Journal of clinical and diagnostic research

Minimally Invasive Plate Osteosynthesis with Locking Plates for Distal Tibia Fractures

Introduction: Distal tibia fractures are challenging injuries with multiple fixation options. Minimal invasive plating for distal tibia fracture is becoming more popular with documented good outcomes. Aim: To evaluate the functional and radiological results of fixation of distal tibia fractures with locking plates with Minimally Invasive Plate Osteosynthesis (MIPO) technique. Materials and Methods: Fifty fractures of distal tibia without Intra-articular extension were operated with locking compression plating with MIPO technique. They were followed up at regular intervals. Functional and radiological results were evaluated at the end on one year. Results: The fractures united in 48 (96%) patients with 2 (4%) cases of delayed union which took 30 weeks of time. Postoperatively, 2 patients developed superficial skin infection, 2 patients developed deep infection and 3 patients developed ankle stiffness due to loss of postoperative protocol and 4 patients had implant failure in form of screw breakage. Good amount of range of mobility of ankle joint was present in almost all patients. Conclusion: MIPO with locking plates for distal tibia fractures is associated with good functional outcomes and is an effective treatment for distal tibia fractures. Although, a larger sample of patients and longer follow up are required to fully evaluate this method of treatment, we strongly encourage its consideration in the treatment of such complex fractures.

Scoring Systems for Outcome Prediction of Patients with Perforation Peritonitis

Murugappan Nachiappan, Manjusha Madhusudhan Litake

Introduction: Peritonitis continues to be one of the major infectious problems confronting a surgeon. Mannheim Peritonitis Index (MPI), Physiological and Operative Severity Score for en Umeration of Mortality (POSSUM) and Morbidity and sepsis score of Stoner and Elebute have been devised for risk assessment and for prediction of postoperative outcome. Aim: The aim of this study was to find the accuracy of these scores in predicting outcome in terms of mortality in patients undergoing exploratory laprotomy for perforation peritonitis. Materials and Methods: The prospective study was carried out in 100 diagnosed cases of perforation at our centre in a single unit over a period of 21 months from December 2012 to August 2014. Study was conducted on all cases of peritonitis albeit primary, tertiary, iatrogenic and those with age less than 12 years were excluded from the study. All the relevant data were collected and three scores were computed from one set of data from the patient. The main outcome measure was survival of the patient. The Receiver Operator Characteristics (ROC) curves were obtained for the three scores. Area Under the Curves (AUC) was calculated. Sensitivity and specificity were calculated at a cut off point obtained from the ROC curves. Results: POSSUM had an AUC of 0.99, sepsis score had an AUC of 0.98 and MPI had an AUC of 0.95. The cut off point score of 51 for POSSUM had an accuracy of 93.8 and positive predictive value of 70.5, the score of 29 for MPI had an accuracy of 82.8 and positive predictive value of 46 and the score of 22 for sepsis score had an accuracy of 95.9 and positive predictive value of 86.67. Conclusion: POSSUM score was found to be superior in prediction of mortality as compared to sepsis score of Stoner and Elebute and MPI. POSSUM and MPI over predicted mortality in some cases. None of these scores are strictly preoperative.

Evaluation of Ocular Side Effects in the Patients on Topiramate Therapy for Control of Migrainous Headache

Introduction: Topiramate, a sulfa-derivative monosaccharide, is an antiepileptic drug which is administered in the control of migraine. It is reported to cause various ocular side effects such as visual field defect and myopic shift. To investigate the alterations in refractive error, properties of the cornea and changes in the anterior chamber in patients that receive Topiramate for migraine control. Materials and Methods: This is a hospital-based, non-interventional, observational study that is conducted at Imam Hossein Hospital, affiliated to Shahid Beheshti University of Medical Sciences, Department of Neurology, in collaboration with the department of Ophthalmology. Thirty three consecutive patients with the diagnosis of migraine that were candidate for Topiramate therapy were recruited. Patients with history of ocular trauma or surgery, keratoconus, glaucoma, congenital ocular malformations and any history of unexplained visual loss were excluded. After thorough ophthalmic examination, all the patients underwent central corneal thickness (CCT) measurement, and Pentacam imaging (Scheimpflug camera) at the baseline. Various parameters were extracted and used for analysis. Anterior chamber volume (ACV), anterior chamber depth (ACD), and anterior chamber angle (ACA) measurement was performed. These measurements were repeated on day 30th and 90th after the initiation of Topiramate therapy. According to the normality tests, parameters with normal distribution were analysed using the repeated measures test and the remaining parameters (with non-normal distribution) were analysed using the non-parametric k-sample test. A p-value< 0.05 was considered statistically significant, according to Bonferroni post hoc correction. Results: There were 66 eyes of 33 patients under the diagnosis of migrainous headache, that Topiramate was initiated for headache control, included in the study. The mean value of refractive error had a statistically significant myopic change, from -0.23 diopters (D) at the baseline to -0.61 D at the 90th day of follow-up period (p-value < 0.001). Mean CCT was 531.43 µm at the baseline and increased to 534.72 µm at the 30th day, and 537.51 µm at the 90th day after the administration of Topiramate (p-value=0.001). Mean value of other parameters, ACV, ACD, and ACA, did not reveal statistically significant change. Conclusion: Myopic shift and gradually increasing CCT in the patients after Topiramate administration should be considered before any refractive surgery. We found no gradual change in the anterior chamber and angle parameters in our patients in the 90 days of follow up. More studies with a longer duration of follow-up are needed to elucidate dose-dependent ocular manifestations.

Comparative Analysis of Interbody Cages Versus Tricortical Graft with Anterior Plate Fixation for Anterior Cervical Discectomy and Fusion in Degenerative Cervical Disc Disease

Pritish Singh, Ashok Kumar, Vishal Shekhawat

Introduction: Multiple techniques and modalities of fixation are used in Anterior Cervical Discectomy and interbody Fusion (ACDF), each with some merit and demerit against others. Such pool of techniques reflects lack of a consensus method conducive to uniformly good results. Aim: A prospective study was done to analyse safety and efficacy of tricortical autograft and anterior cervical plate (Group A) with cylindrical titanium cage filled with cancellous bone (Group B) in procedure of ACDF for single level degenerative cervical disc disease. Materials and Methods: Twenty patients with degenerative cervical disc disease were included in study for ACDF. After a computer generated randomisation, ten patients (10 segments) were operated with anterior locking plating and tricortical iliac crest graft (Group A, Tricortical graft group), while ten patients(10 segments) were operated with standalone cylindrical titanium cages filled with cancellous bone harvested using minimally invasive methods (Group B, Cage group) from April 2012 to May 2015. Odoms’s criteria, visual pain analogue score and sequential plain radiographs were obtained to assess for clinic-radiological outcome. Results: According to Odom’s system of functional assessment, 9 patients from each group (90%) experienced good to excellent functional recovery and 9 of 10 (90%) patients of each groups were satisfied with outcome. In both groups, relief in neck pain or arm pain was similar without any statistical difference as assessed by visual analogue score. Fusion was present in 10 of 10 (100%) patients in tricortical graft group and 10 of 10 (100%) in cage group at the end of 6 months. There was no implant related complications in cage group. Transient postoperative dysphagia was recorded in 3 patients (2 in Group A and 1 in group B), which resolved within 3 days. In tricortical graft group, graft collapse and partial extrusion was detected in one patient, which did not correspond with good results obtained in particular patient. Conclusion: Use of cylindrical titanium cage packed with cancellous bone graft provide adequate stability and reliable functional outcome after fusion in cervical disc disease. Titanium cages for fusion after cervical discectomy constitute a safe and equally efficient alternative to tricortical autograft with anterior cervical plate by providing adequate stability and cessation of rediculopathy symptoms.

The Prevalence and Inter-Relationship of Negative Body Image Perception, Depression and Susceptibility to Eating Disorders among Female Medical Undergraduate Students

Nurajirahbt Abdul Manaf, Coumaravelou Saravanan, Beevi Zuhrah

Introduction: Female students are thought to be more negatively impacted by body image ideals and often more susceptible to various eating related disorders compared to men. A previous study using a sample of female students in Malaysia did not identify whether the increase in susceptibility to eating disorders can be explained by the level of body image acceptance. Aim: To identify the prevalence of depression and susceptibility to eating disorders among a sample of 206 female students in one of the private universities in Malaysia and explore the relationship between depression, body image and susceptibility to eating disorders. In addition, this study aimed to determine whether depression is a mediator between body image and susceptibility to eating disorders among female college students. Materials and Methods: The Body Image Acceptance and Action Questionnaire were used to assess body image acceptance, the Patient Health Questionnaire to measure depression and the Eating Attitude Test- 26 was used to assess susceptibility to eating disorders. Results: The results showed that 65.5% (??=135) of the students were depressed and 6.3% (n=13) were susceptible to eating disorders. There was a significant positive relationship between depression and eating disorders and a negative relationship between body image and depression as well as between body image and eating disorder. Further, the regression model showed that depression was partially mediating the effect of body image on eating disorders. Conclusion: Body image and depression contribute to eating disorders and treating depression could reduce susceptibility to eating disorders.

Variations in Branching Pattern of Renal Artery in Kidney Donors Using Ct Angiography

Introduction: Each kidney is supplied by a single renal artery originating from abdominal aorta. Since there are lots of renal surgeries happening now-a-days, it becomes mandatory for the surgeons to understand the abnormality and variations in the renal vasculature. Aim: To study the variations in the branching pattern of renal artery for the presence of early division and accessory renal artery in Indian kidney donors using CT angiography. Materials and Methods: The CT angiogram images of 100 normal individuals willing for kidney donation were analysed for early divisions and occurrence of accessory renal artery. Results: A 51% of kidney donors showed variation in the renal artery. Out of 51% variations 38 individuals had accessory renal artery and 13 individuals had early division of renal artery. The distribution of accessory renal artery was equal on both sides (13% on right and left) and 12% of individuals had accessory renal artery on both sides. Out of 13% earlier divisions, 5% was on right side, 7% was on left side and 1% was on both sides. Conclusion: This study concludes that 51% of kidney donors had renal artery variations. Hence, awareness of variations by evaluating the donors is a must before renal transplantation, urological procedures and angiographic interventions.

Reported Pain During Labour – A Qualitative Study of Influencing Factors among Parturient During Confinement in Private or Government Hospital

S. Parthasarathy, M. Ravishankar, V.R. Hemanthkumar

Introduction: Labour pain is distressing and it produces undue side effects both to the mother and the baby. The incidence is high in developing countries like India where the awareness about labour analgesia is still lacking. Aim: It is to find out the incidence of labour pain and the influence of various described factors on pain with a comparison between patients admitted in a government set up with a private set up in a south Indian semi-urban area. Materials and Methods: Two hundred continuous uneventful normal deliveries each in a Government (group G) and a private hospital (group P) were enrolled for the study. The reported pain during labour was noted 6-7 hours after delivery by interacting with the patient. The factors like age of the mother, sex and weight of the baby, literacy, socioeconomic status, the use of oxytocics and analgesia were evaluated. Results: The incidence of severe pain was more in group G (43.5%) than group P (12%). There was no analgesic intervention in 68.5% in group G while it was 13.5% (27/200) in group P. Even among these 27 patients who did not receive analgesics, only three parturients reported severe pain. Even administration of analgesics in a Government set up did not decrease pain to a significant extent. There were richer and more literate patients in group P. Booked cases were less in group G. Logistic regression analyses to find out factors which influenced pain in either group was used. Gravida, analgesic intervention and admission in a Govt. hospital influenced the pain experience of the parturient. There was minimal antenatal preparation in both the groups. There were no post partum complications. Conclusion: Mothers suffered from labour pain to a significant extent and there is an urgent need for awareness about labour analgesia. Primigravida, admission in a Govt. set up and analgesic interventions were the factors which influenced pain than others. Patients admitted in Govt. hospitals suffered more pain with less analgesic intervention possibly due to illiteracy. The increased drug intervention in Group P was just incidental and routine on their demand and did not correlate with pain. A sincere effort to increase antenatal counseling should be initiated.

Correlation of Paraoxonase Status with Disease Activity Score and Systemic Inflammation in Rheumatoid Arthritic Patients

Usha Dudeja Bindal, Rahul Saxena, Merajul Haque Siddiqui, Dilutpal Sharma

The Effect of Gabapentin Plus Celecoxib on Pain and Associated Complications After Laminectomy

Aminolah Vasigh, Molouk Jaafarpour, Javaher khajavikhan, Ali Khani

Introduction: Prevention and treatment of postoperative pain is a major challenge in postoperative care and well-being of the surgical patient. The multimodal analgesic method has been recommended as an alternative treatment for the management of postoperative pain. Aim: To assess the comparative effect of gabapentin versus gabapentin plus celecoxib on pain and associated complications after laminectomy. Materials and Methods: In this randomized double- blind clinical trial, 114 patients scheduled for elective laminectomy received gabapentin (n=38, 900 mg daily), gabapentin plus celecoxib (n=38, 200 mg celecoxib plus 300mg gabapentin twice a day), and placebo (n=38, capsule containing starch). Visual Analog Scale (VAS) was used to determine the severity of pain. Complications after surgery, anxiety scores before surgery and patient’s satisfaction 24 hour after surgery were recorded. Results: The mean pain sevenity score and morphine consumption in the gabapentin plus celecoxib group were less compared to the placebo and gabapentin group respectively at various intervals (p < 0.001). The mean anxiety score, shivering, nausea, vomiting and pruritus in the gabapentin group were significantly lower compared to the placebo and gabapentin plus celecoxib groups respectively (p < 0.001, p < 0.05). The frequencies of drowsiness (42.1%) in the gabapentin group were significantly high compared to the placebo and gabapentin plus celecoxib group respectively (p <0.001, p< 0.05). In the gabapentin plus celecoxib group patient satisfaction was significantly higher compared to the placebo and gabapentin group (p< 0.05). Conclusion: Combination of 300 mg gabapentin plus 200 mg celecoxib twice a day is a good alternative in multimodal analgesia, effective in pain control with lesser side effects seen with gabapentin alone.

Role of Adenosine Deaminase in Common Chronic ENT Infections

U.P. Santosh, G.S. Renukananda, S. Abhilash

Intoduction: Adenosine Deaminase (ADA) has been suggested to be an important enzyme which is associated with the cell mediated immunity. But its clinical significance in ENT infections needs to be correlated. Aim: To evaluate the role of serum adenosine deaminase level estimation in common chronic ENT infections. Materials and Methods: This was a prospective randomized study. The subjects were divided into 4 groups. Group A consisted of 25 normal healthy individuals who served as the controls. Group B consisted of 25 patients, who were clinically diagnosed as chronic tonsillitis. Group C consisted of 25 patients, clinically diagnosed as chronic rhinosinusitis and Group D consisted of 25 patients, clinically diagnosed as chronic otitis media of mucosal type. The serum levels of ADA were estimated in all the subjects. Results: The level of serum ADA was found to be elevated in common chronic ENT infections (Group B,C and D), when compared to control group(Group A) and p<0.05, which is statistically significant. Conclusion: From the present study, it can be concluded that serum ADA level can be considered as one of the essential diagnostic tool in diagnosing common chronic ENT infections.

Quantification and Correlation of Angiogenesis with Macrophages by Histomorphometric Method in Central and Peripheral Giant Cell Granuloma: An Immunohistochemical Analysis

Introduction: Angiogenesis is a fundamental process that affects physiologic reactions and pathological processes such as tumour development and metastasis. It is the process of formation of new microvessel from the preexisting vessels. Aim: The purpose of this study was to evaluate angiogenesis, macrophage index and correlate the impact of macrophages on angiogenesis in the central and peripheral giant cell granulomas by evaluating immunohistochemically microvessel density, microvessel perimeter and macrophage index. Materials and Methods: Immunohistochemical analysis was carried on 20 cases of central and peripheral giant cell granulomas each for CD34 and CD68 proteins expression. Inferential statistical analysis was performed using Independent student t-test to assess the microvessel density, microvessel perimeter and macrophage index on continuous scale between Group I and Group II. Level of significance was determined at 5%. Further bivariate analysis using Pearson correlation test was carried out to see the relationship between microvessel density and macrophage index in each group. Results: Microvessel density, micro vessel perimeter and macrophage index was higher in central giant cell granuloma compared to that of peripheral giant cell granuloma. Correlation between microvessel density and macrophage index among these two lesions was statistically insignificant. Conclusion: Angiogenesis as well as the number of macrophages appeared to increase in Central Giant Cell Granuloma in present study. These findings suggest that macrophages may up regulate the angiogenesis in these giant cell granulomas and angiogenesis do have a role in clinical behaviour. However, we could not establish a positive correlation between microvessel density and macrophage index as the values were statistically insignificant. This insignificance may be presumed due to fewer samples taken for study.

Effect of Whitening Dentifrice on Micro Hardness, Colour Stability and Surface Roughness of Aesthetic Restorative Materials

Kb Roopa, N. Basappa, AR Prabhakar, Os Raju, Gagandeep Lamba

Introduction: Whitening agents present in the novel whitening dentifrices may have deleterious effects over the aesthetic restorations. Aim: The present study evaluated the invitro effect of whitening dentifrice on micro hardness, colour stability and surface roughness on aesthetic restorative materials. Materials and Methods: Forty specimens each of compomer and of composite were prepared using brass mould. Specimens were equally divided into 4 groups. Group I (20 disks of compomer are subjected to brushing with conventional tooth paste) Group II (20 disks of composite subjected to brushing with conventional tooth paste), Group III (20 disks of compomer subjected to brushing with whitening tooth paste). Group IV (20 disks of composite subjected to brushing with whitening toothpaste). Each group was further divided into two subgroups, where 10 sample were subjected for two weeks of brushing with respective tooth paste and other 10 were subjected for four weeks of brushing. For the evaluation of micro hardness, colour stability and surface roughness, micro hardness testing machine, spectrophotometer and surface testing machine were used respectively. Initial and final readings were taken for each specimen and difference obtained was subjected to statistical analysis. One-way ANOVA was used for multiple group comparison followed by post-hoc Tukey’s-test. The paried t-test was used for intra group comparison and unpaired t-test for comparing independent sample groups. Results: The compomer and composite showed no significant difference in micro hardness either with conventional or whitening tooth paste both at two and four weeks. Although there was a highly significant colour change observed after using whitening tooth paste for both compomer and composite. Regarding surface roughness, there was a significant change in roughness in both conventional and whitening tooth paste with compomer and composite. However, whitening tooth paste had a significant change in surface roughness compared with conventional tooth paste. Roughness further increased at four weeks interval when compared to two weeks. Conclusion: Colour, surface-roughness and micro-hardness are the inherent properties of the aesthetic restorative materials. Use of whitening tooth paste will cause colour change and surface roughness of restorative material making it prone to deformation and also affects the clinical success of restoration.

Correlation of Salivary pH, Incidence of Dental Caries and Periodontal Status in Diabetes Mellitus Patients: A Cross-sectional Study

C. Seethalakshmi, R.C. Jagat Reddy, Nisha Asifa, S. Prabhu

Introduction: Diabetes mellitus is a chronic disease affecting many parts of the body. A number of oral diseases have been associated with diabetes mellitus with an increased risk of dental caries and periodontal disease. Aim: The aim of the study was to evaluate the salivary pH and incidence of dental caries and periodontal status in diabetes mellitus compared to that of the normal subjects. Materials and Methods: The study population consisted of 40 patients divided into 2 groups with group I comprising of 20 known diabetes mellitus patients and group II comprising of 20 non diabetic subjects as control group. The pH of the saliva was determined using a digital pH meter. Dental caries and periodontal status were assessed by DMFT and PDI indices respectively. Results: There was a decrease in the mean salivary pH of 6.51 in the study group, compared to the normal mean salivary pH of 7.88 in the control group. The mean DMFT index was higher in the study group (8.10) when compared to that of control group (1.15). The mean PDI score was also higher in the study group (4.0) as compared to that of the control group (0.45). Conclusion: The results of the present study concluded that there was a significant relationship between the diabetes mellitus and increased incidence of dental caries and periodontitis and there was also a significant reduction in the salivary pH in diabetes mellitus patients, compared to that of non diabetic subjects.

Anaesthesia Techniques for Maxillary Molars – A Questionnaire–Based Retrospective Field Survey of Dentist in Western India

Ganesh Ranganath Jadhav, Priya Mittal

Introduction: Clinicians use various anaesthesia techniques like Posterior Superior Alveolar (PSA) nerve block, buccal infiltration with or without supplemental anaesthesia like palatal and intraligamentary infiltrations for root canal treatment in maxillary molars. However there is no general consensus regarding which technique is enough for performing endodontic treatment in maxillary molars. Aim: The aim of this questionnaire-based survey is to compare and evaluate the various techniques used to anaesthetize the maxillary molars and its effect on postoperative pain. Materials and Methods: The data were obtained from 290 dental practitioners using a specially prepared questionnaire survey conducted anonymously. The questionnaire contained questions covering data such as years in dentistry, acquired specialty, techniques used for anaesthetizing maxillary molars, success of anaesthesia, and postoperative pain, etc. Results: Buccal infilteration with supplemental anaesthesia in the form of palatal (82%) and intra-ligamentary infilteration (88%) show higher success rate compared to only buccal infilteration (69%). However, intra-ligamentary infilteration group showed highest rate (75%) of postoperative pain. General practitioners (62% of clinicians) prefer to give both buccal and palatal infilterations and specialists opt for only buccal infilteration (66-74% of specialists). Conclusion: Only buccal infilteration is sufficient during root canal treatment of maxillary molars. Routine use of supplemental anaesthesia in the form of palatal and intra-ligamentary infilteration is not necessary unless patient experiences discomfort during endodontic treatment. However, intra-ligamentary infilteration may lead to postoperative discomfort in the form of pain.

Evaluation of the Factors and Treatment Options of Separated Endodontic Files Among Dentists and Undergraduate Students in Riyadh Area

Samah Samir Pedir, Abeer Hashem Mahran, Khaled Beshr, Kusai Baroudi

Introduction: Separation of endodontic files during root canal treatment is a common multifactorial problem facing most of dental practitioners both dentists and students that has high impact on treatment and prognosis outcome. Aim: To compare the incidence, factors and treatment options of separated endodontic files among dentists and undergraduate students in Riyadh area. Materials and Methods: A survery of 35-questionnaire was formulated and e-mailed to all 149 dentists of different dental specialties who are working in different clinical centers in Riyadh area and are attending the 26th Saudi Dental Society International Dental Conference in addition to 130 undergraduate students in different dental colleges in Riyadh. Overall, 118 participants of dentists completed the survey, with response rate of 79% and the same number of students with response rate of 90.7%. Results: Total of 57.6% dentists’ faced separated files problem during root canal preparation, while only 7.6% of students faced this problem. 53% of separated endodontic files (SEF) were hand files, 65% stainless steel files, 81% were small size files most common sizes (#15-20) (p <0.0001). Causes of SEF were root Canal anatomy, in 45%. 66% of SEF occurred in curved canals, 98% were in molars in mesiobuccal and mesiolingual canals, (p <0.0001). 44% of SEF were successfully bypassed, 53% were successfully removed from coronal third of root canal, 42% of SEF successfully removed using ultrasonics under visualization of operating microscope. 73% of retained SEF cases showed good prognosis, (p <0.0001). Conclusion: SEF is a multifactorial clinical problem that must be either removed, by passed to allow complete cleaning, shaping, disinfection, obturation and effective coronal seal.

Motor Imagery Training on Muscle Strength and Gait Performance in Ambulant Stroke Subjects-A Randomized Clinical Trial

Vijaya K Kumar, M. Chakrapani, Rakshith Kedambadi

Introduction: The ultimate goal of physiotherapy in stroke rehabilitation is focused towards physical independence and to restore their functional ability during activities of daily living (ADLs). Motor imagery (MI) is an active process during which a specific action is reproduced within working memory without any actual movements. MI training enhances motor learning, neural reorganization and cortical activation in stroke. The efficacy of MI training involving lower extremity mobility tasks need to be assessed. Aim: To evaluate the effects of combining motor imagery with physical practice in paretic Lower Extremity Muscles Strength and Gait Performance in Ambulant Stroke subjects. Materials and Methods: A Randomized Clinical Trial was conducted in Department of Physical Therapy, Tertiary Care Hospitals, Mangalore, India which includes 40 hemi paretic subjects (>3 months post-stroke) who were ambulant with good imagery ability in both KVIQ-20 = 60 and Time dependent MI screening test were recruited and randomly allocated into task-oriented training group (n=20) and task-oriented training group plus MI group (n=20). Subjects in both groups underwent task orientated training for lower extremity 45-60 minutes, 4 days per week for 3 weeks. In addition, the experimental group received 30 minutes of audio-based lower extremity mobility tasks for MI practice. Isometric muscle strength of Hip, Knee and Ankle using a hand-held dynamometer and self-selected 10 m gait speed were assessed before and after 3 weeks of intervention. Results: Both the groups had found a significant change for all the outcome measures following 3 weeks of interventions with p <.05. The experimental group had shown a significant improvement in paretic hip muscles (both flexors and extensors), knee extensors and ankle dorsiflexors and gait speed compare to control group with p < .05 between group analyses. Conclusion: Additional task specific MI training improves paretic muscle strength and gait performance in ambulant stroke patients.

Comparison of Effectiveness and Safety of Add-on Therapy of Saroglitazar and Fenofibrate with Metformin in Indian Patients with Diabetic Dyslipidaemia

Introduction: Diabetic dyslipidaemia poses a therapeutic challenge. New therapies have emerged in this patient subgroup to enhance outcome and improve compliance. Aim: The aim of this study was to compare the effectiveness and safety of add on therapy of saroglitazar and fenofibrate with metformin in Indian patients with diabetic dyslipidaemia. Materials and Methods: Adults patients with diabetic dyslipidaemia fulfilling the inclusion criteria were randomized in two groups. Group A patients received metformin (1000 mg/ day) and fenofibrate (160 mg/day) while group B patients received metformin (1000 mg/day) and saroglitazar (4 mg/day). Glycosylated haemoglobin (HbA1C), triglyceride (TG), LDL- cholesterol (LDL-C), HDL-cholesterol (HDL-C) levels were measured at baseline and week 12 visits. Fasting plasma glucose (FPG) and post prandial plasma glucose (PPPG) were measured at baseline and on week 4, 8 and 12 visits. Results: TG and HbA1C levels decreased significantly at week 12 from their respective baseline values (p< 0.05) in both groups. FPG and PPPG levels significantly decreased at weeks 4, 8 and 12 compared to their pretreatment values (p< 0.05) in both groups. TG and HbA1C levels in group B decreased significantly compared to group A at week 12. FPG and PPPG levels in group B also decreased significantly compared to group A at every interval. Inter group analysis did not show any statistically significant change in body weight, LDL-C and HDL-C at week 12. Conclusion: Add on therapy of saroglitazar with metformin significantly decreased TG, HbA1C, FPG and PPPG levels compared to add on therapy of fenofibrate with metformin in Indian patients with diabetic dyslipidaemia.

Comparative Study of Atropine Combined with Sodium Nitroprusside Pretreatment to Prevent Trigemino Cardiac Reflex after Trigeminal Ganglion Compression

Introduction: Manipulation of percutaneous compression of the trigeminal ganglion (PCTG) for trigeminal neuralgia (TN) can lead to significant haemodynamic changes, which were termed trigemino cardiac reflex (TCR). Nevertheless, many studies indicated that atropine pretreatment can reduce the incidence of bradycardia and cardiac arrest, but do not take precautions against abrupt rise of blood pressure. Aim: The purpose of our study was to compare control group {patients receiving Sodium Nitro-Prusside (SNP) pretreatment before PCTG} with study groups (patients receiving different doses of atropine combined with SNP pretreatment before PCTG) in cardiovascular parameters {Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and Heart Rate (HR)} at 5 periods during Total Intravenous Anaesthesia (TIVA). Materials and Methods: In total, 120 patients, who underwent PTCG, were enrolled and randomly assigned into control group {group A (SNP pretreatment before PCTG, n=29)} and study groups {group B (0.002mg /kg atropine combined with SNP pretreatment before PCTG, n=30), C (0.004mg/kg atropine pretreatment before PCTG, n=31) and D (0.006mg/kg atropine combined with SNP pretreatment before PCTG, n=30)}, the relationship between haemodynamic changes and using atropine pretreatment or not was compared. Cardiovascular parameters were measured at five periods: preoperative (T0); before puncture (T1); during compression (T2); 1 min after the compression ended (T3); and 1 min after the procedure ended (T4). Multivariate analysis of variance (MANOVA) and Pearson’s ?2 test were used, and a value of p < 0.05 was considered statistically significant. Results: Compared with the group A, means of SBP and DBP in the study groups (group B, C and D) were not observed significant differences at all time points (p>0.05), the mean values of HR showed significant differences, when compared to group C and group D at T2 and T3 (p<0.001). Meanwhile, means of SBP, DBP and HR comparison in the same group were observed between T1 and T2, to the group A, B and D, means of HR (p>0.05 vs. T1) indicated significant differences, however, there was no significant difference in group C (p>0.05). Furthermore, the incidence of post-compression tachycardia was observed in each group. Conclusion: By comparison, it seemed that 0.004mg/kg atropine pretreatment before PCTG was more reasonable for preventing significant haemodynamic changes.

Preliminary Study on Serum Lactate Dehydrogenase (LDH)-Prognostic Biomarker in Carcinoma Breast

Aditi Agrawal, Mahendra Bhauraoji Gandhe, Dilip Gupta, M.V.R.Reddy

Introduction: Serum Lactate Dehydrogenase (LDH) is one of the biochemical markers for breast cancer. Serum LDH is enzyme required for anaerobic glycolysis. One of its isoenzyme is increased in breast cancer due to up-regulation in its gene. It leads to increase in serum LDH level in breast cancer patients. Serum LDH is economical, easily available and easy to estimate. Aim: In the present study, we evaluated the LDH levels in circulation of newly diagnosed patients of breast cancer and tried to correlate it with different TNM staging of carcinoma breast before interventions and after adjuvant therapy of these patients. Materials and Methods: This prospective study was done on 83 diagnosed patients of breast cancer was conducted among poor patients in rural area. This study was conducted in the Department of Surgery between October 2008 to October 2010, at MGIMS, Sevagram, Maharashtra, a rural medical college located in Central India. Out of total 83 participants, 10 participants were having adverse events following surgery and remaining 73 participants were without adverse events following surgery. The significant difference in serum LDH levels between two groups, with and without adverse surgical outcome was calculated by Mann-Whitney U test. Results: Patients with higher clinical TNM staging were having higher serum LDH levels. The serum LDH levels at sixth months following surgery showed a trend of statistically significant difference between patients with and without adverse events. As increased serum LDH levels in breast cancer patients shows poor prognosis, surgical outcome or advanced metastases. Conclusion: Serum LDH monitoring can be used as a prognostic biomarker in patients of breast cancer. For confirmation of this finding, we require further more studies on larger sample size and long-term follow-up in patients specifically with higher serum LDH levels.

Burden of Hypertension and Diabetes among Urban Population Aged = 60 years in South Delhi: A Community Based Study

Introduction: India is going through a demographic transition, and the number of elderly is expected to increase both in absolute numbers, as well as in proportion. The elderly are one of the most vulnerable and high–risk group in terms of health status in any society, and more so for non- communicable diseases. Aims: To estimate the prevalence of diabetes and hypertension among elderly persons and association with socio-demographic variables; & to assess the awareness, treatment and control status of those with diabetes and hypertension. Materials and Methods: A cross-sectional community based study was carried out in a resettlement colony of South-east Delhi in Dakshinpuri Extension, Dr. Ambedkar Nagar. Elderly persons aged 60 years and above were selected by cluster random sampling. Information about self-reported diseases, socio-demographic variables was collected; fasting blood sugar and blood pressure were measured. Prevalence of diabetes and hypertension were calculated and association was tested by Chi-square test. Multivariate logistic regression analysis was used. Results: A total of 710 elderly persons participated in the study. Diabetes was seen in 24.0% and 67% were hypertensive. Isolated hypertension was detected in 25.9%. No statistically significant difference by gender (p=0.11), age (p=0.16), education (p=0.31) and economic dependency (p=0.28), was seen in both diabetes and hypertension. Out of 167 persons with diabetes, 62.3% were on treatment and 33.6% were under control; while out of 477 hypertensives, 41% were under treatment and only one-third of them had their blood pressure under control. Conclusion: This study highlighted a significant burden of non-communicable diseases amongst elderly persons in a low-middle class community in Delhi. It also showed the lack of awareness about their disease conditions and need for screening, diagnostic and treatment services at the primary level.

Mapping the Time Line of Development in Each Layer of Human Foetal Retina

Tulika Gupta, Kanchan Kapoor, Daisy Sahni, Balbir Singh

Introduction: There is need to elucidate the histological developmental stages of various layers of retina, to understand the process better and provide clinically significant insights. Aim: To study the details and chronology of in utero development of different layers of retina. Materials and Methods: To study time of appearance, differentiation and organization of all layers of central retina in different gestational age groups. Retina was studied histologically in 27 foetuses from18th to 34th weeks of gestation. Results: We found the period of mid gestation (19th -21st week of gestation) to be the defining time for retinal layers: The bruch’s membrane was fully formed at 20th week of gestation; the photoreceptor layer became well defined at 21st week of gestation; both the nuclear layers and both the plexiform layers and the ganglion cell layer became distinct at 19th week of gestation. Before the 19th week, outer and inner neuroblastic zones separated by the neuropil were seen. Well defined nerve fibre layer and inner limiting membrane was present at 18th week. The outer limiting membrane was first appreciated at 32nd week of gestation. Foetal retinal pigment epithelium was cuboidal and filled with melanin granules while no trace of lipofuscin pigment was found under fluorescent microscope. Conclusion: Detailed data on retinal histogenesis and its timeline might aid in directed differentiation of retinal cell types from stem cells for therapeutic purposes.

Fate and Development of Human Vomeronasal Organ – A Microscopic Fetal Study

Introduction: The existence of Vomeronasal organ in human is a controversial subject. Presence of Vomeronasal organ and its structure was not reported in standard text books. The presence of Vomeronasal organ in fetal life is doubtful. Hence identification of the organ by histological examination was planned. Materials and Methods: A study was conducted on resected specimens of nasal septum obtained from 45 spontaneously aborted fetuses from Obstetrics and Gynaecology department, PSG Institute of Medical Sciences and Research, Coimbatore, after ethical clearance. Results: The histological structure of Vomeronasal organ was observed from 11 weeks old fetus. The epithelial lining of the organ, presence of cilia, presence of lamina propria, acini and the blood vessel and the types of cells were observed. The organ was lined by pseudostratified columnar epithelium. The organ showed Lamina propria with serous acini from 18 weeks fetus. Vomeronasal duct opening into the nasal cavity and three types of cells were observed in 28 weeks fetus. Conclusion: Knowledge about the persistence of Vomeronasal organ in fetuses and its structure need to be known. The organ may be found as a putative pit posterior to anterior nasal spine. The organ may be damaged in nasal septal surgeries and nasal endoscopic procedures. The organ may not be seen on gross examination in all human fetuses and cadavers.

Virtual Screening of Phytochemicals to Novel Target (HAT) Rtt109 in Pneumocystis Jirovecii using Bioinformatics Tools

Introduction: Pneumocystis jirovecii is a fungus that causes Pneumocystis pneumonia in HIV and other immunosuppressed patients. Treatment of Pneumocystis pneumonia with the currently available antifungals is challenging and associated with considerable adverse effects. There is a need to develop drugs against novel targets with minimal human toxicities. Histone Acetyl Transferase (HAT) Rtt109 is a potential therapeutic target in Pneumocystis jirovecii species. HAT is linked to transcription and is required to acetylate conserved lysine residues on histone proteins by transferring an acetyl group from acetyl CoA to form e-N-acetyl lysine. Therefore, inhibitors of HAT can be useful therapeutic options in Pneumocystis pneumonia. Aim: To screen phytochemicals against (HAT) Rtt109 using bioinformatics tool. Materials and Methods: The tertiary structure of Pneumocystis jirovecii (HAT) Rtt109 was modeled by Homology Modeling. The ideal template for modeling was obtained by performing Psi BLAST of the protein sequence. Rtt109-AcCoA/Vps75 protein from Saccharomyces cerevisiae (PDB structure 3Q35) was chosen as the template. The target protein was modeled using Swiss Modeler and validated using Ramachandran plot and Errat 2. Comprehensive text mining was performed to identify phytochemical compounds with antipneumonia and fungicidal properties and these compounds were filtered based on Lipinski’s Rule of 5. The chosen compounds were subjected to virtual screening against the target protein (HAT) Rtt109 using Molegro Virtual Docker 4.5. Osiris Property Explorer and Open Tox Server were used to predict ADME-T properties of the chosen phytochemicals. Results: Tertiary structure model of HAT Rtt 109 had a ProSA score of -6.57 and Errat 2 score of 87.34. Structure validation analysis by Ramachandran plot for the model revealed 97% of amino acids were in the favoured region. Of all the phytochemicals subjected to virtual screening against the target protein (HAT) Rtt109, baicalin exhibited highest binding affinity towards the target protein as indicated by the Molegro score of 130.68 and formed 16 H-bonds. The ADME-T property prediction revealed that baicalin was non-mutagenic, non-tumorigenic and had a drug likeness score of 0.87. Conclusion: Baicalin has good binding with Rtt 109 in Pneumocystis jirovecii and can be considered as a novel and valuable treatment option for Pneumocystis pneumonia patients after subjecting it to invivo and invitro studies.

Neutrophil–Lymphocyte Ratio in Patients with Adenoidectomy

Serhan Derin, Selvet Erdogan, Murat Sahan, Hatice Topal, Hamdi Sozen

Introduction: Obstructive Sleep Apnea syndrome (OSA) is the most serious consequence of adenoid hypertrophy (AH) and it is one of the most common reasons of nocturnal hypoxia in children. There is some information about the relationship between childhood OSA and atherosclerosis or cardiac diseases. In this study, we evaluated the relationship between, neutrophil-lymphocyte ratio (NLR) and AH which is the most frequent cause leading OSA in children. Aim: Thus we aimed to contribute about subject of preoperative and postoperative NLR values in patients undergoing adenoidectomy that there is limited information. Materials and Methods: The study group comprised 76 children undergoing adenoidectomy. A preoperative and 3rd-month postoperative complete blood cell count was performed to calculate the NLR values in all patients. The NLR values were calculated as the ratio of neutrophils to lymphocytes in peripheral blood. Data analysis was performed using SPSS 15. Results: The mean NLR (min - max) was 1.0 (0.16-3.57) preoperatively and 1.06 (0.35-4.95) 3 months postoperatively (p = 0.052> 0.05). Haemoglobin 12.9 ± 0.95 (preop) 12.94 ± 0.91 (postop) (p= 0.522), WBC (min-max) 7.75 (3.90-14.99) 7.8 (4-15.64) (p= 0.297 <0.005), platelet 344.5 ± 98.7 328.4 ± 68.9 (p<0,005). Conclusion: There is limited information in the English literature. This study has investigated the association between the NLR and adenoidectomy. The results of the present study demonstrate that the NLR is not a statistically significant inflammatory factor. So, NLR values do not appear related to stage of upper airway obstruction.

Assessment of MRI as a Modality for Evaluation of Soft Tissue Injuries of the Spine as Compared to Intraoperative Assessment

Introduction: Traumatic injuries of the spine and spinal cord are potentially devastating as they may lead to significant neurological damage as the clinical and prognostic spectrum of the effects of spinal injuries is vast. Timely imaging studies can help mitigate these possibly life threatening complications. There is a dearth of studies that directly compare MR imaging findings to surgical findings. Aim: Hence, this study was undertaken to assess the sensitivity of MRI in identifying injuries to the soft tissue structures of the spine. Materials and Methods: MRI scans were performed on 31 cases of acute spinal injuries that presented within 72 hours of the trauma and underwent surgical fixation by either an anterior or posterior approach. The non-osseous structures namely; Anterior Longitudinal Ligament (ALL), Posterior Longitudinal Ligament (PLL), Intervertebral Disc, Ligamentum Flavum, Interspinous Ligament (ISP) and the Spinal Cord were evaluated. They were classified as ‘True Positive’ if an injury was found to correlate with intraoperative findings and as ‘False Negative’ when diagnosed falsely as normal. The statistical sensitivity of MRI in diagnosing injuries to the non-osseous structures of the spine were thus calculated. Results: Of the 31 patients, in 51.6% of patients the site of injury was to the cervical spine (n=16), thoracic spine was the next highest in occurrence of 39% (n=12) and lumbar spine accounted for the least. In correlating the imaging findings to the intraoperative findings, MRI was highly sensitive in detecting injuries to the Posterior Longitudinal Ligament (94.4%) and the Spinal cord (93%) and fairly high in detecting injuries to the Intervertebral disc. However coming to the ligamentum flavum and interspinous ligaments, the sensitivity of the MRI dropped to 62.5% and 63.6% respectively. Conclusion: MRI was found to be highly sensitive in detecting injuries to the spinal cord and the posterior longitudinal ligament and moderately sensitive for detection of disc injuries. Though concerning the Anterior Longitudinal Ligament, Ligamentum Flavum and the Interspinous Ligaments MRI performed ineffectively with higher number of false negative interpretations.

Evaluation of Dexmedetomidine as an Adjuvant to Intrathecal Bupivacaine in Infraumbilical Surgeries

Sisinti Sanjeeb Patro, Hemant Deshmukh, Yerramalli Roja Ramani, Gitanjali Das

Introduction: Various adjuvants like morphine, buprenorphine and fentanyl, clonidine, ketamine are being used in anaesthetic practice since long for improvement of peri-operative analgesia following spinal anaesthesia. Such adjuvants have been helpful in induction of early ambulation but at the cost of their associated adverse effects. Therefore search for an effective adjuvant is still going on. Currently Dexmedetomidine, a highly selective a2-adrenoreceptor agonist is being studied for its adjuvant action in spinal anaesthesia. Aim: The present study aims to evaluate the efficacy of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine in spinal anaesthesia in patients undergoing infra-umbilical surgeries. Materials and Methods: It was a prospective, double blind study among 60 patients undergoing infraumbilical surgeries under spinal anaesthesia. The patients were randomly allocated to 2 groups (Group I and Group II) of 30 each. Group I received hyperbaric bupivacaine (15 mg) alone and Group II received hyperbaric bupivacaine (15 mg) with Dexmedetomidine (5mcg). The onset time of sensory and motor block, regression time of sensory and motor block, duration of analgesia, haemodynamic parameters were recorded both intra and postoperatively. The primary efficacy parameters were to determine the onset and duration of sensory block, motor block and duration of postoperative analgesia. Secondarily any associated haemodynamic changes and adverse effects of Dexmedetomidine were also recorded. Statistical Analysis: Continuous data were analysed using the Student’s t-test and categorical variables by two-tailed Fisher-exact test or Chi-square test. Results: Onset of sensory block was 129.33±14.8 seconds in Group II as compared to 208.33±19.18 seconds in Group I with total duration of sensory block as 317.70±16.16 minutes in Group II and 188±11.86 minutes in Group I. Similarly, onset of motor block was 226.33±31.86 minutes and 320.33±29.81 minutes, with total duration of motor block as 286.33±15.15 minutes and 166.5±12.11 minutes in Group II and in Group I respectively. Duration of analgesia was 333.6±20.67 minutes with Dexmedetomidine but 193.67±7.06 minutes in bupivacaine alone group. Conclusion: Dexmedetomidine as an adjuvant had shown early onset of sensory and motor block with longer duration of analgesia and haemodynamic stability in the present study as compared to bupivacaine alone.

The Epidemiology of Anti-Sperm Antibodies Among Couples with Unexplained Infertility in North West Bank, Palestine

Anas Lotfi Yasin, Ahmad Lotfi Yasin, Walid Salim Basha

Introduction: Anti sperm antibodies (ASA) can present in serum and semen and they may lead to impair the sperms function leading to infertility. The precise mechanism of generation of these antibodies is yet to be discovered. Aim: This study was performed to determine the prevalence of anti-sperm antibodies (ASA) in patients with unexplained infertility. The study was initiated also to explore the possible factors that may associate with ASA formation and how ASA status is associated with pregnancy rates after going with in vitro fertilization – intracytoplasmic sperm injection (IVF-ICSI). Materials and Methods: A cross-sectional study was conducted on 42 normal infertile couples consulting Razan Medical Center for Infertility & I.V.F. in Nablus, Palestine, from December 2012 – March 2013. Serum levels of immunoglobulins G (IgG) ASA were measured in participants (males and females) using enzyme-linked immunosorbent assay (ELISA). In addition, participants also filled a questionnaire about the presence of previous varicocele repair, inguinal hernia repair, orchitis, testicular trauma and vasectomy reversal among males and severe coitus bleeding and coitus during menses or puerperium among females. Couples were also asked about previous IVF-ICSI procedures and the outcome of the procedure in terms of either they got pregnant or not. Data was analysed using SPSS software. Results:The prevalence of ASA was 14.3% (6/42) among all couples, 9.5% (4/42) among males and 4.8% (2/42) among females. There was no significant relationship between previous varicocele repair, previous inguinal hernia repair, or orchitis and formation of ASA (p value =0.64, 0.56, and 0.26 respectively). Previous trauma, vasovasostomy, severe coitus bleeding and coitus during menses or puerperium were not observed in any of the study sample. ASA did not seem to affect the outcome of IVF-ICSI (p-value =0.54). Conclusion: Prevalence of ASA in infertile couples in the north part of Palestine is similar to that obtained worldwide. ASA formation does not relate to any of the studied risk factors and does not seem to associate with pregnancy rate after IVF-ICSI. We recommend further studies using a larger sample size and including all parts of Palestine in order to generalize the obtained results.

Adherence to Hospital Antibiotic Policy for Treatment of Escherichia coli ESBL in Urine

R. Someshwaran, K. Gnana Prakash, Shreeram A. Deshpande, Anbu N. Aravazhi

Introduction: Escherichia coli are the most common uropathogen worldwide accounting for 80% of the Urinary Tract Infections (UTIs). Nosocomial infections caused by Multi-drug resistant Gram negative bacteria expressing Extended Spectrum ß Lactamase enzyme, pose a serious therapeutic challenge to clinicians due to limited therapeutic options. Stringent adherence to Hospital Antibiotic Policy in treating Urinary Escherichia coli ESBLs is a borne necessity. Aim: A clinical audit was undertaken in the form of a cross-sectional study to evaluate the compliance on appropriate antibiotic prescription and strict adherence to Hospital Antibiotic Policy for therapeutic management of the patients infected with urinary Escherichia coli ESBL producers. Materials and Methods: A cross-sectional medical audit on adherence to treatment of Escherichia coli ESBL producers from in-patients diagnosed to have urinary tract infections for a duration of 7 months was conducted as a prospective study. Clinical data, culture and sensitivity reports of the patient diagnosed with urinary Escherichia coli ESBLs were compared with the treatment chart to ensure strict adherence to hospital antibiotic policy for appropriate therapy by physicians. Data were analysed using IBM SPSS version 20 software. Results: The incidence of uncomplicated cystitis, pyelonephritis and complicated pyelonephritis cases were 65.24% (107 out of 164), 20.7% (34 out of 164) and 14.02% (23 out of 164) respectively. Resistance to individual fluoroquinolones like norfloxacin, ciprofloxacin and ofloxacin were found to be 60%, 59% and 47.5% respectively. As per hospital antibiotic policy, fluoroquinolones were prescribed in only 23% of the patients for the treatment of urinary Escherichia coli ESBLs. Conclusion: Irrational utilization of antibiotics and non-adherence to antibiotic policy could have been the significant risk factors for drug resistance. Optimized antibiotic use, Microbiology laboratory support and periodic antibiotic audit led by effective infection control team would hasten the development of drug resistance.

Prevalence of Overweight and Obesity in 4 Schools of South Mumbai

Introduction: The paediatric obesity is on the rise so as the complications of obesity like cardiovascular diseases, liver diseases, dyslipidaemia are increasing. The changing dietary habits and less of outdoor activities are risk factors for obesity. Aim:The study was conducted to find out prevalence of overweight and obesity among students in four schools of the Mumbai and compare with studies from rest of the country. Materials and Methods: It is school based, cross-sectional study conducted in four Schools from class of 5th to 10th. The anthropometric measurements of height, weight were taken of each student. The body mass index was calculated based on the age based Cole et al., criteria (International) as well as Khadilkar et al., criteria which are specially develop for Indian children. The data was analysed with chi-square test. Results: Total 1828 students were screened from 4 schools. Out of which 590 were girls and 1238 were boys. The prevalence of overweight and obesity by Cole et al., criteria were 11.3% and 3.3% and by Khadilkar et al., criteria were 17.5% and 7.8 % respectively. Conclusion: It shows significant difference in obesity between boys and girls and also between government and private schools. There is overall decrease in prevalence of overweight and obesity as age increases. The overweight and obesity among these schools in Mumbai is comparable with the rest of the studies from India.

An Odontometric Approach for Estimation of Stature in Indians: Cross- Sectional Analysis

Achla Bharti Yadav, Sumit Kumar Yadav, Neal Bharat Kedia, Abhina v Kumar Singh

Introduction: Height/stature is one of the useful anthropometric parameter for individual identification. Correlation of stature to long bones, even fragmentary bones is frequently reported among various populations. As teeth have the advantage of being composed largely of hard tissue which is relatively indestructible, the careful study of these can enable reliable determination of stature of the person in life. Aim: The present study was designed to elucidate the anthropometric correlation of tooth dimensions with stature and also devises regression formulae. Materials and Methods: This study was carried out on 361 Indian students (151 males and 210 females) in the age range of 21- 45 years to estimate stature using odontometry. Stature and tooth measurements were taken on each partcipant following standard methods and techniques. Karl Pearson’s correlation co-efficient and linear regression was used to estimate stature. Results: Regression analysis showed that the canine width can aid in estimation of stature as an adjunct when only teeth are available for identification. Conclusion: Tooth dimensions can be used only as a supplementary approach for the estimation of stature but with caution.

Antibiotic Resistance, Rapd - Pcr Typing of Multiple Drug Resistant Strains of Escherichia Coli From Urinary Tract Infection (Uti )

Xavier Alexander Marialouis, Amutha Santhanam

Introduction: Global spreading of multidrug resistant strains of Escherichia coli is responsible for Urinary Tract Infection (UTI) which is a major health problem in of concern. Among the gram negative bacteria, the major contributors for UTI belongs to the family Enterobacteriaceae, which includes E. coli, Klebsiella, Citrobacter and Proteus. However, E. coli accounts for the major cause of Urinary tract infections (UTIs) and accounts for 75% to 90% of UTI isolates. Aim: The main aim of this study is to analyse the phylogenetic grouping of clinical isolates of UTI E. coli. Materials and Methods: In this study nearly 58 E. coli strains were isolated and confirmed through microbiological, biochemical characterization. The urine samples were collected from outpatients having symptoms of UTI, irrespective of age and sex in Tamil Nadu, India. The isolates were subjected to analyse for ESBL and AmpC ß-lactamase production. To understand its genetic correlation, molecular typing was carried out using RAPD-PCR method. Results: Here we noted phenotypically twenty seven isolates were positive for ESBL and seven for AmpC ß-lactamase production. However, among the ESBL isolates higher sensitivity was noted for Nitrofurantoin and Cefoxitin. It is worth to note that the prevalence of UTIs was more common among female and elderly male. Phylogenetic grouping revealed the presence of 24 isolates belonged to B2 group followed by 19 isolates to group A, eight isolates to group B1 and Seven isolates to group D. Conclusion: Phenotypically most of the strains were positive for ESBL and showed high sensitivity for Nitrofurantoin and cefoxitin.

Association of Urinary Tract Infection in Married Women Presenting with Urinary Incontinence in a Hospital based Population

Jayakumar Subramaniam, Shilpalakshmiprasad Eswara, Bineshlal Yesudhason

Introduction: Urinary incontinence (UI) is increasingly recognized as a significant health problem, which remains a hygienic as well as social problem. Women have higher risk of developing incontinence in their lifetime compared with men. Urinary tract infection can increase the incidence of incontinence. Present study was undertaken to assess the association of UTI in married women who presented with UI. Aim: The present study was aimed to identify the patients (married women) with complaints of UI and determining its association with UTI; and to identify the causative organism for the UTI along with its antimicrobial susceptibility pattern. Materials and Methods: This is a cross-sectional, non-randomized study of 107 married women with UI, who attended outpatient department in our hospital. Mid-stream urine (MSU) samples were collected from these patients with positive history of incontinence. Screening of urine for significant bacteriuria and culture to identify the etiological agents were performed followed by evaluation of their antimicrobial susceptibility profiles using Kirby Bauer disc diffusion method. Results: Overall 25.2% of patients with incontinence had a positive urine culture. History of UTI was elicited in around 38.3% of patients, among which 15% had positive urine culture and 10.3% of the patients who did not have a history had positive culture. Escherichia coli was the commonest causative organism (66.6) causing UTI, followed by Enterococcus spp. (22.3%), Klebsiella pneumoniae (7.4%) and Proteus mirabilis (3.7%). The antimicrobial susceptibility pattern for Escherichia coli showed high sensitivity to Nitrofurantoin (94.4%) and high resistance to Ampicillin (94.4%). Conclusion: Our study revealed one in every four incontinent patients had UTI and almost half of them suffered from previous episodes of UTI. Thus appropriate correction of the existing UTI can help in the treatment of UI.

Comparison of the Effects of Myrtus Communis L, Berberis Vulgaris and Metronidazole Vaginal Gel alone for the Treatment of Bacterial Vaginosis

Mansoureh Masoudi, Sepideh Miraj, Mahmoud Rafieian-Kopaei

Introduction: There is a growing tendency towards herbal medicines for treatment of vaginitis. Antibacterial and antifungal effects of Myrtus communis L and Berberis vulgaris have been demonstrated invitro and invivo. Aim: This study aimed to compare the therapeutic effects of the vaginal gel of Berberis vulgaris 5% (in metronidazole base) and Myrtus communis L 2% (in metronidazole base) with only metronidazole vaginal gel 0.75% on bacterial vaginosis. Materials and Methods: This study was a randomized clinical trial research on 120 married women aged 18-40 years affected by bacterial vaginosis attended for treatment to gynaecology clinic of Hajar Hospital (Shahrekord, Iran). They were randomly divided into three groups of 40 participants. Diagnostic criteria were Amsel's criteria. Myrtus communis L, Berberis vulgaris vaginal gel or metronidazole vaginal gel for five-night usage were prescribed to each group, and after 7 days therapeutic effects were assessed. Data analysis was performed using ANOVA and Chi-square tests. Results: A statistically significant difference was observed with regard to treatment response among the study groups (p<0.001), with Myrtus communis L and Berberis vulgaris groups having a better response than metronidazole gel alone. Moreover, there was no significant difference between Myrtus communis L and Berberis vulgaris groups (p= 0.18). The patients in groups of Myrtus communis L or Berberis vulgaris in metronidazole base did not experience any relapse, but in metronidazole group, 30% of patients experienced relapse during three weeks follow up. Conclusion: Findings of the study showed that treatment with a combination of Myrtus communis L or Berberis vulgaris in metronidazole base improve the efficacy of bacterial vaginosis therapy.

Assessment of Knowledge of Self Blood Glucose Monitoring and Extent of Self Titration of Anti–Diabetic Drugs among Diabetes Mellitus Patients – A Cross Sectional, Community Based Study

V. Krishnan, J. Thirunavukkarasu

Introduction: Self blood glucose monitoring is an important context of self care in the management of diabetes mellitus. All the guidelines must be followed while performing self blood glucose monitoring and tracking of values is essential to facilitate the physician while titrating the drugs and /or doses of anti diabetes medication. Self titration by patients following self monitoring must be discouraged. Aim: To assess the knowledge and practice of self blood glucose monitoring among diabetes patients and extent of self titration of anti diabetes medicines among diabetes patients based on self blood glucose monitoring. Materials and Methods: This pilot, cross-sectional, observational study was conducted using a validated questionnaire among adult male and female diabetes patients performing self blood glucose monitoring at home. Diabetes patients with complications and juvenile diabetes patients were excluded. Results: Out of 153 patients surveyed, only 37 (24.1%) (20 males, 17 females) patients were aware and have been following self blood glucose monitoring appropriately. About 116 (75.8%) (64 males, 52 females) of patients were devoid of adequate knowledge and did not practice self blood glucose monitoring in a proper way. Ninety eight (64.05%) accepted that they self titrate their anti diabetic medicines based on self monitoring. Conclusion: Self monitoring of blood glucose should be encouraged and patients should be taught importance of following correct steps and tracking of self monitoring by physician or diabetes educator.

Evaluation of Long Term Effect of RV Apical Pacing on Global LV Function by Echocardiography

Introduction: We very often face pacemaker implanted patients during follow-up with shortness of breath and effort intolerance inspite of normal clinical parameters. Aim: The aim of our study is to evaluate the cause of effort intolerance and probable cause of sub-clinical Congestive Cardiac Failure (CCF) in a case of long term Right Ventricular (RV) apical pacing on global Left Ventricular (LV) function non- invasively by echocardiography. Materials and Methods: We studied 54 patients (Male 42, Female 12) of complete heart block (CHB) with RV apical pacing (40 VVI and 14 DCP). Mean duration of pacing was 58+4 months. All patients underwent 24 hours Holter monitoring to determine the percentage of ventricular pacing beats. 2-D Echocardiography was done to assess the regional wall motion of abnormality and global LV ejection fraction by modified Simpson’s rule. These methods were coupled with the Doppler derived Myocardial Performance Index (MPI), tissue Doppler imaging, and mechanical regional dyssynchrony with 3-D Echocardiography. Data were analysed from 54 RV- apical paced patients and compared with age and body surface area of 60 controlled subjects (Male 46, Female 14). Results: Evaluation of LV function in 54 patients demonstrated regional wall motion abnormality and Doppler study revealed both LV systolic and diastolic dysfunction compare with control subjects (regional wall motion abnormality 80±6% vs 30±3% with p-value<0.0001) which is proportional to the percentage of ventricular pacing beats (mean paced beat 78%). Global LVEF 50±4% vs 60±2% (p-valve <0.0001) and MPI 0.46 ±0.12 v/s 0.36±0.09 (p-value <0.0001). Conclusion: RV–apical pacing induces iatrogenic electrical dyssynchrony which leads to remodeling of LV and produces mechanical dyssynchrony which is responsible for LV dysfunction. Alternate site of RV pacing and/or biventricular pacing should be done to maintain biventricular electrical synchrony which will preserve the LV function

The Role of CA19-9 in Predicting Tumour Resectability in Carcinoma Head of Pancreas

Introduction: Carbohydrate antigen 19-9 (CA 19-9) is a tumour associated antigen. Blood levels may be elevated in benign as well as malignant conditions. Its sensitivity (70-90%) and specificity (68-91%) are inadequate for accurate diagnosis. It can be used to predict the extent of disease and outcome after resection. Aim: The aim of the present study was to assess the role of CA 19-9 in predicting the resectability of the tumour in the head of pancreas. Materials and Methods: This was a prospective study which included 30 patients and study period was from May 2012 to October 2014. Data collected from all patients with carcinoma of the head of pancreas on the basis of contrast enhanced computed tomography/Magnetic resonance cholangiopancreaticography. CA 19-9 levels were measured and recorded. Patients who were medically unfit for surgery or those who didn’t warrant palliative surgery were excluded from the study. During surgery the operative findings on operability were documented and tabulated against corresponding CA 19-9 levels. Results: Of the 30 patients who were operated, 13(43.3%) patients had operable tumours and underwent Whipple’s procedure and 17(56.7%) underwent palliative bypass procedure. Of the 30, CA 19-9 levels were elevated in 9(30.0%) and were normal in 21(70.0%). Among 13(43.3%) who had operable tumours, CA 19-9 was elevated in 4(13.3) and was normal in 9(30.0%). Of the 17(56.7%) who had inoperable tumours CA 19-9 was elevated in 5(16.7%) and was normal in 12(40.0%). Among the 17 who had inoperable tumours, 8(47.1%) were diagnosed preoperatively and of them CA 19-9 levels were raised in 2(11.8%) and normal in 6(35.3%). In the group of 9(52.9%) who had inoperable tumours diagnosed intraoperatively, CA 19-9 was raised in 3(17.6%) of them and was normal in the remaining 6(35.3%) of them. Conclusion: Based on the study findings, it can be stated that there is no significant correlation with resectability of pancreatic adenocarcinoma and CA 19-9 and it doesn’t predict vascular involvement and liver metastasis.

The Role of Ischemia Modified Albumin as a Biomarker in Patients with Chronic Liver Disease

Prashanth Ashok Kumar, Kavitha Subramanian

Introduction: Chronic Liver Disease (CLD) is characterised by gradual destruction of liver tissue over time. Ischemia Modified Albumin (IMA) is an upcoming biomarker shown to be elevated in conditions associated with ischemia and oxidative stress. Albumin levels are greatly reduced in patients with CLD and studying its alterations will provide essential information regarding the molecular changes occurring to it. Aim: The study aims to estimate IMA and IMA/Albumin ratio in patients with CLD and to correlate it with parameters assessing liver function and the Model for End Stage Liver Disease (MELD) score. Materials and Methods: The study consisted of 43 CLD patients as test subjects and 28 apparently healthy individuals as controls. Multiple parameters assessing liver function like albumin, bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), Gamma Glutamyl Transpeptidase (GGT), alkaline phosphatase (ALP), Prothrombin Time (PT) INR and creatinine were estimated and the MELD score calculated. Serum IMA expressed as Absorbance Units (ABSU) was estimated using the Albumin Cobalt Binding test (ABT). Student’s t-test and correlation coefficient was used for statistical analysis. Results: Serum IMA was significantly higher in CLD patients (0.5320 ± 0.1677) as compared to the control group (0.3203 ± 0.1257) with a p-value of <0.0001. The IMA/Albumin ratio was also significantly higher (0.2035 ± 0.0970) in patients with CLD compared to control group (0.0714 ± 0.0283) with a p-value of <0.0001. IMA has a negative correlation with albumin. The IMA/Albumin ratio shows positive correlation with MELD score, bilirubin and ALP. There was no correlation with ALT, AST, GGT and PT INR. Conclusion: Decreased serum albumin correlates with increase in IMA in CLD could indicate a qualitative change and not merely a quantitative reduction of albumin. IMA can serve as a biomarker to assess the disease severity and prognosis of CLD patients.

Hyperuricaemia – A Potential Indicator to Diagnose the Risk of Essential Hypertension

Chanchal Shrivastav, Manjinder Kaur, M.L. Suhalka, Suman Sharma, Abhijit Basu

Introduction: Hypertension has turned out to be the major cause of morbidity among the life style diseases. Studies in human and animal models have documented an independent association of hyperuricaemia with early hypertension. Hyperuricaemia is a modifiable and treatable risk factor, which might reduce the incidence of Essential Hypertension (EHT). Aim: Hence, the present study was designed to find out the association between hyperuricaemia and EHT in the population of Southern Rajasthan as there is a dearth of literature on Indian scenario especially in Rajasthan. Materials and Methods: A cross-sectional, case control study was carried out in the Department of Physiology among 125 subjects; aged 20-50 years of both sexes, which were chosen randomly from Medicine OPD and healthy volunteers. The subjects were broadly divided into two groups (A & B); group A comprised of newly diagnosed cases of EHT (n=75) and group B had healthy normotensive controls (n=50). S. Uric Acid (SUA), Serum creatinine and fasting blood glucose levels were estimated by using the respective kit methods on semi auto-analyser in both groups. S. creatinine and fasting blood glucose levels were estimated to exclude renal disorder and diabetes mellitus respectively. The data was analysed by student t-test, chi-square test and Odds Ratio. Results: The mean SUA level in group A was significantly higher than group B (6.56 ± 0.76, 4.91 ± 0.97 mg/dl, p<0.001 respectively). 37.33% of patients had hyperuricaemia in group A as compared to 14% in group B (p<0.01, OR=3.66) indicating that a hyperuricaemic individual has 3.66 times more risk of developing EHT as compared to the one with lower value of SUA. Conclusion: The mean SUA level and the frequency of hyperuricaemia was significantly higher in newly diagnosed cases of EHT as compared to healthy controls. Hence, SUA could be useful as a potential indicator for early risk detection of development of EHT.

Comparison of Vaginal and Oral Doses of Misoprostol for Labour Induction in Post-Term Pregnancies

Masomeh Rezaie, Fariba Farhadifar, Susan Mirza Mohammadi Sadegh, Morteza Nayebi

Introduction: Considering maternal complications, it is preferred to induce labour after 40 weeks. Labour induction is a procedure used to stimulate uterine contractions during pregnancy before the beginning of the labour. Aim: The aim of this study was to compare oral misoprostol with vaginal misoprostol for induction of labour in post-term pregnancies. Materials and Methods: This double blind clinical-trial study was performed on 180 post-term pregnant women who were admitted to the labour ward of Besat Hospital Sanandaj, Iran in 2013-2014. Participants were equally divided into three groups using block randomization method. The induction was performed for the first group with 100 µg of oral misoprostol, for the second group with 50 µg of oral misoprostol, and for the third group with 25 µg of vaginal misoprostol. Vaginal examination and FHR was done before repeating each dose to determine Bishop Score. Induction time with misoprostol to the start of uterine contractions, induction time to delivery, and mode of delivery, systolic tachycardia, hyper stimulation and fetal outcomes were studied as well. Results: First minute Apgar scores and medication dosage of the study groups were significantly different (p=0.0001). But labour induction, induction frequency, mode of delivery, complications, and 5 minutes Apgar score in the groups had no significant difference (p>0.05). The risk of fetal distress and neonatal hospitalization of the groups were statistically significant (p=0. 02). There was no significant difference between the three groups in terms of mean time interval from the administration of misoprostol to the start of uterine contractions (labour induction), the time interval from the start of uterine contractions to delivery and taking misoprostol to delivery. From the administration of misoprostol to start of the uterine contractions the mean difference between time intervals in the three groups were not statistically significant. Conclusion: Based on our findings it can be concluded that prescribing 100µg oral misoprostol is effective than 50 µg oral or 25 µg vaginal misoprostol in terms of induction time, maternal and neonatal outcomes in post- term pregnancy. However, the best dose and route should be decided according to evidence based information.

Effects of Laboratory Disinfecting Agents on Dimensional Stability of Three Commercially Available Heat-Cured Denture Acrylic Resins in India: An In-Vitro Study

Introduction: Dental professionals are exposed to a wide variety of microorganisms which calls for use of effective infection control procedures in the dental office and laboratories that can prevent cross-contamination that could extend to dentists, dental office staff, dental technicians as well as patients. This concern has led to a renewed interest in denture sterilization and disinfection. Heat polymerized dentures exhibit dimensional change during disinfection procedure. Aim: The purpose of this study was to determine the influence of different types of widely used laboratory disinfecting agents on the dimensional stability of heat-cured denture acrylic resins and to compare the dimensional stability of three commercially available heat-cured denture acrylic resins in India. Materials and Methods: Twelve specimens of uniform dimension each of three different brands namely Stellon, Trevalon and Acralyn-H were prepared using circular metal disc. Chemical disinfectants namely 2% alkaline glutaraldehyde, 1% povidone-iodine, 0.5% sodium hypochlorite and water as control group were used. Diameter of each specimen was measured before immersion and after immersion with time interval of 1 hour and 12 hours. The data was evaluated statistically using one way analysis of variance. Results: All the specimens in three disinfectants and in water exhibited very small amount of linear expansion. Among three disinfectants, specimens in 2% alkaline glutaraldehyde exhibited least(0.005mm) and water showed highest (0.009mm) amount of dimensional change. Among resins, Trevalon showed least (0.067mm) and Acralyn-H exhibited highest (0.110mm) amount of dimensional change. Conclusion: Although, all the specimens of three different brands of heat-cured denture acrylic resins exhibited increase in linear dimensional change in all the disinfectants and water, they were found to be statistically insignificant.

Effect of Different Pranayamas on Respiratory Sinus Arrhythmia

Introduction: Respiratory Sinus Arrhythmia (RSA) is the differential change of Heart Rate (HR) in response to inspiration and expiration. This is a noninvasive sensitive index of parasympathetic cardiac control. Aim: To evaluate changes in RSA by utilizing a simple and cost-effective analysis of electrocardiographic (ECG) tracings obtained during performance of four pranayama techniques. Materials and Methods: Fifty two trained volunteers performed the following pranayamas with different ratios for inspiration and expiration: sukha (1:1), traditional (1:2), pranava (1:3) and savitri (2:1:2:1) and ECG was recorded while performing the techniques with rest period of 5 minutes in-between. HR was calculated and maximum HR during inspiration (Imax), minimum HR during expiration (Emin), differences between Imax and Emin (?), percentage differences between Imax and Emin (?%) and expiration: inspiration ratio (E:I) calculated by respective formulae. Statistical analysis was carried out using repeated measures of ANOVA with Tukey-Kramer multiple comparisons test. Results: There were significant differences between groups in all five aspects namely: p= 0.0093 for mean Imax, p = 0.0009 for mean Emin, and p < 0.0001 for ? HR (I-E), ?% HR (I-E) and E:I ratio. Pranava pranayama produced the greatest changes in all five comparisons. Conclusion: We suggest that further short and long term studies be undertaken with pranava pranayama in patients to further qualitatively and quantitatively evaluate inherent mechanisms of this simple technique. Addition of these cost-effective techniques to the medical armory will help patients of rhythm disorders and other cardiovascular conditions.

Cardiac MR Imaging in the Evaluation of Rheumatic Valvular Heart Diseases

Phani Chakravarty Mutnuru, Sn Singh, John D’ Souza, Lakshmi Manasa Perubhotla

Introduction: Rheumatic heart disease is the most common cause of valvular heart disease throughout the world. Echocardiography is the dominant imaging investigation in the assessment of cardiac valvular disease and the role of Magnetic Resonance Imaging (MRI) is so far limited. However, due to rapid improvements in the cardiac MRI technology in past few years, this non invasive technique is gaining interest in the examination of cardiac valves. Aim: Our study was undertaken to define the role of MRI in the evaluation of Rheumatic valvular heart disease and to compare the role of MRI with transthoracic echocardiography with regard to quantity of stenosis and volume regurgitation. Materials and Methods: ECG gated Cardiac MRI was performed with a 1.5-Tesla system (MAGNETOM SYMPHONY- Model 2005) using basic cardiac software (Argus viewer) by a phased-array multicoil on 50 subjects who were known cases of Rheumatic valvular heart disease. A chest radiograph and echocardiography were done in all patients before MR examination. Informed consent was taken from all patients. Results: Mitral stenosis either as an isolated valvular abnormality or in combination with other valvular abnormalities constituted the major bulk of Rheumatic valvular heart disease in our study population. The average ejection fraction by ECHO is 64.94±7.11 and by MRI 67.52±7.84. The average mitral valve area by ECHO is 1.79±0.43 cm2 and by MRI 1.82±0.47 cm2. The average aortic valve area by ECHO is 1.10±0.21 cm2 and by MRI 1.12±0.25 cm2. The Coefficient of Correlation (r) is 0.82 for ejection fraction, 0.98 for mitral valve area and 0.92 for aortic valve area which means a strong positive association between the results by ECHO and MRI. In all instances, the p-value is <0.00001, suggesting that the test is highly significant. Conclusion: In our study echocardiography was found to be the gold standard for the diagnosis of Rheumatic valvular heart disease and the role of MRI remained only complimentary to Echocardiography. However with advanced cardiac software, more advanced techniques, and faster imaging sequences, MRI may become a valuable procedure for investigation and follow-up of patients with valvular heart disease.

Quality of Life after Frey’s Procedure in Patients with Chronic Pancreatitis

Introduction: Chronic pancreatitis is a debilitating disease, associated with excruciating abdominal pain, exocrine and endocrine pancreatic insufficiency. Different types of surgical techniques have been described for the management of complications of this disease. The most common procedure which has been adopted for improving the quality of life of the patients with chronic pancreatitis is Frey’s Procedure. It is an organ preserving procedure in which the main pancreatic duct is drained by lateral pancreatico-jejunostomy along with coring of the head of the pancreas. Aim: In this study, we have assessed the outcome of Frey’s procedure in terms of quality of life in patients with chronic pancreatitis. Materials and Methods: This was a prospective observational study done at a tertiary care center in West Bengal, India. The study period was from 2010 to 2014. All the patients who have undergone Frey’s Procedure during the study duration and with the postoperative histopathology of chronic pancreatitis were included in this study. The preoperative and postoperative pain and quality of life assessment was done using VAS score (0-100) and EORTC QLQ-C30 (Version 3) respectively. The statistical analysis was performed with the help of Epi Info (TM) 3.5.3. Results: A total of 35 patients with chronic pancreatitis underwent Frey’s procedure during the study period. The mean age (mean ± s.e) of the 33 patients included in the study was 38.48±5.55 years with a range of 29-49 years. The mean preoperative Physical Functional Domain (PFD), Physical Domain (PD), Emotional Domain (ED), Social Domain (SD) and general health raw score with standard errors were 32.06±0.40, 37.86±0.36, 15.18±0.32, 8.63±0.31 and 4.48±0.26 respectively. ANOVA showed that there was significant differences in PFD, PD, ED, SD and GH values during different time period of follow up (p<0.0001) and as per Critical Difference the postoperative values of PFD, PD, ED and SD decreased while postoperative value of GH increased significantly in different months compared to the preoperative values. Conclusion: We conclude that Frey’s procedure is a low risk surgery, which significantly improves the quality of life of the patients with chronic pancreatitis in all the domains and can be recommended as a surgical therapy for such patients.

Social, Psychological and Health Concerns of People Living with HIV/AIDS in Mysore District, Karnataka

Shibu Thomas Sebastian, Sunitha Siddanna

Introduction: One of the significant health and social problem the world facing today is Acquired immune deficiency syndrome (AiDS). The patients affected with HIV and their family may face various psychosocial problems during diagnosis and treatment due to the stigma associated with this disease. Aim: The objective of the study was to identify social, psychological and health concerns of people living with HIV/AIDS (PLWHA) and its association with the demographic factors in Mysore District, Karnataka, India. Materials and Methods: A questionnaire based study was conducted among 194 participants in Mysore District, Karnataka state who were receiving care and support services. A 22-item questionnaire provided information regarding social, psychological and health concerns of PLWHA in Mysore district. A general linear regression model was used for assessing the predictors of social, psychological and health concerns. Results: The main social concern was that of "Fear of Losing a loved one" whereas the main psychological concern was "Too much worry", "No cure for AIDS" was the highly rated health concern. Males had more social, psychological and health concerns when compared to females but was not statistically significant. Employed people were having fewer psychological concerns when compared to unemployed people. Unemployed people were having fewer health concerns than employed people. For every unit increase in age there were fewer social and health concerns and both these findings were statistically significant. Conclusion: PLWHA in the present study reported that they were concerned about social, psychological and health issues in spite of the fact they were attending counseling. Health care workers, including those in public health sector should be educated about the importance of these factors that influence the health of the population they are caring for.

Role of Cell Block in Guided FNAC of Abdominal Masses

Introduction: Fine Needle Aspiration (FNA) of space occupying lesions in superficial or deep anatomic sites is an increasingly common procedure, providing rapid and safe diagnosis. However, sometimes FNA does not yield sufficient information for a precise diagnosis and the risk of false negatives and indeterminate diagnosis is always present. Therefore, we attempted to obtain additional information via the preparation of Cell Block (CB) from the residual material of aspirates and thus enhance the diagnostic accuracy. Aim: This study was carried out to evaluate the role of CB as a useful adjunct to smears for establishing a more definitive cytopathologic diagnosis and for its utility in special staining and Immuno-histochemistry (IHC). Materials and Methods: A total of 66 cases of image-guided FNA of abdominal masses were studied. In addition to the routine smears, CBs were prepared from the residual tissues for all possible cases and its diagnostic efficacy was analysed. Further, the use of CBs for special staining and IHC was also established. R esults: This study included a total of 66 patients with abdominal masses who were referred for guided FNA cytology. Out of these cases, adequate material was obtained on FNAC in 64 cases (96.96%) and on CB in 45 cases (68.18%) and the diagnosis was provided. There was a good agreement between the FNA smear diagnosis and CB diagnosis. The histopathology of CB sections further helped in precise final cytopathological diagnosis. Two FNA smears were unsatisfactory for evaluation and hence the diagnosis was done on CB sections alone. With FNA cytology and CB in combination, a cytopathological diagnosis was given for all the 66 cases. The sensitivity of FNA in comparison to the histopathology of CB was 91.6% and specificity was 88.8%. The diagnostic accuracy was 62% and the discordance was 6%. Conclusions: CB in addition to the routine FNA is a simple, reliable and cost-effective technique that further contributes to the final cytopathological diagnosis.

Evaluation of APACHE-IV Predictive Scoring in Surgical Abdominal Sepsis: A Retrospective Cohort Study

Tiffany Chan, Michael S Bleszynski, Andrzej K Buczkowski

Introduction: Evaluation of the effectiveness of care and clinical outcomes in critically ill patients is dependent on predictive scoring models that calculate measures of disease severity and an associated likelihood of mortality. The APACHE scoring system is a logistic regression model incorporating physiologic and laboratory parameters. APACHE-IV is the most updated scoring system for ICU mortality prediction. However, APACHE scores may not accurately predict mortality in patients who require surgery for abdominal sepsis, whose trajectory is modulated by source control procedures. Aim: To evaluate the accuracy of APACHE-IV mortality prediction in a cohort of ICU patients with surgical abdominal sepsis (SABS) requiring emergent laparotomy for source control. Materials and Methods: The study was conducted in a combined medical and surgical intensive care unit in a large urban Canadian tertiary care hospital. Retrospective review of 211 consecutive adult ICU admissions that fulfilled the 2012 ACCP/SCCM criteria for severe sepsis/septic shock due to abdominal source was performed. APACHE-IV score and predicted mortality rate (PMR) were calculated and evaluated using area under the ROC curve (AUROC). Results: Overall in-hospital mortality was 28.4%. There was overestimation of PMR by the APACHE-IV model in the overall cohort with an absolute difference of 16.6% (relative difference 36.9%). APACHE-IV crudely distinguished between survivors and non-survivors, with a PMR of 40% vs. 59% (p<0.001). AUROC of the APACHE-IV score was 0.67, 95% CI (0.58, 0.76) while the AUROC for the PMR was 0.72, 95% CI (0.64, 0.80), indicating poor performance in this cohort. Conclusion: APACHE-IV has poor discrimination in SABS. Future research should explore disease-specific prediction models.

Sensitivity and Specificity of Galectin-3 and Glypican-3 in Follicular-Patterned and Other Thyroid Neoplasms

Dalia Rifaat Al-sharaky, Sheren Fouad Younes

Introduction: Diagnosing follicular-patterned thyroid neoplasm can be quiet challenging in some cases, where an immunohistochemical profiling becomes mandatory. Galectin-3 may be a helpful tool for classical PTC diagnosis, but it cannot be considered as a diagnostic marker of malignancy. Glypican-3, in contrast, is not thoroughly studied in thyroid neoplasms. Aim: Determine the sensitivity and specificity of galectin-3 and glypican-3 in diagnosing thyroid carcinoma and follicular-patterned thyroid carcinoma. Materials and Methods: A retrospective study was conducted on archival blocks diagnosed from pathology department between 2010 and 2012 including 17 cases of follicular adenoma, 16 cases of Classic Papillary Thyroid Carcinoma (PTC), 6 cases of Follicular Variant of Papillary Thyroid Carcinoma (FVPTC), 3 cases of follicular carcinoma, 5 cases of medullary carcinoma and 1 case of Hürthle cell carcinoma. The nearby non neoplastic (normal) thyroid follicles present in both adenoma and carcinoma cases were also evaluated. Study Design: Evaluation of both galectin-3 and glypican-3 expression using standard immunohistochemical techniques. Statistical Analysis Used: Descriptive analysis of the variables and statistical significances were calculated by non-parametric chi-square test using the Statistical Package for the Social Sciences version 12.0 (SPSS). Results: Five (30%) and 4 (24%) out of the 17 studied follicular adenoma cases, were positively stained by galectin-3 and glypican-3 respectively, while 30 (97%) and 25 (81%) cases out of the studied 31 carcinoma cases were positively stained by galectin-3 and glypican-3 respectively. The sensitivity, specificity and diagnostic accuracy of galectin-3 vs. glypican-3 in discrimination between thyroid carcinoma and adenoma was 96.8%, 70.6%, and 87.5%vs. 81% 76.5% and 79% respectively. As for the discrimination between follicular-patterned thyroid carcinoma and follicular adenoma it was 90%, 71% and 78% vs. 90% 76.5% and 82%. Conclusion: Glypican-3 is more specific while galectin-3 is more sensitive in diagnosing thyroid carcinoma while glypican-3 is more specific than galectin-3 in discriminating follicular-patterned neoplasm.

Awareness, Knowledge, Attitude and Skills of Telemedicine among Health Professional Faculty Working in Teaching Hospitals

Zayabalaradjane Zayapragassarazan, Santosh Kumar

Introduction: Telemedicine is an emerging technology in health sector in India. The success of any new technology depends on many factors including the knowledge and understanding of the concept, skills acquired, attitude towards technology and working environment by the concerned professionals. Aim: The main objective of this study was to assess the awareness, knowledge, attitude and skills of telemedicine among the health professionals working in the teaching hospitals of Puducherry Region of India. Materials and Methods: A cross-sectional survey was carried out among various healthcare professionals using a proper sampling frame obtained from a list of teaching hospitals located in Puducherry Union Territory, India. A total of 120 teaching faculties and practitioners from the preclinical, para-clinical and clinical departments were taken up for the study. A pre-validated self-administered questionnaire was used for the survey to assess the awareness, knowledge, attitude and skills of telemedicine. The questionnaires were mailed to the respondents and the completed questionnaires were analysed as per the study objectives using descriptive statistics for the quantitative data and content analysis for the qualitative data. Results: The knowledge level of the respondents was found to be good with 41% of the respondents, 35% possess fair knowledge and 24% don’t have adequate knowledge of telemedicine. With regard to the attitude towards telemedicine 39% of the respondents possess high attitude, 31% possess moderate attitude and 30% possess low level of attitude. Investigations on the skills of the respondents on telemedicine showed that 19% respondents are highly skilled or experts, 25% are moderately skilled which includes learners or beginners, and 56% are unskilled in handling telemedicine and its related equipments. Conclusion: The findings of the study suggest that although the respondents experience and knowledge are limited in telemedicine technology a fair number of them have positive attitude towards telemedicine. It is the need of the hour to educate and train the teaching faculty, practicing physicians, residents, medical students and other health professionals about telemedicine and issues related to its use.

Ischemia Modified Albumin (IMA) - A Marker of Glycaemic Control and Vascular Complications in Type 2 Diabetes Mellitus

Rajinder Chawla, Rinchu Loomba, Deepak Guru3, Vikas Loomba

Introduction: Ischemia modified albumin (IMA) has emerged as a marker for ischemic injury and oxidative damage, particularly in myocardial infarction. There are very few studies on the significance of IMA in other conditions associated with ischemia. The complications of diabetes mellitus (DM) arising out of poor glycaemic control have an underlying ischemic aetiology. Aim: To evaluate correlation of IMA with glycaemic control in type 2 DM (T2DM). Secondary aim was to assess the utility of IMA as a marker for vascular complications in T2DM. Materials and Methods: During this cross-sectional study, a total of 100 diagnosed cases of T2DM were recruited between May 2013 and September 2013. The IMA, HbA1c, lipid profile, creatinine and urine micro-albumin levels were measured and analysed with respect to clinical condition of the patients. Statistical Analysis: The epidemiological software, Epi-Info 7.1.5, was used for the statistical analysis, p-value<0.05 was defined as level of significance. Results: The study subjects were in the age group from 30 to 75 years and 52.4% were males. There was a great degree of variance in the level of glycaemic control and majority (64.6%) had poor or very poor glycaemic control as reflected by their HbA1c levels. The IMA (Mean ± SEM) levels were found to be higher (62.9 ± 1.7ABSU) in the patients with poor glycaemic control compared to those with good glycaemic control (54.2 ± 3.5 ABSU, p-value < 0.05) and correlated with HbA1c levels (r2=0.14). IMA levels also appeared to be related with the changes in lipid profile and increased with increasing total cholesterol levels. The subjects with macro-vascular complications (retinopathy and neuropathy) showed non-significantly higher levels of IMA. The elevation in IMA correlated with the HbA1c and changes in the lipid profile. Conclusion: IMA correlates with poor glycaemic control and dyslipidaemia associated with T2 DM and could serve as an indicator of oxidant stress in these patients.

Evaluation of Renal Allograft Biopsies for Graft Dysfunction and Relevance of C4d Staining in Antibody Mediated Rejection

Introduction: Biopsy remains gold standard for diagnosis of Graft Dysfunction (GD). It guides clinical management, provides valuable insights into pathogenesis of early and late allograft injury and is indispensable for distinguishing rejection from non- rejection causes of GD. Aim: The primary aim of the study was to evaluate the diverse histomorphological lesions in renal allograft biopsy (RAB). Further, we determined the frequency of peritubular capillary (PTC) C4d positivity and its correlation with microvascular inflammation in Antibody Mediated Rejection (AMR). Materials and Methods: This was a prospective study on RAB over a period of 2 months. Histopathological evaluation was undertaken as per revised Banff’13 schema. Immunohistochemistry was performed to detect PTC C4d deposition. Results: Sixty five diagnostic biopsies were evaluated. Mean patient age was 34 years and males were predominant. The time interval between graft biopsy and transplantation ranged from 5 days to 8 years, with 52.3% biopsies belonging to period of = 6 months post-transplant. Immune injuries were observed in 40 biopsies out of which AMR was observed in 35 biopsies. Calcineurin inhibitor toxicity (CNI Toxicity) was the second commonest cause observed in 12 biopsies and other lesions including de novo glomerulopathies were observed in the remaining biopsies. The sensitivity of C4d in detecting acute AMR was 55% and chronic AMR was 23.5% Conclusion: AMR and CNI Toxicity account for majority of graft dysfunction. C4d is not as sensitive a marker of AMR, as was initially thought. Higher proportion of moderate microvascular inflammation is found in diffuse C4d positive cases compared to focal C4d positive cases.

Evaluation of Lipid Profile in Second and Third Trimester of Pregnancy

Introduction: There is a change in energy usage along with accumulation of fat during different trimesters of pregnancy. Lipid physiology and pathophysiology during pregnancy has not been studied extensively in large population-based cohorts. Aim: To study the levels of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TGs) during pregnancy and their changes in second and third trimester. Materials and Methods: This prospective study was conducted at Mahatma Gandhi Mission Hospital, Navi Mumbai, India by enrolling antenatal cases from October, 2012 to October 2014. The study was conducted on 200 pregnant local women after taking an informed consent from patients to get enrolled in the study. Statistical analyses were performed using Statistical Package for Social Sciences (SPSS) version 17. All reported p-values are two-tailed, and confidence intervals were calculated at the 95% level. Results: The mean cholesterol levels in second and third trimester were 214.6±18.16 mg/dl and 242.65±20.44 mg/dl respectively. The mean triglyceride levels in second and third trimester were 188.68±20.88 mg/dl and 216.78±20.09 mg/dl respectively. The mean HDL – Cholesterol levels in second and third trimester were 49.13±6.15 mg/dl and 43.07±4.34 mg/dl respectively. The mean LDL – Cholesterol levels in second and third trimester were 92.41±18.94 mg/dl and 137.82±13.45 mg/dl respectively. The mean VLDL – Cholesterol levels in second and third trimester were 28.22±7.66 mg/dl and 36.27±6.72 mg/dl respectively. Conclusion: This study helps in understanding baseline lipid parameters in the second and third trimester among pregnant women in India. Total Cholesterol, Triglycerides, LDL-Cholesterol, VLDL-Cholesterol increased in both second and third trimester. The increase is more in third trimester, when compared to second. HDL-Cholesterol is decreased in third trimester when compared to second trimester.

Vitamin D Status and Cardio-Metabolic Risk in Indian Postmenopausal Women

Introduction: The prevalence of chronic and non-communicable health disorders like cardiovascular diseases and metabolic syndrome is increasing worldwide including in India. The various risk factors for these health issues need to be addressed. The role of vitamin D deficiency in the causation of all these abnormal health conditions among postmenopausal women is a matter of debate now-a-days. Aim: To determine the correlation of serum vitamin D levels with various cardio-metabolic risk factors and metabolic syndrome (MetS) in postmenopausal women (PMW). Materials and Methods: Total of 64 PMW were included in this cross-sectional study. Clinical (waist circumference, body mass index, blood pressure) and biochemical (fasting plasma glucose, lipid profile and serum 25-hydroxyl vitamin D levels) parameters were measured. MetS was defined using modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) guidelines. Serum 25-hydroxyl vitamin D levels <50 nmol/l, between 52.5-72.5 nmol/l and >75 nmol/l were classified as deficient, insufficient and sufficient, respectively. Results: MetS was prevalent in 33 (52%) subjects. There were no differences in serum vitamin D levels or proportion of vitamin D deficient individuals in those with and without MetS. 33 women (52%) had vitamin D deficiency. Cardio-metabolic risk profile was similar in both vitamin D deficient and replete women. Conclusion: Despite a high prevalence of vitamin D deficiency and MetS in Indian PMW, serum vitamin D concentrations do not correlate with the cardio-metabolic risk factors or MetS.

Paraoxonase Activity and Lipid Profile in Paediatric Nephrotic Syndrome: A Cross-sectional Study

Vijayetha P. Patil, Anuradha B. Patil, Vidya S. Patil, Deepti G. Ingleshwar

Introduction: Dyslipidaemia of Nephrotic Syndrome (NS) is known to be linked to oxidative reactions and atherosclerosis. Paraoxonase (PON1) has been implicated in the prevention of Low Density Lipoprotein (LDL) lipid peroxidation and also degrades biologically active oxidised lipids in lipoprotein. Aim: The present study was taken up to assess PON1 levels in paediatric nephrotic syndrome and also to see if any correlation exists between lipid parameters and PON1. Materials and Methods: This study consists of Group 1 with 40 cases of NS in the age group of 2-14 years and Group 2 with 40 age and sex matched healthy controls. Lipid profile and paraoxonase activity was measured in serum samples of both the groups. Results: Statistical analysis by student’s t-test showed that the mean levels of Total Cholesterol, Trigylycerides, LDL, and VLDL were significantly increased in Group 1 when compared to Group 2 (p <0.001). The mean levels of HDL were similar in both groups. The levels of PON1 were significantly lowered in Group 1 when compared to Group 2. Correlation studies showed no significant correlation between lipid profile and PON1. Conclusion: Cases have atherosclerotic dyslipidaemia and significantly decreased PON1 activity. Decreased PON1 may lead to increased oxidation of LDL accelerating the process of atherosclerosis.

Tooth Jewellery- Its Knowledge and Practice Among Dentists in Tricity, India

Introduction: The world of fashion is ever changing and this dynamics applies to dentistry. As dentistry and dental treatments have become necessary facet of a healthy life and therefore down the line fashion prospect of tooth jewellery are also getting fused into it. Aim: To assess the knowledge and practice of tooth jewellery among practicing dentists of Tricity, India. Materials and Methods: A descriptive, cross-sectional study was conducted among 310 dental practitioners in Tricity (Chandigarh, Mohali and Panchkula), India. A self-administered, close-ended questionnaire was distributed among all the dental practitioners in order to assess their knowledge and practice regarding tooth jewellery. Responses of the questionnaire was obtained on the dichotomous scale with Yes and No. Right answers were given a score of 2 whereas the wrong answers were given as score of 1. The data was analyzed using unpaired students t-test, one way ANOVA (analysis of variance) and multivariate logistic regression. Results: A significant difference was observed among the genders with males being three times more knowledgeable (OR=3.5, 95%CI: 0.8-2.8). It has been found that knowledge and practice scores of dental practitioners who spend more than 10 hours per day have two times more knowledge (OR= 2.3, 95%CI:0.08-1.1) than others. The dentists holding the masters degree were having three times more knowledge than the graduates’ ones (OR= 2.3, 95%C.I:0.1-1.9). Conclusion: The present study concluded that dental practitioners had sufficient knowledge about tooth jewellery. Practice of tooth jewellery in the dental clinics was found to be adequate but it was also associated with some complications. To overcome this, it is advised that professional and government bodies should create strategies for enhancing and improving people’s knowledge as well as make them aware of the pros and cons while using tooth jewellery which shall further enhance their smile.

Urinary Protein Creatinine Ratio in Normal Zero to Three-Day- Old Indian Neonates

Indu Saxena, Varun Shivankur, Manoj Kumar

Introduction: Early neonates (1-7-day-old) may develop acute kidney injury or acute renal failure due to functional (pre-renal, may be caused by decreased renal perfusion), intrinsic (renal, may be caused by acute insult), or obstructive (due to anatomic urinary tract obstruction) causes. Urinary protein estimation is important for diagnosis, follow-up and prognosis of disease. The Protein Creatinine Ratio (PCR) has been successfully used to establish proteinuria in different types of patients. Aim: This study was undertaken to establish normal PCR range in neonates, to rule out abnormal protein excretion in sick neonates. Materials and Methods: A total of 37 normal early neonates of age 0-3 days were enrolled for this study. Random spot urine samples were collected in paediatric urine bags for protein and creatinine estimation. Results: The urinary PCR varied between 0.1-0.8. The range of PCR values obtained was greater in 0-1 day old infants, compared to infants older than one day. Changes in PCR values were due to variations in the creatinine excretion. Conclusion: Urinary PCR values = 0.8 indicate normal protein excretion. However, reference intervals of PCR should be established for narrow age groups in case of early neonates, e.g. 0-6h, 6-12h, 12-24h, 24-72h old babies.

Lung Transfer Factor in Middle Aged Asymptomatic Male Smokers of a City from West India: A Cross-Sectional Study

Introduction: Smoking is an increasingly popular indulgence in India. Assessment by routine spirometry falls short of direct functional parameter like Diffusion Lung Capacity (DLC), also known as lung transfer factor (LTF). Aim: To measure LTF amongst middle aged male smokers and to study various correlates for it. Materials and Methods: Total of 45 asymptomatic male current smokers were enrolled for this cross-sectional study conducted at pulmonary function testing lab of Physiology Department of our college. Smoking history was evaluated and smoking index was defined by product of number smoked per day and years smoked. We used instrument Ultima PFX of Medgraphic Company. After pre syringe calibration LTF was measured by Methane mixture using protocols of ATS. Parameters measured were Dlco-uncorrected, corrected and normalized to VA (alveolar volume). Results were compared for statistical significance and significance was set as p <0.05. Results: In case group of 45(25 bidi and 20 cigarette smokers) mean age was 30 years, mean duration was 8 years, mean smoking index was 60. We found small insignificant decline in actual LTF values than predicted which was not significantly different between bidi and cigarette smokers. Duration, age and intensity of smoking were negatively and significantly correlated with LTF value while anthropometric parameters were not. Conclusion: Smoking adversely affects LTF in young asymptomatic current male smoker that further declines with severity of smoking and with duration regardless of type of smoking. With years to come, these alterations can largely be prevented by smoking cessation, at least theoretically.

Evaluating the Time Interval for Presenting the Signs of Hypocalcaemia after Thyroidectomy

Introduction: Thyroidectomy is one of the most prevalent treatments for thyroid malignancies. It has very low rate of complications except the hypocalcaemia. Only a small number of studies have evaluated the clinical signs of hypocalcaemia but no study have reported the time interval between the procedure and signs of hypocalcaemia. Aim: The aim of this study was to determine that time interval in those patients. Materials and Methods: Medical files of a group of patients who underwent thyroidectomy were reviewed. Demographic characteristics of the patients and the time interval to hypocalcaemia were recorded and analysed by SPSS software. p-value <0.05 was considered significant. Results: One hundred and eight patients, 65 women (60.2%) and 43 men (39.8%) with a mean age of 42.6+12.2 years were included. Perioral numbness was reported in 30 (27.8%) patients while 29 (26.8%) patients had lip numbness. Numbness in extremities and muscle spasm were found in 19 (17.6%) and 13 (12%) patients respectively. Seizure was reported in 3 (2.8%) patients. The Trousseau and Chvostek signs were found in 17 (15.7%) and 9 (8.3%) patients respectively. Only the Trousseau sign was different between the two surgical groups. The mean time interval was 41.25±11.5 hours postoperatively. However the time interval was shorter for the total thyroidectomy. Conclusion: Physical examination is useful for diagnosing hypocalcaemia due to the presentation of sings during the first 48 hours of thyroidectomy. Total thyroidectomy is associated with shorter time interval.

Natural T Regulatory Cells (n Treg) in the Peripheral Blood of Healthy Subjects and Subjects with Chronic Periodontitis – A Pilot Study

Ram Sabarish, Suresh Ranga Rao, Vamsi Lavu

Introduction: The T cells play a central role in the aetiopathogenesis of periodontal disease. Natural T regulatory cells (nTreg) are the key stone immunoregulatory elements having an anergic phenotype and play an important role in the suppression of exaggerated immune responses thereby maintaining homeostasis. There are increasing evidences for the role of nTreg in the periodontal disease pathogenesis. Aim: To identify the proportion of natural T regulatory cells in the peripheral blood of periodontally healthy subjects and subjects with chronic periodontitis. Materials and Methods: A total of 15 subjects (7 with healthy gingiva and 8 with chronic periodontitis) were recruited for this pilot study. Baseline periodontal parameters were recorded and 5 ml of peripheral blood was collected. The samples from both the groups were analysed for the relative proportion of nTreg (identified by the expression CD45RB+CD4+CD25+FOXP3+) using flow cytometry. Results: The mean percentages of the CD45RB+CD4+CD25+ cells expressing FOXP3 in control and chronic periodontitis group were found to be 14.75±5.04 and 43.13±11.17 respectively. The mean proportion of nTreg were compared between the control and chronic periodontitis sample using Mann-Whitney Test and was found to be statistically significant with (p<0.001). Conclusion: A higher proportion of nTreg in the peripheral blood sample of chronic periodontitis subjects were observed as compared to that of healthy individuals.

Preoperative Ultrasound Guided Fine Needle Aspiration Cytology of Ovarian Lesions- Is It a Rapid and Effective Diagnostic Modality?

Introduction: The deep seated ovarian lesions unapproachable by unguided aspiration cytology were easily done under ultrasound guidance. It gave a before hand cytological diagnosis of the lesion to the surgeon determining the modality of treatment for the patient. Aim: To find the diagnostic accuracy of the method of ultrasound guided cytological assessment of ovarian lesion. Materials and Methods: The study was conducted as a prospective observational study over a period of one year, in hospital setting, where ultrasound guided fine needle aspiration had been used to aspirate ovarian lesions, giving a rapid cytological diagnosis. In 43 sample cases, aspiration of fluid done from ovarian lesions were followed by cyto-centrifugation and staining by May-Grunwald-Giemsa (MGG) and Papanicolaou (Pap) stain providing a cytological opinion regarding benign/malignant nature of the lesion and further categorization. Later the cytological diagnosis was compared with final histopathological diagnosis, taking it as a gold standard. Results: The overall sensitivity, specificity, and diagnostic accuracy of ultrasound guided aspiration and cytological analysis were high, 96%, 76.92% and 89.47% respectively as calculated by comparing the cytological diagnosis with histological diagnosis, taking it as gold standard. Conclusion: This method has evolved as a highly sensitive, rapid, simple and effective modality for screening and as well as accurate preoperative diagnosis of ovarian lesions.

Evaluation of Proportion between Incisal Edge to Gingival Zenith Distance and Interdental Papilla in Maxillary Anterior Dentition of Indian Population

Gopi Naveen Chander, Anand Damodaran, Muthukumar Balasubramanium

Introduction: Not many investigations have evaluated the relationship between the height of the interdental papillae, gingival zenith and maxillary anterior teeth. The assessment of these parameters can aid in fabricating definitive aesthetic restoration. Aim: The aim of this study was to evaluate the existence of proportional ratio between the incisal edge to gingival zenith (HGZ) and the tip of the interdental papilla (HIP) in maxillary anterior teeth for Indian population. Materials and Methods: One hundred healthy volunteers with an average age of 25-30 years comprised the evaluation group. Impression was made using irreversible hydrocolloid impression material and type IV Dental stone cast was made. A calibrated digital caliper measured the distance between HGZ and HIP. The values for all six maxillary teeth were recorded and the proportional ratio was evaluated and statistically analysed. Results: The mean ratio between HGZ and HIP of all maxillary anteriors in 1st and 2nd quadrant was 1.80, 1.71, and 2.03 in central incisor, lateral incisor and canine respectively with p-value > 0.9. Conclusion: The mean proportional measurements for maxillary anterior teeth were determined and no definitive proportion existed between HGZ and HIP of maxillary anterior teeth.

Binge Eating Leading to Acute Gastric Dilatation, Ischemic Necrosis and Rupture –A Case Report

Manish Dewangan, Manish Kumar Khare, Sumanta Mishra, Jogesh Chandra Marhual

Acute gastric dilatation is a rarely encountered clinical scenario in our day to day practice. This is very rapidly progressing condition and can lead to ischemic necrosis and perforation/rupture of the stomach. It could be fatal if not timely intervened. We report such a case of a 17-year-old, otherwise healthy boy, who presented with pain and distension of abdomen following binge eating episode after 24 hours of prolonged fasting. On exploration, stomach was dilated with necrosis and perforation at fundus near greater curvature. He was managed with excision of all the devitalized area and primary repair with feeding jejunostomy. The case is presented due to its rarity. Acute gastric dilatation (AGD) leading to ischemic necrosis and perforation because of binge eating episode in an otherwise healthy person is an exceptional occurrence with only few cases reported in literature. The clinician should be aware of this condition for prompt and appropriate management.

Dental Service Utilization: Patterns and Barriers among Rural Elderly in Guntur District, Andhra Pradesh

Introduction: The biological process of ageing is outside human control and has its own dynamics. It is a known fact that elderly people have more treatment needs compared to the younger population and at the same time elderly people are facing a multitude of barriers in utilization of health care as well as oral health care. Aim: To identify the utilization patterns of oral health care and barriers for utilization among rural population. Materials and Methods: A cross-sectional study was done on 621 rural elderly subjects to identify the utilization of oral health care services and the barriers for utilization. Using stratified cluster sampling study area was stratified into 13 rural clusters, fifty houses were randomly selected from each stratum. All the elderly subjects, as defined by the age criteria were considered for study. The data were analysed using SPSS 20 v and Chi-square tests were used to analyse the data. Results: Only 31.9% of participants reported visiting a dentist in the past while 36.7% reported experiencing a dental problem at some point in their life. There were no significant differences in utilization of dental services based on gender, socio-economic status, age groups and religion. However, significant differences were found in utilization of dental services based on the response of participants to past experience of dental problems. Conclusion: The present study results conclude that fear was one of the most commonly reported barriers for utilisation of dental services and there is a need for oral health education and promotion among elderly population.

Knowledge and Attitude about Leprosy among Indian Dental Students in Faridabad

Meena Jain, Ankur Sharma, Vishal Jain, Karim Virjee, Shilpi Singh

Introduction: Role of dentists in prevention and sustainable care of leprosy is known. Changing leprosy scenario has led to requirement of change in leprosy education. However, knowledge and attitude of dental students on leprosy remains unknown. Aim: Hence a study was conducted to assess knowledge and attitude of dental students about Leprosy. Materials and Methods: A questionnaire based, cross-sectional survey was conducted among 350 undergraduate and the postgraduate dental students of two dental colleges in Faridabad, India. The score for knowledge ranged from 0 to 16 and scores for attitude ranged from 0 to 26. These scores were further coded as poor, fair and good. Results: Mean knowledge score for the sample was 7.64±3.23. A total of 32.29% participants were under poor knowledge category; 57.42% had fair knowledge about Leprosy while 10.29% had good knowledge. Mean attitude score was 15.5 ± 5.98. A total of 30.57% had poor attitude scores, 42.57% had fair scores while 26.86% had good attitude scores. Univariate analysis showed year of training to be a significant predictor for knowledge level (t=7.12; p<0.001). Conclusion: The results indicate need for three important changes towards Leprosy in Dentistry. These changes are need for incorporation of leprosy education in Dentistry, need for incorporation of problem based as well as evidence based learning in Dentistry integrated with general health and need for reestablishing public health programs for Leprosy utilizing dental workforce.

Patient’s Comprehension of Prescriptions at Municipal Urban Health Centre, Mumbai

Amrita P Rao, Gajanan D Velhal, Deepakpak S Khismatrao

Introduction: Patient's often fail to follow the prescription given by the doctor. Patients understanding of the prescription play an important role in completion of treatment and quick recovery from the illness. The understanding of prescription is dependent on factors which could be both patient and doctor related. These factors need to be studied in order to improve the therapeutic outcome. Aim: Hence this study was undertaken to identify the various factors which affect patient’s comprehension of prescription. Materials and Methods: Observational, cross-sectional study based on exit interviews were carried out for 370 patients at Cheeta Camp Urban Health Centre, Mumbai over a period of 15 working days of OPD and 25 patients were selected randomly on each day. For data analysis, SPSS 15.0 with Chi-square test were used as test of significance. Results: In the present study it was found that in the patients above 45 years, 19.4% have not understood the prescription completely compared to 5.8% below the age of 45 years. The difference was statistically significant. There is no difference between gender and understanding of prescription. Among the illiterate patients it was found that 16.3% have not completely understood the prescription compared to 5.6% of the literate patients. Also, socio-economic status was significantly associated with patients understanding of prescription. There was no significant difference associated with number of prescription and understanding of prescription. Conclusion: The patient related factors play an important role in understanding of prescription. It was found that patient’s comprehension of prescription was significantly associated with age, socioeconomic status and Education.

Which is More Accurate in Measuring the Blood Pressure? A Digital or an Aneroid Sphygmomanometer

Bhaskar Shahbabu, Aparajita Dasgupta, Kaushik Sarkar, Sanjaya Kumar Sahoo

Introduction: Hypertension is one of the major public health problem affecting the whole world so its accurate measurement is of utmost importance for its early diagnosis and management. Concerns related to the potential ill effects of mercury on health and environment, has led to the widespread use of non-mercury sphygmomanometers. Aim: A study was conducted to compare the accuracy of readings of aneroid and digital sphygmomanometers in reference to mercury sphygmomanometers and determine the hypertensive classification agreement between the mercury and non-mercury devices. Materials and Methods: The study was conducted in an OPD of a health centre in a rural community of West Bengal which is the rural field practice area of our institute. An aneroid and a digital sphygmomanometer were compared to a properly calibrated mercury sphygmomanometer. All the subjects above the age of 25 years, in two days per week, selected randomly from five working days per week in a period of one month were selected. Two blood pressure readings of each of 218 study subjects was recorded with each pretested sphygmomanometer. Paired t-test, Kappa coefficients, sensitivity and specificity tests were done. Receiver Operating Characteristics curve analysis was done and Youden index was estimated to detect the optimal cut off point for the diagnosis of hypertension by non-mercury sphygmomanometers. Results: Data analysis of 218 study subjects showed the mean difference of the mercury reading and the test device was much less for aneroid than that of the digital device for both systolic and diastolic blood pressure. More than 89% of aneroid readings and less than 44% of the readings by digital device had absolute difference of 5mm Hg. when compared with the mercury readings for both systolic and diastolic blood pressure. Sensitivity and specificity of aneroid device was higher (86.7% and 98.7%) than digital device (80% and 67.7%). Receiver Operating Characteristic curve had larger area under the curve for aneroid device than digital device for both SBP and DBP. Conclusion: The aneroid device had better accuracy than the digital device as compared to mercury sphygmomanometer and should be used for proper and better management.

Anti-microbial Activity of Tulsi {Ocimum Sanctum (Linn.)} Extract on a Periodontal Pathogen in Human Dental Plaque: An Invitro Study

Pranati Eswar, C.G. Devaraj, Payal Agarwal

Introduction: Tulsi is a popular healing herb in Ayurvedic medicine. It is widely used in the treatment of several systemic diseases because of its anti-microbial property. However, studies documenting the effect of Tulsi on oral disease causing organisms are rare. Hence, an attempt was made to determine the effect of Tulsi on a periodontal microorganism in human dental plaque. Aim: To determine if Ocimum sanctum (Linn.) has an anti-microbial activity (Minimum Inhibitory Concentration and zone of inhibition) against Actinobacillus actinomycetemcomitans in human dental plaque and to compare the antimicrobial activity of Ocimum sanctum(Linn.) extract with 0.2% chlorhexidine as the positive control and dimethyl sulfoxide as the negative control. Materials and Methods: A lab based invitro experimental study design was adopted. Ethanolic extract of Ocimum sanctum (Linn.) was prepared by the cold extraction method. The extract was diluted with an inert solvent, dimethyl sulfoxide, to obtain ten different concentrations (1%, 2%, 3%, 4%, 5%, 6%, 7%, 8%, 9%, 10%) of extract. Plaque sample was collected from 05 subjects diagnosed with periodontal disease. Isolation of Actinobacillus actinomycetemcomitans from plaque samples was done using Tryptic Soy Serum Bacitracin Vancomycin agar (TSBV) medium. Identification of Actinobacillus actinomycetemcomitans was done based on cultural, microscopic, biochemical characterization and multiple drug resistance patterns. Anti-microbial activity of Ocimum sanctum (Linn.) extract was tested by agar well-diffusion method against 0.2% chlorhexidine as a positive control and dimethyl sulfoxide as a negative control. The zone of inhibition was measured in millimeters using Vernier callipers. Results: At the 6% w/v concentration of Ocimum sanctum (Linn.) extract, a zone of inhibition of 22 mm was obtained. This was the widest zone of inhibition observed among all the 10 different concentrations tested. The zone of inhibition for positive control was 25mm and no zone of inhibition was observed around the negative control. Conclusion: Ocimum sanctum (Linn.) extract demonstrated an antimicrobial activity against Actinobacillus actinomycetemcomitans. The maximum antimicrobial potential was observed at the 6% concentration level.

Insight Into Quality of Prescription Writing - An Instituitional Study

Sujatha Dyasanoor, Ayeesha Urooge

Introduction: Prescription writing is an important task performed by a doctor during patient management. Prescription refers to written instructions given to a patient regarding medications. Lack of attention during prescription writing can lead to prescription errors which in turn can adversely affect patients’ well-being. Thus, prescriptions are an important target area for improvement. Aim: The purpose of the present study was to analyze the quality of prescriptions dispensed by the students of The Oxford Dental College and Hospital, Bangalore and to compare the prescription writing patterns amongst undergraduates, interns and postgraduates of this institution. Materials and Methods: A cross-sectional study was conducted on 500 randomly selected prescriptions dispensed by the students of The Oxford Dental College and Hospital, Bangalore, India. All the prescriptions were analyzed for the presence of (a) Patient’s information: Out-Patient file number, name, age, gender, address and contact number (b) Doctors information: Full name, department name, qualification, contact details, date of prescription, superscription, and signature (c) Drug information: Name, strength, dosage form, dosage instructions, duration and total quantity. Each prescription was further categorized into groups A, B, C or D, depending on the scores obtained. Prescription quality was then compared between the undergraduates, interns and postgraduates. Results: Analysis of prescriptions performed using Chi-square test showed that groups A, B, C and D had 12 (2%), 155 (31%), 333 (67%) and 0 (0%) students respectively. Association between the groups and qualifications showed statistically significant results (p<0.05). Undergraduate prescriptions were better written in comparison to interns and postgraduates. Conclusion: Findings of the current study demonstrate the need for further improvement in the quality of prescription writing by students of The Oxford Dental College and Hospital, Bangalore, India.

Ileostomy for Non-Traumatic Ileal Perforations: Is this the Beginning of the End?

Rajashekara Gangappa Babu, Adithya Malolan, Prashanth Basappa Chowdary

Introduction: Ileal perforations are a common place of occurrence in emergency operation rooms around India. They are also significant contributors to mortality in our country. They are very distressing for patients because of the high morbidity of a laparotomy and in certain cases a stoma if its necessity is felt by the operating surgeon. The nature of the disease itself predisposes to a number of complications including wound infections, faecal fistulas and complications associated with a stoma. Aim: To evaluate the role of ileostomy in patients with non-traumatic ileal perforation. Materials and Methods: A total of 192 cases of ileal perforation, diagnosed per-operatively, were prospectively studied between June 2012 and July 2014. Cases were treated according to standard resuscitation protocols and underwent repair of the ileal perforation either as primary closure or as a bowel resection and anastomosis with or without a proximal diversion ileostomy. Cases were followed up for a period of six months and immediate and late complications and outcomes were noted. Results: A total of 192 patients were studied during the given study period out of which 170 (88.5%) were males. The disease was treated primarily without diversion stoma in 176 patients and in 16 patients a proximal diversion ileostomy was performed. The overall mortality was 15 (7.8%) that was noted to be not significantly different in patients with respect to the performance of a stoma. Enterocutaneous fistula was a complication seen exclusively in the non-ileostomy group whereas stomal complications were expectedly noted only in the stoma group. Conclusion: The authors found that though conventional ileostomy diversion may appear a safe option in patients with ileal perforations, it has its own additional morbidity, which at times can be very difficult to manage. An ileostomy is of use in a very small group of patients that is diminishing as better facilities and equipment are obtained to manage this dreaded disease.

A Comparative Study of Induced Sputum and Bronchial Washings in Diagnosing Sputum Smear Negative Pulmonary Tuberculosis

Nageswar Rao Gopathi, Venu Mandava, Usharani Namballa, Sravani Makala

Introduction: Tuberculosis is one of the most important public health problem worldwide. Detecting patients with active pulmonary Koch’s disease is an important component of tuberculosis control programs. However, at times in patients even with a compatible clinical picture, sputum smears do not reveal acid-fast bacilli and smear-negative pulmonary tuberculosis remains a common problem. Aim: The present study is aimed to compare the results of induced sputum and bronchial washings smear in patients suspected to have sputum smear negative pulmonary tuberculosis. Materials and Methods: A prospective study conducted from August 2014 to July 2015, comprising 120 patients fulfilling study criteria. Patients with respiratory symptoms and chest roentgenogram suspicious of pulmonary tuberculosis with no previous history of anti-tuberculosis treatment and two spontaneous sputum smear samples negative for acid fast bacilli were included. Patients with active haemoptysis and sputum positive were excluded from the study. Sputum induction was done by using 5-10 ml of 3% hypertonic saline through ultrasonic nebulizer taking safety precautions. All the patient underwent fibreoptic bronchoscopy after six hours fasting on the same day. About 20 ml of normal saline instilled into the suspected pathology area and washings were taken with gentle suction. The sample processing and fluorescent staining for acid fast bacilli was done in a designated microscopy lab. Results: Out of 120 sputum smear negative pulmonary tuberculosis patients, induced sputum smear examination detected acid fast bacilli in 76 patients (63.3%) and acid fast bacilli detected from bronchial washings in 94 patients (78.3%). Smear positivity was higher in cavitary and infiltrative lesions as compared to consolidation and infrahilar pattern disease. Conclusion: Even though both induced sputum and bronchial washings procedures were valuable for the diagnosis of sputum smear negative, sputum induction with hypertonic saline should be the initial procedure of choice, which can be repeated twice / thrice in a day or two consecutive days. If the patient still remains induced sputum smear negative and if the clinical probability of tuberculosis is high, starting anti-tuberculosis treatment and closely monitoring patient and reserving bronchoscopy to those patients who do not improve and to exclude alternative diagnosis seems to be a practically useful approach.

Comparative Evaluation of Antimicrobial Activity of Pomegranate-Containing Mouthwash Against Oral-Biofilm Forming Organisms: An Invitro Microbial Study

Introduction: Pomegranate is considered “A pharmacy unto itself”. Hydrolysable tannins called punicalagins which have free scavenging properties are the most abundant polyphenols found in pomegranate-containing mouthwash. Aim: To evaluate antimicrobial effect of pomegranate- containing mouthwash on oral biofilm-forming bacteria. Materials and Methods: The mouthwashes used were divided into three groups- Group A: Chlorhexidine mouthwash (Hexidine); Group B: Herbal Mouthwash (Hiora) and Group C: Pomegranate-containing Mouthwash (Life-extension). Each mouthwash was diluted to five different concentrations. Reference strains of Streptococcus mutans (S.mutans) (ATCC 25175), Streptococcus salivarius (S.salivarius) (ATCC 7073), and Aggregatibacter actinomycetemcomitans (A.a) (NCTC 9710) were selected as being colonizers in dental biofilm formation. On each culture plate, five wells of 5mm were prepared and mouthwashes with different concentrations were added, followed by incubation in a CO2 jar for 24 hours at 37°C. Inhibition zone diameters were measured using a digital caliper. Results: Chlorhexidine (0.12%) presented a zone of inhibition between 38.46% to 96.15% for all the three organisms, while Hiora presented zone of inhibition ranging from 33.33% to 69.23% but was resistant at <10 ml of dilution. Pomegranate mouthwash presented a zone of inhibition ranging from 38.48 to 57.69%, but was resistant at <10ml for S.mutans, and <25ml for A.a and S.salivarius. ANOVA test was done to compare the dilution of mouthwashes for a particular organism and Tukey’s multiple comparison tests were done to find the exact difference. A significant difference was seen between all the three groups at 50ml and 75 ml of dilution. At 75 ml concentration, a statistical difference was found between Groups B &C and Groups A & B; and at 50 ml between Groups A&C. Conclusion: All the three types of mouthwash exhibit anti-microbial activity against biofilm forming organisms but at varying concentrations. Although Chlorhexidine still continues to be the gold standard, pomegranate-containing or herbal mouthwashes can be easily substituted for long term use, avoiding the side effects of chlorhexidine.

Comparison of the Antimicrobial Efficacy of Two Antibiotics Sparfloxacin and Augmentin as Experimental Root Canal Irrigating Solutions against Enterococcus faecalis - An Invitro Study

Introduction: One of the main goals of endodontic treatment is root canal disinfection and to prevent subsequent chances of reinfection. Adjuvant to instrumentation, root canal irrigants are required to eliminate the bacteria found on the root canal walls and lateral canals within the dentinal tubules. Aim: To measure and compare the antibacterial efficacy of two antibiotics as experimental root canal irrigating solutions against Enterococcus faecalis (E. faecalis). Materials and Methods: Fifteen Brain Heart Infusion agar plates were inoculated with Enterococcus faecalis-American Type Culture Collection (ATCC) 29212. 5 micrograms (mcg) Sparfloxacin discs, 30mcg Augmentin discs, and sterile paper test discs saturated with 2% Chlorhexidine (CHX), 3% Sodium Hypochlorite (NaOCl) and 5% NaOCl solutions were placed on agar plates. Sodium Chloride 0.9% (NaCl) paper discs were used as controls. Fifteen plates were incubated aerobically at 37°C. Results were expressed as per the terms of the diameter of the inhibition zone. Results: Results suggested a statistically significant difference in the zones of inhibition between five irrigating solutions (p < 0.001). Conclusion: Although, zones of inhibition were found in all the groups, 5mcg Sparfloxacin and 30mcg Augmentin showed maximum antimicrobial activity against E.faecalis.

Microleakage in Sub-Gingival Class II Preparations Restored Using Two Different Liners for Open Sandwich Technique Supplemented With or Without Ultrasonic Agitation: An In Vitro Study

Hitesh Chandar Gyanani, Naveen Chhabra, Nimisha Chinmay Shah, Pratik Subash Jais

Introduction: Probability of bond failure at sub-gingival cavosurface margin is high in class II cavity designs especially when margins are located in cementum or dentin. Previous researches have proved ultrasonics to be a beneficial tool in improving the marginal adaptation of the restorative material. Therefore, the effect of ultrasonic activation of the lining material at the gingival cavosurface margin was tested in the present research. Aim: The study aimed to evaluate the cervical micro-leakage in class II preparations with gingival margin located below cemento enamel junction and restored using open sandwich technique using two different liners and supplemented with or without ultrasonic agitation. Materials and Methods: Forty recently extracted human molars were collected, disinfected and stored in 0.9% saline solution. Standar dized class II cavities were prepared with gingival margin located 1mm below the cemento-enamel junction. Teeth were randomly divided into four groups (n=10) and restored using open sandwich technique as follows - Group A: Resin Modified Glass Ionomer Cement as liner and Beautifil II as coronal restoration; Group B: Same as group A supplemented with ultrasonic agitation; Group C: Beautifil Flow Plus as liner and Beautifil II as coronal restoration; Group D: Same as Group C supplemented with ultrasonic agitation. Prepared samples were subjected to thermo cycling, followed by immersing in 0.5% methylene blue dye solution. After 24 hours they were cleaned and sectioned in mesio-distal direction using diamond disc and evaluated for microleakage. Obtained scores were statistically analysed using one way ANOVA test and Post Hoc test. Results: Group B showed least microleakage amongst all groups but the results were statistically insignificant (p value > 0.05). Conclusion: Marginal adaptation of liner with ultrasonic activation was somewhat better however, the results were statistically insignificant.

Reliability and Validity of EN-TreeM Dynamometer for Measurement of Shoulder Rotator Strength in Volleyball Players

Kaleem, Shahid Raza, Jamal Ali Moiz, Mohd Iqbal, Shalini Verma

Introduction: Volleyball involves repeated forceful arm actions that produce a high incidence of shoulder injury. Shoulder rotator strength ratio is an important predictor of the likelihood of shoulder injury, especially, secondary shoulder impingement and instability. Therefore, assessment of muscle strength of external and internal rotators of shoulder is imperative to establish the profiles of shoulder rotator performance, strength ratios, and shoulder mobility of volleyball players. Aim: To establish reliability and validity of EN-TreeM dynamometer for the measurement of shoulder rotators strength in volleyball players. Materials and Methods: Thirty male volleyball players aged 18-24 years, mean height 1.7m, weight 69.8 Kg and BMI 23.1 participated in the study. They performed 1RM (one repetition maximum) estimation protocols using EN-TreeM dynamometer and free weights for shoulder rotators, to investigate its concurrent validity. A retest using the same protocol was performed 48 hours later to assess Test-retest reliability of the EN-TreeM dynamometer. Results: The results yielded excellent test-retest reliability (ICC0.96) and internal consistency (Cronbach’s alpha0.98) for both internal and external rotators. The concurrent validity was established using Pearson correlation coefficient (internal rotator r=0.45, p=0.01;External rotator r=0.38, p=0.03). Conclusion: The findings establish the reliability and concurrent validity of EN-TreeM dynamometer for the quantification of shoulder rotators strength. Based on these findings in volleyball players, EN-TreeM dynamometer can be used with confidence as an instrument for assessing muscle performance (strength). Additionally, it may also be used for monitoring changes due to rehabilitation interventions in shoulder injuries.

Effect of Seven Sessions of Posterior–to–Anterior Spinal Mobilisation versus Prone Press–ups in Non–Specific Low Back Pain – Randomized Clinical Trial

Shlesha G Shah, Vijay Kage

Introduction: Low back pain is non-specific in 85% of population. Posterior-to-anterior (PA) mobilization and press-up exercises are common physical therapy interventions used to treat low back pain. Aim: The purpose of this study was to investigate the effect of posterior-to-anterior spinal mobilization and prone press-ups in non-specific low back pain. Materials and Methods: The study design was double blind randomized clinical trial. Forty participants reporting to Physiotherapy Out-patient department in hospital who were 18-45 years of age and had diagnosis of non-specific low back pain were included. Primary outcome measures were lumbar extension range, pain and physical function. Results: Both interventions resulted in significant reduction in the average pain scores for both groups. Similarly, gain in total lumbar extension was significant in both the PA mobilization group and the press-up group. Functional scores significantly improved for both the groups. Both the groups significantly differed in terms of pain, lumbar extension and functional scores. PA mobilization proved to be a superior intervention. Conclusion: PA mobilization and press-ups can be used as an effective intervention in non-specific low back pain.

Impact of Uraemic Pruritus on Quality of Life among End Stage Renal Disease Patients on Dialysis

Introduction: Uraemic pruritus is significant complication in (ESRD) patients and substantially impairs their quality of life (QOL). ESRD is a bothersome problem with attempts being made to increase the survival of patients on dialysis. Aim: An attempt was made to compare the QOL of haemodialysis patients and suffering from uraemic pruritus with the QOL of those on haemodialysis but with no presenting uraemic pruritus. Materials and Methods: A cross-sectional study was conducted to evaluate the QOL of haemodialysis patients suffering from uraemic pruritus. The WHOQOL-BREF questionnaire was used to assess the QOL. Haemodialysis patients with pruritus who had completed three months of maintenance haemodialysis (n=100) were enrolled into the study and 100 controls (n=100) on haemodialysis but with no pruritus were further enrolled. Results: The QOL of haemodialysis patients with pruritus was found to be significantly impaired (p < 0.05) in comparison to those on haemodialysis with no prutitis, particularly with respect to all the four WHOQOL-BREF domains. Conclusion: Quality of life of ESRD patients on dialsysis was siginificantly affected by pruritis.

Anticariogenic Activity of Black Tea - An Invivo Study

Vishal Arya, Lavina Taneja, Ankit Srivastava, Swati Nandlal

Introduction: Teas is known for its anticariogenic properties and various mechanisms have been invoked to explain this effect. One such proposed mechanism is inhibition of salivary alpha amylase activity by endogenous tannins present in tea. Aim: The objective of the present study was to determine whether or not the ingestion of black tea decoction inhibits the enzyme salivary amylase and thus interferes with the release of maltose from intraoral entrapped particles of food. Materials and Methods: A total of 30 children in the age group of 12 - 15 years were selected for the study. After two hours of fasting subjects consumed two salted crackers for 60 second following which they rinsed with water (control solution) and then with 1.5% black tea decoction (test solution) next day. Retained food particles were recovered from buccal aspect of left mandibular premolar and salivary amylase activity was noted via chromatography. Paired t-test was applied for statistical analysis. Results: Maltose to Sucrose ratio was used to evaluate the result. The average ratio was 3.27 for control solution and 1.82 for test solution. The results were statistically highly significant (p <0.005). Conclusion: Tea inhibited the activity of salivary amylase and this inhibition assumes a special significance when it is considered that the effect of tea could be manifested over a prolonged period of time, as in a real life situation.

Peripheral Neurectomy for Trigeminal Neuralgia: Simple Technique for a Complex Disease

Clinico-Epidemiological Profile of Psychiatric Disorders Among Children in a Tertiary Care Hospital of Southern India

Savindika Chamari Nawarathna, Sonu Hangma Subba, Arunav Guha

Introduction: According to the World Health Organization (WHO), mental health disorders are one of the leading causes of disability worldwide and it is as common in children. Anywhere between one to three children may be suffering from psychiatric disorders at any point in time. Aim: This study intended to find the pattern of psychiatric disorders and associated sociodemographic factors among children attending the psychiatric department in a tertiary care hospital in Southern India. Materials and Methods: An analysis was conducted of patients who attended the psychiatric clinic from April 2012 to March 2013. Disorders were classified according to International Classification of Diseases, 10th edition (ICD-10) criteria. Data obtained was analysed by SPSS 11.5 version. Chi-square test was used to see association and p<0.05 was taken as significant. Results: The mean age of the children was 10.9 years (SD=4.3). Predominance of males was noticed. It was seen that the male children, mostly suffered from Pervasive and specific developmental disorders (n=105; 31.1%). While in the female children, a prominence of anxiety, dissociative, stress-related, somatoform and other non-psychotic mental disorders was seen (n=52; 27.1%). Co-morbidity of psychiatric disorders was seen with intellectual disability and a seasonal predominance of psychiatric disorders was seen during autumn. Conclusion: Children presenting with psychiatric disorders in the hospital showed a wide age range and among them, males outnumbered females. Psychiatric disorders showed seasonal variation and the types of disorder varied significantly with age, gender and religion.

Cervicobrachial pain - How Often is it Neurogenic?

Ranganath Gangavelli, N. Sreekumaran Nair, Anil K Bhat, John M Solomon

Age Related Changes in Autonomic Functions

Rachna Parashar, Mohammed Amir, Abhijit Pakhare, Preeti Rathi, Lalita Chaudhary

Introduction: Autonomic Nervous System (ANS) imbalance may trigger or enhance pathology in different organ systems that varies in different age groups hence objective of present study was to evaluate association of different Age-groups with autonomic functions. Materials and Methods: A cross-sectional study was conducted in 62 healthy volunteers in Department of Physiology LLRM Medical College Meerut, India. Volunteers were divided into three groups as younger (15-45 years), middle (45-60) and elder age (above 60), Autonomic functions were tested in three domains viz. Cardio-vagal, adrenergic and sudomotor functions. Numerical data was summarized as mean and standard deviation and categorical data as count and percentage. ANOVA and Chi-square test were used to find difference among groups, p<0.05 was considered statistically significant. Results: Mean ± standard deviation OHT(Orthostatic Hypotension Test) among of younger, middle and elder age groups were 8.80±2.28, 13.40±4.64 and 21.82±6.04 respectively which represent decrease in sympathetic functions with age (p<0.001). Cardio-vagal or parasympathetic responses indicated by DBT (Deep Breathing Test) Valsalva and 30:15 ratio of HR response to standing tests has shown statistically significant (p<0.001) decrease in mean response with increasing age. Sudomotor response appeared normal in younger and middle group but was interrupted in more than half of elderly people (p<0.001). Conclusion: Sympathetic responses & para-sympathetic responses have shown the significant decline with increasing age group. Sudomotor responses were partially interrupted in elderly age group.

Imprudent Gastro-protective Approach in Majority of Specialists’ Clinics of a Tertiary Hospital

Hardik Rameshbhai Patel, Priti Dhande

Introduction: One out of four prescriptions in out-patient departments contains a gastro-protective drug (APUD) - PPI/ H2 Blockers/ Antacids/ Ulcer Protective’s. These drugs should be prescribed only when there is a justified indication. To assess the prescriptions of gastro-protective agents for appropriateness and rationality, in a tertiary care hospital setup. Materials and Methods: It was a cross-sectional observational study conducted from Aug 2013 to Dec 2013 at OPDs of a Tertiary Care Teaching Hospital, Pune. A total of 260 prescriptions containing gastro-protective agents were analysed for appropriateness and rationality. Rationality of drug use was assessed by referring to standard textbooks and guidelines. Cost difference data was analysed by Wilcoxon signed rank test using GraphPad Prism 6. Results: Most common class of gastro-protective agents was Proton pump inhibitors (PPIs)-73.77% (Pantoprazole & Dexrabeprazole). Only 37.3% prescriptions had an adequate indication for these drugs {GI prophylaxis (29.6%) and Acid Peptic Disease treatment (7.7%)}. Two irrational Fixed dose combinations found in the study were PPI with prokinetic agent (n=65) and Proton Pump Inhibitor + NSAID combination (n=2). Formulation, spelling and strength errors were found with 75 prescribed drugs. Medication instructions were lacking with most of the drugs. Drug interactions with co-prescribed drugs could be anticipated in 79 cases. Injudicious use of anti-peptic ulcer agents significantly increased the cost of prescriptions (p<0.0001). Conclusion: Anti-ulcer drugs are overenthusiastically prescribed by all specialties which can predispose to adverse effects, drug interactions, increased cost and even erroneous prescriptions.

Skin Disorders Among Geriatric Population at a Tertiary Care Center in Uttarakhand

Rashmi Jindal, Akanksha Jain, Samarjit Roy, S.D.S. Rawat, Nancy Bhardwaj

Introduction: Ageing results in decline of normal functioning in all organ systems including skin. This predisposes the elderly persons to develop various skin ailments. A thorough knowledge of different diseases prevalent in this population in different geographic regions help the health care providers in better health care policy making. Aim: This study was planned to know the common dermatological diseases prevalent in Uttarakhand region of India. Materials and Methods: Hospital out patients records maintained in Department of Dermatology, Venereology & Leprosy were analysed and information regarding age, sex and diagnosis of patients were recorded. Descriptive statistics for prevalence of skin diseases in patients presenting to hospital were calculated. Results: Out of the total 29,422 patients seen in dermatology department from August 2012 to 2014, 4.7% (1,380) were aged 60 years and above. Male to female ratio was 2:1. Erythemato-squamous disorders taken collectively constituted the major skin disorder seen in 38.9% patients. This was followed by infections and infestations (29.9%), senile pruritus (9.0%) and age related skin changes (3.7%). Benign neoplasms were seen in 1.1% patients followed by cutaneous malignancies in 0.8% and precancerous lesions in 0.4%. Fungal infections were the most common infections seen in 18% patients. Conclusion: This study strengthens the opinion that infections, senile pruritus and eczema-dermatitis are the major dermatological disorders in elderly population.

Digital Mammography in Young Women: Is a Single View Sufficient?

Johannes Gossner

Introduction: Single view mammography may be a less time consuming, more comfortable and radiation reduced alternative for young women, but there are no studies examining this approach after the implementation of digital mammography into clinical practice. Materials and Methods: Retrospective analysis of all mammographies performed in women younger than 40 years during a 24 month period. The sample consisted of 109 women with 212 examined breasts. All patients initially received standard two- view mammography. In the study setting the MLO- views were read by a single viewer and compared to a composite reference standard. Results: In this sample 7 malignant findings were present and the review of the MLO-view detected 6 of them (85%). In patients with dense breasts 4 out of 5 malignant findings were found on the single-view (sensitivity 80%) and all 2 malignant findings were detected in patients with low breast density (sensitivity 100%). There were 7 false positive findings (3.3%). i.e. in total 8 out of 212 examined breasts were therefore misinterpreted (3.8%). Conclusion: Single view digital mammography detects the vast majority of malignant findings, especially in low density breast tissue and the rate of false-positive findings is within acceptable limits. Therefore this approach may be used in different scenarios (for example in increasing patient throughput in resource poor settings, reducing radiation burden in the young or in combination with ultrasound to use the strengths of both methods). More research on this topic is needed to establish its potential role in breast imaging.

Ethnic Association of Cusp of Carabelli Trait and Shoveling Trait in an Indian Population

M Kirthiga, M Manju, R Praveen, W Umesh

Introduction: Variations in the structure of teeth have always been of great interest to the dentist from the scientific as well as practical point of view. Additionally, ever since decades inter trait relationships have been a useful means to categorize populations to which an individual belongs. Aim: To determine the association between Cusp of Carabelli and Shoveling Trait in a selected Indian population native of Bangalore city, Karnataka, India. Materials and Methods: A cross-sectional study was carried out in 1885 children aged between 7-10 years. Casts of the study subjects were made to study the presence of Cusp of Carabelli of right maxillary permanent molar and shoveling trait of right maxillary permanent central incisor using the Dahlberg’s classification and Hrdliucka’s classification respectively. Linear regression was used to assess the association of cusp of carabelli trait with the tooth dimensions and logistic regression was used to evaluate the association of the carabelli trait with gender and presence/absence of shoveling. Results: A 40.5% of subjects had Cusp of Carabelli on first molar and 68.2% had shoveling on upper central incisor. The study revealed positive association between the two traits studied in the population. A significant difference was also found with presence of Cusp of Carabelli and the buccolingual tooth dimension of the maxillary molar (p<0.05). Conclusion: There is an association between the Cusp of Carabelli and the shoveling trait in the present study population, and this will be valuable in the determination of ethnic origin of an individual.

Analysis of the Genotoxic Effects of Mobile Phone Radiation using Buccal Micronucleus Assay: A Comparative Evaluation

Sumita Banerjee, Narendra Nath Singh, Gadiputi Sreedhar, Saikat Mukherjee

Introduction: Micronucleus (MN) is considered to be a reliable marker for genotoxic damage and it determines the presence and the extent of the chromosomal damage. The MN is formed due to DNA damage or chromosomal disarrangements. The MN has a close association with cancer incidences. In the new era, mobile phones are constantly gaining popularity specifically in the young generation, but this device uses radiofrequency radiation that may have a possible carcinogenic effect. The available reports related to the carcinogenic effect of mobile radiation on oral mucosa are contradictory. Aim: To explore the effects of mobile phone radiation on the MN frequency in oral mucosal cells. Materials and Methods: The subjects were divided into two major groups: low mobile phone users and high mobile phone users. Subjects who used their mobile phone since less than five years and less than three hours a week comprised of the first group and those who used their mobile since more than five years and more than 10 hours a week comprised of the second group. Net surfing and text messaging was not considered in this study. Exfoliated buccal mucosal cells were collected from both the groups and the cells were stained with DNA-specific stain acridine orange. Thousand exfoliated buccal mucosal cells were screened and the cells which were positive for micronuclei were counted. The micronucleus frequency was represented as mean±SD, and unpaired Student t-test was used for intergroup comparisons. Results: The number of micronucleated cells/ 1000 exfoliated buccal mucosal cells was found to be significantly increased in high mobile phone users group than the low mobile phone users group. The use of mobile phone with the associated complaint of warmth around the ear showed a maximum increase in the number of micronucleated cells /1000 exfoliated buccal mucosal cells. Conclusion: Mobile phone radiation even in the permissible range when used for longer duration causes significant genotoxicity. The genotoxicity can be avoided to some extent by the regular use of headphones.

Maternal Myocardial Performance in Second Trimester of Pregnancy With Iron Deficiency Anaemia

Padmaja Rao Tangeda, Sumangala Patil, Neerja Shastri, Shah Navid Noorali

Introduction: Anaemia affects various organs in body including the heart. In anaemia, oxygen carrying capacity of blood decreases. Iron depletion and the amount of stored iron are reduced in iron deficiency anaemia which limits red cell production. However, the studies which show the effect of anaemia on myocardial function during pregnancy are few in India. Aim: To study the effect of iron deficiency anaemia on myocardial function by ECG during second trimester of pregnancy and to compare ECG changes with normal pregnant women in second trimester. Materials and Methods: The study was conducted at antenatal OPD between Oct 2014 to Jul 2015. Hundred pregnant women were selected and divided into 2 groups. A total of 50 normal pregnant women (control group) in 2nd trimester (10-14 weeks of gestation) were compared with equal number of pregnant women with anaemia (study group) in 2nd trimester, aged between 20-30 years. Electrocardiogram was recorded using Philips twelve channel ECG machine model TC20 in both control and study groups to evaluate myocardial performance. Haematological parameters were analysed by SYSMEX auto analyser. Analysis of Variance (One way ANOVA) was used for comparison between study and control groups and the data was analysed by t-tests. Results: In our study a significant decrease in QRS duration and increase in QTc were observed in study group (p<0.05). T-wave abnormalities like flat and negative T-waves in lead II, III, avF, V2 – V4 were more frequent (p<0.05). 90% of subjects in study group had tachycardia and ECG abnormalities. There was a negative correlation between Hb level, serum ferritin and tachycardia, ECG abnormalities. Conclusion: Pregnancy with Iron deficiency anaemia brings about various changes in ECG, suggesting that anaemia and volume overload in pregnancy is a risk factor that may lead to cardiac hypertrophy.

Molecular Characterisation of Clinical Isolates of Chikungunya Virus: A Study from Tertiary Care Hospitals in Southern India

Bharath Mudurangaplar, B.V. Peerapur

Introduction: Indian ocean islands and India have experienced massive severe Chikungunya outbreak from 2005 up till now and then Chikungunya became epidemic in India. The mutations that occurred in E1 gene were responsible for increased infectivity, virulence and host adaptability. It is important to find out the genotype and its probable evolvement and novel mutations in the E1 gene reported during 2006-2009 from the current isolates, which may affect the local protein structure. Aim: To perform Molecular diagnosis and Molecular Characterisation of Chikungunya virus isolates. Materials and Methods: A total of 33 samples were included in the study. RNA was isolated from 33 serum samples and Real time PCR was carried out. Further, Nested PCR and E1 partial gene sequencing was performed. Phylogenetic analysis, mutational analysis and protein modelling studies were carried out. Results: Out of 33 samples tested, 31 were found positive for CHIK RNA. Phylogenetic analysis showed that isolates belongs to ECSA genotype and E1K211E, E1M269V and E1D284E mutations were observed from all the isolates. Conclusion: The isolates may have evolved from ECSA Reunion island strains and identified unique mutations in E1 gene were maintained. These mutations have not affected local protein structure.

Diabetic Kidney Disease and Hypertension: A True Love Story

Introduction: Diabetes Mellitus (DM) remains one of the commonest causes of structural and functional kidney abnormalities leading to End Stage Renal Disease (ESRD). The next most common cause is hypertension. It is utmost important to investigate the association between diabetic nephropathy and hypertension because it is a major causal factor of end-stage kidney failure in Type 2 Diabetes Mellitus (T2DM). Aim: The aim of the present study was to investigate the association between albuminuria, hypertension and estimated glomerular filtration rate (eGFR) in a prospective cohort of T2DM patients in a developing country. Materials and Methods: A total of 824 patients were enrolled from a tertiary healthcare center in central India. This study was performed in three groups: normal controls (232), type 2 diabetics without nephropathy (185) and type 2 diabetics with nephropathy (407). Diabetic nephropathy was clinically defined by the presence of persistent proteinuria of > 500mg/day in a diabetic patient in the absence of clinical or laboratory evidence of other kidney or urinary tract disease. Hypertension was categorized based on JNC 7 classification. Detailed clinical history was obtained from all subjects. Students t-test was applied to see the difference in mean values of quantitative data in two groups. Chi-Square test was applied to see the difference in frequency of discrete variables in two groups. Results: A 66.3% diabetic nephropathy patients and 51.9% type 2 diabetics without nephropathy were found hypertensive in present study; In contrast only 14.7% controls had hypertension. No association of hypertension was found with age and gender in either group. Serum creatinine and eGFR was found significantly different in hypertensive diabetic nephropathy patients than normotensive (p=0.002 and <0.0001 respectively). Conclusion: Our study found that hypertension was an independent risk factor for the Diabetic Kidney Disease (DKD). Along with this, a proportional increase in the level of serum creatinine and eGFR was seen with an incidence of hypertension in diabetic nephropathy.

Functional Outcome of Lumbar Discectomy by Fenestration Technique in Lumbar Disc Prolapse – Return to Work and Relief of Pain

Ujjwal Gowardhan Wankhade, Mahesh Kotehal Umashankar, B.S. Jayakrishna Reddy

Introduction: Low back pain affects every population and is one of world’s foremost debilitating conditions. Clinically significant sciatica due to lumbar disc prolapse occurs in 4-6% of population. Fenestration discectomy as a surgical procedure is less time consuming, with lesser blood loss, lesser post-operative complications and does not compromise with stability of spine when compared to laminectomy. Aim: Present study was conducted to determine extent of functional recovery i.e. pain relief and return to work in patients with lumbar disc prolapse treated by fenestration technique. Materials and Methods: From October 2010 to March 2012, 50 patients with signs and symptoms of prolapsed lumbar intervertebral disc who failed to respond to conservative treatment were operated for discectomy by fenestration technique and studied prospectively. Functional outcome was evaluated by ‘Back Pain Functional Score (BPFS)’ of Strafford et al., PROLO rating scale to determine preoperative functional and economical status and outcome at final follow up after 6 months. In order to identify physical signs from non organic signs Wadell’s score system was used. Result of surgery was evaluated with help of McNab’s criteria. Results: In our study, according to Back Pain Functional Scale by Strafford et al., and PROLO scale, good results were found in 42 (84%) cases, fair result in 8 cases (16%) and none with poor results at follow up of six months. According to PROLO economical and functional scale, 84% cases were able to join their previous occupation at end of six months and 76% cases had complete pain relief. In our study, correlation of age and duration of symptoms to functional outcome was statistically significant (p=0.089 & p = 0.098+ respectively) showing more good results among patients with age less than 30 years and patients having duration of symptoms less than 6 months. Conclusion: Functional outcome of fenestration technique in terms of return to work and complete back and leg pain relief at end of six months had been satisfactory in our study. Moreover, old age, long duration of symptoms and presence multiple psychological issues are negative predictors of functional outcome.

A Randomised Controlled Trial Comparing the Efficacy and Side-Effects of Intravaginal Ring (Nuvaring®) With Combined Oral Hormonal Preparation in Dysfunctional Uterine Bleeding

Sandhya Jain, Neelam B. Vaid, Yam Narang, Amita Suneja, Kiran Guleria

Introduction: Combined Oral Contraceptive (COC) pills are being used in patients of abnormal uterine bleeding, especially adolescents and reproductive age women considering their need for contraception. It decreases the blood loss due to haemostatic effect of estrogen and also regularizes the cycle. Intravaginal route has been found to be effective and acceptable; Gastrointestinal absorption and hepatic first-pass metabolism is avoided and steady, uniform blood concentration is achieved. Bioavailability of estrogen and progestogen through oral and vaginal route are same. The convenience of once-a-month administration is another major advantage. Materials and Mathods: Sixty women fulfilling inclusion criteria were randomised into 2 groups in 1:1 ratio. In one group (n=30), monthly insertion of Nuvaring®) was done for three consecutive months. Nuvaring® releases 15µg ethinyl estradiol and 120 µg etonogesterol daily. The other group (n=30) received COC pill containing 30µg EE and 150 µg levonorgestrel for three consecutive months. Primary outcome measures were change in menstrual cycle pattern and pictorial Blood Loss Assessment chart (PBAC) score. Other Parameters included side effects, change in haemoglobin and weight. Data was analyzed by statistical software SPSS 20. Results: Both Nuvaring® and COC were found to significantly decrease blood loss in each cycle. Decrease in PBAC score was more in Nuvaring® group compared to COC, however difference was not significant. Ideal bleed (IB) was frequently higher for Nuvaring® group than COC in all 3 cycles, although no statistically significant difference was observed between groups (p-value=0.286). Late withdrawl, intermenstural spotting was higher in COC group. Compliance was better and women were more satisfied in Nuvaring® group compared to COC group. Minor side effects like headache, mastalgia, nausea and mood changes were seen in both groups, which were not significant. Continuation rate was significantly higher in Nuvaring® group. 30% women discontinued treatment in OCP group after 3 month compare to 10% in Nuvaring® group. Conclusion: Present study shows Nuvaring® to be as effective as COC in controlling heavy menstural bleed, better cycle control, with minor acceptable systemic side effects.

An Unusual Origin of Fetal Lymphangioma Filling Right Axilla

Ali Ozgur Ersoy, Efser Oztas, Erdinc Saridogan, Sibel Ozler, Nuri Danisman

Fetal lymphangioma is a hamartomatous congenital anomaly of the lymphatic system, which is embracing the fetal skin (sometimes mucous membranes) and the subcutaneous tissue. The general consensus is that it occurs as a result of failure in lymphatic drainage. A 36-year-old pregnant woman was referred to our perinatology clinic at 22 weeks’ gestation, because of a fetal right-sided axillary mass revealed by ultrasonography. The mass measuring 5x7x7cm in three dimensions had a multilocular structure without colour Doppler flow and well-circumscribed borders. Amniocentesis revealed a normal constitutional karyotyping. Lymphangioma was considered as prediagnosis. A healthy female baby weighing 3470 grams was delivered at term. Neonatal examination and the postnatal MRI confirmed the diagnosis. The baby is still on follow-up with the medical treatment of Sirolimus an anti-proliferative drug, and the mass got smaller significantly in 8 months after delivery.

Radiological Diagnosis of Neonatal Hydrometrocolpos- A Case Report

A three-day-old female child presented to us with abdominal distension and lower limb swelling. On ultrasound examination, there was a cystic mass contiguous with the uterus in the lower abdomen and pelvis which showed fluid- debris level. This mass was causing displacement of the urinary bladder anteriorly. MRI confirmed the findings of ultrasound. A diagnosis of hydrometrocolpos secondary to imperforate hymen was made following physical examination. Neonatal hydrometrocolpos is a rare condition which requires a high index of suspicion for diagnosis. Hydrometrocolpos refers to the accumulation of secretions within the endometrial and endovaginal canal. Diagnosis can be made prenatally or post natally using ultrasonography and magnetic resonance imaging. Early diagnosis reduces the incidence of complications.

Membrane Assisted Palatal Fistula Closure in a Cleft Palate Patient: A Novel Technique

fistula following cleft palate repair, is one of the considerable complications and remains a challenging problem to the surgeons. The reported recurrence rate of the fistula is between 33% to 37%. Due to fibrosis and poor vascularity of adjacent tissues, high recurrence rates are typical. Closure of palatal fistulas can be achieved by different surgical techniques like local, regional and distant flaps. Local turnover flaps, pedicled flaps from oral mucosa, buccal fat pad flaps, inter-positional cartilage grafts can be utilized for management of small fistulas. For larger fistualas, tongue flaps, temporalis muscle flaps, musculomucosal flaps, nasal septal flaps and free flaps can be used. These procedures are often cumbersome and leave a raw nasal or oral surface, which may increase the incidence of postoperative problems or some flaps can be bulky and may require a second-stage procedure. Different synthetic materials such as alloderm, Poly-D and L-Lactic Acid or “PdLLA” and collagen membrane are used in multilayer repair represented by the nasal mucosa, the inter-positional graft and oral mucosa. These interpositional grafts provide a scaffold for in growth of tissues, revascularization and mucosal epithelialization. We present a case of closure of an oronasal fistula, using resorbable collagen membrane in three layered repair to avoid recurrence.

Concomitant Vesicouterine Rupture with Avulsion of Ureter: A Rare Complication of Vaginal Birth after Cesarean Section

Nalini Sharma, J Lalnunnem Thiek, Stephen Sialo, Santa Singh Ahanthem

Uterine rupture is the most serious and life threatening complication and occurs in 0.7-0.9% of vaginal birth after lower segment caesarean section. Cases of bladder rupture along with uterine rupture have been rarely reported and avulsion of ureter, required ureteric implantation is even rarer. This case report describe a very rare case of vesicouterine rupture with avulsion of ureter following vacuum assisted delivery in a grandmulti with previous lower segment cesarean section (LSCS). Haematuria is the most common presentation of bladder rupture. Antenatal counseling regarding this entity is recommended if woman opted for vaginal birth after cesarean section. Intrapartum and postpartum high index of suspicion are important in clinching the diagnosis.

Primary Paranasal Tuberculosis in a Diabetic Mimicking Odontogenic Infection: A Rare Case; A Unique Presentation

Amit Gupta, Monica Mehendirratta, Chanchal Sareen, Anju Aggarwal

The incidence of Tuberculosis (TB) is high especially in developing countries but primary para-nasal TB is still a rarity. The latter often remains quiescent until it reaches an advanced stage and offers a diagnostic challenge. In the present case report maxillary sinus TB mimicked a destructive periodontitis induced space infection, thus causing a delay in treatment. The present case report describes clinical presentation, diagnosis, management and outcome of a 50-year-old diabetic/HIV seronegative patient with histopathologically confirmed case of maxillary sinus TB.

Gaucher's Disease: A Rare Case, Diagnosed By Fine Needle Aspiration Cytology

Rashmi Rani Bharti, Bipin Kumar

Fine Needle Aspiration (FNA) is a simple, inexpensive and innocuous diagnostic tool. It is increasingly accepted in daily medical practice. We report a case of Gaucher’s disease diagnosed by FNA of enlarged spleen in a seven-year-old male presented with complaints of fever, on and off irregular bowel habits, abdominal distension and asymmetric gaze for four years and decreased vision in night for last one year. The diagnosis was based on the finding of large, macrophage like cells with abundant, pale, fibrillary cytoplasm and small nuclei. The patient had no family history of Gaucher's disease, and the diagnosis was not suspected clinically.

Basal Cell Adenoma with Perplexity in Diagnosis – A Case Report

Priyanka Kardam, Shweta Rehani, Yulia Mathias, Manish Wadhwa

Every salivary gland tumour irrespective of its benign or malignant nature or occurrence, exhibits certain unique and overlapping histopathologic features. Basal Cell Adenoma (BCA) is a rare salivary gland tumour and hence it becomes our responsibility to report every case with unique histopathologic features so that it can add to our present knowledge of this lesion. Often, the pathologists experience difficulty while diagnosing lesions like BCA which contain basaloid cells due to its similarity with other lesions of similar histological appearance. Hence, this paper discusses a case of BCA with rare histopathologic features along with the possible differential diagnosis.

Horseshoe Appendix: An Extremely Rare Appendiceal Anomaly

Appendiceal anomalies are extremely rare malformations that are usually found incidentally. Agenesis and duplication of the appendix has been well documented however, the cases of horseshoe appendix reported is very limited, only four cases reported so far. Here, we report a four and half-year-old who underwent interval appendectomy. Intraoperatively both the ends of the appendix were found to be communicating with the cecum with two separate base or stump located at a sagital disposal- the so called “horseshoe appendix”.

Herpes Zoster as the Presenting Manifestation of Systemic Lupus Erythematosus (SLE): A Rare Case Report

Arshna Qureshi, Debasish Chaudhury

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease and is usually diagnosed with the SLICC criteria. Here we report a case of SLE presenting as Herpes Zoster (HZ). She had presented with painful vesicular eruptions from 8th thoracic nerve to 10th thoracic nerve segments and oliguria. There were no clinical manifestations suggestive of SLE. However, on further workup, haematological and immunologic laboratory profiles were suggestive of SLE. A diagnosis of lupus nephropathy was confirmed by renal biopsy and final diagnosis of SLE as the underlying systemic illness associated with HZ was established. We report this case because this patient had none of the manifestations of SLE, as a result of which this would have been an incomplete diagnosis.

Bilateral Painful Ophthalmoplegia: A Case of Assumed Tolosa-Hunt Syndrome

Ilko Kastirr, Peter Kamusella, Reimer Andresen

We present the case of a man of 47 years with vertical and horizontal paresis of view combined with periorbital pain that developed initially on the right side but extended after 3-4 days to the left. Gadolinum uptaking tissue in the cavernous sinus was shown by MRI of the orbital region in the T1 spin echo sequence with fat saturation (SEfs) with a slice thickness of 2 mm. As no other abnormalities were found and the pain resolved within 72 hours of treatment with cortison a bilateral Tolosa-Hunt Syndrome (THS) was assumed. THS is an uncommon cause for Painful Ophthalmoglegia (PO) and only few cases of bilateral appearance have been reported. Even though the diagnostic criteria for THS oblige unilateral symptoms we suggest that in patients with bilateral PO THS should not be excluded as a differential diagnosis. Further more when using MRI to detect granulomatous tissue in the orbital region the chosen sequence should be T1 SEfs and slice thickness should possibly be as low as 2 mm, as granulomas are often no larger than 1-2 mm.

Multilocular Radicular Cyst – A Common Pathology with Uncommon Radiological Appearance

Peeyush Shivhare, Ankur Singh, Naqoosh Haidry, Monu Yadav, Lata Shankarnarayan

Radicular cyst is the most common odontogenic cyst of inflammatory origin. It is almost all the times associated with pulpal necrosis leading to inflamed periapical tissues. The cyst is usually asymptomatic unless infected. Radiographically, it presents as a well defined unilocular radiolucency. Although, multilocular radiolucent radicular cysts have also been reported, which is extremely rare and there are very few reported cases. Here, we present a rare case of radicular cyst periapical to the first molar of third quadrant, presenting clinically as a painless, bony hard swelling and radiographically presented as a multilocular radiolucency.

An Atypical and Resistant Case of Obsessive Compulsive Disorder Responding Satisfactorily with an Unusual way of Exposure and Response Prevention Therapy

Kamal Nath, Robin Victor, Subrata Naskar

It is well established fact that a combination of pharmacological therapy plus cognitive behaviour therapy (CBT) - exposure and response prevention (ERP) is considered first line for the treatment of obsessive compulsive disorder (OCD). This case presented here supports this point in unusual way of ERP administration in an atypical and resistant case of OCD proved to be beneficial over pharmacotherapy. The case was atypical in the sense that it had many overvalued ideas, superstitions and religious beliefs playing major role in its aetiology. Also, misconstruction of chance associations, intense stimulus generalization and invivo exposure proving the best modality of treatment made it atypical.

Primary Gastro Intestinal Lymphoma Presenting as Perforation Peritonitis

Suhaib Abdul Rehaman, Chandrashekar Shastry Ramachandra, Reuben Prakash Jackaya

Primary gastrointestinal lymphoma is very rare compared to gastrointestinal tract lymphoma arising Secondary to Primary nodal disease. Extra nodal lymphoma can involve any part of the gastrointestinal tract, most commonly being the stomach followed by small intestine and ileocecal region. They are indistinguishable from other benign and malignant conditions and clinically non-specific. Here, we have an interesting case where a patient presented with peritonitis and was found to have a perforated swelling in jejunum. Subsequently resection and anastomosis was done. Biopsy showed lymphoma. Patient was evaluated further by doing CECT of abdomen and thorax, which didn’t show any other site of lymphadenopathy. Patient improved with chemotherapy and is on regular follow up. Perforation in patient undergoing treatment for lymphoma are common but presentation of primary gastrointestinal lymphoma as perforation is rare and needs proper evaluation and management.

A Rare Case of Multiple Myeloma Presenting As Lytic Lesion of the Rib

Dhruva Sharma, Vivek Rawat, Rajkumar Yadav

Multiple Myeloma (MM) is a disease which results from malignant proliferation of plasma cells. It is commonly encountered in elderly patients. Diffuse bony lesions are the most frequent thoracic involvement with MM. We report a case of 42-year-old male patient who came with pain and full swelling in the right chest wall since two years. On CT scan of thorax, heterogenously enhancing soft tissue density lesion with lytic sclerotic destruction of right 4th rib seen. En-bloc resection of third and fourth rib was done and plasmacytoma was confirmed on biopsy.

Clinical Utilization of M Spring for the Space Closure of Midline Diastema – Clinical Case Reports

People approach orthodontist mainly for aesthetic purpose, midline diastema is one of the condition which causes aesthetic compromise. The midline diastema can be caused by various reasons such as high frenal attachment, midline pathology, etc. In the field of orthodontics, relapse rate is high while treating midline diastema. This relapse can be reduced only when there is bodily movement of the incisors in mesial direction. In this article, two cases of midline diastema are selected. Both the cases were treated using “M” spring which has three coils; two at periphery and one at the center and each coil was of 3mm diameter. “M” spring was fabricated using round 0.018” AJ Wilcock wire for one case and 0.017 X 0.025 TMA for another case. For both cases the duration of treatment was for six weeks. IOPA was taken after six weeks, the case in which rectangular wire was used; there was bodily movement of the central incisor in mesial direction. Whereas in round wire technique, predominantly tipping type of tooth movement was seen. The rectangular wire has two point contacts, because of which bodily movement was obtained. This technique of using rectangular wire to fabricate “M” spring has less inventory and chair side time.

Rare Anatomical Variation of Dual IVC with Left Sided IVC Draining into Hemiazygous Vein- A Case Report

Shruti P. Gandhi, Pranjal Modi, Harsh Sutariya, Kajal Patel

Congenital anomalies of the Inferior Vena Cava (IVC) result from the persistence of the embryonic venous system. Knowledge of such anomaly is of great importance during abdominal surgery, liver and kidney transplantation, renal venous sampling and in the treatment of thromboembolic diseases. Here, we report a rare anatomical variation of dual IVC with normal course of right sided IVC and hemiazygous continuation of left sided IVC with interiliac communication in potential renal donor. Congenital abnormalities of the inferior vena cava are easily identified on Computed Tomography (CT) and should be considered when interpreting any CT of the abdomen or chest.

Orofacial Manifestations of Autosomal Recessive Robinow’s Syndrome: A Rare Case Report

Santosh Mali, Neha Bansal, Amol Dhokar, Monica Yadav

Robinow’s syndrome is a very rare genetic disorder which bears a resemblance to a foetal face. It is characterized by short-limbed dwarfism, defects in vertebral segmentation and abnormalities in the head, face and external genitalia. It has a genetic heterogeneity with autosomal dominant and recessive forms which relates to the severity of phenotype presentation. A rare case of an autosomal recessive form of Robinow’s syndrome is presented with emphasis on, characteristic craniofacial and intraoral manifestations to aid in diagnosis and dental management of this patient.

A Series of Congenital High Airway Obstruction Syndrome – Classic Imaging Findings

Rajaram Sharma, Amit Kumar Dey, Shah Alam, Kartik Mittal, Hemangini Thakkar

Congenital high airway obstruction syndrome (CHAOS) is a very rare entity with very poor prognosis in which upper airway is intrinsically obstructed, the most common reason being laryngeal atresia. In summary prenatal early diagnosis of patients with CHAOS is necessary so that perinatal management can be undertaken successfully or elective termination of pregnancy can be undertaken. The fetoscopic approach may be a life saving modality in a subset of CHAOS patients. Involving a multidisciplinary team comprising of paediatricians, radiologists, obstetricians and anaesthesiologists increases the efficiency of management.

Basal Cell Carcinoma Developing from Trichoepithelioma: Review of Three Cases

Trichoepitheliomas (TE) are benign tumours but occasionally can undergo transformation to malignant neoplasms more commonly as Basal Cell Carcinoma (BCC). The correct diagnosis between these tumours is very important because basal cell carcinoma is locally aggressive neoplasm and requires total surgical excision with wide healthy margins while trichoepithelioma needs simple excision. We describe three patients who developed basal cell carcinoma with facial trichoepitheliomas. The only clinical feature that distinguished the carcinomas from the trichoepitheliomas was their larger size, in all three patients, one patient with recurrent, hyper pigmented swelling with surface ulceration and in another patient there are multiple trichoepitheliomas, and other family members are also affected. The history, clinical features and histopathological findings were suggestive of the evolution of basal cell carcinoma directly from trichoepithelioma in our first two cases, but in the third case TE and BCC were separate lesions on face and we are uncertain about whether the BCC developed independently or by transformation from a trichoepithelioma. Based on our clinicopathological observations in the three patients and reports in the recent literature, BCC with follicular differentiation and trichoepithelioma are considered to be highly related.

Multifocal Tumefactive Demyelination Mimicking Intracranial Neoplasm

Tom George, Soumya Cicilet, Ravi Hoisala, Prithilata Rout

Demyelinating disease presenting with clinical and radiologic features similar to a brain tumour is referred to as tumefactive demyelination. These lesions pose considerable diagnostic uncertainty. This is partly due to the atypical neurologic symptoms that the patient can present with as a consequence of the size, location, and potential for associated mass effect and oedema. The MRI appearance of these lesions can aid in preoperative diagnosis and assist with the final pathologic interpretation. We report a case of tumefactive demyelination where MRI played a vital role in arriving at a diagnosis. The diagnosis was confirmed histopathologically.

Low Level Laser Therapy in the Treatment of Intra-Osseous Defect- A Case Report

Smiti Bhardwaj, Joann Pauline George, Divakaran Remigus, Divya Khanna

Low level laser has been documented in literature to promote wound healing by reducing postoperative inflammation, oedema and reduces pain. This case report demonstrates the safe and positive outcome of LLLT in conjunction with demineralised bone matrix of bovine origin in the surgical treatment of a periodontal infrabony defect. After surgical defect debridement, low level semiconductor diode laser (GaAlAr) was delivered for 5 minutes to the inner margins of flap in contact mode and the defect was irradiated with LLLT in a non-contact mode for 10 minutes. Demineralised bone matrix graft was used as a bone grafting material. Repeat irradiation was done for the next 5 days on the outer buccal and lingual flap surfaces. A CAL gain of 4 mm and 37% bone fill was noted radiographically at end of 12 months. LLLT can be used as an adjunct to periodontal regeneration.

Infra–cardiac Total Anomalous Venous Connection to Portal Vein – Unusual Dynamic Hepatic Flow Phenomenon Demonstrated with MRI

Venkatraman S. Bhat

Functional information regarding fluid movement within the body can be derived by magnetic resonance methods. Some of the observations were overlooked in early days of magnetic resonance imaging (MRI) application. This presentation illustrates an unique, intra-hepatic haemodynamic phenomenon, demonstrated by magnetic resonance imaging, in a case of infra-cardiac Total Anomalous Pulmonary Venous Connection (TAPVC) Demonstration of such phenomena is unreported even after widespread use of cardiac MRI, although patho-physiology of such a phenomenon is expected in TAPVC. Brief explanation and possible basis of such observation in the context of current knowledge is discussed.

Primary Ovarian Malignant Mixed Mullerian Tumour: A Case Report and Brief Review of Literature

Malignant Mixed Mullerian Tumour of the Ovary (OMMMT), also referred to as carcinosarcoma is a very rare tumour accounting for less than 1% of all ovarian cancers. Due to the rarity of OMMMT, little is known about the disease course and outcome of women with these tumours. It is important to evaluate because of its aggressive behaviour with extremely unfavourable prognosis. These tumours are composed of both malignant epithelial and mesenchymal elements. Current data in the literature is still limited to small case series and case reports, therefore, its optimal treatment is somewhat controversial. In the current report, we introduce a case of OMMMT which was successfully treated with Platinum-based combination chemotherapy after optimal cytoreductive surgery. The clinical manifestations, pathologic characteristics, diagnosis and management of these tumours are reviewed here. Although the most effective treatment is currently unknown, optimal cytoreductive surgery and platinum-based chemotherapy appears to improve the outcomes. Despite the aggressive nature of this tumour and its poor response to the treatment, management works best when cancer is found early. The stage of the disease is the most important prognostic factor. Therefore, the crucial question is how to diagnose the cancer at earlier stages rather than seeking the optimal treatment.

Multiple Small Intestine Perforations after Organophosphorous Poisoning: A Case Report

Organophosphate poisoning has significant gastrointestinal manifestations including vomiting, diarrhea, cramps and increased salivation. We report an uncommon gastrointestinal complication of multiple small intestinal perforations following organophosphorus poisoning. A 28-year old male presented after ingesting dichlorvos mixed with alcohol. Following the initial cholinergic symptoms, the patient developed severe shock with fever, attributed to aspiration pneumonia. Despite appropriate antibiotics, shock was persistent. Over the next 24-hours, he developed abdominal distension, loose stools and high nasogastric aspirates. Computed tomography showed pneumoperitonium. Exploratory laparotomy revealed six perforations in the jejunum and ileum. The involved portion of the bowel was resected and re-anastomosed, following which only 80-cm of small bowel was left. Postoperatively, shock resolved over 72-hours. However, over the next few days, patient developed features of anastomotic leak. Since only a small portion of the small bowel was preserved, a conservative approach was adopted. He deteriorated further and finally succumbed to the illness.

Rhinosporidiosis of Parotid Duct Presenting as Consecutive Bilateral Facial Swelling: A Rare Case Report and Literature Review

Rhinosporidiosis is a chronic granulomatous infection caused by Rhinosporidium seeberi. Sporadic cases of rhinosporidiosis has been reported from many countries but is endemic in Southern India ( Madurai, Ramnad, Rajapalayam and Sivaganga), Nepal, Bangladesh and Sri Lanka. This disease commonly affects the mucous membrane of the nose or naso-pharynx and presents as a leafy, polypoidal mass. The reported extranasal sites include the oro-pharynx, eye, ear, larynx, trachea, bronchi, skin and genital mucosa. It may also become disseminated to present as a generalized form. In our case a 40-year-old female from rural West Bengal (Eastern India) presented with right sided facial swelling. Our provisional diagnosis was parotid duct cyst on the basis of careful history, scrupulous clinical examination and relevant investigations comprising CECT scan of face. Although Rhinosporidiosis was not taken into consideration in the clinical differential diagnosis, it was eventually diagnosed postoperatively by histopathological examination of surgical specimen. Two months later in follow-up, the same patient presented to us with left sided facial swelling. We managed the left facial swelling successfully with minimally invasive surgery and 100mg twice daily dapsone for 6 months. We present this case firstly because Rhinosporidiosis of parotid duct (stensen’s duct) is a rare entity and secondly non-neoplastic cysts of the salivary glands are also uncommon and represent only 2-5% of all salivary gland lesions. Furthermore our case emphasizes that the clinicians should aware of this rare clinical entity specially in endemic areas, because minimally invasive techniques and medications might solve the problem while helping patients to avoid surgical excision.

Non Operative Approach to Isolated Traumatic Pancreatic Duct Disruption

Sheshang U Kamath, Satish B Dharap

Management of isolated traumatic pancreatic duct disruption remains challenging due to associated morbidity and mortality. Two children with isolated pancreatic ductal disruption were treated conservatively. Both developed a pseudocyst which resolved spontaneously due to the atrophy of the distal pancreas in a five-year-old girl while remained persistent and was treated by endoscopic cystogastrostomy in an eight-year-old boy. Non-operative management may be pursued in patients with pancreatic ductal injury in the hope of a pseudocyst formation which may spontaneously resolve or may be treated later with a minimally invasive procedure. However, the literature review precludes its practice as a standard due to high incidence of associated complications of non-operative management.

Pathogenesis and Management of Hepatolithiasis: A Report of Two Cases

Hepatolithiasis or primary intrahepatic stones are prevalent in the Far-East countries such as Korea, Japan and Taiwan. It has been associated with helminthiasis, bacterial infections, environmental and dietary factors. Despite high prevalence of helminthiasis like ascariasis, poor environmental condition and low protein diet, India and Middle-East countries have a low incidence of hepatolithiasis. We report two cases of hepatolithiasis associated with bacterial infections and were surgically managed. The first case is a 45-year-old female presenting with upper abdominal pain and fever. She had multiple calculi in intrahepatic biliary radicles, common bile duct, common hepatic duct and gall bladder. She was managed by cholecystectomy, left lateral liver sectionectomy, choledochoscopy assisted stone clearance of the residual liver and Roux-en-Y hepatico-jejunostomy. The second case is a 60-year-old female presenting with epigastric pain and fever and past history of cholecystectomy for cholelithiasis. She had multiple right and left intrahepatic calculi and managed by left lateral liver sectionectomy with excision of CBD and Roux-en-Y hepatico-jejunostomy. Both the cases showed growth of bacteria in the culture of the intraoperatively collected bile.

Ileo-ileal Intussusception and Bowel Obstruction Caused by Plasmablastic Lymphoma of Small Bowel- A Rare Entity in Rare Location

Aditya Atul Kulkarni, Sanjiv S. Thakur

Intussusception of small bowel is considered a rare cause of bowel obstruction in adults accounting for only about 1% of bowel obstruction in adults. Intussusception in adults is uncommon with 95% cases of intussusceptions occurring in children. Adult intussusception from small intestinal lymphoma is also rare with only 36 cases reported in the literature between 2000 and 2011. Plasmablastic lymphoma (PBL) is an aggressive lymphoid neoplasm usually seen in the oral cavity in the clinical setting of human immunodeficiency virus (HIV) infection. Plasmablastic lymphoma of the small intestine is extremely rare. Here, we report a case of plasmablastic lymphoma of small bowel with ileoileal intussusception in an HIV-negative immunocompetent male patient.

An Arrow Poison (Abrus Precatorius) Causing Fatal Poisoning in a Child

MM Patil, SV Patil, AS Akki, Bhavana Lakhkar, Sharan Badiger

Ingestion of whole seeds of Abrus precatorius often does not produce serious illness. It generally presents initially with gastrointestinal manifestations. Haemolysis, acute renal damage, hepatotoxicity and seizures are the other manifestations. Herewith we report a child with accidental ingestion of abrus precatorius seeds who presented with altered sensorium and convulsions. The case is being reported on account of its rarity in its initial neurological manifestation and has not been reported earlier in paediatric age group.

Iatrogenic Pseudo–aneurysm of Profunda Femoris Artery Following Fixation of Intertrochanteric Femur Fracture – A Case Report and Review of Literature

The Profunda Femoris is a common site for arterial pseudo-aneurysms and these have been described in literature following fractures as well as orthopaedic procedures of the femur and hip region. These are an uncommon complication and a high index of suspicion is required for correct diagnosis and prompt management. We present a case of pseudo-aneurysm of the Profunda Femoris in an operated case of Intertrochanteric femur fracture with acute presentation. The case was managed successfully by angiographic coil embolization.

A Rare Case of Type IV Dual Left Anterior Descending Coronary Artery

Onur Baydar, Veysel Oktay, Ugur Coskun, Ahmet Yildiz, Tevfik Gurmen

Coronary artery anomalies are usually asymptomatic and associated with other cardiac malformations. Dual left anterior descending coronary artery (LAD) is an uncommon congenital anomaly with four subtypes. This anomaly has been described in the angiographic literature and dual LAD types depending on the origin of major septal and diagonal branches and course within the anterior interventricular sulcus. Type IV expresses the anomaly of a rudimentary LAD artery ending in the mid-portion of the anterior interventricular sulcus, and the presence of other LAD originating from the right coronary artery and continuing to the anterior interventricular sulcus. We report the rare case of a patient with the type IV dual left anterior descending coronary artery.

Isolated Complete Jejunal Transection After Blunt Abdominal Trauma: CT Imaging

Chetan Mehta, Raman G. Shingade, Juhi Patel, Gautami Parmar

Abdominal injury following road traffic accident is less common, compared to the extremities, head and chest. Bowel may get injured following blunt abdominal trauma, but perforation and complete transection is rare. Initial clinical examination may be unreliable, as signs of bowel injury may take some time to develop. Imaging plays a crucial role in the early and accurate diagnosis of bowel injuries. We report a case of 21-year-old male, who presented with severe abdominal pain, following a road traffic accident. Chest X-Ray was normal and abdominal ultrasound revealed intra-peritoneal free fluid with internal echoes. Contrast enhanced CT scan showed pneumoperitoneum and intraperitoneal free fluid with disruption in continuity of proximal jejunum along with signs of shock bowel and bowel ischemia. This report highlights the role of CT imaging in the prompt diagnosis of bowel transection following blunt abdominal trauma.

A Case of Hepatopulmonary Syndrome

P.B. Sriram, R. Sindhuja, M. Natarajan, P.S. Arul Rajamurugan, B. Palanikumar

We report the case of a 52-year-old female, a known case of Chronic Liver Disease with portal hypertension. She presented with dyspnoea, platypnoea, melena, cyanosis, clubbing and orthodeoxia. She had oesophageal varices and splenomegaly indicating portal hypertension. Her arterial blood gas revealed hypoxaemia and orthodeoxia. From this clinical background and investigation, a diagnosis of hepatopulmonary syndrome was made. Patient was managed conservatively as she was not willing for liver transplantation.

Familial Hepatocellular Carcinoma- First Reported Case from India

Smita Chandra, Anuradha Kusum, Harish Chandra, Kanika Yadav, Sanjiv Kumar Verma

Familial clustering of Hepatocellular Carcinoma (HCC) is commonly observed in various parts of the world including China and Eastern Asia where HBV is endemic while in western world, genetic factors and metabolic disorders may play an important role. In India, HCC is considered to be a rare tumour and till date no case of familial HCC has been reported here. Therefore the present case demonstrates rare occurrence of familial HCC which is being reported for the first time from India on cytology. The case also highlights an unusual feature that it was not associated with any risk factor including HBV, HCV infection, alcoholism, obesity, diabetes or smoking suggesting its independent association with genetic factors. Cytology is uncomplicated diagnostic tool for HCC and may be useful for its early diagnosis. This case also highlights the importance of early surveillance and follow up of blood relatives for every case of HCC so that early diagnosis and management of familial HCC is possible.

Fatal Haemoptysis Associated with Dramatic Response to Crizotinib in an ALK-Rearranged Lung Adenocarcinoma

The presence of an ALK (Anaplastic Lymphoma Kinase) rearrangement is a rare molecular feature in Non-Small Cell Lung Carcinoma (NSCLC), and concerns mainly non- or light smokers, young patients, with adenocarcinoma histological type. These tumours are particularly sensitive to Alk-targeted therapies, as crizotinib. Crizotinib is usually well-tolerated. We report a case of fatal haemoptysis associated with dramatic response to crizotinib in a patient with an ALK-rearranged lung adenocarcinoma. The patient presented a mediastinal invasion with tracheal involvement and compression of the right pulmonary artery. The initial evolution under crizotinib was good with tumour response. At 6 weeks of crizotinib the patient presented a massive haemoptysis with a tracheobronchial fistula and pneumomediastinum. She died of acute respiratory failure. Our case is the first to report a fatal effect of crizotinib associated with tumour necrosis and good tumour response on a massive mediastinal infiltration. Precautions are recommended with the use of crizotinib in proximal lung tumours with vascular invasion.

Limbus Vertebra Presenting with Inflammatory Low Back Pain: A Case Report

Serpil Tuna, Tayfun özdemir, Hande Ece Öz

Limbus vertebra is a condition characterized by marginal interosseous herniation of the nucleus pulposus, and causes non specific symptoms like low back pain, back pain, muscle spasms and radiculopathy. It is frequently confused with vertebral fracture, infection, schmorl nodule or tumour because it has not a spesific symptom. It usually causes mechanical low back pain rather than inflammatory low back pain. We reported a patient presented with inflammatory low back pain and diagnosed with anterior limbus vertebra because it is rare and the patient has atypical clinical presentation.

Periorbital Dirofilariasis: A Rare Case from Western India

Shubha Nagpal, Varsha Kulkarni

Dirofilariasis is a zoonotic disease caused commonly by Dirofilaria repens and Dirofilaria immitus. The definitive hosts are domestic dogs and cats. Human beings are accidental dead end hosts, and acquire infestation through mosquito bites. So far, very few cases have been reported from western India. We report a case of a 27-year-old male who presented with preseptal cellulitis right eye and a firm mass in the lower lid. Histopathological examination after surgical excision of the mass revealed a diagnosis of dirofilariasis. Although rare in Western India a diagnosis of dirofilariasis should be considered in cases of preseptal cellulitis associated with a periorbital mass.

A Novel Approach for the Retrieval of Broken Catheter Fragment – Using Balloon Dilatation Technique

In this era of an ever increasing number of interventions in cardiology, there is a parallel increase in the number of complications associated with these interventions, such as broken catheter tip and guide wire embolisation. The most commonly used and effective method for the percutaneous retrieval of such broken fragments is a goose neck snare. However in cases where this technique has been a failure, newer and novel innovations have been implemented for the retrieval of such broken fragments. We present a case of seven-year-old female child with a 3mm peri-membranous ventricular septal defect who was taken up for device closure. During the procedure the internal mammary catheter was broken in the left ventricle and subsequently the broken fragment was embolised to the left common carotid artery. The broken fragment was snared down upto the common iliac but could not be retrieved out of the sheath. A novel approach was used, consisting of negotiating a coronary guide wire across the broken catheter and inflating a balloon in the catheter fragment which helped to achieve a co-axial alignment with the arterial sheath and hence by which it was possible to retrieve the broken catheter fragment out of the circulatory system.

Duplication of Inferior Vena Cava with Associated Anomalies: A Rare Case Report

Pramod Shaha, Ashish Garg, Kulamani Sahoo, Nupoor Kothari, Pooja Garg

Duplication of inferior vena cava is an uncommon abnormality and is important in daily today practice for vascular surgeons, radiologist and urologist especially during retroperitoneal surgeries and treatment of thromboembolic disease. Radiologically, Duplicated IVC can be mistaken for lymphadenopathy or left pyeloureteric dilatation. Crossed fused kidney with a single ureter defy the embryological theory of ureteric bud crossing the opposite side and induce nephron formation associated anomaly of Duplication of inferior vena cava and malrotation of gut are not reported in a same patient. On meticulous search of literature no such combination of abnormalities has been reported. In this case report we bring forward this rare type of combination of three congenital malformations that is Duplication of IVC, crossed fused kidney and malrotation of gut.

Leriche Syndrome Presenting as Depression with Erectile Dysfunction

M.S. Bhatia, Priyanka Gautam, Rashmita Saha

Leriche syndrome results from thrombotic occlusion of the abdominal aorta immediately above the site of its bifurcation. Impotence in leriche syndrome is caused due to proximal obstruction, commonly involving isolated common iliac, internal iliac, internal pudendal or dorsalis penis artery. The symptoms of Leriche syndrome include intermittent and bilateral claudication, pallor, coldness and fatigue in lower extremities. Data regarding psychiatric morbidity in Leriche syndrome is unavailable. We hereby report the case of Leriche syndrome, presenting to psychiatry outpatient department with depressive disorder and erectile dysfunction (ED) with focus on dilemmas faced in the diagnosis and management in psychiatry.

Incidental Identification of Possible Delta-Beta Thalassemia Trait in a Family: A Rare Cause of Elevated Hb F.

B. Vinodh Kumar, Chidambharam Choccalingam, Premila Samuel

Delta-Beta thalassaemia is an unusual variant of thalassaemia with elevated level of foetal haemoglobin (HbF). The clinical presentation of delta-beta thalassaemia is mild in both heterozygote and homozygote cases. We hereby describe a rare cause of elevated Hb F in a father and his two daughters. A 52-year-old diabetic male patient, on evaluation of chromatogram of cation exchange HPLC for HbA1c, we incidentally identified elevated Hb F of approximately 20%. Haematological investigation of the patient revealed decreased haemoglobin, normal RBC, leucocyte and platelet count, decreased MCV and MCH. Red cell morphology showed predominantly normocytic normochromic cells with mild anisopoikilocytosis, few microcytes and hypochromic cells seen. His liver function test was normal. Haemoglobin variant analysis revealed decreased Hb A (79.4%), normal Hb A2 (2%) and increased Hb F (19.75%). A possible diagnosis of heterozygous dß-thalassaemia was considered. Since most laboratories perform HbA1c by cation exchange HPLC method, a careful evaluation of the chromatogram yields useful information. In our case, the elevated Hb F in a father and further careful evaluation of clinical and haematological parameters in the family members made us to possibly think of rare disorders like heterozygous Delta-Beta thalassaemia in the family and provide valuable genetic counseling.

Baroreflex Dysfunction in Prader Willi Syndrome

Manpreet Kaur, Shival Srivastav, Ashok Kumar Jaryal, Kishore Kumar Deepak

Prader-Willi syndrome is a classical hypothalamic insufficiency disorder. This syndrome is often associated with cardiovascular morbidity and mortality - which could probably be attributed to autonomic dysfunction. A 21-year-old Prader Willi syndrome patient was referred for cardiovascular and autonomic function assessment. We performed a battery of tests assessing vascular structure (carotid intima thickness), vascular function (arterial stiffness indices), baroreflex sensitivity (overall integrator of short term regulation of blood pressure), blood pressure variability and autonomic tone (heart rate variability) along with autonomic reactivity tests.We observed impaired baroreflex sensitivity along with orthostatic tachycardia with normal vascular function tests. Prader- Willi syndrome patient have baroreflex dysfunction with probable afferent and/ central autonomic neural defects.

Homicidal Cut Throat: The Forensic Perspective

Muditha Vidanapathirana, Jeewana C Samaraweera

The forensic pathologists have a challenging task during the ascertainment of the manner of death in cut throat injuries when presented with no proper history or witnesses. We report a rare homicide, where a person was killed by the father of his gay partner. A 51-year-old married man was found dead in his car on the driving seat at a road. There were blood stains on the dash board and windscreen. No weapon had been recovered. At autopsy, a deep, oblique, long incised injury was found on the front of the neck. There were no hesitant or defense injuries. The cause of death was cut throat. The findings were compatible with a homicidal cut throat by a right handed person from behind after head being restrained firmly. Findings were compatible with the history provided by the suspect.

Primary Paratesticular Lymphoma with Testicular Sparing: Account of an Unusual Scrotal Mass

Vidya Monappa, Ranjini Kudva, Satadru Ray

Tumours of the testicular adnexa include a heterogeous group of mesothelial, mesenchymal and germ cell tumours. Adenomatoid tumour, pseudosarcomatous myofibroblastic proliferations and rhabdomyosarcoma are the more frequently encountered neoplasms. Lymphoma/leukemic infiltration secondary to testicular involvement or primary tumour elsewhere is not unusual. However, Primary Para-Testicular Lymphoma (PPTL) involving spermatic cord and/or epididymis with sparing of the testicular parenchyma is extremely rare. Accurate staging and typing is crucial for effective management. We present a rare case of Diffuse Large B Cell Lymphoma (DLBCL) involving the left paratesticular tissue with testicular sparing in a young immunocompetant male patient.

Pancreatoblastoma an Unusual Occurrence of a Tumour in Paediatric Age Group: A Case Report

Pankaj Halder, Bedabrata Mukhopadhyay, Chhanda Das, Madhumita Mukhopadhyay

Pancreatoblastoma, is rare exocrine malignant tumour of childhood. We are reporting a case of three-year-old child presented to our hospital suffering from vague abdominal pain for further examination and treatment. Clinical examination revealed only a palpable abdominal mass. CT Scan revealed a huge complex space occupying lesion 9.1x8.8x9.2cm with large central cystic degeneration and lobulated enhancing peripheral solid components with foci of calcification, seem to arise from body and tail regions of pancreas. Surgery was done and mass was removed. By histopathology and immunohistochemistry it was diagnosed as pancreatoblastoma. The prognosis is very good in paediatric age, lacking evidence of metastatic disease at first presentation. Therefore early diagnosis is needed for specific treatment. The case is being reported because of its rarity.

Constitutional Mosaic Trisomy 13 in Two Germ Cell Layers is Different from Patau Syndrome? A Case Report

Fulesh Kunwar, Vidhi Pandya, Sonal R. Bakshi

The heterogeneous phenotype of known syndromes is a clinical challenge, and harmonized description using globally accepted ontology is desirable. This report attempts phenotypic analysis in a patient of constitutional mosaic trisomy 13 in mesoderm and ectoderm to make globally comparable clinical description. Phenotypic features (minor/major abnormalities) were recorded and matched with the Human Phenotype Ontology terms that were used to query web-based tool Phenomizer. We report here a case of 24-year-old girl born to non consanguineous parents with history of one abortion. Her phenotypic evaluation included short columella, low-set ears, seizures, enlarged naris, bifid tongue, infra-orbital fold, smooth philtrum, microtia, microcephaly, carious teeth, downslanted palpebral fissures, proportionate short stature, high palate, thin upper lip vermilion, small for gestational age, broad fingertip, broad hallux, mandibular prognathia and dental malocclusion. Karyotype and interphase FISH (Fluorescence in situ hybridization) was done in blood cells. Interphase FISH was also performed on buccal epithelial cells. Cytogenetic analysis demonstrated trisomy 13 mosaicism in 25% cells i.e. 47, XX,+13(9)/46,XX(27). The interphase FISH in blood cells showed trisomy 13 in 15%, whereas in buccal mucosa cells showed nearly 6%. Mosaic aneuploidy in constitutional karyotype can be responsible for variation in clinical and morphological presentation of patient with genetic disorder.

Fatal Nevirapine-Induced Toxic Epidermal Necrolysis in a HIV Infected Patient

Sabyasachi Paik, Sukanta Sen, Nikhil Era, Bibhuti Saha, Santanu Kumar Tripathi

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are the most Severe Cutaneous Adverse Reactions (SCARs) which mainly caused by exposure to drugs and having significant morbidity and mortality. TEN represents an immunologic reaction to a foreign antigen and is most often caused by drugs. Nevirapine (NVP), a non-nucleoside reverse transcriptase inhibitor (NNRTI) is an important component of Highly Active Antiretroviral Therapy (HAART). It is sometimes associated with life-threatening adverse reactions. Here, we report the fatal case of 72-year-old male who developed TEN secondary to intake of nevirapine. This fatal case report will increase awareness among treating physicians for careful monitoring of patients on NNRTI-based antiretroviral therapy and better counseling of the patient on NVP regimen for early identification and reporting of SCARs so that fatalities due to adverse drug reactions can be prevented with timely intervention.

Bilateral Simultaneous Tubal Ectopic Pregnancy: A Case Report, Review of Literature and a Proposed Management Algorithm

Bilateral simultaneous Tubal Ectopic Pregnancy (BTP) is the rarest form of ectopic pregnancy. The incidence is higher in women undergoing assisted reproductive techniques or ovulation induction. The clinical presentation is unpredictable and there are no unique features to distinguish it from unilateral ectopic pregnancy. BTP continues to be a clinician’s dilemma as pre-operative diagnosis is difficult and is commonly made during surgery. Treatment options are varied depending on site of ectopic pregnancy, extent of tubal damage and requirement of future fertility. We report a case of BTP which was diagnosed during surgery and propose an algorithm for management of such patients.

Metolazone Associated Stevens Johnson Syndrome-Toxic Epidermal Necrolysis Overlap

Prabhat Kumar, Ajay Chauhan, Riyaz Charaniya, Anindya Ghosh, Vaibhav Tandon

Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe mucocutaneous disease with high mortality rate. It is characterised by severe necrosis and detachment of the epidermis. Drugs are the most common triggering agent for SJS/TEN. These are commonly reported with the use of aromatic antiepileptics, antiretrovirals, allopurinol, NSAID’S and sulfonamide antibiotics. Non antibiotic sulfonamides rarely cause SJS/TEN. Metolazone is a well known diuretic and is extensively used by clinicians. Although this drug is in market for last several decades, no case of SJS/TEN has been reported till date. We report a rare case of metolazone induced SJS/TEN overlap in a 55-year-old lady.

Endometrial Cholesterol Granuloma Associated with Prolapsed Uterus- A Rare Case Report with Unusual Clinical Presentation

S. Sumathi

Cholesterol granuloma is a chronic inflammatory reaction to cholesterol deposition. It may develop in variety of sites including middle ear, mastoid process, para nasal sinuses, mediastinum, breast, testis and kidney. But endometrial cholesterol granuloma is a rarely reported case and is usually presented clinically as pyometra. This article reports a case of cholesterol granuloma in the endometrium associated with prolapsed uterus. In this case the patient clinically presented with urinary retention and overflow incontinence of urine. The reason of acute urinary retention in this case was pelvic fibrosis and adhesion secondary to this chronic inflammatory reaction. This was supported by the presence of pus like yellowish material over the uterine surface and pelvic adhesion, noted during surgery. Endometrial biopsy revealed cholesterol granuloma that confirmed the source of chronic inflammatory reaction and pelvic fibrosis.

Right Sided Sigmoid Colon and Redundant Loop of Descending Colon with Its Embryological Correlation and Clinical Significance

Pooja Bhadoria, Shahid Bahksh, Shilpi Agarwal, Babita Pangtey, Smita Kakar

Anatomical variations of colon are mostly developmental and can lead to variety of acute and chronic pathological conditions. So it becomes important to recognize and understand the importance of clinical implications of such anomalies to benefit surgeons, clinical geneticists and research community. We describe two cases of right sided sigmoid colon and long descending colon which had two segments: vertical and horizontal. The mesentery of ascending and descending colon was retained. This mesentery along with the mesentery of transverse colon was continuous with the mesentery of small intestine. There were variations in blood vessels supplying these anomalous colons. The findings of this study may be helpful to make surgeons and radiologists aware about different varieties of presentations while undertaking an investigative or surgical procedure in this area like sigmoidoscopy, percutaneous cecostomy and anterior transperitoneal aproach of kidney to avoid colon puncture.

Antisynthetase Syndrome: A Rare Cause for ILD

HJ Gayathri Devi, MD Majeed Pasha, Mantha Sathya Padmaja, Sujith Halappa

Anti-Synthetase Syndrome (ASS) is a rare autoimmune disorder characterized by Interstitial Lung Disease (ILD), inflammatory myositis, fever, Raynaud’s phenomenon, mechanics hand, and inflammatory polyarthritis in the setting of antibodies against amino acyl-transfer RNA synthetases, with anti-Jo-1 antibody being the most common. It can sometimes present as interstitial lung disease without any other expression of the syndrome. Clinical and radiological features can be similar to atypical pneumonia and could be a challenge to diagnose at an early stage. Prognosis is generally poor, especially when there is associated ILD and delay in diagnosis can lead to increase in morbidity due to progression of pulmonary involvement. We report a patient of ASS presenting with ILD, diagnosed early and treated successfully with immunosupression.

Tubercular Uveitis with Ocular Manifestation as the First Presentation of Tuberculosis: A Case Series

Jayashree S. Shah, Niharika Shetty, Sharath Kumar D. Shah, Neelesh kumar S shah

Tuberculosis is very common disease in India. It is one of the most common causes of Granulomatous Uveitis in our Country even today. So the strongest suspicion in our mind when we are treating a case of Uveitis, should be TB. We reviewed all the cases of clinically suspected ocular tuberculosis attending the Ophthalmology OPD of Sri Siddhartha Medical College between December 2012 and December 2014 who were refractory to routine uveitis management and later on responded to anti-Tubercular treatment. History of TB contact, Ocular manifestation, Demographic Profile of the patients, Diagnostic test, Treatment regime were looked into. Here by we present a case series of 15 cases of refractory uveitis that later were detected to be of tuberculous origin. We studied the characteristic features, complications and correlation of mantoux test, ESR and Kochs contact with these cases.

Candidal Infection of the Gingiva Mimicking Desquamative Gingivitis: A Case Report

There has been an increase in the occurrence of fungal infections in humans in the recent years due to the discrete use of broad spectrum antibiotics and immunosuppressive therapies. The genus candida is the most frequently found fungi in humans. Candida albicans is a mucosal microbiota although it can cause infections which can be mucosal or life threatening infections in susceptible individuals. Candidiasis is the most common oral opportunistic fungal infection in humans. Candidiasis usually affects oral mucosa (buccal mucosa) and hard palate. Candidiasis affecting gingiva is not so common, but when it occurs, it is often misdiagnosed as desquamative gingivitis because of its clinical appearance. This paper discusses a case of Candidal infection of gingiva that mimics desquamative gingivitis.

A Case Report of Dyschromatosis Universalis Hereditaria (DUH) with Primary Ovarian Failure (POF)

N.S Jayanthi, V. Anandan, W. Afthab Jameela, V. Senthil Kumar, P. Lavanya

Dyschromatosis Universalis Hereditaria (DUH) belongs to a group of congenital diffuse reticulate pigmentary disorders characterised by both hypo and hyper pigmented macules. It is both hereditary and sporadic. A number of associated cutaneous and systemic diseases have been reported. The recent discovery of the mutation in ATP binding cassette protein, ABCB6 in DUH attempts to explain the reason behind the pigmentary abnormalities and varied associations. We add a new association by reporting a case of DUH with primary ovarian failure (POF) and hypothyroidism.

A Case of Reverse Palmaris Longus Muscle- An Additional Muscle in the Anterior Compartment of the Forearm

It is uncommon to have additional muscles in the upper limb. Some of them may restrict the movements or compress the nerves and vessels, while others may go unnoticed. During the routine dissection for undergraduate medical students, we observed an additional muscle in the anterior compartment of the forearm in about 60-year-old male cadaver. The muscle had a prominent belly and a long tendon. Distally, it was attached to the flexor retinaculum by a short and thick tendon. Proximally, long tendon of the muscle passed between the flexor carpi ulnaris and palmaris longus and was attached to the common aponeurosis shared by the extensor carpi ulnaris and flexor digitorum profundus muscles. The additional muscle belly was supplied by a branch from the anterior interosseous nerve. The ulnar nerve and artery was passing deep to the fleshy belly of the muscle. The muscle reported here might compress the ulnar nerve and artery and may produce neurovascular symptoms. On the other hand, the tendon and fleshy belly of the muscle could be useful in muscle/tendon grafts. The observations made by us in the present case will supplement our knowledge of variations of the muscles in this region which could be useful for surgeons during the forearm and hand surgeries.

A Fatal Case of Acute Myeloid Leukaemia—Methotrexate Related or Primary Autoimmune Disease Related: A Rare Case Report

Saurabh Agarwal, Nidhi Kaeley, Priyanka Gupta, Vibha Gupta, Rohan Bhatia

Methotrexate is being used for many years in the treatment of chronic medical disorders e.g. rheumatoid arthritis since 1951. It has been associated with various systemic toxicities and complications including bone marrow suppression and lymphomas. The development of leukaemia in a patient of chronic rheumatoid arthritis is either related with the primary disease or due to the drugs which are used in the treatment like cyclophosphamide. In our present case, a 70-year-old female who was a known case of Rheumatoid Arthritis (RA) and was on methotrexate once a week orally for the past 20 years presented with complaints of loss of appetite, loss of weight and anaemia since 2 months. After thorough examination and investigation, she was diagnosed with acute myeloid leukaemia (AML-M4) with bilateral chest consolidation.

Incidental Finding of Ebstein's Anomaly in an Adolescent with an Upper Respiratory Infection: A Case Report

Rohit Kapoor, Premila Paul, Premchand Anne

Ebstein’s anomaly is a rare congenital heart disorder and has a varied clinical course, with detection as late as the seventh decade. We hereby describe an 11-year-old child in whom Ebstein’s anomaly was diagnosed. The most common presentation in early second decade is due to an arrhythmia; however, the present case report is about a patient who presented with acute congestive heart failure due to decompensation from an acute upper respiratory tract infection, which is a rather uncommon presentation.

Pleomorphic Adenoma of Minor Salivary Gland Arising de novo in the Parapharyngeal Space- A Rare Case Report

Rahul Laturiya, Jendi Shoeb Kasim, Ajit Suryakant Jankar, Syed Ahmed Mohiuddin

Parapharyngeal space tumours are rare. Pleomorphic adenoma is the commonest salivary gland tumour that is found in this space. This tumour may arise in the deep lobe of parotid gland and extend into the parapharyngeal space or may arise de novo from the aberrant minor salivary glands in parapharyngeal space. The latter entity is an extremely rare finding. CT scan and fine-needle aspiration cytology form the important diagnostic tools in case of these tumours. Surgery is the mainstay for the treatment of these tumours. The strategic location and also the extension of these tumours may at times demand to alter the surgical procedure for their excision. This article presents a case of a 27-year-old female, who presented with a mass in the right submandibular region that was excised successfully using transcervical approach in conjunction with transoral approach without mandibulotomy. The biopsy report suggested it to be “pleomorphic adenoma of minor salivary gland”.

Co-existence of Endometriotic Cyst of the Ovary and Arias-Stella Reaction in a Non-Pregnant Woman: Report of a Rare Case

Endometriosis is defined as presence of endometrial tissue outside the uterus. It can occur anywhere in the ovary. In the ovary it is usually presented as cyst, termed as endometriotic cyst or Chocolate cyst. Arias-Stella reaction is usually seen in gestational endometrium or in ectopic gestation site and rarely in non-pregnant uterus with hormonal intake. Co-existence of endometriosis and Arias-Stella reaction is very rare. We present a very rare case of endometriotic cyst of the ovary exhibiting Arias –Stella reaction which was seen in of non pregnant patient without any history of hormonal intake.

Sporotrichosis of Maxillary Sinuses in a Middle Aged Female Patient from Rural Area of Eastern India

Sporotrichosis is commonly a chronic infection caused by Sporothrix schenckii, a saprophytic fungus and is usually limited to cutaneous and subcutaneous tissues. Disseminated systemic, osteoarticular or pulmonary sporotrichosis have been reported but nasal sinusitis by this fungus is extremely infrequent. Earlier report from southern India documented a case of maxillary sinusitis by Sporothrix schenckii. Here we report a similar case of bilateral maxillary sinusitis in a middle aged female from a village of Bihar, a state in eastern India. She underwent endoscopic maxillary sinus surgery for nasal symptoms and diagnosed to have sporotrichotic infection of maxillary sinuses. The diagnosis was done by mycological and histopathological examination and patient improved under antifungal chemotherapy.

Traumatic Optic Neuropathy – A Conundrum

Vinoth Kanna Selvaraj, Ramachandran Viswanathan, Vasudevan Devanathan

Visual impairment following head injury may be an enigma especially if the onset of symptoms were to be few days after the actual trauma and the bias arising out of the initial normal ophthalmological examination is not neutralised by unbiased repeated formal clinical evaluation aided with electrophysiology. We report and discuss here a 32-year-old lady with delayed onset of indirect traumatic visual loss with anaemia who failed to improve after blood transfusion but improved immediately following steroid therapy seven days after trauma. Though steroids have not been shown to have a significant contribution on outcomes following Traumatic optic neuropathy, this report rekindles its role in delayed progressive visual loss following head trauma and the need to re-analyse the role of steroids in patients with delayed progressive visual disturbance following head injury excluding those with acute onset symptoms in view of different pathologies in both these presentations. This paper also highlights potential mechanisms for the two major types of presentation.

Imperforate Anus with Fistula Exiting at the Penile Skin

We present the case of a male neonate with imperforate anus and a fistula exiting on the penile skin. Anorectal malformations in boys often present themselves with an entero-perineal or entero-urinary tract fistula, the type of which is a key feature for the classification and the treatment plan. A fistula exiting in front of the scrotum, such as described in our case, is very rare and is not incorporated in the current classification and treatment algorithms. Scarce reports on misjudgment concerning the position of the blind rectal pouch in similar cases, led us to perform a colostomy instead of a one-stage correction. A posterior sagittal anorectoplasty was performed eight months later and the rectal pouch was found inside the levator sling, justifying the cautious approach. The colostomy was closed three months later and after six months the distal part of the fistula was excised. We believe that in cases with a rare fistula presentation, the position of the rectal pouch is not predictable and the surgeon should proceed with caution.

An Unusual Course and Termination of Small Saphenous Vein: A Case Report

Prakashchandra Shetty, Melanie Rose D’Souza, Satheesha B. Nayak

The superficial veins of the lower limb can vary in their course and termination. We report a relatively rare type of variation in the course and termination of small saphenous vein. The small saphenous vein had normal origin and course in the leg. However, instead of terminating into the popliteal vein, it continued up in the posterior compartment of the thigh and terminated into the femoral vein after piercing the fleshy part of the adductor magnus muscle. This course might lead to varicosity of the small saphenous vein due to the compression by the fleshy fibres of adductor magus near its termination. The case may be of interest to general and plastic surgeons and even cardiothoracic surgeons.

Nescient Aetiology of Splenic Laceration – An Enigma Unveiled

Saraswathy Sreeram, Hanaganahalli B Sridevi, Urmila N Khadilkar, Deepa Adiga

Malaria is a common endemic disease prevalent in developing countries like India that presents with wide spectrum of clinical symptoms and complications. Splenic rupture is an uncommon but life-threatening complication which can be either spontaneous or as a result of trauma. We present a case of 50-year-old man with left upper quadrant pain following a polytrauma. Based on the radiological evidence of laceration and rupture of markedly enlarged spleen, emergency splenectomy was performed. Postoperative haematological evaluation established the co-infection of Plasmodium falciparum and vivax with high parasitaemia and marked thrombocytosis. The incidences of splenic rupture due to malaria are under-reported. In endemic areas, the management of splenic rupture in malaria should be focused on splenic preservation, thereby reducing the risk of future attacks of malaria in those patients who are highly susceptible to Plasmodium species and also reducing the incidence of overwhelming sepsis.

Disseminated Histoplasmosis with Haemophagocytic Lymphohistiocytosis in an Immunocompetent Host

Haemophagocytic lymphohistiocytosis (HLH) is a devastating syndrome due to uninhibited immune activation. Disseminated histoplasmosis is a rare cause of HLH. There have been few case reports and series demonstrating a relation between the two disease entities in immunosuppressed hosts. HLH secondary to disseminated histoplasmosis is even rarer in an immunocompetant host. We report a rare case of HLH triggered by disseminated histoplasmosis in an immunocompetant patient.

MRI 3D CISS – A Novel Imaging Modality in Diagnosing Trigeminal Neuralgia – A Review

Radhika Besta, Y. Uday Shankar, Ashwini Kumar, E. Rajasekhar, S. Bhanu Prakash

Trigeminal Neuralgia (TN) is considered as one of the most painful neurologic disorders affecting oro-facial region. TN is often diagnosed clinically based on the patients complete history of pain (severity, duration, episodes etc), relief of pain on test dose of Carbamazepine, regional block of long acting anaesthetic. However, Magnetic Resonance Imaging (MRI) plays an important and confirmatory role in showing Neuro Vascular Conflict (NVC) which is the commonest causative factor for TN. This article reviews the effectiveness of three-dimensional constructive interference in steady-state (3D-CISS) MRI in diagnosing the exact location, degree of neurovascular conflict responsible for classical as well as atypical TN and possible pre-treatment evaluation and treatment outcome.

Diagnostic Methods for Detection of Cotinine Level in Tobacco Users: A Review

Mitali Raja, Aarti Garg, Pramod Yadav, Kunal Jha, Sahil Handa

The greatest disease-producing product known to man is tobacco. It is a cause of many oral diseases and adverse oral conditions. In India, tobacco is available in smokeless and smoking form. Tobacco contains nicotine which metabolises to form a toxic alkaloid i.e. cotinine. It stimulates autonomic ganglia and central nervous system. Cotinine is the best indicator of tobacco smoke exposure. Various methods are used to measure cotinine level in blood, saliva and urine such as high performance liquid chromatography, colorimetric assay, gas chromatography, NicAlert saliva test, etc. Thus such wide range of methods for cotinine detection in tobacco users requires a detailed discussion regarding their utility. This review will help readers to compare various methods for cotinine detection and enable them to make scientifically informative decision.

Prime Drug Interplay in Dental Practice

Sumedha Mohan, Vivek Govila, Ashish Saini, Sunil Chandra Verma

Drug interaction is a negative representation of pharmacotherapy. In order to provide the best patient care possible, a thorough knowledge of how the drug interactions occur is needed for proper application in practice. Possible interactions among current medication and drugs being prescribed should be considered always. A thorough understanding of the mechanism of interactions among drugs is a must for the health care practitioner. Considering the astounding number of drugs patients may be taking, this task seems discouraging. The count of possible interactions in dental practice are less due to few number of drugs utilized and brief period of therapy, but still notable number are to be considered. The aim of present preview is to consider the manifold and multiplex nature of pharmacological drug-drug interaction in the general dental practice setting.

Bacterial Heat Shock Protein Activity

Farajollah Maleki, Afra Khosravi, Ahmad Nasser, Hamid Taghinejad, Mitra Azizian

Bacteria are exposed to different types of stress in their growth conditions. They have developed appropriate responses, modulated by the re-modeling of protein complexes and by phosphorylation dependent signal transduction systems, to adapt and to survive in a variety range of nature. Proteins are essential components for biologic activity in the eukaryotic and prokaryotic cell. Heat Shock Proteins (HSP) have been identified from various organisms and have critical role in cell hemostasis. Chaperone can sense environment and have different potential role in the organism evolution.

Dental Informatics in India: Time to Embrace the Change

Dental informatics is comparatively a juvenile and new field that has noteworthy potential for supporting clinical care, research, education and management. This field utilizes computer science, information sciences and the application of same to espouse dentistry. However, in the under-developed and developing countries almost most of the dentists are unacquainted about dental informatics, its goals, what it is capable of achieving and by what means they can get involved into it. Despite of emerging advances, certain conflicts also go along with it such as, professional under representation, security issues of the stored information due to universal access to computers high speed internet connections. Endnote software was used as resource material to collect literature which was carefully arranged in a synchronized way. Hence, the purpose of this review was to give an overall scenario of dental informatics, its applications, challenges and recommendations for further enhancement in this area.

Cell Culture, Technology: Enhancing the Culture of Diagnosing Human Diseases

Shuaibu Abdullahi Hudu, Ahmed Subeh Alshrari, Ahmad Syahida, Zamberi Sekawi

Cell culture involves a complex of processes of cell isolation from their natural environment (in vivo) and subsequent growth in a controlled environmental artificial condition (in vitro). Cells from specific tissues or organs are cultured as short term or established cell lines which are widely used for research and diagnosis, most specially in the aspect of viral infection, because pathogenic viral isolation depends on the availability of permissible cell cultures. Cell culture provides the required setting for the detection and identification of numerous pathogens of humans, which is achieved via virus isolation in the cell culture as the “gold standard” for virus discovery. In this review, we summarized the views of researchers on the current role of cell culture technology in the diagnosis of human diseases. The technological advancement of recent years, starting with monoclonal antibody development to molecular techniques, provides an important approach for detecting presence of viral infection. They are also used as a baseline for establishing rapid tests for newly discovered pathogens. A combination of virus isolation in cell culture and molecular methods is still critical in identifying viruses that were previously unrecognized. Therefore, cell culture should be considered as a fundamental procedure in identifying suspected infectious viral agent.

Myocardial Salvaging Effects of Berberine in Experimental Diabetes Co-Existing with Myocardial Infarction

Introduction: Berberine, an isoquinoline alkaloid isolated from the Berberis aristata, has been shown to display a wide array of pharmacological activities (hypoglycaemic and hypolipidemic). Aim: The present study was designed to investigate whether these pharmacological properties translate into the cardioprotective effects of Berberine in the setting of diabetes mellitus. Materials and Methods: Necessary approval from the Institutional Animal Ethics Committee was taken for the study. Experimental diabetes was produced with single dose of Streptozotocin (STZ): 45mg/kg ip and myocardial infarction was induced by administering Isoproterenol (ISP): 85mg/kg, sc to rats on 35th & 36th day. After the confirmation of diabetes on 7th day (>200mg/dl), Berberine (100 mg/kg) was administered orally to experimental rats from day 8 and continued for 30 days thereafter. Various anti-diabetic (Glucose, HbA1c), cardioprotective (CPK-MB), metabolic (lipid profile), safety {liver function (SGPT, kidney function (Creatinine)} and histopathological indices of injury were evaluated in Healthy Control, Diabetic Control and Berberine treated groups. Results: Administration of STZ-ISP resulted in a significant decrease in body weight (p<0.001), diabetic changes (increase in blood glucose, HbA1c), cardiac injury (leakage of myocardial CPK-MB), altered lipid profile, SGPT, creatinine levels (p<0.001) in the diabetic control group rats as compared to healthy control. Berberine treatment demonstrated significant antidiabetic as well as myocardial salvaging effects as indicated by restoration of blood glucose, HbA1c and CPK-MB levels (p<0.001) compared to diabetic control group. In addition, Berberine favourably modulated the lipid parameters (total cholesterol, triglycerides, HDL, LDL). Subsequent to ISP challenge, histopathological assessment of heart, pancreas and biochemical indices of injury confirmed the cardioprotective effects of Berberine in setting of diabetes. In addition, Berberine was found to be safe to the liver and kidney. Conclusion: Berberine treatment produced myocardial salvaging effects in the setting of diabetes challenged with ISP induced myocardial necrosis. Cardioprotection may be attributed to anti-diabetic and hypolipidemic activities.

Antioxidant and Nephroprotective Activities of Aconitum heterophyllum Root in Glycerol Induced Acute Renal Failure in Rats

Aim: The present study was to evaluate the antioxidant and nephroprotective activities of ethanolic extract of Aconitum heterophyllum root (EEAHR) in glycerol induced acute renal failure (ARF) in Wistar albino rats. Materials and Methods: In vitro antioxidant activity of EEAHR was assessed using the 2, 2-diphenyl-picrylhydrazyl (DPPH assay), nitric oxide radical scavenging (NO assay), hydrogen peroxide (H2O2 assay) and ferric reducing antioxidant power (FRAP) scavenging activity assays. In vivo study, rats were divided into four groups of six each for assessing the nephroprotective activity. Group-1 received normal saline, group-2 received 50% glycerol (10 ml/kg) alone, group-3 received glycerol and 250 mg/kg of EEAHR and group-4 received glycerol and 500 mg/kg of EEAHR. The renal injury and recovery was measured by serum creatinine, blood urea nitrogen (BUN), total proteins, albumin, urine output and histopathological changes. Results: In vitro antioxidant activity of root extract was found to be equal to Vitamin C and in an in vivo study root extract treated animals showed significant attenuation of biochemical parameters and histopathological changes of the kidney compared to glycerol treated group and it was found to be more significant with the extract at 500 mg/kg than 250mg/kg. Conclusion: The present study revealed that Aconitum heterophyllum root has shown antioxidant and nephroprotective activities.

In Vivo Evaluation of Anti Diabetic, Hypolipidemic, Antioxidative Activities of Saudi Date Seed Extract on Streptozotocin Induced Diabetic Rats

Marghoob Hasan, Abdelmarouf Mohieldein

Introduction: Phoenix dactylifera (date palm) is major fruit of gulf region. In folk medicine; dates have been traditionally use. The date seed is used as hypoglycaemic, expectorant, tonic, aphrodisiac, antidiarrheic and mouth hygiene. Aim: This study intended to evaluate the anti-diabetic, hypolipidaemic and antioxidative activities of date seed extract in diabetes-induced rats. Materials and Methods: Total of seven groups of rats, consisting of control rats and streptozotocin induced diabetic rats treated with aqueous seed extract in concentration of 100g/L in dosage of 10ml/day/rat. To evaluate the anti-diabetic property, glucose and weight was analysed weekly and at the end of eight week all rats were sacrificed. To evaluate the hypolipidaemic and antioxidative activities, serum cholesterol, triglyceride, malondialdehyde, superoxide dismutase, 8-hydroxy-2-deoxyguanosine were estimated. Liver enzymes and kidney function tests were performed. Moreover to verify the glycaemic effect; glycated haemoglobin and serum insulin was performed. Results: Aqueous seed extract in concentration of 100 gm/L in dosage of 10ml/day/rat brings a significant reduction of blood glucose levels in diabetic rats in comparison of control rats. There were significant differences in the investigated clinical chemistry and oxidative stress parameters between control and diabetic rats with both seed extract of Ajwa and Sukkari dates. Conclusion: Present study verifies the antidiabetic property, of aqueous seed extracts of two different varieties of dates namely Ajwa and Sukkari of Kingdom of Saudi on streptozotocin induced Diabetic rats. Prolong treatments with the extract restores the function of liver and kidney and balance the oxidative stress condition in diabetic treated rats.

Selective Serotonin Re-uptake Inhibitors (SSRIs) Induced Weight Changes: A Dose and Duration Dependent Study on Albino Rats

Alka Aggarwal, S.L. Jethani, R.K. Rohatgi, Juhi Kalra

Introduction: Selective Serotonin Re-uptake Inhibitors (SSRIs) are the most significant and safe drugs among the antidepressants. Fluoxetine is the prototype drug of SSRIs. Various clinical studies showed that SSRI causes change in body weight in patients. This study was conducted to know the extent of weight change with different doses for different durations. Aim: The aim of this study was to find out whether fluoxetine causes weight gain or weight loss, and to deduce the comparative weight change after intraperitoneal injection of fluoxetine for different duration and doses. Materials and Methods: Present study was conducted on 72 adult (36 males and 36 females) albino rats, in 3 phases of 2 weeks, 4 weeks and 12 weeks duration. Each phase consisted of 24 (12 males and 12 females) albino rats. These 24 rats were further randomly subdivided into 4 Groups of 6 albino rats each (3 males & 3 females). Group 1(Control) received normal saline (vehicle). Rest 18 rats of each phase were experimental rats, of Group 2, Group 3 and Group 4 (6 rats each). Group 2, group 3 and group 4 experimental rats received 10mg/kg, 20 mg/kg and 40mg/kg of intraperitoneal injection of fluoxetine respectively. All rats were weighed on each day for growth monitoring. Data was subjected to statistical analysis (Mean, standard deviation and Student’s t-Test). Results: All experimental group rats which received fluoxetine showed decrease of body weight. Rats which received high doses of fluoxetine could not tolerate the drug for more than two weeks and died due to excessive body weight loss, loose stools and muscle twitching. Conclusion: Present study conclude that SSRIs can cause weight change in the form of decrease of body weight. This property of SSRIs can be used clinically by prescribing these drugs to obese psychiatric patient without any fear of withdrawal of drug.

Heart Rate Changes in Electroacupuncture Treated Polycystic Ovary in Rats

Simple and Efficient Technique for Correction of Unilateral Scissor Bite Using Straight Wire

Unilateral scissor bite is a relatively rare malocclusion. However, its correction is often difficult and a challenge for the clinician. This article presents simple and efficient technique for the correction of severe unilateral scissor bite in a 14 year old boy, using 0.020 S.S. A. J. Wilcock wire (premium plus) out of the spool, with minimal adjustments and placed in mandibular arch. After about six weeks time, good amount of correction was seen in the lower arch and the lower molar had been relieved of scissor bite.

Surgical Management of Ectopic Kidney with Bilateral Iliac Vein Invasion

Renal cell carcinoma (RCC) is a very rare phenomenon in an ectopic kidney. We come across a 61-year-old gentleman with a history of 2 months of gross, painless haematuria and palpable pelvic mass on examination. CT scan showed 6.5cm X 5.1cm X 5.8cm mass in pelvic kidney with bilateral iliac vein invasion. With the help of intra-operative ultra-sound, tumour thrombus was extracted from both iliac veins with en mass removal of tumour. Patient was well intraoperatively as well as in postoperatively. We also presented an elegant imaging for the case.

Maxillary Incisor with Internal Resorption: Endodontic and Restorative Management

Alberto Dagna

Adult Wilms’ Tumour

Amit Sharma, Irfan Shaikh, Radhyeshyam Chaudhri, Mukund Andankar, Hemant Pathak

Intestinal Volvulus: A Life- Threatening Disease

Mohammed Y Hasosah, Wael I Meer, Khalid AlSaleem

An Inquisitive Case of Transient Corneal Oedema

Bijnya Birajita Panda, Sucheta Parija, Susanta Pujahari, Jyotiranjan Mallick

Gist Jinx – A Rare Case of Acute Massive Life Threatening Bleed from a Jejunal Gastro–Intestinal Stromal Tumour

Innovative Method of Conservative Aesthetic Treatment for Gingival Recession

Deepti Dhingra, Ashok kumar Gupta, Harmeet Singh

Impacted Central Incisor with Dilacerated Root-Treat with Ease

Navneet Singh, Tulika Tripathi, Priyank Rai, Shilpa Kalra, Neha

Anticoagulation for Atrial Fibrillation after Resolution of Dengue Haemorrhagic Fever

Henrique Horta Veloso

A Rare Cause of Sudden Onset- Severe Metabolic Acidosis in Paediatric Surgical Patients- Organic Acidemia

vipin kumar singh, rajeev ratan singh yadav

Are the Newer Antidiabetic Agents Worth the Cost?

Correspondence: Acute Lymphoblastic Leukaemia and HbE-alpha Thalassaemia

Sora Yasri, Viroj Wiwanitkit

Correction: 2016 Jan: 10(1)): ZJ02-ZJ03.

Dhanya S. Kumar, Devaki Murugesan, Kandasamy Murugan, Divya Subramanian, S. Uma Maheshwari,Crouzon Syndrome: Report in a Family (Published in Journal of Clinical and Diagnostic Research. 2016 Jan: 10(1)): ZJ02-ZJ03. In this article Table/Fig-2 has been changed with Table/Fig-3 and Table/Fig-3 has been changed Table/Fig-2, but legends are same.

Rare Hernias Presenting as Acute Abdomen- A Case Series

Hernia is an abnormal protrusion of an organ or tissue through a defect in its surrounding walls. It can be divided into internal, external and diaphragmatic hernias. Most of them can be asymptomatic. If they become symptomatic they can present with features of intestinal obstruction, incarceration or strangulation. In this case series we compare the incidence of these rare presentations of hernias with world literature and to warn surgeons not to cut the obstructing band in cases of internal hernias. In this case series, we review the clinical details of 7 rare presentations of hernia, who presented with various types of hernias to a tertiary care centre in Kerala over a period of one year. Of these 7 cases 6 cases were internal hernias (3 left paraduodenal hernias, 2 transmesentric hernias, and 1 pericaecal hernia) and a case of spigelian hernia above the level of umbilicus. All of them presented as acute abdomen in the emergency department. Among these 7 cases, only one case was diagnosed preoperatively. Three patients had bowel gangrene and had to undergo resection- anastomosis of the bowel. The survival rate among these cases was 100% as compared to 50% in the world literature if they had been left untreated. Even though internal hernias are a rare entity, we need to have it as a differential diagnosis in case of intestinal obstruction, in a previously non-operated abdomen.