous, 2 cases of Lepromatous Lep-rosy, 1 case of Type 1 reac-tion and 2 cases of Type 2 reaction. Stains used were Hematoxylin and Eosin stain for the histopathological diagnosis, Fites stain for Bacillary index and S-100 immunoperoxidase staining for nerve changes. 5 cases of granulomatous dermatosis of skin other than leprosy (5 cases of lupus vulgaris) were included as controls. Results: On Hematoxylin and Eosin staining, the nerve fibers showed vertical orientation in relation to epidermis in Borderline Tuberculoid leprosy. In addition, the nerve fibers showed rounded contour in Tuberculoid leprosy. The entire spectrum of leprosy showed evidence of nerve damage in S-100 immunostaining which was categorized in 4 patterns 1. Absent, 2. Fragmented, 3. Discontinuous and 4. Intact. The majority of Borderline Tuberculoid leprosy cases showed absent pattern of nerve damage. Dendritic cells were also positive for S-100 immunostaining with granular positivity in Borderline Tuberculoid Leprosy cases and membranous positivity in Lepromatous spectrum. Conclusion: Nerve damage is seen across the entire spectrum of leprosy and the early identification of this nerve damage using S-100 immunostaining, helps to differentiate between Lepromatous and Tuberculoid leprosy, especially in the borderline and indeterminate forms.

Correlation of Cytohistlogical Expression and Serum Level of Ca125 in Ovarian Neoplasm

Context or Background: CA125 is a biomarker that has potential utility across the spectrum: risk assessment, early detection, diagnosis, prognosis, monitoring and therapy. Aims and Objectives: This study was conducted to establish the validity and reliability of correlation of CA125 serum level with immunochemistry expression in imprint cytology and tissues for diagnostic purpose. Materials and Methods: A prospective study was done on 50cases of clinically and radiologically diagnosed ovarian tumor. Imprint smears were made intraoperatively from fresh samples and stained with M.G.G. stain for air dried smears and Papanicolaou stain for alcohol fixed smears. Stained smear was assessed and compared with subsequent histopathology report. Preoperative blood samples were obtained from all patients and sent for the assay of serum CA125 levels. Analysis of CA125 immunochemistry expression in imprint cytology and tissue was done and correlated with preoperative serum blood CA125 levels. Results: Significant positive correlation was found between elevated serum CA125 levels and cytohistological expression of CA125. Overall sensitivity was 100%, specificity was 86%, positive predictive value was 74% and negative predictive value 100%. Diagnostic accuracy was 90% with high statistical significance (p<0.001). Conclusion: We considered 35 U/mL as the cut-off value when evaluating serum CA125 ovarian cancer. Patients with high serum levels show good cytohistological expression.

Spectrum of Cytology of Neck Lesions: Comparative Study from Two Centers

Background: The objective of this descriptive study was to observe the frequency of various pathological conditions detected in FNAC of patients presenting with neck swellings coming from two different regions of southern India. Materials and Methods: This study included 100 consecutive patients from each region (Region 1: Wyanad, Region 2: Salem) presenting to the department of Pathology with swelling in the neck region as the chief complaint. All age groups were included. All patients underwent FNAC and results were recorded. Frequency of various pathologies was determined. Results: Thyroid lesions were predominant in both the regions with colloid goiter being the commonest lesion followed by lymphadenitis. Metastasis was more common compared to primary malignancies in Salem due to the elderly population under study. Conclusion: Non-neoplastic lesions were commonly encountered in our study which is in accordance with findings in similar studies conducted in other developing countries. FNAC should be the primary investigation of choice as it is inexpensive, safe and has a high degree of diagnostic accuracy.

Follicular Variant of Papillary Thyroid Carcinoma: Cytological Indicators of Diagnostic Value

Manimaran D, Karthikeyan T M, Dost Mohamed Khan, Thulasi raman R

Background: Fine needle aspiration cytology (FNAC) is an important investigation in preoperative diagnosis of thyroid lesions. Follicular variant of papillary carcinoma thyroid (FVPTC) is a well defined entity in histopathology, but its diagnosis in FNAC is usually missed and is challenging compared to classic papillary thyroid carcinoma. Aims: The purpose of this study is to retrospectively analyze cytological features in histologically confirmed cases of FVPTC, compare them with literature and document the features that could increase the sensitivity of FNAC diagnosis. Materials and Methods: Cytological smears from 22 histologically confirmed cases of FVPTC were evaluated for microscopic pattern and nuclear features by two independent pathologists and results compared with previous studies. Statistical analysis was done based on bivariate Pearson’s correlation coefficient. Results: Among 22 cases 21 were female and one male with age range 21 – 50 years . All patients had a solitary nodule except one with multicentric presentation. Preoperative cytological diagnosis were, classic papillary thyroid carcinoma (PTC); 7, FVPTC; 3, suspicious for PTC; 4, follicular neoplasm; 5 and adenomatous goiter;3. Diagnosis upon cytological review were, FVPTC; 11, classic PTC; 7 , suspicious for PTC; 2, follicular adenoma;1 and adenomatous goiter; 1. Conclusion: We conclude that cellular smears with features as observed in our case like microfollicular pattern, syncytial clusters, fine powdery chromatin, anisonucleosis and nucleomegaly should alert the pathologist to look carefully for other more specific features like nuclear grooves and nuclear pseudoinclusions. This approach will help in avoiding misdiagnosis of FVPTC and would aid in choosing the right treatment modality.

Correlation Among Lip Print Pattern, Finger Print Pattern and Abo Blood Group

Srilekha N, Anuradha A, Vijay Srinivas G, Sabitha Devi R

Aim: To study correlation between lip print pattern, finger print pattern and ABO blood group. Materials and Methods: The study group consisted of 27 males and 27 females who were aged between 20–40 years. Lip prints, finger prints and ABO and Rh blood groups of each individual were recorded. Lip prints were classified, based on Suzuki’s and Tsuchihashi’s classification and finger prints were classified, based on Michael’s and Kucken’s classification. The results were statistically analyzed by using Chi – square test. Results: Complete vertical lip print, loop finger print pattern, O+ blood group were predominant among individual groups. O+ blood group-type I lip print combination, loop finger print pattern-type IV lip print pattern combination, O+ blood group-loop finger print pattern combination and both B+ blood group-loop finger print pattern- type IV lip print pattern combination and O+ blood group-loop finger print pattern-type I lip print pattern were predominant. Conclusion: Though lip prints, finger prints and blood groups had their own specificities, correlation of the three parameters did not show any significance.

Comprehension Evaluation of Drug De-addiction Centres (DDCs) in Punjab (Northern India)

Vikram Kumar Gupta, Paramjeet Kaur, Gurmeet Singh, Priya Bansal, B. S. Sidhu

Background: Drug addiction is on the rise in Punjab,India. There are 15 DDCs which are supported by the Indian Red Cross Society. There is alleged mushrooming of private Drug De-addiction Centres (DDCs) in the smaller towns, villages and cities of Punjab. Objective: This study aimed to evaluate DDCs in Punjab. Materials and Methods: A total of 10 DDCs were included in the study and scheduled visits were made to collect data by using a pre-tested questionnaire. Results: The duration of treatment was 1 month at the Red Cross DDCs and it was approximately 6 months at private DDCs. The staff at the private DDCs were inadequate. The major drugs which were abused by patients were Propoxyphene, Alcohol, Bhukki and Cannabis. Patients were usually referred to the DDCs either by family members (35.3%) or social workers (29.8%). About 72.5% of patients were married, 36.3% had passed 10th standard and 54.4% were employed. A majority dropped out of the DDCs due to personal reasons and lack of family support. On comparison, more patients were found to be treated at Red Cross centres (75.3%) than at private centres (65.8%). All DDCs had conducted regular sessions of individual, group and family counseling for patients. Red Cross DDCs ensured that ex-clients received follow-ups and home visits. More patients were satisfied with the services which were provided by the Red Cross DDCs. On the contrary, more patients at the private DDCs complained about harassment fromstaff personnel (p>0.05). Conclusion: It is recommended that all DDCs should be checked regularly, and that the private centres should be provided with additional support from the government, to help run them more efficiently.

Status of Biomedical Waste Management in NursingHomes of Delhi, India

Introduction: Improper management of biomedical waste (BMW) poses a risk for health and environment. Healthcare workers have an important responsibility to properly segregate and train the staff in its disposal. Objective: To study the awareness, attitude and practices of health care workers in biomedical waste management and to observe the appropriateness of the same in the private nursing homes in Delhi, India. Materials and Methods: A cross-sectional study was conducted among private nursing homes in Delhi. In both south and east zones, 116 nursing homes were selected by random sampling method. Data was collected using a validated questionnaire of WHO. Data was analysed using SPSS software (version 16). Chi-square or fisher tests were used and accepted statistically significant if p-value was less than 0.05. Results: 41.7% of the workers in south zone and 25% in east zone had no knowledge about BMW generation (?2=24.26, p=0.001). 57 (95%) workers in south zone and 55 (98.2%) in east zone agreed strongly that BMW management is helpful in reducing spread diseases in the community (?2=1.22, p=0.5). On observation, it was found that 13 (21.7%) nursing homes in south zone and 15 (26.8%) in east zone did not have black bags. Practice of biomedical waste management in nursing homes in both the zones of Delhi was poor. Conclusion: The study concluded that the awareness regarding biomedical waste management was not satisfactory among health care workers in private sector. There is a need of strict implementation of guidelines of BMW management.

Study in Southern India Among Hypertensive Patients Using ECG To Screen Left Ventricular Hypertrophy – Can We Do It in Rural Health Centres?

Jostol Pinto, Peter George, Narasimha Hegde

Background: Electrocardiogram (ECG) is a cost effective tool to evaluate left ventricular hypertrophy (LVH). However, its reliability is often questionable when compared to the gold standard - echocardiography.The validation of ECG as a tool to diagnose LVH would benefit centres that lack access to echocardiography. Aim: (1) To assess the efficacy of ECG criteria to screen for left ventricular hypertrophy in comparison to echocardiography. (2) To determine whether ECG can be used as a screening tool for LVH in rural primary health centres Materials and Methods: Fifty hypertensive patients admitted to a tertiary level hospital fulfilling the inclusion and the exclusion criteria, were evaluated for LVH using ECG and echocardiography. Romhilt-Estes and Sokolow-Lyon criteria were applied to all subjects and their efficiency in detecting LVH was measured using Kappa statistics in comparison to echocardiography. Results: Among the 50 patients, 23 had LVH by echocardiography. In comparison to echocardiography, Romhilt-Estes and Sokolow-Lyon criteria were specific for LVH (96.3%, 88.9% respectively), but were poorly sensitive (43.5%, 43.5%). Combining both the criteria, raised the sensitivity to 60.9% and specificity to 85.2%. Kappa statistical analysis showed moderate to fair agreement of the Romhilt-Estes criteria with echocardiography. Both criteria had high positive predictive values (90.9%, 76.9%). Conclusion: Both Romhilt-Estes and Sokolow-Lyon ECG criteria are poor screening tools due to low sensitivity. But during routine screening of hypertensive patients with ECG alone, if any patient is positive by Romhilt-Estes criteria or both criteria, it would certainly warrant echocardiographic evaluation. As echocardiography cannot be recommended to screen every patient with hypertension in developing countries, initial evaluation using ECG can certainly help in selecting those who require echocardiography.

Relation Between Neonatal Icter And Gilbert Syndrome in Gloucose-6-Phosphate Dehydrogenase Deficient Subjects

Yadollah Zahedpasha, Mousa Ahmadpour, Haleh Akhavan Niaki, Ehsan Alaee

Background and Aim: The pathogenesis of neonatal hyperbilirubinemia hasn’t been completely defined in Gloucose-6-Phosphate Dehydrogenase (G6PD) deficient newborns. The aim of this study was to detect the relationship between Gilbert’s syndrome and hyperbilirubinemia in Gloucose-6-Phosphate Dehydrogenase (G6PD) deficient neonates. Materials and Methods: This case-control study was conducted in Amirkola pediatrics teaching hospital, Babol, Iran. A total number of one hundred four infants were included in the study (51 infants with neonatal jaundice and Gloucose-6-Phosphate Dehydrogenase (G6PD) deficiency admitted to phototherapy or transfusion were selected as the case group and 53 infants with Gloucose-6-Phosphate Dehydrogenase (G6PD) deficiency admitted for other reasons than jaundice were selected as the control group). Exclusion criteria were ABO or Rh incompatibility or other reasons that made Coombs test positive, sepsis, hepatosplenomegaly, metabolic diseases, medical treatment and phototherapy. The promoter and coding regions of Uridine diphosphate Glucuronosyl Transferase 1A1 (UGT1A1) of genomic DNA were amplified by polymerase chain reaction (PCR) isolated from leukocytes. We used chi-square test and t-test to compare cases and controls. Results: Distribution of Gilbert genome was not significantly different between the two groups; among cases, 33.3% were homozygote, 35.3% heterozygote, and 31.4% normal. Among controls, 22.6% were homozygote, 34% heterozygote, and 43.4% normal (p-value=xxx). Hyperbilirubinemia family history didn’t differ significantly between these two groups. Conclusions: We showed that in Gloucose-6-Phosphate Dehydrogenase (G6PD) deficient neonates, there was no significant association between Gilbert’s syndrome (promoter polymorphism) and hyperbilirubinemia.

Epidemiological Trends of Trauma in Tertiary Care Centre in Dakshina Kannada District of Karnataka, India

Caren Dsouza, Vinay V Rao, Arun Kumar, Erel Diaz

Aims and Objectives: To study the pattern and burden of trauma cases which presented to a tertiary care centre in an upcoming Dakshina Kannada District of Karnataka, India. Methods: This was an epidemiological study. Data was collected by purposive sampling technique. Study period lasted from Jan 2013 to Aug 2013. Collected data was analyzed. Results: The annual incidence of trauma at our centre was 15.96% (1140 cases). Most of the injuries were reported in 21-30 years age group. The male to female ratio was approximately 2.3:1. Limb injury (66.92%) constituted the commonest form of injury. Among the various injuries, fall was the commonest cause of injury (60.78%), followed by RTA (16.75%) and assault (11.6%). A majority of the cases were admitted during night time (61.24%). Conclusion: There has been an alarming increase in the number of trauma cases in the past decade. The target age group being the most productive one; it affects the economy directly . There is a need of urgent protective measures which are required for the benefit of the community.

Impact of Injectable Progestogen Contraception in Early Puerperium on Lactation and Infant Health

Seema Singhal, Nivedita Sarda, Shipra Gupta, Saks hi Goel

Introduction: Unmet need for family planning approaches 40% or higher and many women are at risk of unintended pregnancy. Progesterone contraception after birth is frequently recommended, but concern remain of inhibition of lactation or effects on infant health. In present study we aimed to evaluate impact of short term use of injectable depot medroxy progesterone acetate (DMPA) if given in early post partum period on infant health and breast feeding performance. Material and Methods: A prospective case control study was conducted and 250 women immediately after delivery were recruited in the study. 150 women who were recruited as study group received Inj. DMPA 150 mg intra muscularly after initiation of lactation before discharge from hospital (Day 2-Day 10 of their delivery). 100 post partum women, not using hormonal contraception were taken as controls. All the subjects were followed to complete a full 6 months follow up. Duration and frequency of lactation, gain in weight, gain in height and any illness spells in the infant were noted at 6 weeks, 3 months and 6 months follow up. In the study group 100 subjects completed 6 months follow-up. The statistical analysis was carried out by using SPSS software version 7. The statistical technique used was z score(significance shown by z score> 1.96) and repeated measure analysis (two way Anova technique). Results: Hundred percent of primigravidas in the study group and 95% in the control group were satisfied with their lactation amount. The average gain in height was comparable in both study and control group {4.36±0.56 vs 4.33±0.54 (z score 0.38) at 6 weeks, 12.44±0.73 vs 12.40±0.71 (z score 0.39) at 3 months 17.30±0.91 vs 17.28±0.83 (z score 0.16) at 6 months}. Similarly average gain in weight was also not significantly different in two groups {0.89±0.11 vs 0.93±0.10 (z score 0.71) at 6 weeks, 1.77±0.17 vs 1.78±0.16 (z score 1.07) at 3 months and 3.53±0.30 vs 3.46±0.33 (z score 1.19) at 6 months}. The results were comparable with other studies. Conclusion: Injectable DMPA use as a contraceptive in the immediate post partum period was found to be a safe and effective alternate method with no deleterious effect on mother’s milk and infant’s growth.

The Impact of Labour Epidural Analgesia on the Childbirth Expectation and Experience at a Tertiary Care Center in Southern India

Hitansh u Bhatt, Sunil Pandya,Geeta Kolar, Praveen Kumar Nirmalan

Background: Labour epidural analgesia is increasingly used as a means of pain relief for women during labour and delivery. The significant pain during labour and delivery can be terrifying for mothers-to-be and the prospect of relief from pain can help reduce fear of childbirth to an extent. However, it is not necessary that reduced fear of childbirth may lead to an increased satisfaction with the childbirth experience. Aim: To determine the influence of labour epidural analgesia (LEA) on the experience of childbirth in pregnant women at a tertiary care center in southern India Methods: A pre-post interventional non-randomized study design at a tertiary care perinatal institute that used the Wijma Delivery Expectation and Experience questionnaires to determine baseline expectations of labour and childbirth and the actual experience in pregnant women. Labour analgesia was provided on maternal request or demand. Total and domain scores were compared between the two groups using non-parametric tests and a generalized linear repeated measures model after adjusting for factors that were found significant in the bivariate model. Results: The study included 235 pregnant women who opted for LEA and 219 pregnant women who opted against LEA. Overall, 37 (15.74%) of woman with LEA and 30 (13.70%) of women without LEA had a worse than expected experience of childbirth. Significant pain relief (p<0.001) was provided with LEA, however, the post-delivery scores did not differ significantly between the two groups (F=0.90, p=0.34) in a generalized linear repeated measures model. Conclusion: Maternal satisfaction with the process of childbirth is a complex dynamic that is not limited to the significant relief from pain provided by LEA.

Airway Management in Maxillofacial Trauma: Do We Really Need Tracheostomy/ Submental Intubation

Geeta Mittal, Rajinder K. Mittal, Sunil Katyal, Sanjeev Uppal, VarVar un Mittal

Background: There are various techniques available for airway management in patients with maxillofacial trauma. Patients with panfacial injuries may need surgical airway access like submental intubation or tracheostomy, which have their associated problems. We have been managing these types of cases by a novel technique, i.e, intraoperative change of nasotracheal to orotracheal intubation. Aim: To review our experience about various techniques for the airway management in patient with maxillofacial trauma. To analyse the possibility of using nasotracheal intubation and intraoperative change of nasotracheal to orotracheal intubation in panfacial fractures. Materials and Methods: In a tertiary care centre four hundred eighty seven patients of maxillofacial injuries, operated over a period of 2 years were reviewed in relation to age, sex, mode of injury, type of facial fractures, methods of airway management and their associated complications. Results: Young patients with male predominance is the most common affected population. Panfacial fracture is the most common type of injury (39.83%) among facial fractures. Airway was managed with intraoperative change of nasotracheal to orotracheal intubation in 33.05% of the patients whereas submental intubation or tracheostomy was done in 8.62% of the patients. Conclusion: Nasal route for endotracheal intubation is not a contraindication in the presence of nasal fractures, base of skull fractures and CSF leak. By changing the nasotracheal intubation to orotracheal intubation intraoperatively in cases panfacial fractures, most of the tracheostomies and submental intubations can be avoided.

i—gel™ in Ambulatory Surgery: A Comparison with LMA—ProSeal™ in Paralyzed Anaesthetized Patients

Introduction: Supraglottic devices have mostly eliminated the need of hemodynamically stressful routine endotracheal intubation for ambulatory surgeries. We aimed to compare hemodynamics- like blood pressure (BP) and heart rate (HR) alterations caused by stress response due to i-gel™ and LMA-ProSeal™ usage in Day care surgeries. Secondary outcomes included ease of insertion, time and number of attempts for the placement of devices. Materials and Methods: From April 2008 to July 2009, Sixty adult ASA I-II patients of either sex, aged 20-30, were randomly allocated into two groups (Group i-gel (n=30) receiving i-gel and Group PLMA (n=30) receiving LMA-ProSeal for airway maintenance) undergoing day care surgical procedures under general anaesthesia (GA).The ease of insertion and time taken for placement of device, postoperative complications were assessed. Haemodynamic parameters (HR, BP) were noted. It was a prospective, double blinded, and randomized controlled study. Parametric data were analyzed with the unpaired t-test and non-parametric data were analyzed with the Chi-square test. Unless otherwise stated, data are presented as mean (+ SD). p<0.05 was considered statistically significant. Results: Demographically both the groups were similar. i-gel was more easily inserted than LMA-ProSeal (90% vs. 83.33% respectively). i-gel insertion time was shorter than PLMA (14.9 vs. 20.0 sec respectively) and was statistically significant. Hemodynamics (HR, BP) were less altered in i-gel than PLMA and the results were statistically significant (p<0.05). Conclusion: i-Gel; a relatively newer and cheap supraglottic device; insertion is easier and quicker as well as hemodynamically less stressful when compared with LMA—ProSeal in a day care setting.

Design of Customizable Automated Low Cost Eye Testing System

Ganesan K, Shalini D

Background and Objectives: In many underdeveloped and third world countries, eye care is often neglected due to illiteracy. Particularly people in rural areas suffer with eye problems due to mal nutrition. The government is spending lot of money and efforts in screening the people at periodic intervals. One of the challenges faced by the doctors is screening the school children. Materials and Methods: The standard Snellen letter chart based diagnostic system does not work always. There are instances where the first few students who undergo this diagnostic system, memorize the letter sequence of the Snellen letter chart and convey the same to other fellow students. Hence other students simply read out the Snellen letter sequence from their memory, not by looking at the Snellen letter chart. Thus there is a need of randomizing the sequence of letters being displayed on the Snellen letter chart for every student to be diagnosed for eye testing. Conclusion: In the present paper we are proposing a customizable, software based, cost effective solution which involves a standard personal computer (PC) fitted with a camera, headphone and speaker system. The envisaged system can be administered even by the trained persons. The proposed system is also suitable for remote diagnosis of patients, particularly in the field of telemedicine.

Surgical Importance of Arterial Segments of Human Kidneys: An Angiography and Corrosion Cast Study

Neerja Rani, Seema Singh, Pushpa Dhar, Rani Kumar

Objective:Variations in the arterial supply of human kidney have been observed frequently, either in routine dissections or surgical practice. The main objective of the present study was to describe the arterial segmental pattern of human kidneys and its variation by angiography and corrosion cast techniques. Materials and Methods:Forty kidneys were washed and a plastic cannula was inserted into renal artery and the omnipaque dye was injected into it and X-ray was taken. The corrosion casts were prepared by injecting coloured acetate butyrate (CAB) granules solution. Results:Five vascular segments of kidney were seen based on the branching pattern of the renal artery by angiography and corrosion cast techniques. The renal artery was divided into anterior and posterior branches. The anterior branch further divided into four branches viz. apical segmental artery (ASA), Upper segmental artery (USA), middle segmental artery (MSA), lower segmental artery (LSA) while the posterior branch continue as posterior segmental artery. The origins of segmental arteries were variable. In 60% cases apical segmental artery (ASA) had common origin with upper segmental artery (USA) while in 40% cases it took origin directly from the main renal artery. Similarly the variations in the origin of the other branches of anterior division of renal artery were observed. The posterior segmental artery (PSA) however was single and comparatively small and supplied the posterior surface of the kidney. Conclusion:The knowledge of the vascular pattern of the kidney is thus important for the purpose of angiography and surgical procedures especially for nephrectomy and kidney transplantation.

Effect of Aging on the Quantitative Number of Brunner’s Glands

Pottayan Ayyapp akutty Nandagopalan, Kanapilly Francis Magdalene, Areekal Binu

Background: Age related changes in the number of Brunner’s Glands (BG) in four anatomical parts of human duodenum were studied. The few studies done on this topic were conducted mainly in men. Studies involving a much larger age group, from foetuses to elderly individuals up to 85years of age including both sexes were not done earlier and were evaluated. Aim: To find out whether the number of (BG) differs with increasing age in the four anatomical parts of duodenum. Materials and Methods: This study was carried out on the basis of 74 specimens taken from still-born foetuses. The patients were divided into four groups as <1-25 years, 26-50 years, 51-75 years and 76-85 years. Duodenal biopsies without gastrointestinal disorders were included in the study group. Sections were prepared and stained with haematoxylin-eosin. Ten microscopic fields of vision (FOV) were examined under high power on every representative slide from each duodenal portion and average was calculated. The (BGs) were analyzed quantitatively. The final result was expressed as the number of glands per high power field. The average number of (BG) in field of vision per high power field for each of the age groups was tabulated for subsequent statistical study. The documented data was calculated by the SPSS, version 16.0 software. Result: The decrease in (BG) is significant (p-value < 0.001) in the superior (first) and ascending (fourth) part of duodenum in all the age groups. Conclusion: It suggests that the number of glands can differ according to variations in age in duodenum.

Morphometric Study of Suprascapular Notch in Indian Dry Scapulae with Specific Reference to the Incidence of Completely Ossified Superior Transverse Scapular Ligament

Usha Kannan, N.S.Kannan, J.Anbalagan, Sudha Rao

Background: The suprascapular notch, a depression on the lateral part of the superior border of the scapula, medial to the coracoid process, is bridged by the superior transverse scapular ligament, which is sometimes ossified and the foramen which is thus completed, transmits the suprascapular nerve to the supraspinatus fossa. Variations in the morphology of suprascapular notch have been identified as one of the causes of suprascapular nerve entrapment. Rengachary et al. classified this notch into six types, based on its shape. Aim of Study: To study morphological variations of suprascapular notch in Indian dry scapulae and to analyze the incidence of completely ossified superior transverse scapular ligament with other ethnic populations which have been cited earlier. Materials and Methods: A total of 400 human dry scapulae which were obtained from the Department of Anatomy of selected eight medical colleges were analyzed. The type of suprascapular notch was noted and it was recorded as per the description given by Rengachary et al. The results of the present study were compared with the results of previous authors in different populations. Results: In our study, out of 400 scapulae, 40 (10%), were identified to have completely ossified superior transverse scapular ligaments. The frequencies of various types of suprascapular notches were: Type I -20%, Type II -10%, Type III -52%, Type IV -4%, Type V -4%, Type VI -10%. Conclusion: Since the suprascapular nerve entrapment syndrome might be caused by complete ossification of superior transverse scapular ligament with formation of suprascapular foramen and other morphometric variations of suprascapular notch, the knowledge on such variations is essential for clinicians, for making a proper diagnosis and for planning the most suitable surgical intervention.

Assessment of RV Function in Patients of (COPD)

Introduction: Chronic Obstructive Pulmonary Disease (COPD) has considerable effects on cardiac functions primarily affecting the pulmonary vasculature and then right ventricle along with left ventricle. One of the important causes of increased morbidity and mortality associated with COPD is cor pulmonale. Echocardiography provides a rapid, non-invasive method to evaluate cardiac changes. Our aim was to evaluate RVfunction in COPD as per guidelines of American Society of Echocardiography with an aim to find a simpler way of predicting cardiac morbidity. Materials and Methods: A cross sectional observational study was conducted on 17 COPD patients attending Respiratory Medicine outdoor of R. G. KAR Medical College, Kolkata, India, through history taking, clinical examination, PFT (PFT) and Echocardiography. Statistical analysis was done by using Statistical Package for the Social Sciences (SPSS) version-17. Results: Fractional area change of RV (FAC-%) was positively correlated with Forced Expiratory Volume in One Second (FEV1) (r = 0.4879), FEV1/ Forced Vital Capacity (FVC) ratio (r = 0.5048) and Peak Expiratory Flow Rate (PEFR) (r = 0.5361). There was strong negative correlation of Systolic Pulmonary Artery Pressure (SPAP) with FEV1/FVC ratio (r = -0.5553) and PEFR (r = - 0.4604). Right Index of Myocardial Performance (RIMP) of right ventricle was negatively correlated with FEV1/FVC ratio (r = - 0.598), PEFR (r = - 0.619), Forced Expiratory Flow (FEF) 25-75 (r = -0.515). Tricuspid annular plane systolic excursion (TAPSE) did not show any association with PFT parameters though it showed strong positive correlation with RV wall thickness. Conclusion: This study substantiates that FAC% and RIMP can be vital prognostic factors for RV function apart from SPAP, TAPSE to define RV dysfunction and predict morbidity in COPD.

Significance of Ferritin in Recurrent Oral Ulceration

Sumathi K., Shanthi B., Subha Palaneeswari M., Manjula Devi A.J.

Background:Ferritin is the storage form of iron. Hence, the sensitive test which can be used for diagnosing iron deficiency anaemia is estimation of ferritin in serum. One of the causative factors of oral ulceration is nutritional deficiency, which includes iron also. Aim: To study the meaningful association between recurrent oral ulcer and ferritin. Materials and Methods: Fifty oral ulcer cases which were diagnosed clinically in the E.N.T. Department of Sree Balaji Medical College and Hospital and Twenty Five controls were included in this study. Serum ferritin was estimated by doing a particle enhanced turbidimetric immunoassay for both cases and controls. Results: 66% of cases had decreased ferritin values and 34% had normal values, which was significant. Conclusion: From this study, it can be concluded that it is mandatory to screen oral ulcer patients for iron deficiency anaemia by estimating serum ferritin and it is also advisable for the patients to have iron supplementation on regular basis, along with diet rich in iron in addition to vitamins.

Effect of Ramadan Fasting on Body Weight, (BP) and Biochemical Parameters in Middle Aged Hypertensive Subjects: An Observational Trial

Salahuddin M, Sayed Ashfak AH , Syed SR, Badaam KM

Introduction: Ramadan fasting is a religious obligation which is practised by Muslim population all over the world. However, there is scarcity of scientific literature regarding its effects on health determinants in cardiovascular disturbances like hypertension. Objective: The present study was done to assess the (BP), body weight and serum cholesterol changes over the period of Ramadan fasting in patients with hypertension. Materials and Methods: This prospective observational trial was done on 15 hypertensive subjects who were in the age group of 35 to 65 years, who were determined to complete Ramadan fast. All subjects were on antihypertensive therapy. Outcome measures of (BP), body weight and serum cholesterol were assessed in all the subjects before and after Ramadan month. Results: Mean age of subjects was 44.6±5.62 years. Systolic BP decreased from 148±19.6 to 132.5±17.9 mm of Hg. The decrease of 15.5 units (95% CI: 7.5 to 24.4) was statistically significant (p = 0.0009). Diastolic BP decreased from 90.4±7.8 to 81.1±6.3 mm of Hg. The decrease of 9.3 units (95% CI: 5.7 to 13) was statistically significant (p<0.0001). There was statistically significant decrease in body weight from 66.6±13 to 65.2±12.7 kg (p<0.0001). There was no significant difference in serum cholesterol from 187.3±28.9 to 192.7±31.3 mg% (p=0.37). Conclusion: Hypertensive patients with continuation of their medicines showed a decrease in blood pressure and reduction in body weight at the end of Ramadan fasting duration. However there was no change found in serum cholesterol levels.

Hepatitis B Virus (HBV) Infection in Liver Disease Patients in Mumbai, India with Special Reference to Hepatitis B Surface Antigen (HBsAg) Mutant Detection

Shweta P. Kamat, Preeti R. Mehta, Supriya M. Paranjpe, Nayana A. Ingole

Objectives: To determine the prevalence of Hepatitis B Surface antigen (HBsAg) in patients attending the Hepatology Out Patient Department (OPD) of a tertiary care hospital and to compare the routinely used HBsAg detection kit with the mutant detection kit to find out the presence of mutants in a given setting. Materials and Methods: A cross-sectional study was carried out in adult patients with liver disease attending the Hepatology OPD, of a tertiary care hospital in Mumbai, India. Age, gender and clinical history of the patient were recorded. Blood specimen was tested for HBsAg (MicroscreenTM ELISA, Span diagnostics, India) and HBsAg mutants (Hepanostika HBsAg UltraTM ELISA, Biomerieux, France). The samples with discordant results between these two ELISAs were confirmed by Hepatitis B Virus (HBV) Deoxyribonucleic Acid (DNA) Polymerase Chain Reaction (PCR) (Cobas TaqmanTM, Roche Molecular Systems, USA). Results: Seven hundred and eighteen patients were enrolled in the study. The mean age of patients in the study group was 41 years (range 17 to 69 years). Four hundred and ninety seven (69.22%) were males and remaining were females. The prevalence of HBsAg was found to be 17.4%. The positivity amongst the male population was 18.1% which was higher than the female population (15.8%). Of the 718 samples tested, 120 were positive for HBsAg by MicroscreenTM ELISA and 132 were positive by Hepanostika HBsAg ultraTM. Of the 12 discordant samples, HBV DNA was detected in five samples indicating 0.7% prevalence of mutants. Conclusion: Hepatitis B is prevalent in liver disease patients. The mutant detecting assay is recommended in set-ups where missing HBsAg in patients would have tremendous impact on the outcome such as in blood donors, organ or tissue donors and antenatal screening of mothers. It is also helpful in chronic liver disease patients where the routine HBsAg detection test is negative and the other causes of chronic liver disease have been ruled out. However, it is not recommended for use in routine diagnostic set-ups where high false positivity would lead to over-diagnosis of the condition.

Prevalence of Invasive Aspergillosis Among (PTB) Patients in Kanchipuram, India

Background: Tuberculosis (TB) remains a major health problem worldwide. (PTB) is commonly associated with secondary aspergilloma. Repeated exposure of Aspergillus spores can aggravate the bronchial pathology and can manifest as asthmatic episodes. Aim and Objective: Pulmonary invasive aspergillosis is difficult to evaluate. Culture based diagnosis is time consuming. Hence (PCR) was done to evaluate the invasive fungal aspergillosis in (PTB) patients. Materials and Methods: Eighty sputum samples collected from TB patients were processed as per standard protocol. Species level identification was done using PCR. Results: Among 80 patients, 26 isolates were obtained, only 8 were Aspergillus species. All Aspergillus were taken up for PCR evaluation. Conclusion: Fungal infection should be suspected in all sputum positive patients. PCR is an effective tool to diagnose invasive aspergillosis.

Anticonvulsant Effect of Hydroalcoholic Seed Extract of Croton Tiglium in Rats and Mice

Raghunandan Mudium,Bhanuprakash Kolasani

Aims and Objectives: The study was aimed to evaluate the anticonvulsant effect of hydro-alcoholic seed extract of croton tiglium in rats and mice. Materials and Methods: Forty -eight each of rats and mice of either sex were randomised into four groups and subjected to seizures induced by electroconvulsiometer and pentylenetetrazole. The hydroalcoholic seed extract of croton tiglium (250 and 500mg/kg) was studied for its anticonvulsant effect using sodium valproate (200mg/kg) as standard and distilled water as control. The parameters observed were time for onset of HLE (Hind Limb Extension) and duration of HLE in electrically induced seizures, and time for onset of convulsions and duration of convulsions in chemically induced seizures. Mortality of the animals over 24 hours was observed in both the models. For testing statistical significance between various groups unpaired student t-test was used. Observations and Results: In electrically induced seizures croton tiglium produced dose dependant prolongation of time for onset of HLE and a reduction in duration of HLE and in chemically induced convulsions, it prolonged time for onset of convulsions and reduced the duration of convulsions indicating its anticonvulsant effect in both models. However, anticonvulsant effect was less compared to sodium valproate. There was a higher percentage of mortality in croton tiglium group in chemically induced convulsions when compared to sodium valproate. Conclusion: Croton tiglium has dose dependant anticonvulsant effect in electrically induced seizures, while in pentylenetetrazole induced-seizures the protection is very minimal.

Alternate Day versus Once Daily Atorvastatin for Primary Prevention of (CHD) in Naïve Patients of Dyslipidemia

Introduction: Statins (or HMG-CoA reductase inhibitors) have become drug of choice for raised Low-Density Lipoprotein Cholesterol (LDL-C) in treating. Of these, Atorvastatin, because of its prolonged 3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) reductase inhibition has been considered for alternate day therapy in primary prevention of (CHD). Objectives: To compare the efficacy and safety of daily versus alternate day 10 mg Atorvastatin on reduction of lipid levels in patients of dyslipidemia and to evaluate the number of patients reaching the target Low-Density Lipoprotein (LDL) goals in these groups. Methodology: In this comparative, randomized, parallel group, non-blinded study, 100 naïve dyslipidemic patients in low to moderate risk group as per NCEP ATP (III) Guidelines were divided in two groups. Group A (n=50) received Atorvastatin 10 mg every alternate day for three months and Group B (n=50) received Atorvastatin 10 mg daily for three months. Apart from general examination and baseline investigations, lipid profile was also done. Efficacy was assessed by the percentage reduction in LDL and attainment of LDL goals as per NCEP ATP III Guidelines at the end of the study. Safety of the medication was assessed. Results: Atorvastatin 10 mg daily produced a significant reduction in Total Cholesterol (TC), LDL, Very Low Density Lipoprotein (VLDL) as compared to Atorvastatin 10 mg alternate day. The increase in the HDL level was also greater with a daily dose as compared to alternate day (but not statistically significant). In Low risk category 86.12 % patients (n=31) on daily dose reached their LDL-C goal vis-a-vis 66.67% (n=18) of patients on alternate day therapy. In the moderate risk category 100 % of daily Atorvastatin patients (n=10) achieved their LDL-C goal versus 33.33% patients (n=4) on alternate day therapy. Adverse events with alternate day therapy (n=4) were less as compared with daily treatment (n=10). Conclusion: Atorvastatin 10 mg daily was found to be safe and efficacious in patients with dyslipidemia compared to an alternate day therapy.

Pharmacovigilance Knowledge among Patients at a Teaching Hospital in Lalitpur District, Nepal

Nisha Jha, Devendra S Rathore, P Ravi Shankar, Sudesh Gyawali

Background: Consumer’s knowledge and perception towards adverse drug reactions (ADR) can play an important role in ensuring a healthy lifestyle and proper use of medicines. Aims: This study aimed to assess the knowledge and perception towards pharma covigilance in general and consumer pharmacovigilance in particular among out patients in a teaching hospital of Nepal. Settings and Design: A descriptive cross-sectional study using qualitative and quantitative methods was carried out from 1st May to 3 June 2013. Methods: Every fifth patient visiting the outpatient pharmacy was interviewed using a semi-structured questionnaire. Gender, age, educational qualification, profession and ethnicity were noted. Twenty-three patients were interviewed. Results: There were 10 males and 13 females. The age of the respondents ranged from 11 to 50 years with a mean age of 27.8 (SD = 5.61) years. Seven (30.43%) respondents were students studying in different levels. Thirteen (56.52%) participants were from the Newar community. Majority of the patients (86.95%) knew ADRs may be caused by the medicines they consume and 18 (78.26%) were of the opinion that ADRs should be reported to doctors and other health care professionals including pharmacists. Conclusion: Knowledge and perception were low in certain areas. There is a need for educational interventions for improving the awareness of patients and general public for ensuring medicine safety and promoting rational use of medicines.

Antidepressant Activity of Brahmi in Albino Mice

Sldv Ramana Murty Kadali, Das M.C, Srinivasa Rao A.S.R, Karuna Sri G

Context: In traditional system of medicine brahmi has been used to enhance memory. Recently it has been reported to have action in psychiatric disorders. With these backgrounds the work has been undertaken to study antidepressant activity of brahmi in albino mice. Aim: To evaluate antidepressant activity of brahmi in experimental models. Materials and Methods: The antidepressant activity was studied in albino mice using forced swimming test (FST), tail suspension test (TST) and shock induced depression (SID). Imipramine (10mg/kg), fluoxetine (30mg/kg) were used as standard drugs and brahmi (10, 20, 30mg/kg) was used as test drug. Results: Brahmi exhibited significant decrease in duration of immobility in FST and reduced the shock induced decrease in activity in SID models. It didn’t show any activity in the TST model. Conclusion: Brahmi has shown antidepressant activity in FST and SID.

Genetic Risk of Azoospermia Factor (AZF) Microdeletions in Idiopathic Cases of Azoospermia and Oligozoospermia in Central Indian Population

Background: Genetic factors cause about 15% of male infertility. Azoospermia factors (AZFa, AZFb, and AZFc) present on Yq are most important for spermatogenesis. We have made an attempt to evaluate the frequencies of microdeletions of AZFa, AZFb, AZFc in idiopathic cases of azoospermia and oligozoospermia from central Indian population. Materials and Methods: We have analyzed a total of 156 subjects (95 oligozoospermia and 61 azoospermia) & 50 control subjects. DNA samples were analyzed for microdeletions of Y chromosome by PCR-screening of 18 sequences-tagged-site (STS) markers from different region of the AZF on Yq and SRY on Yp. Results: Out of 156 cases analyzed, 13 (8.33%) subjects (8 azoospermia and 5 oligozoospermia) showed partial deletion of AZF regions, of which deletion in AZFc region was the most common (84.6%) followed by AZFb (15.4%) and AZFa (15.4%). The sites and sizes of deletions varied among patients. Histological study of the testicular tissue of the available subjects, who showed microdeletions of Y chromosome, showed spermatogenic arrest at different stages. The frequency of Y chromosome microdeletion in our subjects was 8.33%. Conclusion: Some Indian studies reported low frequencies of microdeletions than that of our result. We suggest that the frequency of deletions may be affected by the involvement of different genetic factors, ethnic population and different geographical regions. PCR based Y chromosome screening for microdeletions will be useful and great help to infertility clinics for genetic counselling and assisted reproduction.

Sertoli -Leydig Cell Tumor of Ovary- A Diagnostic Dilemma

Rohini Dhanya C.S., Somanath Padhi, Renu G’Boy Varg hese

Sertoli Leydig Cell Tumours (SLCTs) are rare, unilateral, sex cord stromal tumours of ovary, which constitute less than 1% of all the ovarian neoplasms. These tumours can be functionally diverse and they may have heterologous elements. We aim to report a case of a 25-year- old woman who presented with suprapubic pain of 5 days duration, a unilateral adnexal mass, hypertestosteronism without virilization. Intraoperative frozen section of the unilateral salpingo-oophorectomy specimen was suggestive of granulosa cell tumour. Histopathological examination, supplemented with alpha-inhibin immunohistochemistry, was diagnostic of Meyer’s type II SLCT. Clinical presentation, pathology and the diagnostic pitfalls in the present case have been presented with a brief review of literature.

Circumaortic Left Renal Vein-A Rare Case Report

During routine dissection which was carried out for the medical students, a circumaortic left renal vein draining into inferior vena cava was observed. There were 2 renal veins through which the left kidney drained into the inferior vena cava, of which the larger one ran ventral to aorta and the other smaller one ran posterior to aorta and received lumbar veins before opening into inferior vena cava. This is a relatively rare condition which can result in left renal hypertension (LRVH) syndrome which is otherwise called as anterior and posterior nutcracker syndromes. This venous anomaly results from the errors of embryological development. It is of clinical significance, mainly during retroperitoneal surgeries and intra caval interventions. It is also important in conditions which warrant extensive venous dissections, venous reconstructions as in transplantations and invasion of veins by cancerous tissue, resulting in life threatening haemorrhage.

Microfilaria in Human Subcutaneous Dirofilariasis: A Case Report

Human subcutaneous dirofilariasis, a rare zoonosis is being increasingly reported from various parts of the world. Most of the reported cases have lesions in and around the eye. The adult female dirofilariae release microfilaria into the definitive host’s blood. Various mosquitoes that serve as intermediate hosts such as Culex, Aedes and Anopheles take up the microfilariae (mf-L1) while feeding on an infected host. Microfilariae develop in the mosquitoes. The transmission to dogs or other hosts including humans occurs through mosquito bite during subsequent blood meal. Humans may be infected as aberrant (accidental) hosts, mainly by D. repens and D. immitis. D. repens usually resides subcutaneously, while D. immitis frequently ends up in the human lung. In human infections usually just one larva develops, which does not reach sexual maturity. In India, almost all reported cases of dirofilariasis in humans have involvement of face in the form of ocular dirofilariasis with a few reports on subcutaneous dirofilariasis. We report a case of human subcutaneous dirofilariasis, from western India, involving leg and showing microfilaria in tissue indicating presence of gravid female dirofilaria (sexual maturity). To the best of our knowledge, it is among rare cases of subcutaneous dirofilariasis wherein microfilariae have developed in human host.

Solitary Necrotic Nodule of Liver (SNNL): A Report of Two Cases

Garima Goel, Seema Rao, Nita Khurana, A. K. Sarda

SNNL is a rare, benign lesion which may arise from trauma, a sclerosing haemangioma or it may represent a burned out phase of various conditions like parasitic infections, or chronic infections like tuberculosis. Histopathology provides the definite diagnosis, which thus helps clinicians in allaying unnecessary anxiety of the patient and in planning proper management.We are reporting two cases here, which had solitary necrotic nodules of liver (SNNL), with emphasis on the aetiology and morphology of the lesions. SNNL was incidentally detected during cholecystectomy done in both young female patients. The lesion was solitary in one case and it was multiple in the other. The suspected aetiology in one of the cases was parasitic, whereas it was tuberculosis in the other. The clinical features in both cases were suggestive of neoplasms.

Adrenocortical Carcinoma Presenting as A Rupture and Extensive Retroperitoneal Haemorrhage

Adrenocortical carcinoma (ACC) is an extremely rare tumour. We are reporting a 45-year-male patient who had a history of sudden severe worsening epigastric pain and fullness in abdomen, with giddiness. The radiological investigations showed a large right suprarenal mass with extensive destruction and retroperitoneal haemorrhage, with extra capsular, periportal and liver metastases. Exploratory laparotomy was done for excisions of mass and surrounding tissue. On histopathological examination, diagnosis was given as Adreno Cortical Carcinoma with capsular, vascular, and soft tissue nodular involvement.

Benign Hepatic Mesenchymal Hamartoma (HMH) – A Case Report

A one-year-old male child presented with progressive enlargement of abdomen and loss of appetite which he had suffered from, since 4 months. Physical examination showed a palpable mass in right hypochondrium. Ultrasonography and MRI showed a solid mass arising from right lobe of liver. The resected mass was well encapsulated, yellowish white in colour and it measured 20 x 18 x 17cm. Cut surface showed a Nutmeg like appearance. Histology showed a well-defined, fibrous capsule with numerous ducts which were lined by flat to low cuboidal epithelium and which were surrounded by concentric layers of fibrous tissue which showed myxoid changes at places. Intervening area showed normal appearing hepatocytes with clear cell changes, dilated congested sinusoids, along with extramedullary haematopoiesis. Based on distinctive morphological features, a histological diagnosis of Benign Hepatic Mesenchymal Hamartoma of liver was made. IHC was not done, as no specific marker has been described for making a differential diagnosis. Benign Hepatic Mesenchymal Hamrtoma (HMH) of liver is an extremely rare tumour of childhood and therefore, the case was considered worth documentation.

Nasal Discharge Cytology an Important Diagnostic Method for Allergic Fungal Sinusitis: Report of Three Cases

Allergic fungal sinusitis (AFS) is a distinct clinicopathological entity. It occurs in immunocompetent individuals with history of atopy, increased IgE levels and peripheral eosinophilia and causes noninvasive pansinusitis. It is histologically characterised by the presence of ‘allergic mucin’ with clusters of eosinophils, charcot – Leyden crystals and scattered fungal hyphae. AFS is an immunological reaction to fungal deposits. As AFS is noninvasive, fungal hyphae can be demonstrated in nasal secretions on cytology. Etiological agent of AFS is Aspergillus or pigmented dematiaceous family. Special stains are helpful for identification. We came across three cases of age group ranging from 26 to 60-year of recurrent rhinitis with nasal discharge. The nasal secretions were collected by nasal swabs onto the glass slide and stained with Giemsa and silver stains. Smears revealed fungal hyphae amidst inflammatory cells with occasional Charcot-Leyden crystals. Nasal secretion cytology plays an important role in diagnosis and can be used for preoperative as well as intraoperative diagnosis of AFS and can be used as an additional diagnostic tool.

Sclerosing Peritonitis Occurring in Association with Juvenile Granulosa Cell Tumour – A Cause of Concern

Amita K., Vijayshankar S., Gangadhar C., Abhishek Khera

Sclerosing peritonitis (SP) is characterized by fibrous thickening and adhesions of the peritoneum and it is encountered frequently in association with peritoneal dialysis, practolol and anticonvulsant therapy. Rarely does it present as a gynaecological complication, most commonly in conjunction with luteinized thecoma of ovary. Very rarely has sclerosing peritonitis been reported to occur with ovarian cystic teratoma and a luteinized variant of adult granulosa cell tumour, among which only one case has been reported in the English literature. An 18-year-female presented with a history of lower abdominal pain, of one month’s duration. At surgery, an ovarian mass was noted, along with adhesion of bowel loops which were enclosed within a diffusely thickened peritoneal membrane, forming a cocoon. Adhesions were seen in bilateral paracolic gutter and infracolic omentum, which were suggestive of metastatic deposits. Histopathology of ovarian lesion was interpreted as a juvenile granulosa cell tumour. The peritoneal process revealed sclerosing peritonitis. We emphasize this rare association of sclerosing peritonitis with juvenile granulosa cell tumour and that the peritoneal process of sclerosing peritonitis in a juvenile granulosa cell tumour should not lead to over staging of an ovarian tumour.

Sclerosing Lobular Hyperplasia- Correlation between Cytomorphological and Histological Findings

Rachna Lamichaney, Mingma Sherpa, Diwakar Pradhan

Sclerosing lobular hyperplasia of the mammary gland is an uncommmon benign lesion which is mainly seen in adolescents and young women. The breast lobules are enlarged due to ductal and acinar proliferations but they have normal architecture. There is extensive fibrosis of the intralobular stroma, and to a lesser degree, of the interlobular parenchyma. Patients generally complain of a palpable, painless/slightly tender and well-defined lump in breast. Fine-needle aspiration cytology of sclerosing lobular hyperplasia is non diagnostic with features similar to fibroadneoma except for the absence of stromal fragments. In order to reach a definitive diagnosis, a histopathologic evaluation is needed. However, a distinction between the two benign entities is of no clinical significance.We are describing a case of sclerosing lobular hyperplasia that occurred in the left breast of a 26-year-old lady.

Dermatofibrosarcoma Protuberans – A Recurrent Lesion with Unusual Presentation in the Parotid Region

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous malignant neoplasm consisting of relatively monomorphous mononuclear spindle cells that show diffuse CD34+ positivity. Management of this lesion poses problem because of its infiltrative margins and high propensity for local recurrence and rare distant metastasis. It is said that clear margins with minimal removal of normal tissues can be achieved by Mohs’ micrographic surgery, which is particularly important in head and neck locations where the presence of vital anatomical structures and aesthetic considerations hinders a wide surgical excision. A case of DFSP, at a very uncommon site of parotid region, which recurred within 9 months after initial surgical treatment, is being reported.

Perforated GIST in Jejunum – A Rare Cause of Abdominal Cocoon

Usha M, Vijay Kumar, Rau Aarathi R, Sulatha Kamath

Gastrointestinal stromal tumours [GISTs] are rare but they commonly arise in stomach, and small or large intestines. They are usually accompanied with gastrointestinal bleeding. We are reporting a case of GIST which occurred in a 52-year-old male,who presented with acute abdomen. On laparotomy, the entire segment of jejunum was found to be partially encased in fibrocollagenous tissue, which formed a cocoon. Moreover, the intestine showed diffuse thickening with multiple tumour masses, which is an uncommon gross finding in GIST. This case report highlights variable clinical and morphological manifestations of GIST. Awareness on its rare clinical manifestations, including abdominal cocoon, may help in making an early diagnosis and providing timely appropriate treatment.

Extraskeletal Chondroma of the Foot–A Case Report

V. Rajalakshmi, Jayaraman, Venu Anand, Narmada Ramprasad

Extraskeletal Chondroma (ESC) is uncommon which occurs predominantly in hands and feet. It has a variable histology, with two thirds of the ESCs showing mature hyaline cartilage which is arranged in distinct lobules with fibrosis, or ossification, or myxoid areas and few showing immature patterns, with chondroblasts mimicking extraskeletal myxoid chondrosarcomas (ESMCSs). ESCs can recur but they never metastasize, whereas ESMCSs can metastasize, which require aggressive treatment. We are reporting a case of ESC which was located in the distal phalanx of right foot great toe in a 58-year-old male patient. The histopathology in our case showed features of ESC, with some foci showing myxoid stroma and few chondroblasts with atypical pleomorphic nuclei mimicking ESMCS. Hence, the case had to be carefully evaluated to exclude ESMCS and to make the diagnosis of ESC. The treatment was limited to simple excision of the tumour and extensive surgery and post operative radiotherapy were avoided.

A Case of Massive Broad Ligament Leiomyoma Imitating an Ovarian Tumour

Preeti Bansal, Dinesh Garg

Leiomyomas are the most common benign tumours of female reproductive system which occur in women of child- bearing ages. Large fibroids are known to arise from uterus, but rarely from broad ligament. An unusual clinical presentation of a massive, broad ligament fibroid which measured 25 cm x 22 cm x 21 cm, and imitated an ovarian tumour because of its myxoid and cystic degenerations, has been described.

Papillary Poroid Hidradenoma: A Distinct Histopathological Entity A Rare Case Report

Dravid NV, Gadre AS, Damle RP, Bagale PS, Suryawanshi KH

Papillary poroid hidradenoma is a very rare entity which belongs to poroid neoplasms, which represents 10% of sudoriferous tumours. It can be easily misdiagnosed as a malignant neoplasm. A 34-years-old male presented with an asymptomatic mass over the right chest wall, below the nipple, of 18 months duration. Clinical examination revealed tense cystic swelling which revealed hypoechoic and solid components on imaging. Clinically, a malignancy was suspected and a surgical excision was done. Histology and immunoreactivity to pan cytokeratin, epithelial membrane antigen and carcino- embryonic antigen confirmed the diagnosis. We are reporting this case because of the rarity of its presentation.

Struma Ovarii with Elevated Ca-125 Levels and Ascites Mimicking Advanced Ca Ovary

Navin Kumar Sinha

Struma ovarii is uncommon tumor of ovary which can mimic as advanced carcinoma of ovary. Thyroid tissue is relatively frequent constituent of mature ovarian teratoma. Case of struma ovarii masquerading as cancer of ovary in a female aged 63 yrs showing complex large unilateral multilocular adnexal mass with elevated CA 125 (more than 1721 IU/L) and massive ascites mislead treating surgeons for long time. Clinicians were virtually clueless about preoperative diagnosis. Combination of ascites has been seen in one third cases but association with raised CA 125 is rare(only 8-10 cases so far). This case developed hypothyroidism one week after surgery

Chondrosarcoma Arising in an Enchondroma of the Metacarpal Bone - A Case Report

Honnappa Sridhar, Mysorekar Vijaya, Wilfred Clement, Chirukuri Srinivas

Chondrosarcoma is a rare malignant tumour of proliferating cartilaginous tissue. It may arise as a primary lesion, or occur secondarily at the site of a previous benign lesion such as enchondroma . Primary chondrosarcomas are rare in the hand with a frequency of less than 0.5% to 3.2% of all chondrosarcomas, and are seen involving the phalanges, trapezium and trapezoid. Malignant transformation of a benign solitary enchondroma to secondary chondrosarcoma, especially in the hand, is extremely rare. We report a case, where the patient had developed a painful swelling in the 5th metacarpal bone of the right hand, 15 years back, which was diagnosed as enchondroma. Subsequently the patient presented with a 3-year history of increase in the size of the swelling at the same site, which on radiological and histopathological examination revealed malignant transformation into chondrosarcoma. We also discuss the differential diagnosis of chondrosarcoma. Keeping in mind the possibility of local recurrence and metastasis of chondrosarcoma, a ray amputation of the 4th and 5th digits of the right hand along with the mass was performed retaining the normal functioning of the hand.

Angiolymphoid Hyperplasia with Eosinophilia of Root of Nose: A Rare Phenomenon

Angiolymphoid Hyperplasia with eosinophilia (ALHE), also known as epithelioid haemangioma, is an atypical vascular tumour which occurs with a predilection for the head and neck region. It is characterized by the presence of solitary or multiple lesions with varying clinical appearances, from intradermal papules to subcutaneous nodules.

Calcified Vocal Cord Nodule – A Unique Case Report

S.Sundarapandian, Revathy V Suresh

Vocal cord nodules are benign neoplastic lesions which occur due to submucosal oedema and haemorrhage, leading to fibrosis and hyalinization. Calcification in vocal cord nodules has not been reported so far in literature. It is thought to be a laryngeal counterpart of idiopathic calcinosis cutis. Here, we are reporting a case of a 38-year-old male patient who presented with a change in voice, which had a duration of one month. Laryngoscopic examination revealed a globular, yellowish white, sessile mass which arose from anterior commissure region of right vocal cord. Micro laryngeal excision was done. Histopathological examination was suggestive of a calcified nodule in vocal cord.

Grade-III Paraplegia in Spinal Tuberculosis: Follow up of A Case Report and Review of Literature

Tahziba Hussain

This is a case report of spinal tuberculosis which could not be diagnosed in the early stages. Individuals who work in hospital settings and suffer from psychological stress need to be aware of the various hospital acquired infections and consequences of late diagnoses. A CT scan is indicated to rule out the spinal involvement, at the beginning of a severe backache, which does not respond to painkillers, rest, and if X-ray is normal. It is of immense help and much of the problems like paraplegia and morbidity which are associated with this kind of extra - pulmonary tuberculosis, could be avoided. Once paraplegia sets in, the response to treatment as well as the recovery are slow. The cost of CT Scan or MRI (Magnetic Resonance Imaging), no doubt, is very high, which ranges from Rs.4,500/- to Rs.5,000/- for an average Indian, but which goes a long way in reducing the debilitating conditions, excruciating pain and confinement to bed which occur during the spinal tuberculosis. Prolonged follow-up is essential in cases of Pott’s disease, as it was in the presented case. A strict treatment schedule of 18 months, combined with good nutritional support and bed rest, with spinal braces, is adequate for recovery from immobility and paraplegia caused by an advanced stage of spinal infection. This case therefore, supports an approach of nonoperative treatment over surgery, where the patient had progressive paralysis.

Cerebral Stroke After Valvular Surgery in Young Patients: Case Studies

Ravi Ghatanatti, Sundeep Sanjivan Tirkey, Anita Teli

Intracranial haemorrhage (ICH) is a dreaded complication caused by oral anticoagulants (OAC) after valvular heart surgeries. Anticoagulant use in conventional doses increases the risk of ICH 7-10 fold. Intracerebral haematomas constitute 70% of the anticoagulant-related intracranial haemorrhages, with mortalities approaching 60%. Predisposing factors for anticoagulant-related ICH in Indian patients are unique as compared to those seen in their western counterparts. In anticoagulated patients, ICH evolves rapidly within hours; hence, emergency reversal of anticoagulation is crucial. We are reporting four cases of cerebral strokes which followed valvular surgeries in our institution, who were admitted during August 2012 to July 2013. There is an increasing need to educate the patients and update the physicians regarding the various issues which are involved in anticoagulation management.

Single Therapeutic Catheterization for Treatment of Late Diagnosed Native Coarctation of Aorta Using A Covered Stent

Here in we are reporting a 35-year-old pregnant, hypertensive woman with a strict descending aorta coarctation. She had two missing pregnancies which were complicated with hypertension, but which were not diagnosed for any pathologies before. We diagnosed coarctation of aorta, but however postponed her treatment after delivery of baby, because hypertension was under control with medical treatment and she had no complication. She had an uneventful delivery. MRI angiography revealed coarctation of aorta and it was successfully treated by using an endovascular covered stent during a single cardiac catheterization. Endovascular covered stent implantation is an easy, safe and effective method for treating coarctation of aorta in adults.

Haemophagocytic Lymphohistiocytosis with Lung Cavity and Lytic Bone Lesion in A 45 Day Infant

Sanjay A Natu, Ujjwala S Keskar, Manas K Behera , Sambhaji C Chate

Haemophagocytic lymphohistiocytosis (HLH) is a potentially fatal, hyper inflammatory condition which is caused by a highly stimulated but ineffective immune response. We are presenting here, a case of HLH which occurred in a 45 day infant. Presence of lung cavity and a lytic bone lesion in the skull, as was seen in this case, have not been reported in HLH in the literature. This raises a possibility of a simultaneous occurrence of HLH and Langerhans cell histiocytosis. In a child who presents with septicaemia but does not respond to treatment, the possibility of HLH needs to be considered.

Cryptogenic Gelastic Epilepsy: A Pediatric Case Vignette

Devendra Mishra, Monica Juneja, Taruna Chutani, Debashish Chowdhury

Gelastic seizures, characterized by epileptic laughter, are rare and the majority is associated with hypothalamic hamartomas. We report a case with cryptogenic Gelastic seizure (without hypothalamic hamartoma), as the MRI was normal and, EEG and clinical data suggested a focal origin of the seizures.

Cow's Milk Protein Allergy Mimicking Acrodermatitis Enteropathica

John Solomon, Rugmini Kamalammal, Mohammed Yaseen Sait, Harita Lohith

Cow’s milk protein allergy is an adverse immune reaction to one or more of the constituent proteins of milk obtained from any animal, most commonly alpha s 1-casein cow’s milk. In many cases, the allergy is genetic in origin. The infants may experience symptoms within minutes after feeding (rapid onset) or commonly after 7-10 days of consuming the cow’s milk (slower onset). Many children with cow’s milk protein allergy develop symptoms in at least two of the following organ systems: gastrointestinal, skin and respiratory tract. Acrodermatitis Enteropathica (primary or secondary zinc deficiency) can also produce lesions in the skin and also gastro intestinal symptoms which can mimic milk protein allergy and differentiating between these two may be difficult. We are reporting a case of cow’s milk protein allergy in an infant, which was initially diagnosed as Acrodermatitis Enteropathica and treated with zinc. The lesions did not subside completely even after achieving adequate zinc levels, but on stopping the cow’s milk all the symptoms and signs disappeared completely and there was no recurrence on long term follow up.

Persistent Mullerian Duct Syndrome with Transverse Testicular Ectopia: Rare Entity

Deepika, Abhay Kumar

We are reporting on a 35-year-old male from low socio-economic strata, who presented with a left-sided inguinal hernia. Intraoperatively, a uterus and two fallopian tubes were found in the hernial sac which was adjacent to the two gonads, which received their blood supply partly, along with Mullerian duct remnants (Persitent Mullerian duct Syndrome with Transverse testicular ectopia). The gonads were testes by histological examination, with features of degeneration and fibrosis. Complete excision of the mass was done and mesh hernioplasty was done.The diagnosis of persistent Mullerian duct syndrome with Transverse testicular ectopia was confirmed. Persistent Mullerian duct Syndrome is a rare entity and itís association with Transverse testicular ectopia is even more rare.

Spontaneous Cholecystocolic Fistula: Case Report

Nandkishore Gora, Amit Singh, Sharad Jain, Ummaid Singh Parihar, Shyam Bhutra

Cholecystocolic fistula is a rare billiary-enteric fistula with variable clinical presentation. Despite modern diagnostic tool a high degree of suspicion is required to diagnose it preoperatively. These fistulae are treated by open as well as laparoscopic surgery, with no difference in intraoperative and postoperative complications. We are describing a 50-year-old female patient with the diagnosis of chronic cholecystitis with cholelithiasis, which was investigated with routine lab investigations, and abdominal ultrasonography but none of these gave us any clue to the presence of fistula, were discovered incidentally during an open surgery and were appropriately treated.

Be Careful with an IV Line

Raghunath Prabhu, Rajgopal Shenoy, Nitin Thinda, Anisha Patel, Sakshi Sadhu

Obtaining an intravenous (IV) access is a simple procedure which can be done in almost any hospital setting. One of the most dreaded complications of this procedure is an inadvertent intra-arterial cannulation. This can result in an accidental injection of medications intra- arterially, which can potentially lead to life altering consequences. In the hope that these types of events can be prevented, we are presenting a case of a 57-year-old male who underwent bougie dilatation for an oesophageal stricture and was accidentally given medication for pain management intra-arterially through an improperly placed IV line, which resulted in ischaemia, gangrene and subsequent loss of the hand. Those who try to obtain an IV access should always be on the lookout for possible clues that can prevent an inadvertent IA injection, especially if cannulation is in an area where an artery is in close proximity to a vein; these clues include but are not limited to the following: a bright-red flash of blood in the cannula, pulsatile movement of blood in the IV line, and intense pain or burning at the site of injection. These signs, as well as educating the patient on early symptoms of ischaemia, may allow early action to be taken, to prevent irreparable damage. We always have to be careful when we insert an I.V line.

A Rare Case of Small Bowel Obstruction Due to Primary Trichobezoar

Vikas Goyal, P.K.Goyal, Monica Gupta

A trichobezoar is a mass of culminated hair within the gastrointestinal tract. Stomach is the common site of occurrence. Intestinal obstruction due to primary trichobezoar is extremely rare. Only few cases have been reported so far. We also present a case of 13-year-old girl having primary ileal trichobezoar causing intestinal obstruction.

Anaesthetic Implications and Management of a Giant Ovarian Cyst

Nalini KB, Prathima PT, Shivakumar Shivanna, Mohan CVR

With improvement in health care, improved access to hospitals and better imaging modalities, huge abdominal tumours are rarely seen in modern day surgical practice. They present many challenges to anaesthesiologists. Difficult intubations, life threatening cardiovascular and pulmonary complications, are commonly encountered. Management of such cases is associated with significant mortality and morbidity. The consequences of surgery are mainly attributable to the size of the mass rather than to its distinctive pathology.We hereby report a very rare case of a giant ovarian cyst weighing 57kg, which was successfully managed by a careful pre-operative evaluation, maintenance of intraoperative haemodynamic and fluid management.

Anaesthetic Management of a Patient with Dilated Cardiomyopathy for Fracture Femur Surgery-A Case Report

Koramutla Pradeep Kumar, Gudaru Jagadesh

Dilated cardiomyopathy (DCM) is defined as impairment of the ventricular function of the myocardium. The management of a patient with dilated cardiomyopathy, who undergoes a non-cardiac surgery, is always a challenge for an anaesthesiologist, as this situation is associated with a high mortality rate. We are reporting the successful anaesthetic management of a patient with severe dilated cardiomyopathy for fractured femur surgical repair under graded epidural anaesthesia.

Solitary Sessile Osteochondroma of Scapula, A Rare Case Report

Yashavantha Kumar C, Satish Shervegar , Daksh Gadi, Rahul P

Osteochondromas are the most common benign tumours of bone. These are most commonly seen on the metaphysis of a long bone, but they can arise from any bone which is preformed from cartilage. To best of our knowledge, very few cases of osteochondroma scapula have been reported in literature. We hereby report a very rare case of osteochondroma which arose from scapula in a four year old boy, which was treated by excisional biopsy.

Alkaptonuric Arthropathy with Periprosthetic Fracture: A Case Report

Alkaptonuria or Ochronosis is an autosomal recessive congenital metabolic error due to absence of enzyme homogentisic acid oxidase. Recently, we had an opportunity to diagnose this condition in one of our patients. An old aged man developed a pathological fracture of femur after a trivial fall at home. He was diagnosed to have intracapsular fracture neck of femur. Intraoperatively we noticed blackish discoloration of femoral head which lead us to investigate the case for alkaptonuria. Hemiarthroplasty was done with Austin moore prosthesis. Patient had cutaneous pigmentation and gross arthritic changes at multiple joints including spine. After one and half year patient developed a periprosthetic fracture of the femur for which open reduction and internal fixation was done. A periprosthetic fracture in ochronotic patient has never been reported till date which makes it a rarer entity. This article presents the clinico-radiologic manifestations of the case with surgical management and a follow up of two years.

Utility of Diagnostic Ultrasound in Evaluating Fracture Healing

Sushil G. Kachewar, Devidas S. Kulkarni

With increase in population, modes of transportation and a fast pace of life, an individual’s chances of accident and thereby chances of getting fractured have increased significantly. Fracture has thus become a significant factor contributing to morbidity and mortality. To resume a normal life, after one suffers from a fracture is also an ordeal. The transition appears smooth if the fracture healing goes on in a smooth manner as is expected through its routine stages of reactive phase, reparative phase and remodeling phase. But if in this chain something goes wrong or some factors are not optimum upto the mark, then the process becomes unsuccessful and the repair is either partial or directionless. It is therefore very vital to confirm whether or not the callus which bridges the fractured fragments is healthy or not. Here in lies the role of imaging as it can show the status of callus without disturbing it. What complicates the picture is that a callus might not be well demonstratable unless it mineralizes or calcifies. An imaging modality like ultrasound therefore stands out as it can show the state of callus in its different stages. This article aims at demonstrating how ultrasound- a non invasive diagnostic imaging modality can give precise information about the progress of fracture healing and thereby aid in management of fractures, so that an individual can return back to normal productive lifestyle. This preliminary study highlights the spectrum of fracture healing as seen on ultrasound.

Radiomorphometric Indices of the Mandible – An Indicator of Osteoporosis

Poornima Govindraju, Poornima Chandra

Introduction: Osteoporosis is a regressive change which occurs in the bone and it is seldom diagnosed before the occurrence of fractures. Hence, determination of mandibular bone density is of paramount importance for the detection of this silent disease. Aims and Objectives: The purpose of this study was to evaluate the influences of gender and age on the radiomorphometric indices and to assess the differences in the various indices, if any, between digital and analog radiographs. Materials and Methods: Two hundred and fifty six panoramic radiographs (128 digital and 128 analog) were obtained and they were grouped into 8 age groups which were between 21 to 60 years with 5 year intervals between them, with equal sex distributions. The mandibular cortical index (MCI), mental index (MI) and panoramic mandibular index (PMI) were analyzed. Results: C2 and C3 categories of MCI increased as age advanced in females. MI showed a significant difference in genders and MI Values decreased from younger to older females. PMI (p<0.05) was significant for both the genders. Conclusion: This study showed that MCI, MI and PMI indices were useful for identifying patients with low skeletal bone mineral densities (BMD) or osteoporosis and that digital panoramic radiographs were better than analog radiographs for measuring the indices.

A Changing Trend In Eruption Age and Pattern of First Deciduous Tooth: Correlation to Feeding Pattern

Background: Feeding mode during infancy and its effect on deciduous tooth appearance in oral cavity in two generations and among genders. Aim and Objective: Study aimed to compare and correlate times and patterns of deciduous tooth eruption in breastfeeding (OBF), partial breastfeeding (PBF) and spoon feeding (SF) infants and initiation of semisolid food feeding (SSF) in infants. It also aimed to address the variations in the time of eruption of first deciduous tooth and its pattern in two generations who had more than a decade of difference in ages. Materials and methods: An open-ended questionnaire study was conducted on mothers of 265 patients from two groups, generation 1 (G1)-adults who were aged 20-35 years and second group, generation 2 (G2)-children who were below 5 years of age. Results: A statistical significance was observed with respect to age, gender, generations, and frequency of breastfeeding, partial breastfeeding and time of initiation of semisolid food. Conclusion: There is a delayed eruption of teeth in present generation. For girls, it occurs at age of 7.88 months and for boys, it occurs at the age of 8.08 months.

Assessment of Lingual Frenulum Lengths in Skeletal Malocclusion

Swarna Meenakshi, Nithya Jagannathan

Background: The orofacial musculature plays a pivotal role in maintaining a balance in positioning of the teeth and any imbalance which occurs in this, results in malocclusion. Lingual frenum is a soft tissue structure which tethers the ventral surface of the tongue to the floor of the mouth. Objective: This study was performed to analyze the lingual frenal lengths in skeletal class I, class II and Class III malocclusion and to correlate relationship between both. Materials and Methods: This study comprised of 30 subjects, with 10 in each group and an impression was made with the maximum mouth opening position and the tip of tongue touching the incisive papilla. The length of the lingual frenum was then measured from the casts. The maximum mouth opening position was also determined by measuring the interincisal distance with the maximum mouth opening position. Statistical analysis was done to analyze the relationship between both. Results: The lingual frenum was found to be longest in class III malocclusion, with a statistical significant value of p<0.01. The class II and class I malocclusion did not show much difference. The maximum mouth opening position was also increased in class III malocclusion, followed by class II and class I malocclusion, in a descending order. Conclusion: The lingual frenum exerts erratic forces and a long lingual frenum pushes the mandibular anteriors forwards, resulting in malocclusion. Hence, a relationship between the lingual frenum and malocclusion is essential, so that the erratic forces can be eliminated and excellent results can be achieved, following the correction of malocclusion.

Drug Abuse in Paediatric Dentistry: a Cross-Sectional Study

Compared to adult medicine, drug use in children is not extensively researched. Objective: The objective of present study is to find out drug prescribing pattern in the Department of Pedodontics and Preventive Dentistry and Orthodontics in teaching hospitals in Rajasthan, India. Methods: A prospective study was conducted in June 2011. A total of 619 prescriptions were collected randomly. Prescribing pattern was analyzed using WHO basic drug indicator. Results: The average number of drugs and antimicrobial agent prescribed per prescription were 2.24 and 0.81 respectively. Antimicrobial agent contained 81.74% of all prescriptions. Most common groups of drugs prescribed by pedodontist were NSAIDS & Antipyretics (37.7%), Antimicrobial (36.4%) and Vitamins (12.3%). Prophylactic use of antimicrobial agents was 5.5 ± 0.5 days. Fixed dose combination (45.6%) frequently used by brand name. Twelve percent generic drugs were used. Most of the drugs were from Essential Drug List especially a only one drug was prescribed. Conclusion: There is a need of mass awareness amongst dentists about good prescribing habit. Every institution must have Drugs and Therapeutic Committees. The five steps of WHO Program on Rational Use of Drugs (RUD) should be followed for rational prescribing of drugs.

In-vitro Evaluation of Fracture Strength Recovery of Reattached Anterior Fractured Tooth Fragment Using Different Re-Attachment Techniques

Background: Traumatic injuries caused to anterior teeth are most common. Emergency management of fractured fragments is necessary, for preserving their vitalities and for retaining aesthetics in an economical way. Various methods are available for restoring fractured, uncomplicated teeth, such as reattachment of fractured fragments, composite restoration. But only limited data is available on evaluation of the strength of reattached fractured fragments. Hence, the present study was designed. Objectives: The objective of this study was to evaluate the fracture strength recovery of re-attached anterior fractured tooth fragment by using different re-attachment techniques. Methodology: Forty human upper central incisions were used in this study. The roots of the teeth were confined in a special device (holder) and adapted in a Universal Testing Machine. Load was applied to each tooth in bucco-lingual direction, by using a small stainless steel ball. The force which was required to fracture the tooth was recorded. Both the fragment and remaining fractured tooth was restored by using four reattachment techniques - simple reattachment, external chamfer, over contour and internal dentinal groove. Specimens were loaded in same pre-determined area which was used in procedure to obtain fragments. The force required to detach each fragment was recorded and it was correlated with the fracture strength of an intact tooth and that which was obtained after doing restorative procedures for all groups i.e. fracture strength recovery. Results: Technique I (simple reattachment) and Technique 2 (external chamfer) showed fracture strength recoveries of 44.3% and 60.6% respectively. However, these values were lower than those which were obtained by usingTechnique 3 (Over contour) -86.8% and Technique 4 (internal dentinal groove) -89.5%. Conclusion: Over contour and internal dentinal groove reattachment is a preferred technique as compcompared to the other reattachment techniques which were tested.

Toothpaste Utilization Profiles among Preschool Children

Darshana Bennadi, Nandita Kshetrimayum, Sibyl S, C.V.K. Reddy

Background: Oral healthcare for pre-school children is given due priority, as their oral health will determine the oral health status of future generations. Generally, the type, frequency and quantity of toothpaste used by children are based purely on parental preferences. Methodology: A descriptive, cross-sectional study was conducted among mothers of preschool children by using a questionnaire. Results: Sixty two percent (n=154) mothers started brushing their children’s teeth more than one year after eruption of their teeth. A majority of the mothers used adult toothpaste to brush their children’s teeth and supervised their children while brushing. Fiftytwo percent mothers were aware about presence of fluoride in tooth paste but its clinical significance. Half the mothers applied full length of tooth paste to their children’s brushes and most mothers made their children brush their teeth twice daily. Conclusion: Based on the findings of this study, it appears that there is still much lack of awareness on the proper guidelines on the selection and usage of toothpastes in children. Dental professionals should use this knowledge to help and motivate parents to properly supervise and assist their children’s brushing, with the goal of reducing the potential risk of fluorosis.

Intra Osseous Jaw Lesions in Paediatric Patients: A Retrospective Study

Aadithya B. Urs, Shelly Arora, Hanspal Singh

Objective: This study was undertaken to comprehensively analyze the distribution of intra-osseous paediatric jaw lesions (0-16 years) and to correlate the same with the data which has been published in the literature. Study Design: A total of 171 hard tissue paediatric pathologies obtained from the archives of Department of Oral Pathology, Maulana Azad Institute of Dental Sciences, India were retrospectively reviewed over a period of 6 years. All the cases were analyzed for gender, site, radiographic findings, histopathological diagnosis, treatment modality and recurrence rate. Results: The present study revealed 54/171 odontogenic cysts, 45/171 odontogenic tumours, 33/171 bone pathologies, 2 malignant tumours, 1 connective tissue pathology and 36/171 miscellaneous category cases. The highlights of this analysis showed a relatively higher incidence of odontogenic tumours (26.3%) as compared to those seen in other studies which have been published in literature. KCOT and ameloblastoma (solid and unicystic) were the most frequently diagnosed tumours. Also, one case of dentigerous cyst which was converted into calcifying ghost cell odontogenic tumour was a unique feature which was noted in the current study. Conclusion: In the current study, a preponderance of odontogenic pathosis was seen in the paediatric age group which was studied.

Comparative Evaluation of the Effects of Light Intensities and Curing Cycles of QTH, and LED Lights on Microleakage of Class V Composite Restorations

Background: The purpose of this study was to evaluate the effects of light intensity and curing cycles of QTH and LED lights on the microleakage of Class V composite restorations. Materials and Methods:Eighty freshly extracted human maxillary premolars were used for this study. Standardized Class V cavities were prepared and they were restored with microhybrid resin composite. According to the curing protocol, the teeth were then divided into 4 groups (n=20): QTH curing (standard and soft start modes), and LED (standard and soft start modes) irradiations. Microleakage was evaluated by immersion of the samples in 50% silver nitrate solution. The samples were then sectioned, evaluated under a stereomicroscope, and scored for microleakage. Results: The results of the present in-vitro study showed mean dye leakage scores of 1.9, 1.2, 1.45 and 0.90 for Group I (QTH-Standard mode), Group II (QTH-Soft Start mode), Group III (LED-Standard mode) and Group IV (LED-Soft Start mode) respectively. Conclusion: It was thus concluded that the soft start polymerization showed a highly significant difference as compared to the standard curing modes of QTH and LED lights, respectively.

Importance of Different Modalities of Treatment For the Management of Keratocystic Odontogenic Tumour with Five year follow-up

Vijay Ebenezer, Balakrishnan Ramalingam

Background: The keratocystic odontogenic tumors is a benign but one of most aggressive developmental cyst with many distinguishing clinical and histologic features and high recurrence rate. In the given study, authors have studied and presented their experience of managing Keratocystic odontogenic tumour. The aim of the study was to define an appropriate treatment protocol for the management of KCOT. Materials and Methods: Total eight patients, whose histopathological reports confirmed Gorlin – Goltz syndrome and KCOT, with age between 10 – 50 years, were selected from cases being treated at Sree Balaji Dental College, Chennai, India. Enucleation and resection were the surgical techniques employed. Modality of treatment was based on parameters like age , size, aggressiveness and extent of the lesion. All the patients were operated under general anaesthesia. Cases were studied, reviewed and followed up for five years between 2007-2012. Results: The study included 8 cases in which three cases were opted for resection and five cases for enucleation followed by application of Carnoy’s solution. Conclusion: Treatment modality should be decided on age, extent, aggressiveness and nature of the tumour.

Diagnostic Efficacy of Saliva For Dengue - A Reality in Near Future? A Piloting Initiative

Spoorthi Ravi Banavar, Vidya G.S

Background: Dengue, a mosquito-transmitted viral infection presents variable symptoms, including death. Due to their increasing incidences, early detection and improved diagnoses of severe cases are of prime importance. Currently, viral antigens and antibodies are detected by traditional serological tests. However, the introduction of oral fluid as an alternative, has led to many researches. Hence, this prompted us to carry out a pilot study to evaluate the diagnostic efficacy of saliva in detecting dengue antibody by using Enzyme Linked Immunosorbent Assay (ELISA). Aim and objectives: To evaluate the presence of Dengue antibody in saliva and its sensitivity and specificity through ELISA. Methodology and Results: Twenty seropositive patients and twenty seronegative patients of Dengue were considered individually. Saliva samples collected from these patients were subjected to ELISA test for detection of Dengue antibody. A sensitivity of 100% and a specificity of 100% were obtained for making a diagnosis of Dengue infection. Conclusion: Many studies have been conducted by utilizing saliva as a diagnostic tool, especially in western population. Its advantages over venipuncture are many, especially as it is less invasive, safe, less expensive and as it allows large numbers of samples to be collected easily for screening and epidemiological purposes. In a developing tropical country like India, such a diagnostic tool has to be encouraged. Further research necessitates the implementation of saliva as a diagnostic tool.

Odontometric Sexual Dimorphism: A Sibling Correlation

Sonali Sharma, Ajit D.Dinkar, Sumit Bedi

Aims and Background: Teeth form an excellent material for anthropological, genetic, odontologic and forensic investigations. The aim of this study was to establish the genetic control of sexual dimorphism in tooth size amongst siblings of Goan children in age range of 14-22 years. Materials and Methods: Twenty-two sibling pairs were selected (22 males and 22 females) to assess genetic control of sexual dimorphism in tooth size. Alginate impressions were obtained for maxillary and mandibular arches and study models were prepared. Measurements were done using Zoom Digimatic Vernier Calipers with a resolution of 0.01 mm. Statistical Analysis: Correlation between mesiodistal and buccolingual tooth sizes amongst siblings was calculated using Pearson’s correlation coefficient. Results: A statistically significant association was found between Mesiodistal Widths of Permanent Maxillary Right and Left Second Molars and between Maxillary Right and Left First Premolars amongst sibling pairs. A statistically significant association was also found between Buccolingual Widths of Mandibular Right and Left First Premolars amongst sibling pairs. This statistically significant correlation found amongst siblings establishes a genetic control over sexual dimorphism in these teeth. Conclusion: The genetic basis of sexual dimorphism in human dentition was ascertained as a significant correlation was found between mesio-distal and bucco-lingual widths of premolars between sibling pairs.

The Evaluation of Effect of Developer Age in the Detection of Approximal Caries Using Three Speed Dental X-Ray Films: An In-Vitro Study

Vijaylaxmi B Madalli, Rajeshwari G Annigeri, Shrinivas M Basavaraddi

Background and Objectives: Ever since the first radiograph was taken in 1895, radiographs have become an essential part of dental practice. Since radiation exposure for the patients is a major concern, it is important for us to reduce the radiation exposure to the patient and surrounding environment, without compromising the quality of image. Since improper film processing is one of the major causes of poor image quality, it is very important to test dental films under a variety of processing conditions. So this study was conducted to compare the diagnostic accuracy between Kodak Ultraspeed, Ektaspeed and Agfa Dentus M2 Comfort films for the detection of approximal caries in fresh as well as in aged processing solution. Methods: Hundred extracted unrestored maxillary and mandibular teeth were aligned in a group of five teeth in each plaster model. Total of 20 plaster models were constructed and only 3 teeth in the middle were utilized for the study. The final sample consisted of 60 teeth in the study. The exposure time for Ultraspeed film was standardized at 0.5 seconds and for Ektaspeed and Agfa Dentus M2 films, the exposure time was 0.32 seconds. For each radiograph two blocks were used simulating bitewing radiograph. All 20 plaster blocks were exposed using three film types at standardized exposure timings with 30 radiographs each week. The procedure was repeated every week until 6 weeks. Radiographs were evaluated by an observer and assessed by following four point scale 0- sound tooth, 1- lesion in enamel, 2- lesion in amelodentinal junction, 3- dentinal lesion. Only distal surfaces were assessed. Thereafter all the teeth were subjected for histological study and actual depth of the lesion was recorded which acted as gold standard and this reading was subtracted in observer readings after radiographic examination. All data collected were analyzed statistically using ANOVA, paired and unpaired t-tests. Results: Ektaspeed and Agfa films required less exposure compared to Ultraspeed film. With respect to film, all films had equal diagnostic accuracy upto three weeks. From fourth week Ultraspeed and Agfa films were considerably better than E speed film. E speed film was inferior in the depleted solution compared to other two solutions. With respect to lesion detection Agfa film was inferior to other two films. Conclusion: All three films had equal diagnostic accuracy in fresh solution. Considering the significant reduction in patient radiation with Ektaspeed film, this should be the film of choice whenever possible. As far as the diagnosis of approximal caries is concerned processing solutions should not be used longer than 3 weeks.

Study Comparing the Effectiveness of Chlorhexidine, Calcium Hydroxide and Linezolid Based Medicaments Against Enterococcus Faecalis

Purpose: This study evaluated the efficacy of 2% chlorhexidine (CX), calcium hydroxide (CH), Vitapex® (VP), linezolid (LZ), a combination of LZ with CH (LC) against Enterococcus faecalis (EF). Study Design: EF strains were mixed with peptone water and the turbidity was adjusted to the McFarland’s turbidity standard tube No: 0.5. The inoculum obtained was used to make lawn cultures on the agar plates. A total of 30 agar plates were prepared, such that each plate had five wells containing the five medicaments. The plates were incubated and evaluated for zones of inhibition after intervals of 24 hours and 72 hours. The results were statistically evaluated by paired t-test, ANOVA and Post-hoc analysis using Tukey’s HSD. Results: The difference between values of the zones of inhibition around various medicaments after 24 hours and 72 hours was found to be statistically significant. A comparison between the five groups after 24 hours or 72 hours showed that each group differed significantly from the rest of the groups. Conclusions: LC had the greatest effectiveness against EF, followed by LZ, CX, VP and CH.

Comparative Evaluation of Marginal Adaptation of BiodentineTM and Other Commonly Used Root End Filling Materials-An Invitro Study

Aim: The purpose of this investigation was to evaluate the marginal adaptation of three root-end filling materials Glass ionomer cement, Mineral trioxide aggregate and BiodentineTM. Methodology: Thirty human single-rooted teeth were resected 3 mm from the apex. Root-end cavities were then prepared using an ultrasonic tip and filled with one of the following materials Glass ionomer cement (GIC), Mineral trioxide aggregate (MTA) and a bioactive cement BiodentineTM. The apical portions of the roots were then sectioned to obtain three 1 mm thick transversal sections. Confocal laser scanning microscopy (CLSM) was used to determine area of gaps and adaptation of the root-end filling materials with the dentin. The Post hoc test, a multiple comparison test was used for statistical data analysis. Results: Statistical analysis showed lowest marginal gaps (11143.42±967.753m2) and good marginal adaptation with BiodentineTM followed by MTA (22300.97±3068.883m2) and highest marginal gaps with GIC (33388.17±12155.903m2) which were statistically significant (p<0.0001). Conclusion: A new root end filling material BiodentineTM showed better marginal adaptation than commonly used root end filling materials

Physico-Chemical and Bacterial Evaluation of Packaged Drinking Water Marketed in Delhi - Potential Public Health Implications

Introduction: Quality of drinking water is a powerful environmental determinant of health. The main objective of introduction of bottled water in the society was its better safety, taste and convenience over tap water. The present study was conducted to assess physicochemical and bacterial qualities of bottled water and sachet water which were available in various markets of Delhi. Materials and Methods: Sixteen water bottles and four water sachets were selected through stratified random sampling from various public places in Delhi and their analysis was done at National Test House, Ghaziabad. Results were then compared with national (IS10500, IS14543) and international (WHO, FDA, USEPA) standards. Results: Bottled water showed better quality than sachet water. The mean value of copper (0.0746mg/l) in bottles exceeded the standard values of IS10500 and IS14543(0.05), while the mean value of lead (0.008mg/l) exceeded the FDA standard value (0.005). When the results of sachets were compared with those of standards, the mean values of selenium (0.1195mg/l) and lead (0.862mg/l) were found to exceed values of both Indian and International standards. For the biological parameter i.e. coliform count, the mean value for bottles was 0 (nil), whereas the mean value for sachets was 16.75, which showed the unhealthy nature of sachets. Conclusion: The parameters which were tested in the present study showed excess of various chemical and bacterial parameters in drinking water, which could pose serious threats to consumers. Thus, these results suggest a more stringent standardization of bottled water market with special attention to quality, identity and licensing by concerned authorities, to safeguard health of consumers.

A Comparative Evaluation of the Effect of Resin Based Sealers on Retention of Crown Cemented with Three Types of Cement – An In Vitro Study

Aim: In an effort to control postoperative sensitivity, dentin sealers are being applied following crown preparations, with little knowledge of how crown retention might be affected. A previous study demonstrated no adverse effect when using a gluteraldehyde-based sealer, and existing studies have shown conflicting results for resin-based products. This study determined the retention of the casting cemented with three types of cement, with and without use of resin sealers and it determined the mode of failure. Materials and Methods: Extracted human molars (n=60) were prepared with a flat occlusal, 20-degree taper, and 4-mm axial length. The axial surface area of each preparation was determined and specimens were distributed equally among groups (n=10). A single-bottle adhesive system (one step single bottle adhesive system) was used to seal dentin, following tooth preparation. Sealers were not used on the control specimens. The test castings were prepared by using Ni-Cr alloy for each specimen and they were cemented with a seating force of 20 Kg by using either Zinc Phosphate (Harvard Cement), Glass Ionomer (GC luting and lining cement,GC America Inc.) and modified-resin cement (RelyXTMLuting2). Specimens were thermocycled for one month and were then removed along the path of insertion by using a Universal Testing Machine at 0.5 mm/min. A single-factor ANOVA was used with a p value of .05. The nature of failure was recorded and the data was analyzed by using Chi-square test. Results: Mean dislodgement stress for Zinc phosphate (Group A) was 24.55+1.0 KgF and that for zinc phosphate with sealer (Group D) was 14.65+0.8 KgF. For glass ionomer (Group B) without sealer, the mean value was 32.0+1.0 KgF and mean value for glass ionomer with sealer (Group E) was 37.90+1.0 KgF. The mean value for modified resin cement (Group C) was 44.3+1.0KgF and that for modified resins with sealer (Group F) was 57.2+1.2 KgF. The tooth failed before casting dislodgement in 8 to 10 specimens cemented with modified-resin cement. Conclusion: Resin sealer decreased casting retentive stress by 46% when it was used with Zinc phosphate. However, sealer use resulted in 60% increased retention when it was used with Glass ionomer cement. The modified-resin cement produced the highest mean dislodgement stress, which nearly always exceeded the strength of the tooth.

Alcohol Saliva Strip Test

Alcohol is a factor in many categories of injury. Alcohol intoxication is frequently associated with injuries from falls, fires, drowning, overdoses, physical and sexual abusements, occupational accidents, traffic accidents and domestic violence. In many instances, for forensic purpose, it may be necessary to establish whether the patients have consumed alcohol that would have been the reason for the injury/accidents. Combining rapidity and reliability, alcohol saliva strip test (AST) has been put forward for the detection of alcohol in saliva for blood alcohol concentration (BAC).

Ehlers Danlos Syndrome – A Case Report

Pragati Kaurani, Nikhil Marwah, Mayank Kaurani, Narendra Padiyar

Ehlers Danlos syndrome (EDS) is a hereditary collagen disorder which primarily manifests in the skin and joints. Clinically, it is characterized by hyperelasticity of skin and joint hypermobility. This article has described a rare condition seen in a 10-year-old boy who was diagnosed with EDS, based on the clinical, radiographic and histological findings.

Prosthetic Management of A Masticatory Muscle Disorder with Customized Occlusal Splint

Pavankumar R Koralakunte

Occlusal splints of various types and designs are used in the diagnosis and treatment of different masticatory muscle and TMJ disorders. These appliances or devices provide a relatively simple, reversible and non-invasive form of treatment management. Treating such a disorder is really challenging for both dental and medical specialists and often it is difficult to diagnose as the presenting symptoms can be variable. The present article thus describes a case report on fabrication of simplified customized occlusal splint emphasizing the importance of medico-dental team approach for successful management with occlusal splint therapy.

Endodontic Management of a Mandibular Central Incisor with Type IV Canal Pattern: A Case Report

Sunandan Mittal, Tarun Kumar, Jyotika Sharma, Shifali Mittal, Tarun Ahuja

The success of endodontic treatment requires the knowledge of tooth morphology and its variations. Mandibular incisor’s anatomy presents a challenge when an endodontic access is made, because of its small size and high prevalence of two canals. We are describing a Weine’s Type IV root canal configuration that was detected in a mandibular central incisor, which was demonstrated by a radiographic examination. This article also focuses on the successful endodontic treatment of a mandibular central incisor with a single canal at the pulp chamber, which divided into two distinct and separate canals (buccolingual) at the middle third of the root.

Intra-Oral Schwannoma- A Case Report

Swati Parhar, Harkanwal Preet Singh, Amit Nayyar, Adesh S Manchanda

Neurilemmoma (Schwannoma) is a benign tumour of neuroectodermal origin. It usually occurs as a asymptomatic, solitary, smooth-surfaced and slow growing lesion, emerging at any age, with as such, no gender prelidiction. Occurring as a common tumour in the head and neck region, its intraoral presentation is very rare. Here, we are reporting a rare case of intraoral schwannoma of the posterior palate which occurred in a 34-year-old female patient who had chief complaint of a painless, slow growing swelling on posterior palate.

Adenoid Cystic Carcinoma of the Buccal Mucosa: A Case Report with Review of Literature

Vidyalakshmi S., Aravindhan R.

Minor salivary gland neoplasms of the buccal mucosa are relatively uncommon. Adenoid cystic carcinoma (ACC), a well-defined entity, occurs most of the times in the parotid, submandibular glands and palate, as far as the intraoral site is concerned. Adenoid cystic carcinoma tends to have an indolent, extended clinical course with wide local infiltration and late distant metastases. We are presenting a case of an adenoid cystic carcinoma of the buccal mucosa in a 48-year-old female patient.

Prosthognathic Rehabilitation of A Patient With Underlying Skeletal Discrepancy- A Case Report

Vertical and anterioposterior maxillary excesses can be treated with a combination of orthopaedic functional appliances, orthodontics and surgery. Treatment varies according to the age, patient reports for treatment. In patients who are treated with either of the above mentioned treatment modalities, if they require prosthetic replacement on a later date, especially of anterior teeth, prosthetic treatment alone does not give an aesthetic outcome. A partially edentulous, elderly patient with underlying skeletal discrepancy (Class II Skeletal deformity) in relation to 12,11,21,22 was treated with a combination of orthognathic surgery and prosthetic rehabilltation. An orthognathic surgery (leforte I osteotomy) was performed to manage vertical maxillary excess, class II skeletal pattern of maxilla and increased lower third facial height. Dental compensations in the mandibular arch were decompensated surgically with lower subapical osteotomy. Prosthetic restorations of missing anterior teeth were done later, such that facial and dental aesthetics. The records showed that the results were stable 12 months after prosthognathic (prosthodontic and orthognathic) treatment. A team approach enabled the female patient in her fifth decade of life, to receive better function, aesthetics and increased quality of life. Doing prosthetic restorations in patients with underlying skeletal discrepancies may become a challenge , which should be achieved without compromising on final outcome, with a calculated risk benefit ratio.

Primary Extranodal Lymphomas of Lip – A Rare Manifestation in Sjogren´s Syndrome

Shwetha V., Yashoda Devi B.K., Vijaya V. Mysorekar, Namrata P. Kamath

Sjogren’s syndrome (SS) is a chronic autoimmune disorder which is characterized by lymphocyte-mediated destruction of exocrine glands, which produces the classical symptoms of dry eyes and dry mouth, which is referred to as primary SS or the Sicca complex. When it is associated with another autoimmune disease such as rheumatoid arthritis or lupus erythematosus, the condition is termed as secondary SS. One of the known major complications in patients with Sjogren’s syndrome is the occurrence of Non-Hodgkin’s lymphoma of B cell type. It is not uncommon for malignant lymphomas to occur in head and neck region at nodal and sometimes, extranodal sites. However, only rarely may they involve the oral cavity primarily. This case report describes a rare occurrence of isolated extranodal lymphomas in the upper and lower lips of a patient, which clinically resembled a mucocele, and eventually was diagnosed as lymphoma which was associated with Sjogren’s syndrome, thereby stressing the importance which was played by an oral diagnostician.

Herbal Toothpowder Induced Erythema Multiforme

Pranali Satpute, Lalita Yadav, Riyaz Ahmed, Avinash Kashid, Kalpak Peter

Herbal toothpowders are available in market in a wide varieties, which consist of various ingredients. In rural areas of the developing countries, they are still used for cleansing teeth. Erythema multiforme (EM) is an acute mucocutaneous disorder that is believed to be a sequel of a cytotoxic immunologic attack on keratinocytes which express non-self-antigens. A 31-year-old male who used herbal toothpowder for oral-hygiene maintenance presented with ulcers in mouth, encrustation on lips and target lesions on both hands, suggesting Erythema multiforme. An oral biopsy confirmed the diagnosis. To the best of our knowledge, there is no report of an association of herbal extracts and EM in the English literature. With this report, we present a rare new triggering factor of Erythema mutiforme, thus adding it to the endless list of aetiologies.

Pericoronal Occurrence of Cemento-Ossifying Fibroma: An Unexemplified and Unusual Case Report with Review of Literature

Kumaraswamy K.L., Arvind Babu R.S., Sheshadri P., Santhosh Kumaran

The Cemento-ossifying fibroma (COF) is an odontogenic neoplasm that is predominantly considered as a fibro osseous lesion of the jaw bone. The histogenetic origin of COF was thought to be derived from the periodontal cells, which have the ability to form fibrous, cementum and osseous tissue. Due to the periodontal cellular origin, the lesion often occurs in the radicular portion of the bicuspid and molar tooth region of the lower jaw. We present a case of Cemento-ossifying fibroma in a 43-year-old female in the pericoronal aspect of an impacted third molar mimicking an odontogenic lesion. The occurrence of COF in pericoronal region is an unusual site. This article also discusses about the various hamartomatous lesions occurring in the pericoronal region of the teeth.

Endodontic Retreatment of a Mandibular Second Molar with four Separate Roots: A Case Report

Mohamed Idris, Nasil Sakkir, Nandakishore KJ, Annapurna Kini

Aberrations in the root canal anatomy are a commonly occurring phenomenon. Although the mandibular second molar is commonly a bi-rooted tooth with an uncomplicated endodontic anatomy, variations have to be considered every time endodontic therapy is performed. This case report describes the non-surgical endodontic retreatment performed on a mandibular second molar with four seperate roots and canals. ProTaper Universal rotary nickel-titanium instruments (Dentsply Maillefer, Ballaigues, Switzerland) for treatment and retreatment were used to remove the old gutta percha and to clean and shape all root canals, followed by the complete obturation of root canal system. Post-operative CBCT scan was taken to confirm the quality of the performed treatment.

Magangement of Velopharyngeal Defects: A Review

Nitin Bhaskar Shetty, Sanyuktha Shetty, Nagraj E., Raina D’souza, Omkar Shetty

Success in Maxillofacial Prosthetics depends on full cognizance of the principles that underlie facial harmony, anchorage and retention, weight bearing and leverage, durability, tissue compatibility and tolerance. The maxillofacial prosthodontist normally provides appliances to restore aesthetics and function to the patients who cannot be restored to normal appearances or functions by means of plastic reconstructions. The velopharynx is a dynamic anatomic structure which is essential for normal breathing, eating, and speaking. The soft palate acts as a separator between oral and nasal cavities. Impairment of velopharyngeal function can be caused by insufficiency or incompetency. This article describes in brief about velopharyngeal defects and their management.

Aviation Dentistry

Lakshmi, D Sri Sakthi

With the rapid expansion of the airline industry in all sectors, dentists should pay special attention to crews and frequent flyers, due to change of pressure in-flight, that cause different types of oro-facial pain. Aviation dentistry deals with evaluation, principles of prevention, treatment of diseases, disorders or conditions which are related to oral cavity and maxillofacial area or adjacent and associated structures and their impact on people who travel or on aircrew members and flight restrictions. Dentists should prevent the creation of in-flight hazards when they treat aircrew members and frequent flyers.

Taxonomy of Salivary Gland Neoplasm

C. Sreeja, Tanveer Shahela, Syeda Aesha, Muthu Kumar Satish

Classification of neoplasms of any organ should be predicted on the patterns of differentiation that reflect the organization and cell types of the parental tissue. The ability to classify a neoplasm instills confidence in its predicted biologic behavior and the selection of treatment. There has not been a single universally used classification system for salivary gland tumor. Histogenetic and morphogenetic concepts and the developing information on various molecular parameters will have significant influence on the classification of salivary glands tumors. In this article we would highlight the histogenetic and morphogenetic concepts in salivary gland neoplasms and elaborate on the taxonomic system of classification of salivary gland neoplasms.

Haptics Touchfeedback Technology Widening The Horizon of Medicine

Shalini Kapoor, Pallak Arora, Vikas Kapoor, Mahesh JayaChandran, Manish Tiwari

Haptics, or touchsense haptic technology is a major breakthrough in medical and dental interventions. Haptic perception is the process of recognizing objects through touch. Haptic sensations are created by actuators or motors which generate vibrations to the users and are controlled by embedded software which is integrated into the device. It takes the advantage of a combination of somatosensory pattern of skin and proprioception of hand position. Anatomical and diagnostic knowledge, when it is combined with this touch sense technology, has revolutionized medical education. This amalgamation of the worlds of diagnosis and surgical intervention adds precise robotic touch to the skill of the surgeon. A systematic literature review was done by using MEDLINE, GOOGLE SEARCH AND PubMed. The aim of this article was to introduce the fundamentals of haptic technology, its current applications in medical training and robotic surgeries, limitations of haptics and future aspects of haptics in medicine.

Evaluation of Teaching by Students of a Professional Institution

Dental Implant Fractures – Aetiology, Treatment and Case Report

Purpose: This study aimed to investigate the etiology, clinical manifestations, and treatment options of dental implants fractures through a literature review and to relate a clinical report. Methods: A literature review was performed using the Medline database and this paper describes a case demonstrating the management of implant fracture. Twenty two articles were selected in the present literature review. Results: Nowadays the use of dental implants to rehabilitate completely and partially edentulous patients became the best treatment option; however, this treatment is suitable to failure. The fracture of implant body is a possible complication. The fracture of implant body is a late complication and is related to the failure in implant design or material, non-passive fitting of the prosthetic crown and overloading. Clinically, prosthesis instability and spontaneous bleeding are observed. Three options of treatment have been indicated: complete removal of implant fragment, maintenance of implant fragment, and surface preparation of the fragment with insertion of a new abutment. Conclusion: The literature indicates the complete removal of the fragment as the best treatment option.

Effect of Various Physical Stress Models on Serum Cortisol Level in Wistar Rats

Background:Stress indicates the response or reaction of an organism to the environmental circumstances and their outcomes. Acute stress is well known to trigger several hormonal alterations in animals. An increase in glucocorticoid concentration can represent intensity of discomfort or distress experienced by an animal. The study was undertaken to evaluate the effects of various physical stress models on serum cortisol level in Wistar male rats. Methodology:In this study six Wistar male rats weighing 150- 200 gm were randomly selected. Animals were exposed to ‘forced swim test’ and ‘restraint test’. Their serum cortisol level was measured by ELISA test using alpha prime ELISA system before and after the tests respectively. Results:Results were analyzed by students paired t-test. Serum cortisol level was significantly higher after forced swim test as well as after restraint test. When both the physical activities were compared, serum cortisol level was increased more after restraint stress than after forced swim test however, the difference was not significant statistically. Interpretation and conclusion: The rise in serum cortisol level was observed in both the physical activity models . Rise in serum cortisol level was significantly higher after restraint test than exposing them to forced swim test. This indicates that restraining the rats produced more stress than making them forcefully swim

Rare Cause of Recurrent Stroke: Bilateral Cervical Internal Carotid Artery Aneurysm

Hanish Bansal, Ashwani Kumar Chaudhary, Birinder Paul

Precaval Right Renal Arteries with Circum-aortic Left Renal Vein

C.S.Ramesh Babu

An Early Sign of Wilson’s Disease: Dysarthria

Ratan J Lihite, Urmi Choudhury, G.Surender, Biplab Pal, Mangala Lahkar

Hospital Based Serosurveillance Study of Dengue Infection

Beuy Joob, Viroj Wiwanitkit

A Position for Administration of Difficult Spinal Anesthesia

Gholamreza Shabanian, Mitra Saadat