Journal of clinical and diagnostic research

Nasal NK/T Cell Lymphoma Presenting with Perforation of Palate: A Case Report and Review of Literature

Nasal Natural Killer (NK)/T cell lymphoma, commonly mentioned in the literature as Lethal Midline Granuloma (LMG) is an unusual pathology of the oro-maxillo-facial region characterized by aggressive and progressive destruction of the face, nose, palate and pharynx. This disease is now classified as a T-cell lymphoma based on modern cytogenetics, immunologic and molecular studies. However, it is mentioned in various literatures by various names. Here, we present one such clinically diagnosed, histopathologically and immunologically confirmed case of LMG, designated as NK/T cell lymphoma in a 56-year-old male. The uncommon presentation of NK/T cell lymphomas should be kept as a differential diagnosis for management of patients.

Fat Free Pleomorphic Lipoma of Oral Cavity: A Rare Entity

Pleomorphic lipoma is a rare, benign, soft tissue neoplasm that characteristically occurs as a subcutaneous mass in the posterior neck or upper back and rarely in the tonsillar fossa and oral cavity. Histologically, pleomorphic lipoma contains varying amounts of mature fat, areas of spindle and pleomorphic cells, floret giant cells and thick rope – like collagen in a myxoid stroma. Pleomorphic lipoma with scanty fatty elements is called the fat free variant of pleomorphic lipoma. The combination of meagre amount of fat and presence of pleomorphic elements gives a pseudosarcomatous picture under the microscope leading to misdiagnosis and over treatment. Here, we report a case of fat free pleomorphic lipoma, first of its kind in the oral cavity and discuss the diagnostic features and differential diagnosis.

Fibroadenoma in Axillary Ectopic Breast Tissue Mimicking Lymphadenopathy

Pooja Kamlesh Gajaria, Ujwala M Maheshwari

Swellings in the axilla especially in women are always viewed with suspicion owing to a large number of these being associated with breast carcinoma presenting as nodal metastasis. In a country like India, tuberculous lymphadenopathy is also amongst the first differentials. We present a case of a woman with right sided axillary swelling mimicking lymphadenopathy which on Fine Needle Aspiration Cytology (FNAC) turned out to be fibroadenoma of the ectopic breast tissue. This condition is a rare occurrence in Ectopic Breast Tissue (EBT) as opposed to that in the normal breast, the most common pathology affecting ectopic breast being carcinomas.

Statin Induced Rhabdomyolysis with Non Oliguric Renal Failure: A Rare Presentation

Hashir Kareem, Devavrata Sahu, Mugula Sudhakar Rao, Tom Devasia

Statins are safe, well tolerated, efficient and time tested drugs for the management of hypercholesterolemia, and thus play a cardinal role in the management of patients with heart disease. Although safe in clinical practice, they are associated with adverse effects, clinically the most important and most severe being muscle related complications/myotoxicity. Rhabdomyolysis, though rare, is the most severe form of myotoxicity. The US Food and Drug Administration (USFDA) adverse event reporting system reports rate of statin induced rhabdomyolysis at 0.3-13.5 cases per 1,000,000 patients. We present a case of a 74-year-old male who presented with an acute coronary syndrome and was initiated on atorvastatin. However, patient developed atorvastatin induced rhabdomyolysis, with non oliguric renal failure, which subsequently improved on cessation of medication.

Light Chain Myeloma induced Severe Hypertriglyceridemia

Hyperlipidemia is very common in general population and incidence has further increased in recent years. Evaluation of patient presenting with lipid disorders is essential to obtain a definite diagnosis to prevent complications, and apply the most appropriate treatment. An isolated elevation in triglyceride levels may be caused by a primary disorder of lipid metabolism like familial hypertriglyceridemia. It may also arise secondary to a number of conditions like diabetes mellitus, alcohol intake, hypothyroidism, drugs, infections and nephrotic syndrome. Herein, we describe a case of secondary hypertriglyceridemia leading to Nonalcoholic Steatohepatitis (NASH) in a young female which was attributed to Multiple Myeloma (MM). Significant reduction in triglyceride levels after starting anti-myeloma therapy established their relation. This is the first case of light chain myeloma causing severe secondary hypertriglyceridemia.

A Giant Cutaneous Horn Projecting from Verrucous Carcinoma of Buccal Mucosa: A Rare Case Report

Priyankar Singh, Dipesh Nathani, Shashi Ranjan, Rashmi Issar

Cutaneous horn is conical shape of compact keratin that resembles a miniature animal horn. Though morphologically similar to horns in animals they are histologically very different from them. It is a circumscribed, conical, hyperkeratotic dense protrusion with epithelial cornification above the skin surface in response to a wide range of underlying benign and malignant pathological changes. Though benign, a cutaneous horn holds the potential to be premalignant or malignant. In India till now six cases has been reported with cutaneous horn at various unusual sites. We report a unique case of 52-year-old woman with a giant cutaneous horn at left oral commissure with underlying verrucous carcinoma of left buccal mucosa which is a very rare location for such lesion. Considering its malignant potential, adequate therapy requires wide excision with a tumour-free margin of at least 1 cm, particularly in the facial region where the incidence of malignancy is higher.

Patent Vitellointestinal Duct with Patent Urachus Presenting as Umbilical Discharge

Darshanjit Singh Walia, Anand Singla, Deeksha Singla, Rishabhpreet Kaur

Patent urachus with patent vitellointestinal duct is a rare combination to present in the same patient. We present a rare case of one year old male child with such a condition presenting with complaint of discharge from umblicus along with severe anaemia and an umblical granuloma. On exploratory laparotomy, patent tracts joining umblicus to ileum and umblicus to apex of urinary bladder were found. Both the tracts were excised and appropriate closure was done. Patient had been under follow up and is doing well.

Pseudoangiomatous Stromal Hyperplasia: A Rare Cause of Breast Lump in a Premenopausal Female

Zeeshan Kareem, Sandhya Iyer, Mansha Singh

Pseudoangiomatous Stromal Hyperplasia (PASH) of the breast is a rare benign proliferating breast condition. We report a case of a 26- year-old female who was being worked up for infertility and was incidentally noted to have a well defined lump in the left breast. Fine Needle Aspiration Cytology (FNAC) and core needle biopsy of the lump were suggestive of benign breast disease. Patient underwent excision of the lump. Histopathology report of which was suggestive of PASH of the breast.

Undifferentiated Uterine Sarcoma: An Uncommon Case Report

Madhumita Mukhopadhyay, Chhanda Das, Tamanna Parvin, Keya Basu

Endometrial Stromal Sarcomas (ESS) are rare uterine malignancy of mesodermal origin. A 65-year-old female presented with postmenopausal bleeding in the Department of Gynaecology in our hospital. Computed Topography (CT) revealed an enlarged uterus with areas of low attenuation. On gross appearance endometrial cavity was distorted with an irregular friable necrotic mass. Histopathologically, it was diagnosed as undifferentiated uterine sarcoma. Rhabdoid, osteoid and cartilaginous differentiation were found along with osteoclast like giant cells. Immunohistochemistry was strongly positive for CD10.

Effect of Trauma to Primary Tooth on Permanent Maxillary Incisors: A Clinical Case Report

Bhawana Gupta, Sachin Gupta, Jitesh Wadhwa, Alpa Gupta

Trauma to primary tooth leads to abnormal variations in crown and root canals of permanent teeth that presents a challenge in diagnosis and clinical management to the practitioner. This article presents a detailed case report of the endodontic treatment of a three canalled maxillary central incisor and maxillary lateral incisor having single canal with open apex linked with periodontal defect. Root canals were prepared with hand files and canals were irrigated with 2.5% sodium hypochlorite solution. Calcium hydroxide was placed as an intracanal medicament. As the expected healing did not occur even after one month of calcium hydroxide therapy, so periapical endodontic surgery was performed using Platelet Rich Plasma (PRP). Satisfactory clinical and radiographic results were obtained at 12 months. Detailed knowledge of the anatomical variations in the root canal and awareness of their configuration is essential for the success of such cases.

Cu-sil Denture- A Space Maintainer for Function- In Paediatric Patients

Shilpa Hiremath, Abhishek Jairaj

The purpose of this report is to introduce Cu-sil like denture as a functional space maintainer. Here, we report two paediatric cases treated with Cu-sil like denture with multiple edentulous spaces and partially erupted/compromised permanent teeth. Cu-sil like denture not only serves as removable partial functional space maintainer, but also restores the vertical dimension of occlusion, mastication and aesthetics in children. Cu-sil like denture is used in elderly patients who are not willing for extraction of remaining few healthy teeth in the oral cavity. This concept utilizes the remaining natural teeth in the arch, accommodates them within the denture through perforations made in the denture base. The gap between the denture base and the tooth is sealed using a resilient liner. Such denture is used for the paediatric age group in this report for functional rehabilitation temporarily. The report describes the pros and cons of the Cu-sil like denture use in children with technique of preparation along with review of literature.

Utilization of Intraoperative Real-time Three-Dimensional Transoesophageal Echocardiography to Objectively Assess Improvement in Synchronization and Regional Wall Motion after Coronary Reperfusion

Abhishek Karnwal, Clinton Z Kakazu, Sonia Shah, Bassim Omari, Charu Dutt Arora

It is well known that myocardial ischemia leads to Regional Wall Motion Abnormalities (RWMAs) and reversible depression of Left Ventricular (LV) systolic function. Transoesophageal Echocardiography (TEE) is an established tool for early diagnosis of new RWMAs. However, evaluation of RWMAs by echocardiography is largely qualitative and relies on visual assessment of wall segments. Evaluation of LV systolic function and Ejection Fraction (EF) is more reproducible and accurate with Real-Time 3D Echocardiography (RT3DE) as compared with two-dimensional and M-mode techniques. Primary advantages for RT3DE are fast and largely automated volumetric analysis of LV function and LV volumes, without geometric assumptions and risk of underestimating volumes in foreshortened views. This case illustrates the use of intraoperative RT3DE during coronary artery bypass surgery to objectively assess: LV systolic function with LV volumes and RWMAs and improvement in cardiac synchronization following coronary reperfusion.

Primary Orbital Follicular Lymphoma: A Case Report and Review

G Lakshmi Prasad, Ajay Hegde, Girish Menon, Mary Mathew

Orbital Lymphomas (OL) constitute a heterogeneous group of lymphoproliferative disorders of the orbit. They are predominantly of the Mucosa-Associated Lymphoid Tissue (MALT) subtype. Radiotherapy is the mainstay of treatment in localized orbital tumours, while chemotherapy is reserved for systemic disease. Authors report a case of a primary orbital lymphoma of follicular subtype (stage 1E) in a 54-year-old female managed by surgery and adjuvant radiotherapy.

Primary Ovarian Endometrioid Stromal Sarcoma Presenting with Infertility

Sandhya Ilanthodi, Meghashree vishwanath, Muktha Ramesh Pal

Endometrioid Stromal Sarcoma (ess) is an uncommon tumour that occurs in women over wide age range of 11 years to 76 years accounting for only 0.2% of all uterine malignancies and for 15%–26% of primary uterine sarcomas. These tumours arising from ovary are extremely rare. Most of them are associated with nulliparous or perimenopausal women. It is commonly associated with endometriosis of the ovary. Here we present this rare case to emphasize on the uniqueness and histomorphology of ovarian ESS in patients with endometriosis.

Community Acquired Burkholderia cepacia Bacteraemia Presenting as MODS in an Immunocompetent Individual: An Unusual Case

Ritesh Ranjan, Priti Chowdhary, Aman Kamra

Burkholderia cepacia has been recognized as a group of highly virulent organisms known as Burkholderia cepacia complex (Bcc). Bcc are ubiquitous in nature and most commonly found in moist environment, on plant roots and soil. Because of its high intrinsic antibiotic resistance, Bcc is a major cause of morbidity and mortality in hospitalized patients. It is reported most commonly in immunocompromised patients especially in patients with cystic fibrosis. Here, we report a rare case report of bacteraemia by Burkholderia cepacia in an immunocompetent male, who presented with fever and Multiple Organ Dysfunction Syndrome (MODS). Burkholderia cepacia was isolated from his blood culture, which he acquired from his work place. He was treated successfully and discharged after negative blood culture.

Choroidal Metastasis as Initial Presentation in Adenocarcinoma of Lung: A Case Report

Vision impairment as an initial presentation detecting choroid metastasis in primary lung cancer is rare. Prevention or treatment of visual loss and improvement in quality of life can be achieved by treatment of intraocular metastasis. The survival of the patient in choroid metastasis with lung primary is poor with the median survival being 3.3 months. However, proper treatment may increase the quality of life and survival to an extent. We report a case of adenocarcinoma of lung in a female patient, presented initially with visual impairment as a result of choroidal metastasis and treated with external beam radiotherapy for choroidal metastasis followed by palliative chemotherapy. The patient was survived with improved vision and quality of life since last 12 months of diagnosis.

Cuff Closure by Vaginal Route in TLH: Case Series and Review of Literature

Huseyin Aydogmus, Serpil Aydogmus, Servet Gençdal, Sefa kelekçi

Total Laparoscopic Hysterectomy (TLH) represents one of the most performed gynaecological procedures nowadays. The closure of the vaginal cuff is the most diffucult part of TLH because of the difficulty of laparoscopic suturing techniques. Our aim was to evaluate the efficacy and safety of vaginal cuff closure by vaginal route on patients submitted to TLH. During the period between January 2013 to December 2015 total number of 64 laparoscopic hysterectomy were performed in our clinic. TLH and vaginal vault closure was performed as described by Ghezzi for all patients. The length of cuff closure time and the frequency of vaginal cuff-related complications were measured. Mean age was 48.1 (38-71) years, mean parity was 2.6 (1-9). Most ranked indications for hysterectomy were abnormal uterine bleeding and symptomatic leiomyoma. Average cuff closure time was 6 (2-17) minute. In average 24 (2-36) month followup there were no vaginal vault dehiscence. Transvaginal vaginal cuff closure seems to be safe, easy and effective for total vaginal hysterectomy. Using vaginal route can significantly reduce the length of closure time. This technique has comparable complication rates with endoscopic suturing techniques.

Story of a Giant Endometrial Polyp in Asymptomatic Postmenopausal Female

Endometrial polyps are localized overgrowth of endometrial glands and stoma through the uterine cavity. They are associated with postmenopausal bleeding, infertility and menorrhagia and are affected by unbalanced oestrogen therapy or increased frequency of tamoxifen exposure. We report a case of giant endometrial polyp in postmenopausal female without vaginal bleeding and hormone or drug use. A 65-year-old, postmenopausal female P3L2 with hypertension and Diabetes Mellitus (DM) came for routine health check-up. Her physical examination was normal. Pelvic examination uterus was multiparous sized, mid positioned and bilateral fornices were free. Patient was planned for hysteroscopic guided biopsy as her Ultrasonography (USG) showed endometrial thickness to be 12.3 mm. On hysteroscopy, there was hyperplastic endometrium with large endometrial polyp of size 8.5 cm. Polypectomy was done and the same was sent for histopathological evaluation. Report showed cystic hyperplasia without atypia. To summarize, postmenopausal female will not always present with symptoms and USG can also quite frequently miss the diagnosis, so proper evaluation is needed using hysteroscopy which is gold standard for diagnosis and treatment of endometrial polyp.

Iris Positioning Using a Grid Attached to a Spring Bow for a Custom Ocular Prosthesis

Ankita Chamaria, Meena Ajay Aras, Vidya Chitre, Godwin Clovis Da Costa

Eyes are among the first features of the face to be noticed. Loss of an eye due to congenital, traumatic or pathologic aetiologies causes disfigurement and loss of sensory feedback. It leaves a psychological impact on the patient, thus prosthesis should be provided at the earliest to raise the spirits of the afflicted. Iris positioning is one of the important steps in fabricating customized ocular prosthesis. In facial asymmetry cases, comparison of both irises together can be a major disadvantage. This case report illustrates the use of a unique customized frame spring bow assembly to position the iris disk using the established parallelism between inter pupillary line to the horizontal plane.

Bardet Biedl Syndrome – A Report of Two Cases with Otolaryngologic Symptoms

Mahendra K Singh, Shrinkhal, Sidharth Pradhan, Priyanko Chakraborty

Bardet-Biedl Syndrome (BBS) is a rare autosomal recessive disorder characterized primarily by rod-cone dystrophy, postaxial polydactyly, central obesity, mental retardation, hypogonadism, and renal dysfunction. We present two cases of this syndrome, both female, who presented with complaints of nyctalopia and mental retardation, and additionally one of them had sensorineural hearing loss while the other had serous otitis media. Hearing loss being a rare presentation is worth reporting. Both the patients were given a course of vitamin A and the parents were counseled regarding the prognosis and additional complications associated with the syndrome.

Magnetic Resonance Imaging in Mixed Mullerian Tumour: Report of Two Cases

Pratiksha Yadav, Vidhi Bakshi, Rajul Bhargava

Malignant Mixed Mullerian Tumours (MMMTs) or carcinosarcomas of uterus are rare aggressive tumours of mesenchymal origin. It is associated with high incidence of lymphatic, pulmonary and peritoneal metastasis. We hereby present two cases of mixed mullerian tumour. Case-1 was a 60-year-old post menopausal woman who had come with complaint of metrorrhagia and a protruding mass in the vagina. Case-2 was of a 54-year-old post-menopausal woman who came with complaints of heavy vaginal bleeding, pelvic pain since two months. For the assessment of these tumours Magnetic Resonance Imaging (MRI) is preferred imaging modality due to excellent tissue contrast to detect the myometrial invasion, local extent and staging. Preoperative differentiation of mullerian tumour with endometrial carcinoma is important as both have different treatment.

Cervical Pregnancy Masquerading as an Incomplete Abortion- A Learning Lesson

Namrata Kumar, Smriti Agrawal, Vinita Das, Anjoo Agrawal

Cervical pregnancy is a rare site of ectopic pregnancy compared to tubal. The trophoblast implant into the cervical tissue and become a potentially dangerous site of torrential haemorrhage. The widespread use of Ultrasonography (USG) has led to a dramatic increase in the detection rates of extra uterine pregnancy. We hereby report an interesting case of extra uterine pregnancy with a unique situation where only a high index of suspicion prevented an iatrogenic mishap. The patient was referred as a case of incomplete abortion with a documented report of minimal retained products. Because of a high index of suspicion a serum beta Human chorionic gonadotropin (hCG) was sent prior to deciding for discharge. This indeed turned as a major change in the diagnosis of the case as the serum beta hCG was elevated. On re-evaluation, we diagnosed it as a case of cervical pregnancy which was successfully managed medically.

Achondroplasia with Polydactyly: A Case Report

An eight-year-old girl child reported to the Department of Oral Medicine and Radiology with the chief complaint of unerupted permanent teeth for past two years. The child presented features like disproportionately short stature, rhizomelic shortening of arms and legs, long face, frontal bossing and saddle nose. Based on the findings of chest and spine radiographs and ultrasound the case was diagnosed as a rare bone disorder “Achondroplasia”. This case also presents a unique feature of polydactyly. Polydactyly is a manifestation in clinical medicine because it can serve as an indicator for a plethora of congenital anamolies. This case gained dental interest because of its characteristic craniofacial features. This article highlights the peculiar manifestations of this anamoly.

Chaput Tubercle Fracture in an Adult- A Rare Case Report

Pankaj Kumar Mishra, Vikram Patidar, Satya Prakash Singh

Chaput tubercle fracture occurs at the antero-lateral position of the distal tibia in adult as a counterpart of adolescent Tillaux fracture. It is a case of adult male which presented to us with onset of acute pain, swelling and restricted movements of ankle after a road side accident. A clinical diagnosis of Chaput tubercle fracture was established after a CT-scan. The displaced fracture was managed by open reduction and internal fixation by screw. At the end of follow up, the foot and ankle ability score measured. Through this case report we convey that Chaput tubercle fracture in an adult is a rare entity.

Unusually High Serum Levels of CA 19-9 in an Ovarian Tumour: Malignant or Benign?

Divya Pandey, Ritu Sharma, Shakti Sharma, Sudha Salhan

Carbohydrate antigen 19-9 (CA 19-9) is a tumour marker found to be elevated in some ovarian tumours. We share our experience with a 55-year-old postmenopausal lady with unusually high CA19-9 levels arising from a benign mucinous cystadenoma of the ovary. The levels returned to normal eight weeks following staging laparotomy and a total abdominal hysterectomy with bilateral salpingo-oopherectomy. This report shows rare and significant elevation of CA 19-9 levels with benign mucinous cystadenomas of the ovary thus showing that women with unusually elevated tumour markers may actually harbour benign disease. The tumour markers should not be used to predict the malignant status of a tumour.

Thromboangitis Obliterans involving Bilateral Upper limb Extremities - A Rare Case Report from Malaysia

Murali Uthamalingam, Mohammad Azhar Anis Ahmad, Fatin Najihah

Thromboangiitis Obliterans (TAO) or Buerger’s disease is a non-atherosclerotic, occlusive, progressive and highly inflammatory disorder of distal arteries seen predominantly affecting the lower limb in smokers. TAO presenting itself in upper limb or bilaterally involving the upper limb is a very rare entity. We report on a rare case of TAO in a 46-year-old gentleman who presented with bilateral upper extremity digital gangrene with 18 pack-years of smoking. Brachial and radial pulses were palpable bilaterally and were of good volume but right ulnar pulse was faintly felt, while on the left side it was not appreciated due to malunion. Further Computed Tomography (ct )- angiography showed occlusion of distal right ulnar artery, stenosis of distal left ulnar artery with bilateral poor opacification of palmar and digital arteries. This case reports on the unusual and rare presentation of TAO in upper extremity involving both limbs. The case is reported for the first time from Malaysia.

Neoumbilicoplasty in a Laparoscopic Port Site: Description of a New Technique and Review of Literature

Aravind Menon, Alagesan Ganapathi

The umbilicus contributes significantly to the cosmetic appearance of the abdomen especially in women. Loss of umbilicus may result not only in cosmetic disfigurement but also in significant psychological effects. Omphalectomy may accompany certain surgical procedures like ventral hernia repairs and abdominoplasty. For such patients, many techniques have been described by various authors in literature for creation of a neoumbilicus for good cosmetic appearance. In this report, we describe how a laparoscopic port site was utilized to create a neoumbilicus in a patient who required omphalectomy as a part of large umbilical hernia repair. Satisfactory postoperative result promted us to report this novel technique of neoumbilicus creation. This can be utilized in patients who have been previously subjected to laparoscopic procedures. This is the first case description in literature where a laparoscopic port scar was utilized for neoumbilicoplasty.

Basaloid Squamous Cell Carcinoma of Tongue: A Report with Emphasis on Immunohistochemistry

Basaloid Squamous Cell Carcinoma (BScc ) is a rare entity with its histopathological distinction from conventional squamous cell carcinoma. It is frequently considered a high-grade carcinoma with poor prognosis because of higher rate of distant metastases. Here by, we are reporting a case of 39-year-old male with an ulcer on the left lateral border of the tongue since a month. Histopathological examination of incisional biopsy revealed basaloid tumour cell islands accompanied by component of well differentiated squamous cell carcinoma. To reconfirm this incidental finding immunohistochemistry was carried out for Proliferative Cell Nuclear Antigen (PCNA) and pancytokeratin (AE1/AE3) which was positive to conclude diagnosis of BScc . Further p16 staining was done to rule out Human Papilloma Virus (HPV) infection.

Inferior Vena Cava Agenesis: A Rare Cause of Pelvic Congestion Syndrome

Satyendra Narayan Singh, Trilok C Bhatt

Complete absence of Inferior Vena Cava (IVC) is a rare anomaly with a reported incidence of 0.0005% to 1%. This is often asymptomatic with incidental detection during cross-sectional imaging. It may also present with deep venous thrombosis, pulmonary thromboembolism or compressive symptoms in form of nerve root compression. Pelvic Congestion Syndrome (PCS) is an increasingly recognized entity with well laid out diagnostic criteria and evolving management protocols. Complete absence of IVC is a rare cause of pelvic congestion syndrome. We present a case of young female presenting with symptoms typical of pelvic venous congestion who was found to have complete absence of IVC as the underlying cause. She also had associated small left kidney with compensatory hypertrophy of the right kidney which is another rare association.

Delayed Presentation of Isolated Jejunal Perforation Following Accidental Trauma

Blunt abdominal trauma can injure any abdominal organs which had significant morbidity and mortality in paediatric age group. It can lead to duodenal, jejunal or rather any bowel perforation. Isolated jejunal perforation still remains rare entity with less documented reports in specifically paediatric age group. We hereby present a case of three-year-old female child with isolated jejunal perforation, post history of fall from height. Early exploration and prompt surgical intervention led to successful outcome in this patient.

Angiolymphoid Hyperplasia with Eosinophilia Involving the Occipital Artery: Case Report and Review of Literature

Angiolymphoid Hyperplasia with Eosinophilia (ALHE) is an atypical vascular tumour occurring primarily in the head and neck area, which must be distinguished from Kimura’s disease. The lesions can appear as single or multiple grouped intradermal papules or subcutaneous nodules. We report a rare case of ALHE in a 57-year-old female with a large lesion of three nodules involving the right occipital artery which had a long term evolution and we treated it by surgical excision. The definitive histopathological diagnosis was ALHE. Our case report is accompanied by a discussion of clinical, radiological and histological features. Surgical excision with free margins is the treatment of choice but, even though ALHE is considered a benign condition, recurrence is common.

A Case Report of a Giant Cholesteatoma

Neelam Sood, Binit Kumar Khandelia, Gitanjali Bugnait

Cholesteatoma is a well demarcated, non-neoplastic, temporal bone cystic lesion with extensive keratinisation. Keratoma and epidermoid cyst are other possibly more accurate names suggested to describe the same. It can be classified as congenital or acquired. Its management is often complicated by its tendency to recidivism/recurrence. Long standing cholesteatomas can be a precursor for squamous cell carcinoma. We hereby present a case of giant cholesteatoma in a 45-year-old female with radiological involvement of the left temporal region, periauricular region and infratemporal fossa with lytic destruction of left middle ear ossicles, mastoid and squamous part of temporal bone with intracranial extension. The enormity of the present lesion along with its bony erosions raised the strong clinical suspicion of malignancy. The underlying case report highlights the relevance of exhaustive sectioning and immunohistochemistry to reach the diagnosis.

Portal Venous Thrombosis: Eosinophilic Vasculitis

Vasanthi Natarajan, David Jose, Kevin John, Ashok Kumar Das

Portal Vein Thrombosis (PVT) is caused by various thrombophilic states. PVT secondary to underlying vasculitis especially Churg-Strauss disease is among the rarest presentation. Here, we report a case of peripheral eosinophilia, eosinophilic ascitis and venous thrombosis involving portal vein and superior mesenteric vein diagnosed as Churg-Strauss Syndrome (CSS). He was managed with steroids and anticoagulants. Following initiation of steroids, eosinophilia and eosinophilic ascitis improved.

Catheter-Assisted Balloon-Supported Retrieval of a Broken Semi-Compliant Balloon from a Coronary Artery

Brajesh Kumar Kunwar, Pranay Jain, Mahesh Ghogare

Incidents of broken balloon in a coronary vasculature during percutaneous coronary angioplasty are very rare. Such events in cath-lab may create panic and can be life threatening for patients. Hence, immediate retrieval of broken balloon becomes vital. Here, we report an unusual complication of broken balloon in the mid portion of the left anterior descending coronary artery, which had a calcified and totally occluded in-stent restenotic lesion. The broken balloon was retrieved successfully with no eventual complication using a simple catheter-assisted balloon-supported retrieval technique. The present case highlights the need for interventional cardiologist to be acquainted with different retrieval techniques.

Tuberculosis of Acromioclavicular Joint

Archit Agarwal, Amish Bhandari, Rajesh Maheshwari

Tuberculosis (TB) arthritis accounts for approximately 1%–3% of all cases of TB and for approximately 10%–11% of extra pulmonary cases. Isolated acromioclavicular joint TB has been reported rarely with varied presentations as case series of one to three cases none of them being large studies. In our case, patient presented with pain in left shoulder since one month. Patient was investigated and was diagnosed to have acromioclavicular joint TB on basis of positive Acid Fast Bacilli (AFB) stain and cytology. Patient recovered well with antitubercular therapy. Thus, it is important to send Ziehl-Neelsen (ZN) stain in all cases in an endemic country like India.

Rectus Sheath Haematoma Secondary to Enoxaparin Injection- A Rare Case Report

Rectus sheath haematoma is a well-documented condition with an elusive diagnosis. It is an uncommon complication of anti-coagulation therapy, which can have a mortality of upto 25%. The patient discussed here is a 40-year-old female who was on Inj. Enoxaparin, who developed severe abdominal pain and hypovolemia after three days of treatment. Ultrasonography and CT scan showed a large rectus sheath haematoma on the right side, which was crossing the midline towards the left side. Inj. Enoxaparin was stopped and the patient was posted for surgery. In surgery, all clots were evacuated and inferior epigastric vessels were ligated. Patient recovered well following surgery. Here, this report presents forward a case of rectus sheath haematoma secondary to enoxaparin injection, its presentation and its surgical management.

Jejunal Gastric Heterotopia causing Multiple Strictures and Perforation Peritonitis- A Case Report with Review of Literature

M Vani, Ajit Nambiar, K Geetha, Byju Kundil

Gastric heterotopias beyond the ligament of Treitz though rare, should be thought of in the differential diagnosis of polypoid lesions presenting with gastrointestinal bleed or obstructive symptoms especially in children and in the young. Here is a 24-year-old male with multifocal jejunal gastric heterotopias causing multiple strictures and perforation peritonitis. Patient presented with acute abdomen pain and an emergency laparotomy was performed revealing jejunum with multiple strictures and perforation, followed by jejunal resection. On gross examination polypoid mucosa was noted at the stricture sites which showed heterotopic gastric mucosa on microscopy. Jejunal gastric heterotopias are extremely rare with less than ten reported cases and those presenting with multiple strictures are even rarer. To our knowledge this is the second case of jejunal gastric heterotopia presenting with multiple strictures.

Temporary Blindness after Inferior Alveolar Nerve Block

Inferior Alveolar Nerve Block (IANB) anaesthesia is one of the common procedures in dental clinic. This procedure is safe, but complications may still occur. Ocular complications such as diplopia, loss of vision, or ophthalmoplegia are extremely rare. This case report explains an event where due to individual anatomic variation of the sympathetic vasoconstrictor nerve and maxillary and middle meningeal arteries, intravascular administration of anaesthetic agent caused unusual ocular signs and symptoms such as temporary blindness.

Immediate Placement of Zirconia Implants in Teeth with Periapical Lesions: A Case Report

Nizar A Ahmed, Caroline Annette Jacob, Preetham Prasad Nittla

This case report records the replacement of two failed endodontically treated mandibular molars with one piece zirconia implants in a patient with metal hypersensitivity. The two molars were atraumatically extracted and curetted to remove any remnants of a periapical granuloma. Immediate implant placement with primary stability was achieved using one piece WhiteSky® Bredent zirconia implants which were restored after four months with a zirconia crown. One year follow up revealed successful osseointegration with optimal form and function.

Eyelid Malignancies- Always Quite Challenging

Arumugham Balasubramanian, Narayanasamy Subbaraju Kannan

The diagnosis and management of eyelid cancers are quite challenging. Eyelid tumours are relatively rare diverse group of diseases varied in their presentation and extent. Many benign tumours and inflammatory conditions quite frequently masquerade eyelid cancers. Eyelid cancers are not single entity but comprise a wide range of tumours with extremes of tumour biology from indolent to very aggressive histopathologic types. Compromise on aesthetics and eyelids’ indispensable function of protecting the eyes during management, may lead to untoward cosmetic disfigurement and loss of vision. On the other hand, inadequate cancer clearance will also be vision threatening and life threatening due to loco regional recurrence and metastasis. To strike an optimal balance is a challenging task, to achieve ‘cancer cure’ with maximum preservation of function and cosmetics. In addition, the integration of other modalities of treatment, judicious selection and their sequencing require multidisciplinary discussion and joint management by different specialists. We are presenting four case scenarios, we met with in our teaching hospital with reference to literature review to emphasize that eyelid malignancies are not always simple with respect to diagnosis and management.

Gerbode Ventricular Septal Defect –A Rare Cardiac Anomaly Associated with Genetic Variants in Indian Population– A Case Series

Gerbode defects are rare Ventricular Septal Defects (VSD) constituting approximately one percent cases of congenital heart diseases. The genetic predispositions towards the Gerbode Defect (GD) have remained an unexplored area of study till date. We investigated the genotype-phenotype correlation in patients with Gerbode VSD. Molecular genetic study on Sanger sequencing and subsequent data analysis showed that the contributing sequence variations in the NKX2-5, GATA4 and TBX5 gene lies in one of the highly conserved regions and this region is responsible for encoding a functional protein. The resulting genotype variation may be responsible for causing the diseased phenotype known as GD.

Bladder Adenocarcinoma: A Persisting Diagnostic Dilemma

Primary urinary Bladder Adenocarcinoma (PBA) is an uncommon neoplasm and can cause diagnostic difficulties due to histologic similarities with adenocarcinomas of adjacent structures like Gastrointestinal Tract (GIT) and prostate, since involvement of the bladder by metastasis or direct spread can occur. Seven cases of bladder adenocarcinomas were diagnosed during a period of four years in a tertiary care hospital. Patient’s age ranged from 26-78 years with a male predilection. Three cases were signet ring type adenocarcinomas, two cases were subtyped as enteric variant, one as mucinous variant and one as adenocarcinoma Not Otherwise Specified (NOS) variant. One case showed urachal involvement. Common site of involvement was the base and posterior wall of the bladder. Three cases had prior history of GIT malignancy. No morphologic difference was identified to differentiate primary from secondary adenocarcinomas. Bladder adenocarcinoma is rare tumours. Primary and secondary adenocarcinomas cannot be distinguished from each other on morphologic grounds. Ancillary studies may have limited role in distinguishing between the two. Hence, clinical correlation has a major role in their evaluation.

Kedo–S Paediatric Rotary Files for Root Canal Preparation in Primary Teeth – Case Report

Ganesh Jeevanandan

Nickel-Titanium (Ni-Ti) instrument are widely used for root canal preparation in permanent tooth compared to primary teeth. Hand instrumentation technique remains the conventional method for root canal preparation in primary teeth. The time taken for root canal preparation with the conventional method is more resulting in patients and clinicians fatigue. Recently Ni-Ti rotary files designed for permanent tooth has been used for root canal preparation in primary teeth. Using rotary instruments for primary tooth pulpectomies resulted in better and predictable root canal filling. This article presents case reports of pulpectomy treatment performed using Kedo-S an exclusive paediatric Ni-Ti rotary files. The advantages and disadvantages in use of Ni-Ti rotary files in primary teeth are discussed in this article.

Occurrence of Cusp of Carabelli in Primary Second Molar Series of three Cases

Mythri Sarpangala, Ashwin Devasya

Morphological variations are seen in both primary and permanent dentitions. Cusp of Carabelli is also one of them. It is suggested that it is due to over activity of dental lamina but definitive aetiology is unknown. It is a type of accessory cusp, occurs more often in permanent maxillary first molars, whereas, its occurrence in primary tooth is rare. The present case series discusses the presence of cusp of Carabelli in primary maxillary second molars in three different cases. This case series will help clinicians to identify, diagnose and take proper preventive care and also adds to the incidence in literature.

Rehabilitation of a Patient with Facial and Palatal Defect - A Case Report

Litty Francis

Defects involving the face and maxilla present a challenge to the prosthodontists as these have a direct effect on aesthetics, function as well as the psychology of the patient. An array of problems awaits the clinician from restoring the previous contour of the oral cavity, facial form, etc. to the mental state of the patients. This article deals with the rehabilitation of a hemimaxillectomy patient with a facial defect, using an interim hollow bulb obturator and a silicone facial prosthesis, which helped to improve the general well being of the patient. Rehabilitative procedures provide patients considerable care so that they can continue their life with confidence.

Assessment of Lipid Peroxidation and Antioxidant Status in Vanillic Acid Treated 7,12-Dimethylbenz[a] Anthracene Induced Hamster Buccal Pouch Carcinogenesis

Vinoth Anbalagan, Kowsalya Raju, Manoharan Shanmugam

Introduction: Vanillic acid, a naturally occurring bioactive substance, possesses diverse pharmacological potential including free radical scavenging and anticancer properties. Excessive generation of Reactive Oxygen Species (ROS) and insufficient antioxidant potential has been involved in numerous pathological disorders, including cancer. Aim: To explore the anti-lipid peroxidative and antioxidant efficacy of vanillic acid in Dimethylbenz[a]Anthracene (DMBA) induced oral carcinogenesis. Materials and Methods: Topical application of DMBA for 14 weeks in the buccal pouch of hamsters resulted in well developed oral squamous cell carcinoma. Vanillic acid at a dosage of 200 mg/kg body weight was orally administrated to the hamsters for 14 weeks. The status of lipid peroxidation and antioxidants were measured in the plasma and buccal mucosa of hamsters using specific colorimetric methods. Results: Altered levels of lipid peroxidation by-products {Thiobarbituric Acid Reactive Substances (TBARS)} and disturbances in antioxidants status {Superoxide Dismutase (SOD), Catalase (CAT), Glutathione Peroxidase (GPx), vitamin E, vitamin C and reduced Glutathione (GSH)} were observed in the plasma and buccal mucosa tissues of hamsters treated with DMBA alone. Vanillic acid (200 mg/kg bw p.o) significantly restored the above mentioned plasma and buccal mucosa biochemical variables to near normal range in DMBA treated hamsters. Conclusion: Present findings thus confirm the anti-lipid peroxidative and antioxidant efficacy of vanillic acid in DMBA induced hamster buccal pouch carcinogenesis.

Evaluation of Acute Oral Toxicity of Ethanol Leaves Extract of Catharanthus roseus in Wistar Albino Rats

Venkateswar Rao Vutukuri, M.C.Das, Muralidhar Reddy, Siva Prabodh Padma Sunethri

Introduction: Herbal drugs have gained importance globally in the treatment of various diseases. Catharanthus roseus is traditionally used as an anti diabetic and anti cancer drug. To the best of our knowledge limited data are available on acute and sub acute toxicity of C. roseus extract despite its wide spread use in traditional medicine. The present study was under taken to evaluate the acute oral toxicity of the ethanol leaves extract of C. roseus. Aim: To investigate the acute oral toxic effects of ethanol leaves extract of C. roseus. The objective of the study was to evaluate organ toxicity related to heart, liver and kidney in wistar albino rats. Materials and Methods: The experiment was done based on the Organization for Economic Co-operation and Development (OECD) guideline 420. The study included twenty five non pregnant female wistar rats (n=25). Sighting study was done using the fixed dose method. The study was conducted by giving a single dose of test drug varying from 5, 50, 300 and 2000 mg and animals were observed for fourteen days. Blood samples were collected and biochemical findings SGPT, SGOT, urea, creatinine, creatinine phosphokinase and Lactate Dehydrogenase (LDH) were analyzed. Food consumption, water intake and histopathology changes were evaluated. Results: Catharanthus roseus Extract (CRE) at a dose of 2000 mg did not produce mortality. SGOT, SGPT, Creatinine phosphokinase, LDH, urea and creatinine were elevated in 300 mg and 2000 mg doses. Conclusion: Though there was no mortality, the extract of C. roseus higher than 300 mg can produce signs of biochemical and histopathological toxicity in liver, kidney and heart. It is recommended that lower doses than the studied ones should be used for treatment.

Neurobehavioural Changes in a Hemiparkinsonian Rat Model Induced by Rotenone

Sukala Puthuparambil Maniyath, Narayanan Solaiappan, Muthusamy Rathinasamy

Introduction: Rotenone, a mitochondrial complex I inhibitor is used as a neurotoxin agent to reproduce the neuropathological, and behavioural feature of Parkinson’s Disease (PD) in rat. Due to acute and chronic exposure of rotenone with various doses through different routes of administration, mortality is being reported. Low dose takes a longer duration to produce PD symptoms in animals. This present study was designed to create hemiparkinsonian ‘partial’ lesion model by rotenone at a single moderate dose in two sites of striatum in albino rats and also to assess its toxicity by behavioural parameters and by microscopic study. Aim: To assess all the motor deficits in lesioned animals that are due to the depletion of dopaminergic neurons or its terminals, the lesioned animals were administered with anti-parkinsonian drug, Levodopa which should counteract motor deficits in rats. Materials and Methods: The unilateral partially lesioned PD model was induced by rotenone stereotaxically into two sites of striatum of male Wistar albino rats at a dosage of 25 µg of rotenone/site. Rats were tested for its neurobehavioural activity on 7th day, 14th day, 21st day and on 30th day after rotenone infusion and compared with the sham group and sacrificed on 21st and 30th day for microscopic studies. L-DOPA was administered from 21st day to 30th day after lesion and compared with the lesioned group for the motor performance and sacrificed on 30th day for histology. Statistical analysis using One-way Analysis of variance followed by Tukey's test was applied for behavioural studies. Results: Statistical analysis showed that the signs and symptoms like motor in-coordination and postural disturbances are highly significant (p<0.05) on 14th and 21st day after administration of rotenone when compared to sham group. In L-DOPA treated rats, all the motor deficits were reversed. The neuronal cell death was minimal and sprouting of nerve terminals was detected. In lesioned group, the degeneration of nerve terminals and striatal neurons were in progressive manner. Conclusion: These findings suggest that intrastriatal infusion of rotenone at a moderate dose could be used for producing hemiparkinsonian partially lesioned animal model without any mortality. Hence, this model is suitable for evaluating behavioural studies and in drug screening programs even for a long term study.

Effect of Sodium Valproate and Docosahexaenoic Acid on Pain in Rats

Sushil Kiran Kunder, Laxminarayana Kurady Bairy, Avinash Arivazhahan

Introduction: Analgesics are commonly prescribed medications used to alleviate pain of various aetiologies without affecting the patient’s consciousness. They interfere with the transmission of pain signals. A commonly used antiepileptic drug, sodium valproate has been used in various non-epileptic conditions like migraine prophylaxis and in the treatment of bipolar disorder because of the multiple mechanisms by which it acts. Docosahexanoic Acid (DHA), an omega 3 fatty acid, is known to possess analgesic activity. We planned a study to assess the effect of sodium valproate alone and in combination with DHA in rat models of pain. Aim: To evaluate the analgesic activity of sodium valproate and DHA supplementation using various experimental models in albino Wistar rats. Materials and Methods: For analgesic activity, A total of 48 adult Wistar albino rats were divided into eight groups of six rats each. Group I was control (distil water 1 ml/kg), Group II received intraperitoneal injection of tramadol (10 mg/kg), Group III, IV, V were injected intraperitoneal sodium valproate 100, 200, 400 mg/kg with distil water respectively and Group VI, VII, VIII were given sodium valproate 100, 200, 400 mg/kg plus DHA 300 mg/kg (intraperitoneal) respectively. Analgesic activity was assessed using hot plate, tail flick and acetic acid writhing models. Results: We found that sodium valproate at higher doses (400 mg/kg) used either alone along with DHA (300 mg/kg) showed statistically significant analgesic activity in comparison to control in various experimental models for assessing pain. Conclusion: Combination of sodium valproate along with DHA has shown promising analgesic activity.

Extramedullary Haematopoiesis Presenting as an Adrenal Mass

Cannon Ball Lung Metastases from a Previously Unreported Primary

Arjun Lakshman, Ram Nampoothiri, Vikas Suri, Subhash Varma

Azygos Lobe - A Rare Anatomical Variant

Regulation of Molecular Diagnostic (NAT) Kits For HBV, HCV and HIV in India

Manoj Kumar Rajput

Correspondence: Predictors of Mortality in Paediatric Myocarditis

Anirban Mandal, Amitabh Singh, Puneet Kaur Sahi, Bhavika Rishi

Morphological and Morphometric Analysis of Hypoglossal Canal in North Indian Dry Skulls and It's Significance in Cranial Base Surgeries

Shalini Kumar, Ranjana Verma, Arpita Mahajan Rai, Raj D Mehra

Introduction: Hypoglossal Canal (HC) is a paired bony passage which is situated above the Occipital Condyle (OC) and transmits hypoglossal nerve and blood vessels. Studies on the osteotic variations of HC has been a field of considerable interest to research workers especially because of its clinical, radiological and surgical significance. Aim: The aim of the present study was to analyze the morphological and morphometric features of HC and its topographical relationship with OC. Materials and Methods: The present study was done on 50 human dry skulls. The HC was looked for presence of spur and septa along with its location in the canal and were classified into different types accordingly. The distance of extracranial and intracranial openings of HC from the posterior end of OC was measured by Sliding Vernier caliper. Angle of inclination of HC with the midsagittal plane was measured with the help of goniometer. Results: In the present study, we observed osteotic variations in the HC in 52% skulls. The spur (Type 2) was seen in 28% and incomplete septa (Type 3) was noted in 26% skulls. In some cases, spur and septa were seen in different locations of same HC. However, complete septa (Type 4) were not observed in our study. Spur and septa, both were present more frequently on the left side. The external and internal distance of HC from posterior end of OC was more on the left side in comparison to the right side. The anterior angle of HC to the midsagittal plane is less in comparison to posterior angle in case of double internal opening of HC. Conclusion: The present study regarding morphologic and morphometric analysis of HC and its relation to the OC will provide important information in North Indian population. It will enable effective and reliable surgical intervention in the area of HC and craniovertebral junction leading to better postoperative outcome.

Internet Based Obesity Prevention Program for Thai School Children- A Randomized Control Trial

Lakkana Rerksuppaphol, Sanguansak Rerksuppaphol

Introduction: Internet based obesity prevention program is one approach in learning strategies to improve healthy behaviour. It has been advocated as one strategy to address the rising prevalence of childhood obesity; however, their efficacy is not seen consistently. Aim: The purpose of this study was to assess the efficacy of internet based obesity prevention program in Thai school children. Materials and Methods: Healthy children studying in public schools in one township of central Thailand were randomly assigned to either the intervention (internet based) program or the control group. Anthropometric characteristics were recorded at baseline and for the next four following months at monthly intervals. Changes in the percentage of overweight/obese children and changes in BMI at the end of study were considered as the primary and secondary outcome, respectively. Results: A total of 217 children, mean age of 10.7 years, were included into the final analysis. Baseline anthropometric parameters and percentages of overweight/obesity were not significantly different between groups. At the end of the study, the control group had a higher percentage of overweight/obesity than the intervention group (56.6% vs. 39.6%, respectively; p-value=0.009). Children in the control group had a significantly higher increase in net BMI gains than those in the intervention group (1.24kg/m2 vs. 0.40kg/m2, p-value=0.027). The intervention group had no changes in BMI z-score (-0.001, 95%CI -0.19 to 0.18, p-value=0.988), contrary to those in the control group, which had significant gain of BMI z-score at the end of study (0.45, 95%CI 0.27 to 0.63, p-value<0.001). Conclusion: Internet the based obesity prevention program was effective in modifying anthropometric outcome and helped to address the rising prevalence of overweight and obese status in Thai children.

Impact of Nutritional Status on Cognition in Institutionalized Orphans: A Pilot Study

Sanjana M Kamath, Kavana G Venkatappa, Ergod manjunath Sparshadeep

Introduction: Proper nutrition is critical for maximizing brain function and enhancing learning. There is accumulating evidence that early malnutrition, marked by stunting, is associated with long-term deficits in cognitive and academic performance, even when social and psychological differences are controlled. All over the world, children living without permanent parental care are at a heightened risk for under-nutrition, putting their health and development in great jeopardy. Aim: To assess the nutritional and cognitive status in institutionalized orphans which might help to formulate effective interventions for improving the nutritional status of vulnerable children in future. Materials and Methods: This cross-sectional, case control study included 70 children (35 orphans and 35 non-orphans). Their anthropometric measurements (height, weight, and BMI) were measured and cognition was assessed using subsets of Wechsler Intelligence Scale for Children-Revised (WISC-R): Block design and Digit span. The data obtained was subjected to descriptive statistical analysis. Results: 18.57% (13) of children had stunting, 15.71% (11) had wasting, 22.86% (16) were underweight, and 17.14% (12) showed thinness. Mean±SD of Block design in non-orphans was significantly higher compared to orphans (p-value 0·05). Mean±SD of Digit span in non-orphans was significantly higher compared to orphans (p-value 0·000). For Block design, there was moderate positive correlation with nutritional status based on Z-scores (p-value <0·05). Digit span also showed moderate positive correlation (p-value <0·05). Conclusion: The results of our study indicate that children in orphanages have high rates of both malnutrition and cognitive delay compared to the non-orphans and there was a direct correlation between both the variables. If orphanages are here to stay as a last resort for children deprived of a family there is an urgent need to improve the institutional environment in order to foster the development of millions of children in orphanages around the world.

Pregnancy Outcome of Abnormal Nuchal Translucency: A Systematic Review

Nasibeh Roozbeh Maryam Azizi, Leili Darvish

Introduction: Nuchal Translucency (NT) is the sonographic form of subcutaneous gathering of liquid behind the foetal neck in the first trimester of pregnancy. There is association of increased NT with chromosomal and non-chromosomal abnormalities. Aim: The purpose of this systemic review was to review the pregnancy outcome of abnormal nuchal translucency. Materials and Methods: The present systematic review was conducted by searching English language articles from sources such as International Medical Sciences, Medline, Web of science, Scopus, Google Scholar, PubMed, Index Copernicus, DOAJ, EBSCO-CINAHL. Persian articles were searched from Iranmedex and SID sources. Related key words were “outcome"," pregnancy", "abnormal", and "Nuchal Translucency" (NT). All, randomized, descriptive, analytic-descriptive, case control study conducted during 1997-2015 were included. Results: Including duplicate articles, 95 related articles were found. After reviewing article titles, 30 unrelated article and abstracts were removed, and 65 articles were evaluated of which 30 articles were duplicate. Finally 22 articles were selected for final analysis. Exclusion criteria were, case studies and reports and quasi experimental designs. This evaluation has optioned negative relationship between nuchal translucency and pregnancy result. Rate of cardiac, chromosomal and other defects are correlated with increased NT=2.5mm. Cardiac disease which were associated to the increased NT are heart murmur, systolic organic murmur, Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD), tricuspid valve insufficiency and pulmonary valve insufficiency, Inferior Vena Cava (IVC) and Patent Ductus Arteriosus (PDA). The most common problems that related with increased NT were allergic symptoms. Conclusion: According to this systematic review, increased NT is associated with various foetal defects. To verify the presence of malformations, birth defect consultations with a perinatologist and additional tests are required.

Antioxidant-Oxidant Index as a Biomarker in Oral Potentially Malignant Disorders and Oral Squamous Cell Carcinoma: A Biochemical Study

Saurabh Juneja, Ajit Singh Rathore, Kanika Sharma, Devicharan Shetty, Anshi Jain

Introduction: Oxidative stress has been implicated in tumourigenesis by affecting the actions of various protein kinases and transcription factors, and resulting in damage to DNA structure by the deamination of nucleotides and the generation of free radicals. Derangements in the antioxidant defence mechanism have been considered in the pathogenesis of oral cancer. Aim: To evaluate and compare the serum levels of nitric oxide and vitamin C in cases of Oral Potentially Malignant Disorders (OPMDs) and Oral Squamous Cell Carcinoma (OSCC) and healthy controls. Materials and Methods: Serum from 20 patients with OSCC, 20 patients with OPMDs and 10 healthy subjects were analyzed for levels of nitric oxide and vitamin C using UV spectrophotometry. Antioxidant-Oxidant Index (AOI) was calculated by calculating the ratio between the levels of nitric oxide and vitamin C. Results: The mean nitric oxide levels were elevated in OSCC group, as compared to OPMD and control group, whereas, mean serum vitamin C levels were reduced in OSCC group as compared to OPMDs and control group (statistically significant, p<0.05). There was significant increase in AOI from control group (0.023), OPMDs (0.167) and OSCC group (0.279) (p<0.05). Conclusion: Assessment of levels of antioxidant oxidant markers are useful tools in monitoring the progression of OPMDs to OSCC. AOI is an objective tool to assess the oxidative stress in these patients.

Postoperative Pain and Flare-Ups: Comparison of Incidence Between Single and Multiple Visit Pulpectomy in Primary Molars

Shrirang Anand Sevekar, Subhadra Halemane Nagaraj Gowda

Introduction: Endodontic treatment performed in either singleor multiple visit can be followed by numerous short- and long term complications. One of the short term complications include postoperative pain and flare–ups. The ability to predict its prevalence and forewarn the patient may go some way towards enabling coping strategies and help dentist in pain management treatment decisions Aim: To compare the incidence and intensity of postoperative pain and flare-ups between single- and multiple visit pulpectomy in primary molars. Also, to correlate the preoperative status of the pulp to postoperative pain and flare-ups. Materials and Methods: Eighty primary molars indicated for pulpectomy were included in the study and divided into two groups. Tooth treated and preoperative status of the pulp vitality was recorded. All the conventional steps in pulpectomy were followed. Teeth in Group 1 (single visit pulpectomy) were obturated on the same visit. Teeth in Group 2 (multiple visit pulpectomy) were obturated in the subsequent appointment. The recording of postoperative pain, flare-ups, use of medication were done after 24 hours, seven days and one month. Results: Four cases in both the groups reported postoperative pain (10%) at 24 hour recall, p=0.74. One flare-up (2.5%) was recorded in each group p=0.67. None of the patients reported pain at seventh day and one month recall. Postoperative pain was recorded in five non-vital teeth (13.5%) and three vital teeth (6.9%). However, it was statistically not significant p=0.53. Conclusion: From the perspective of our study there was a low incidence of postoperative pain. The majority of patients in both groups reported no pain or only minimal pain within 24 hours of treatment. There were no differences between single- and multi visit treatment protocols with respect to the incidence of postoperative pain. No significant correlation could be found between pulp vitality and the incidence of postoperative pain.

The Effect of Entonox on Labour Pain Relief among Nulliparous Women: A Randomized Controlled Trial

Introduction: Labour pain is one of the most severe pain in humans. Fear of labour pain is the most dreadful reason for Caesarean Section (CS). Entonox (a mixture of nitrous oxide+oxygen) is a safe inhalational analgesia during labour pain. Aim: This study investigated the effect of entonox on pain relief and length of labour in nulliparous women. Materials and Methods: A clinical trial study was conducted among 120 nulliparous women (60 in intervention and 60 in control group) in 2015 in Atieh Hospital, Hamadan city, Iran. The women were chosen randomly to receive either entonox in the intervention group or oxygen in the control group. For the intervention group, entonox inhalation was introduced at the initiation of pain at each contraction. entonox gas was administrated via a face-mask. This enabled the women to breathe fresh gas in each inspiration. In the control group the oxygen inhalation was given with occurrence of pain at each contraction too. In both groups, the gas administration continued until the end of contraction pain with the patient finally breathing room air. Pain using Visual Analogue Scale (VAS), duration of labour and side effects were compared in two groups. Results: The mean age of women was 25.69 (SD=4.83). There were significant differences between two groups on labour pain at the first, second, third and fourth hours after intervention (p<0.05). Duration of labour in the intervention group (64.80 minutes) was significantly shorter than the control group (98.33 minutes) (p<0.05). There were no significant differences between the two groups on women’s blood pressure and neonatal Apgar score. Only dizziness was slightly higher in the intervention group compared to the control group (p<0.05). Conclusion: Entonox provides significant pain relief and it can quickly be implemented during painful labour.

Comparative Study on Insall-Salvati Index by Radiological and Clinical Methods in a Tertiary Care Centre of North Bengal, India

Maitreyee Kar, Dipankar Bhaumik, Samar Deb, Kaushik Ishore, Chinmaya Kar

Introduction: Patellar height is an important parameter of patellar stability. Its importance is evident from various attempts to measure it, by different scientists from time to time and many indices have been derived among which Insall-Salvati index (IS index) is the most simple, accurate and easy to measure. In this study a new clinical method has been tried to measure patellar height by applying the same principle of IS index. Aim: To compare clinical method of measurement of IS index with the one derived radiologically and to establish the higher cut off value of the clinical method. Materials and Methods: In the present study 186 knee joints (93 subjects) were subjected to measurement of patellar height by both clinical and radiological methods. The IS index was measured bilaterally from lateral view of X-ray plates and it was measured clinically in every knee joint. Both the values were compared using students t-test and higher cut off values were set for normal knee joint for the clinical method. Results: Among 93 study participants majority were females (54.83%), age of the patients varied from 10-68 years with mean age of 28 years and Standard deviation (SD) of 16.4. It was found that, there was no statistically significant difference between the mean values obtained by clinical method of measurement, compared to conventional one (IS Index) for both the genders and age groups on both the sides. A cut off value of 0.98 cm by clinical method gives sensitivity of 80% and specificity of 36% with area under the ROC curve 0.596. Conclusion: The subjects with patellar height of less than cut off value by clinical method can avoid radiological investigation as there was no statistically significant difference of IS index between radiological and clinical methods.

Knowledge Attitude and Perception of Sex Education among School Going Adolescents in Ambala District, Haryana, India: A Cross-Sectional Study

Introduction: Adolescence is a highly dynamic period characterised by rapid growth and development. Adolescents have limited knowledge about sexual and reproduction health, and know little about the natural processes of puberty, sexual health, pregnancy or reproduction. Sex education should be an integral part of the learning process beginning in childhood and continuing into adult life, because it is lifelong process. Aim: This study was carried out to identify the knowledge and attitude of imparting sex education in school going adolescents in rural and urban area of Ambala district Materials and Methods: A cross sectional study design was used to study the knowledge of reproductive and sexual health among school going children. A total of 743 adolescents from age group of 13-19 year were studied, using self designed semi-structured questionnaire to assess the knowledge regarding reproductive and sexual health among adolescents Results: The mean age of study subjects was 15.958±1.61 years, majority of adolescents i.e., 93.5% favour sex education. An 86.3% said sex education can prevent the occurrence of AIDS and 91.5% of adolescents prefer doctors should give them sex education followed by 83.0% school/teacher and least preference was parents 37.3%. Conclusion: There were substantial lacunae in the knowledge about reproductive and sexual health. Students felt that sex education is necessary and should be introduced in the school curriculum.

A Comparative Study of Liquid Nitrogen Cryotherapy as Monotherapy versus in Combination with Podophyllin in the Treatment of Condyloma Acuminata

Nidhi Sharma, Sanjeev Sharma, Chetna Singhal

Introduction: Condyloma Acuminata (CA) is a common viral sexually transmitted disease. Although various treatment modalities are available for treating CA, but none of them can achieve 100% response rate. In a search for better response rate and less recurrence rate, the combination of cytotoxic agent Podophyllin with ablative liquid nitrogen cryotherapy was evaluated over cryotherapy alone. Aim: To evaluate the synergistic effect of Podophyllin as a chemotherapeutic adjunct to an ablative therapy of liquid nitrogen cryotherapy versus liquid nitrogen cryotherapy alone in the treatment of CA. Materials and Methods: Sixty patients with multiple CA were randomly assigned to two groups in the study. Thirty patients in group A received double freeze thaw cycle of 25 seconds of liquid nitrogen cryotherapy. Thirty patients in Group B were subjected to liquid nitrogen cryotherapy in a similar manner followed by application of not more than 0.5 ml of 25% Podophyllin solution. All patients were followed up at 1, 4, 8, 12 and 24 weeks after the treatment to monitor the response to therapy and evaluation for any recurrence. When the number of unresponsive lesions were more than 30% of original lesions at 4 weeks follow-up, then the whole procedure was repeated again. Results: The complete response rate and the recurrence rate in the Group B in our study were comparable to Group A as the difference was statistically insignificant. But the differentiating point was that the similar results were obtained in Group B with an average1.2 sessions per patient in comparison to an average of 1.67 sessions per patient in Group A. Conclusion: Cryotherapy represents a simple, safe and effective regimen for the treatment of multiple CA which in combination with Podophyllin is even more effective as a single session procedure; thereby shortening the treatment regimen.

Intra-operative Diagnosis of Breast Lesions by Imprint Cytology and Frozen Section with Histopathological Correlation

Asha Mahadevappa, Thattamparambil Gopalakrishnan Nisha, Gubbanna V Manjunatath

Introduction: The most common malignant tumour among women is breast carcinoma. Early lesions of the breast including carcinoma are potentially curable if treated properly in the era of breast conservative therapy. For this purpose different diagnostic strategies are in practice. Intra operative Imprint Cytology (IC) and Frozen Section (FS) have a role in spite of the intense recognition of aspiration cytology in the following settings: inconclusive cytological/core biopsy findings; for evaluation of lumpectomy margins and intra operative nodal status. Both IC and FS are dependable intra operative diagnostic consultation modalities and provide accurate results in minutes thereby making appropriate therapeutic decision. Aim: To study the IC and FS features of breast lesions with correlation of final Histopathologic (HP) diagnosis and to determine its diagnostic accuracy. Materials and Methods: This was a descriptive cross-sectional study conducted in the Department of Pathology, JSS Medical College, JSS University, Mysuru over a period of two years (October 2011-September 2013). A total of 62 cases of surgically resected breast specimens were evaluated for features of IC, FS and correlation with HP diagnosis. After describing gross features, representative tissue fragment was taken, three imprint smears were made and same tissue fragment was subjected to FS and later for routine HP processing. Slides prepared by IC, FS were interpreted and later correlated with HP diagnosis. Statistical analysis was done with SPSS for windows (version 16.0) by applying appropriate tests. Results: Out of 62 cases, 33(53.23%) were malignant and 29(46.77%) were benign. Sensitivity, specificity and accuracy of IC were 100%, 96.43% and 98.36% and for FS were 100%, 96.55% and 98.39% respectively. p-value for both were <0.001 indicating significant correlation with HP study. Conclusion: IC is a simple, accurate, rapid and cost effective diagnostic tool intra operatively where services for FS are not available. It preserves crisp cellular and nuclear detail. FS tissue architecture strongly approximates permanent HP sections but is frequently hampered by freezing artifact. But FS is able to differentiate carcinoma in situ and infiltrative lesions from benign breast lesions. Thus, IC and FS together offer a more reliable diagnosis; hence, it is always useful to prepare both the slides intra operatively. HP study still remains the gold standard in final diagnosis of any breast lesion. In surgical pathology, the correlation of intra operative IC and FS diagnosis with the final HP diagnosis form an essential part of quality assurance activity.

Evaluation of CYP1B1 Expression, Oxidative Stress and Phase 2 Detoxification Enzyme Status in Oral Squamous Cell Carcinoma Patients

Introduction: Oral Squamous Cell Carcinoma (OSCC) affects global health with increasing incidence and mortality rate. It may involve exposure to carcinogens from tobacco smoking or chewing. Alteration in expression of gene encoding the enzymes concerned with carcinogen biotransformation along with oxidative stress may increase or decrease the risk of cancer. Aim: To evaluate the expression of CYP1B1 gene in OSCC patients along with its relation with oxidative stress and phase 2 detoxification enzyme status. Materials and Methods: In the present study, CYP1B1 genotypic analysis was carried out along with estimation of serum Total Antioxidant Activity (TAA), erythrocyte Malondialdehyde (MDA) levels and serum Glutathione-S-Transferase (GST) activity in 20 OSCC patients and statistically compared with that of age matched 20 healthy subjects, served as control by using student’s t-test. Results: It was observed that 85% of histopathologically diagnosed OSCC patients had CYP1B1 expression with significantly elevated levels of MDA (p<0.001). In addition, plasma total antioxidant status and serum GST levels were decreased significantly (p<0.05) in OSCC patients as compared to the healthy controls to overcome the burden of oxidative stress. Conclusion: On the basis of the present study, we conclude that the expression of CYP1B1 is an important determinant of carcinogenesis and significantly associated with oxidative stress characterized by decreased serum GST and total antioxidant levels in OSCC patients.

Emergency Peripartum Hysterectomy: Indications and Outcome in a Tertiary Care Setting

Anshuja Singla, Rajlaxmi Mundhra , Latika Phogat, Sumita Mehta, Shalini Rajaram

Introduction: Emergency Peripartum Hysterectomy (EPH) is an important lifesaving procedure, mostly reserved for conditions deemed to be serious and life threatening, and not amenable to conservative methods. In the present scenario, the advent of newer medical and conservative surgical methods for controlling obstetric haemorrhage has influenced the incidence, trend and the outcomes of the procedure. Aim: To evaluate the demographic profile, indications, operative details, maternal morbidity and mortality and neonatal outcomes of women undergoing EPH. Materials and Methods: A descriptive analysis of case records of women who underwent EPH between September 2006 to July 2014, at Guru Teg Bahadur Hospital Delhi, India was done. Data were collected from the medical records department. Results: A total of 194 cases (n) were identified among 1,00712 deliveries, an incidence of 1.92 per 1000 deliveries. Majority of the women were unbooked i.e., they did not receive any form of antenatal care and were gravida 3 and above. The indications were atonic PPH in 89 (45.87%), rupture of unscarred uterus in 36 (18.56%), morbidly adhered placenta in 30 (15.46%), scar rupture in 20 (10.31%) and gangrenous uterus 19 (9.79%). The mean blood loss was around 1.6±0.45 litres. Approximately 14% cases underwent stepwise devascularisation prior to hysterectomy and in only 2% women, B-Lynch suture was applied. Thirteen (6.7%) cases had bladder injury and 22 (11.34%) needed re-laparotomy for hysterectomy. Around 76 (39%) women were shifted for ICU care. Nineteen (9.79%) women developed Disseminated Intravascular Coagulation (DIC). The case fatality rate was 7.2% and perinatal mortality was 30%. Conclusion: Atonic PPH remains the leading cause of EPH in our analysis. Surprisingly rupture of unscarred uterus was more common compared to scar rupture. Creating awareness among women to seek health services in time with facilities for early referral, teaching younger obstetricians with conservative surgical procedures like stepwise devascularisation steps and compressive sutures should be of utmost priority.

Assessment of Oxidant-Antioxidant Status and Stress Factor in Recurrent Aphthous Stomatitis Patients: Case Control Study

Sherin Ziaudeen, Rathy Ravindran

Introduction: Despite its vast occurrence, the aetiology of Recurrent Aphthous Stomatitis (RAS) still remains unknown and its aetiology is multifactorial. The factors believed to be associated with the aetiology of RAS, may disturb the equilibrium of oxidant-antioxidant status of the organism and may accelerate the formation of free radicals, resulting in Oxidative Stress (OS). Psychological stress is believed to act as a triggering factor or modifying factor for RAS. Aim: To find whether oxidant-antioxidant status and psychosocial stress play a role in the pathogenesis of RAS. Materials and Methods: The study was conducted on 60 subjects over a period of one year (August 2014-August 2015) equally divided into two groups-patients with RAS and healthy controls. Psychosocial stress was analyzed by using Recent Life Changes Questionnaire (RLCQ). Saliva was analyzed to evaluate Superoxide Dismutase (SOD) and Glutathione Peroxidase (GSHPx) activities, Malondialdehyde (MDA) and Uric Acid (UA) levels in both the study and the control groups, using UV spectrophotometry. Results: The mean value of salivary SOD and MDA was increased while the activity of GSHPx and UA decreased in the study group when compared to the controls; the difference being statistically significant (p<0.005). The mean RLCQ stress score was also found to be increased in the RAS group, which showed elevated levels of mental stresses when compared to physical stresses. No significant association was observed between SOD, MDA, GSHPx and UA with high levels of stress score (p>0.05). In the study group, no correlation was observed between the study variables and gender, the number of ulcer episodes in one year, the number of ulcers per episode or the duration of ulcers. Conclusion: This study shows that salivary antioxidant levels show a significant difference in response to OS in RAS patients. An increase in levels of psychosocial stress is seen associated with patients with RAS indicating its role as a modifying or triggering factor in the initiation of RAS.

Attitudes of Mashhad Public Hospital's Nurses and Midwives toward the Causes and Rates of Medical Errors Reporting

Introduction: Patient’s safety is one of the main objective in healthcare services; however medical errors are a prevalent potential occurrence for the patients in treatment systems. Medical errors lead to an increase in mortality rate of the patients and challenges such as prolonging of the inpatient period in the hospitals and increased cost. Controlling the medical errors is very important, because these errors besides being costly, threaten the patient’s safety. Aim: To evaluate the attitudes of nurses and midwives toward the causes and rates of medical errors reporting. Materials and Methods: It was a cross-sectional observational study. The study population was 140 midwives and nurses employed in Mashhad Public Hospitals. The data collection was done through Goldstone 2001 revised questionnaire. SPSS 11.5 software was used for data analysis. To analyze data, descriptive and inferential analytic statistics were used. Standard deviation and relative frequency distribution, descriptive statistics were used for calculation of the mean and the results were adjusted as tables and charts. Chi-square test was used for the inferential analysis of the data. Results: Most of midwives and nurses (39.4%) were in age range of 25 to 34 years and the lowest percentage (2.2%) were in age range of 55-59 years. The highest average of medical errors was related to employees with three-four years of work experience, while the lowest average was related to those with one-two years of work experience. The highest average of medical errors was during the evening shift, while the lowest were during the night shift. Three main causes of medical errors were considered: illegibile physician prescription orders, similarity of names in different drugs and nurse fatigueness. Conclusion: The most important causes for medical errors from the viewpoints of nurses and midwives are illegible physician's order, drug name similarity with other drugs, nurse's fatigueness and damaged label or packaging of the drug, respectively. Head nurse feedback, peer feedback, fear of punishment or job loss were considered as reasons for under reporting of medical errors. This research demonstrates the need for greater attention to be paid to the causes of medical errors.

Solving the Mystery of the Antero Lateral Ligament

P H Sonia Farhan, Rathi Sudhakaran, Jai Thilak

Introduction: The cruciate ligaments are essential for the antero-posterior stability of the knee joint. In Anterior Cruciate Ligament (ACL) rupture, though reconstructive surgery is a widely accepted and proven procedure, there is still an unacceptably high re-injury rate. The fact that the rotational instability persists even after the surgical reconstruction of ACL injury has evoked a new interest in the study of the soft tissue structures on the anterolateral aspect of the knee joint. The stability of the knee joint was found to improve dramatically if ACL reconstruction is accompanied with the reconstruction of the anterolateral soft structures of the knee. Aim: To identify the attachment and observe the measurable parameters of Antero Lateral Ligament (ALL) and its relationship with the adjacent bony landmarks. Materials and Methods: Twenty six cadaveric specimens of knee joints were collected from the Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi and were dissected for the anterolateral ligament. Various parameters of ALL in extended knee- the length, width at midpoint and at the femoral-tibial attachments and thickness– were measured. The relationship of femoral attachment of ALL with the lateral femoral epicondyle as well as the tibial attachment with the Gerdy’s Tubercle (GT) and head of fibula were also noted. Results: ALL was identified in all the 26 cadaveric knee specimens. It was 39.2±7.2 mm in length, 6.5±2.7 mm in width at femoral attachment and 7.4±3.4 mm at tibial attachment, while the thickness was 1.0±0.5 mm. At the femoral attachment it was 7.1±3.4 mm proximal to and 4.0±2.9 mm posterior to the lateral epicondyle while at the distal attachment it was 20.4±3.1 mm posterior to the GT and 21.33±4.6 mm anterior to the head of the fibula. Conclusion: The ALL was found to be a distinct, supporting anatomical structure on the anterolateral aspect of the human knee. There is a high incidence of ALL lesions in ACL injuries which causes high-grade pivot-shift. The reconstruction of ALL along with that of ACL could lead to a decrease in the re-injury rates. The anatomical descriptions and the morphometry of ALL may be of great value to the orthopaedic surgeons in performing a more effective reconstructive surgery of ACL.

Clinical Profile and Outcome of Newborns with Acute Kidney Injury in a Level 3 Neonatal Unit in Western India

Introduction: Acute Kidney Injury (AKI) is a serious condition in neonatal care. It complicates the management necessitating the restrictive use of medications. Aim: To evaluate clinical profile, identify associated and prognostic factors in newborns with AKI. Materials and Methods: This was a case control study done between January 2008 to January 2010. Total 1745 newborns were admitted, of which 74 babies had AKI. It was defined as serum creatinine >1.5mg/dl. Control group was selected randomly from the hospital numbers of the newborns derived from the electronic registry with serum creatinine below 1.5 mg/ dl. Demographic variables like birth weight, gender, gestational age, admission age, growth restriction, Apgar scores, electrolyte levels; and common clinical conditions like asphyxia, sepsis, meningitis, persistent pulmonary hypertension, Necrotizing Enterocolitis (NEC), mechanical ventilation, congenital heart disease; were compared amongst the two groups. Information was obtained from the admission register, admission files, labor register of obstetrics and gynaecology department and electronic registry. Chi square/independent sample t-test as applicable and logistic regression were used to establish an association of various factors and outcome with AKI. Results: The incidence of AKI in our study was 4.24%. Demographic variables more common in AKI group were inborn (p=0.011), male gender (p=0.032), term gestation (p=0.001), Appropriate for gestational age (0.001), higher birth weight (p<0.001), full term (p<0.001), sepsis (p<0.001), NEC (p=0.042), low ApGAR scores at one minute (p=0.011) and five minute (p=0.003). However, on multivariate logistic regression only male gender [Odds Radio (OR)=2.84, Confidence Interval (CI)=1.12- 7.21] and Sepsis (OR=14.46, CI=4.5-46.46) were associated with AKI. Respiratory distress syndrome was more prevalent in the control group (p<0.003). No need of mechanical ventilation and absence of shock, improved the survival. Conclusions: AKI continues to be of clinical significance in neonatal intensive care. Further studies are needed to evaluate newer associations (like male gender and low APGAR scores).

Assessment of Disease Severity and Role of Cytomegalo Virus Infection in Patients with Ulcerative Colitis

Nobin Babu Kalappurayil, Jino Thomas, Baburajan Mankuni, Varghese Thomas

Introduction: Course of Ulcerative Colitis is characterized by intermittent flares interposed between variable periods of remission. Identification of exacerbating factors and appropriate assessment of disease activity are crucial in deciding the choice of treatment. Aim: To evaluate various clinical, endoscopic and histological parameters in assessing disease activity and to find out various risk factors involved in the exacerbation of ulcerative colitis especially the role of Cytomegalo Virus (CMV) infection. Materials and Methods: It was a prospective study of patients diagnosed as ulcerative colitis presenting with acute exacerbation of symptoms (cases) and those who were in remission (controls). A detailed evaluation of the disease history including personal history, treatment compliance and clinical disease severity were noted. Investigations including blood routine, endoscopic examination with biopsy, histopathological examination and immunohistochemistry for CMV were done on the biopsy sample. Results: A total of 58 patients with ulcerative colitis were studied which included 37 cases and 21 controls. Out of the various clinical and demographic parameters, Good treatment compliance (p =0.0003) and Perceived Stress Scale (PSS) score (p=0.0001) showed significant difference between cases and controls. Basic laboratory parameters {Haemoglobin level, Total Leucocyte Count (TLC) and Erythrocyte Sedimentation Rate (ESR)}, clinical disease severity predictors (Truelove and Witt’s criteria, Mayo score and endoscopic disease severity grade) and Geboes histological scoring showed significant difference between cases and controls. The prevalence of CMV colitis in our study was only 5.4% (two cases). Conclusion: Clinical and endoscopic disease severity indicators can be used as predictors of histological activity in ulcerative colitis. Poor treatment compliance and stress are important risk factors for acute exacerbation of ulcerative colitis. Clinicians should be aware of the possibility of concurrent CMV infection while treating patients with acute exacerbation of ulcerative colitis not responding to the conventional management. Reduced prevalence of CMV colitis in cases of acute exacerbation of ulcerative colitis in our study may be due to the small sample size, reduced number of steroid dependent cases or reduced severity of our cases.

Mechanism and Immediate Outcome of Significant Mitral Regurgitation Following Balloon Mitral Valvuloplasty with JOMIVA Balloon

Introduction: Balloon Mitral Valvuloplasty (BMV) with inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique with Joseph Mitral Valvuloplasty (JOMIVA) balloon and is being followed in certain centres. We hypothesized that, the incidence and mechanism of Mitral Regurgitation (MR) is likely to be different from that of inoue balloon. Aim: To assess the mechanism and immediate clinical outcome of significant MR following BMV with JOMIVA balloon retrospectively. Materials and Methods: We retrospectively analyzed the outcome of 48 patients who developed moderate to severe MR out of 249 patients who underwent BMV in our institute. We analyzed the echocardiographic and clinical parameters of these patients. Results: Nineteen (7.6%) patients developed severe MR and 29 (11.2%) patients developed moderate MR. Commisural separation resulting in MR was the most common cause which was contributing to 73.6 % and 85.7% of patients with moderate and severe MR respectively. Leaflet tear was the second most common cause which contributed to 15.7% and 14.2% of patients with severe and moderate MR respectively. Chordal rupture contributed to 10.5% of patients with severe MR. Six (31.6%) patients with severe MR developed worsening breathlessness among them one had to be referred for mitral valve replacement during index hospitalization and the rest could be managed medically. Patients with moderate MR remained asymptomatic and stable. Conclusion: Severe MR following JOMIVA BMV results most commonly due to wide separation of commisures. JOMIVA balloon is less likely to cause damage to subvalvular structures than inoue balloon. Most patients who develop severe MR will not require emergency mitral valve replacement. Moderate MR is well tolerated clinically.

Study on Steroid Induced Ocular Findings in Children with Nephrotic Syndrome

Vijay Agrawal, Kusum Devpura, Laxmikant Mishra, Sajan Agarwal

Introduction: Long term use of corticosteroids in Nephrotic Syndrome (NS) is associated with ocular complications such as Posterior Subcapsular Cataract (PSC), glaucoma, increased intra-ocular pressure, ptosis, mydriasis, eyelid skin atrophy, keratisis, thinning of cornea and sclera, repeated hordeolum exacerbations. Aim: To determine ocular abnormalities in children with NS and their association with steroid dosing and duration. Materials and Methods: Hundred patients with NS in the age group of 2-18 years, with no evidence of other systemic disease, were considered for the study. Group I included cases (66) who took standard steroid regimen for first episode of NS. Group II included cases (34) who took steroid irrationally (daily basis for long time) other than standard regimen. Steroid induced ocular complications were compared in both groups after detailed ophthalmological examination. Statistical analysis was done using Statistical Package for Social Science (SPSS-20.0). Results: Ocular abnormalities were found in 12 patients out of 66 in Group I (18%) and 16 patients out of 34 patients in Group II (47%). Out of 12 patients of Group I who had ocular problems, three had myopic astigmatism, eight patients had PSC and one had temporal disc pallor. While in Group II, out of 16 patients who had ocular complications, two patients had raised intra ocular pressure and two patients had myopic astigmatism and 12 patients had posterior sub capsular cataract. The difference in mean cumulative steroid doses in both groups was statistically significant but no such difference was there between duration of steroid intake in both group. Conclusion: Our study concluded that ocular complications were more common in patients with irrationally steroid intake and cumulative steroid dose intake was also significantly higher in same patients.

Early Experience of Sofosbuvir based Combination Therapy in “Real-Life” Cohort with Chronic Hepatitis–C Infection

Rajiv Mehta, Mayank Kabrawala, Subhash Nandwani, Rini Tekriwal, Payal Nandania

Introduction: There is scarcity of data in literature regarding the treatment response with Sofosbuvir (SOF) based therapy in Indian patients with chronic Hepatitis-C Virus (HCV) infection. Aim: This study was designed to observe initial treatment response to SOF based therapy in a “real-life” cohort of Indian patients with HCV infection. Materials and Methods: This is a prospective, observational and single center study. A total of 107 patients who were diagnosed with chronic HCV infection and received SOF based treatment between March 2015 and December 2015 were included. The patients were treated with either triple drug regimen [SOF, Ribavirin (RBV) and Pegylated Interferon-a (Peg IFN-a)] or dual drug regimen (SOF and RBV) for either 12 or 24 weeks. The virological responses were obtained at baseline and thereafter weekly (up to four weeks) till viral load became undetected during treatment. Results: A total of 107 patients who received SOF based therapy for chronic HCV infection were included in the study. Mean age of the patients was 48.7±10.7 years. Among included patients, 24 (22.4%) patients were treatment-experienced. Majority of the patients (n=69; 64.5%) were infected with HCV genotype-3. Except one patient, all the included patients achieved virological response up to week-4 of the treatment. There was statistically insignificant association between virological response (up to four week of the treatment) and severity of the disease (cirrhosis and non-cirrhosis) or treatment status (treatment-naïve and treatment-experienced), or HCV genotype (genotype-1 and 3). Conclusion: The results of this observational study demonstrated rapid initial virological response of SOF based therapy in “real-life” cohort of Indian patients with chronic HCV infection. However, long-term follow-up data are needed to ensure the sustained antiviral efficacy of SOF based therapy.

Role of Omega-3 Fatty Acids on Lipid Profile in Diabetic Dyslipidaemia: Single Blind, Randomised Clinical Trial

Shaylika Chauhan, Hanish Kodali, Jawad Noor, Karuna Ramteke, Vidisha Gawai

Introduction: Diabetic dyslipidaemia is characterised by hypertriglyceridaemia, low High Density Lipoprotein (HDL), postprandial lipaemia, small and dense LDL particles is considered to be a major predisposing factor for various macrovascular complications. Omega-3 fatty acids are fish oil derivative introduced in the market for dyslipidaemia associated with increased triglyceride level. Aim: To study the effect of omega-3 fatty acids on lipid profile in Type II diabetes patients. Materials and Methods: This study was prospective, single blind, randomized comparative trial. Hundred patients were randomized into three groups. Group I received metformin 500 mg twice daily and placebo, Group II received metformin 500 mg twice daily and omega-3 fatty acids (1 gram) once daily and the Group III received metformin 500 mg twice daily and omega-3 fatty acids (1 gram) twice daily. ANOVA test was applied for analysis. Results: Group II was effective in reducing the triglyceride level from 144.59±14.18 mg/dl to 101±13.31 mg/dl which was significant as compared to Group I from 147.67±18.57 mg/dl to 145.8±19.86 mg/dl respectively. Group III containing 1 g of omega-3 fatty acids twice daily showed decrease from 144.83±22.17 mg/dl to 86±17.46 mg/dl and was more effective in reducing triglyceride levels than Group II containing 1 gram of omega-3 fatty acids once daily. Conclusion: Omega-3 fatty acids can be given in conjunction with metformin to reduce triglyceride levels in diabetic dyslipidaemia without any adverse drug reactions or any drug interaction. Omega-3 fatty acids were effective in reducing the triglyceride level significantly as compared to placebo. Two grams of omega-3 fatty acids were more effective than 1 gram of omega-3 fatty acids in reducing triglyceride levels.

Effect of Anti-Cyclic Citrullinated Peptide and HLA-DRB1 Subtypes on Clinical Disease Activity Index in Rheumatoid Arthritis Patients

Introduction: Rheumatoid arthritis (RA) is a crippling disease with a global prevalence of approximately 0.5%-1% in adults. Genetic, environmental and immunologic factors contribute importantly to pathogenesis of RA. American College of Rheumatology (ACR) assists in early diagnosis of the disease. Aim: The aim of this study was to investigate the effects of HLADRB1 gene and anti-Cyclic Citrullinated Peptide (CCP) antibody on Clinical Disease Activity Index (CDAI) and to determine the frequency of HLA-DRB1 alleles in the patients with RA. Materials and Methods: In this descriptive-analytical study, 64 patients with RA referring rheumatology clinic of Hajar Hospital, Shahr-e-Kord, Iran were enrolled based on ACR criteria (1987) by convenience sampling. All patients were examined to assess primary CDAI and referred to laboratory for serologic tests [Rheumatoid Factor (RF) and anti-CCP]. After the patients’ DNA was extracted, HLA-DRB1 was determined per single specific primer-polymerase chain reaction by inno-train kits. The patients were re-examined six months later. Results: The most prevalent type of HLA-DRB1 in the studied patients was 04. In patients with HLA-DRB1 (04), HLA-DRB1 (01), and HLA-DRB1 (15), CDAI decreased pronouncedly after six months, but in other patients it did not (p<0.05). Of the patients, 81.3% had high titers of anti-CCP, but no association between anti-CCP and CDAI was found. Conclusion: RA could be a multifactorial disease. The patients with HLA-DRB1 (04), HLA-DRB1 (01) and HLA-DRB1 (15) showed a good response to routine treatments. The patients with HLADRB1 (04) are likely to have no decrease in secondary CDAI. High titers of anti-CCP in patients may indicate the severity of RA in the studied region and perhaps environmental, genetic and unknown or idiopathic factors are aetiologically crucial.

A Community Based Study on Pelvic Inflammatory Disease in Postmenopausal Females: Microbiological Spectrum and Socio- Demographic Correlates

Samreen Khan, M Athar Ansari, Shaista M Vasenwala, Zehra Mohsin

Introduction: Pelvic Inflammatory Disease (PID) is a common and serious complication of sexually transmitted diseases in young women but is rarely diagnosed in the postmenopausal women. Very few studies have been done regarding postmenopausal PID. Aim: To determine the burden of PID, associated micro-organisms, pathophysiology and risk factors among post-menopausal women of the community. Materials and Methods: A cross-sectional study was conducted among 530 post-menopausal women in the registered field practice areas of the JN Medical College and Hospital, Aligarh, Uttar Pradesh, India. A pre designed and pre tested proforma was used to obtain data regarding socio-demographic details and factors associated with PID. Clinical and laboratory examinations were done to confirm the diagnosis of PID. Data was analyzed using SPSS 23.0. Association between categorical variables was tested with chi-square test and logistic regression analysis was used to find independent risk factors. The value of p<0.05 was considered as significant. Results: About 11.55% of the study subjects were diagnosed with PID (12.5% in rural areas and 10.6% in urban areas). Bacterial vaginosis followed by Trichomonas vaginalis were most common. Among the important risk factors, significant association was found with occupation of the women, increasing parity, multiple sexual contacts, and associated pelvic organ prolapse. Association with smoking, chronic illnesses, diabetes mellitus and hypertension, and associated urinary tract infection were not found to be significant. Conclusion: The study shows the hidden burden of the disease in the community and the associated risk factors, which can be prevented by life style and cultural changes if incorporated earlier in the lives.

Effect of Ketofol on Pain and Complication after Caesarean Delivery under Spinal Anaesthesia: A Randomized Double-blind Clinical Trial

Molouk Jaafarpour, Aminolah Vasigh, Javaher Khajavikhan, Ali Khani

Introduction: Pain is the key concern of women after caesarean delivery that may interfere with breastfeeding. Aim: The aim of this study was to assess effect of ketofol (ketamine/propofol combination) on pain and complication after caesarean delivery under spinal anaesthesia. Materials and Methods: In this randomized double-blind clinical trial, 92 parturient scheduled for elective caesarean delivery under spinal anaesthesia were included. The simple random sampling method was used to place subjects in four groups of ketamine (0.25 mg/kg), propofol (0.25 mg/kg), ketofol (25 mg ketamine plus 25 mg propofol) and placebo (saline). The drugs were administered intravenously immediately after clamping the umbilical cord. Visual Analog Scale (VAS) was used to determine the intensity of pain. Complications after surgery including shivering, nausea and vomiting as well as onset of breastfeeding were recorded. Results: The mean score of pain, morphine consumption and time of breastfeeding in the ketofol group were significantly lower than other groups at various intervals (p<0.05, p<0.001). The frequencies of shivering, nausea, vomiting, retention and pruritus in the ketofol group were significantly lower than other groups (p<0.001, p<0.05) Conclusion: The effective role of ketofol on reducing pain and complication after caesarean delivery indicated that it can be considered as a safe and alternative drug in these patients.

Erythrocyte Alloimmunization and Autoimmunization among Blood Donors and Recipients visiting a Tertiary Care Hospital

Daljit Kaur, Lovenish Bains, Manoj Kandwal, Indu Parmar

Introduction: The ultimate aim of pretransfusion testing is the acceptable survival of donor red cells in recipient’s body and antibody detection plays a critical role in achieving the same. The cornerstone of antibody detection method is detecting an unexpected antibody as against the expected antibodies of ABO blood group system. Autoantibodies can also interfere with the detection of clinically significant alloantibodies. Aim: To study the frequency of alloantibodies and autoantibodies in the healthy blood donors and patient population visiting our hospital. Materials and Methods: The Column Agglutination Technology (CAT) was used for ABO RhD blood grouping, Direct Antiglobulin Test (DAT), Autocontrol (AC), Indirect Antiglobulin Test (IAT) and red cell antibody screening and the unexpected reactions in any of these tests were recorded for further evaluation. Ethylene Diamine Tetra Acetic Acid (EDTA) blood samples were used for all these tests for both blood donors and admitted patients. The CAT was exercised for the blood grouping (using ABDReverse Diluent cassettes) and antibody screening (using 0.8% Surgiscreen, Ortho Clinical Diagnostics Limited, USA and Low Ionic Strength Saline Ortho BLISS with AHG cassettes) on the automated immunohaematology platform Ortho AutoVue® Innova system (Ortho Clinical Diagnostics Limited, USA). Results: Among all blood donors (n=6350), seven (0.11%) donors had showed unexpected reaction. Of these, four had positive antibody screen (three having naturally occuring antibodies 2=anti-M, 1=anti-Lea and 1=inconclusive) and the other three had positive DAT. Of all the patient samples (n=6136) screened for irregular red cell antibodies, four (0.06%) patients were found to have unexpected reaction revealing one (0.02%) with anti-M antibody and the other three (0.05%) had autoantibodies in their serum. Conclusion: The combined prevalence for both blood donor and recipient population (n=12,486) was found to be 0.11% at our center. The alloimmunisation among patient population was found to be lower than many other studies worldwide as our hospital does not cater to multitransfused or transfusion dependant patients with haematological disorders and majorly elective surgery patients with no history of previous blood transfusions visit our hospital.

Relationship of on Admission Hypocalcaemia and Illness Severity as Measured by APACHE-II and SOFA Score in Intensive Care Patients’

Introduction: Hypocalcaemia is very much prevalent in critically ill patients yet very less is known about its association with severity of illness. Acute Physiology and Chronic Health Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) are two commonly used and validated scoring tool used to assess the severity of illness in critically ill patients. Aim: To analyze the relation of on admission hypocalcaemia with severity of illness as measured by APACHE-II and SOFA scores. Materials and Methods: After institute approval, 111 patients admitted during May to June 2016 were evaluated. Age, sex, on admission ionized calcium (iCa0) levels, first day APACHEII and SOFA scores were collected. Data were then divided in different classes based on iCa0 levels (i.e., normocalcaemic, mild, moderate and severe hypocalcaemic), APACHE-II and SOFA scores and their relationship was assessed using INSTAT software (GraphPad Software, Inc, La Zolla, CA, USA) with appropriate statistical tests. Results: Seventy eight (70.27%) patients were having hypocalcaemia on admission (<1.15 mmol/L). The mean APACHE-II score of normocalcaemic patients were significantly (p<0.05) lower as compared to moderate and severe hypocalcaemic patients (15.57±6.85 versus 21.72±6.37 and 15.57±6.85 versus 22.34±7.53, respectively). The mean iCa0 level in patients with APACHE-II > 20 were significantly lower than patients with APACHE-II < 9 (0.88±0.26 versus 1.09±0.24, p <0.05) but the mean iCa0 level in patients with SOFA > 9 were not significantly lower than patients with SOFA < 4 (0.99±0.41 versus 1.04±0.23, p > 0.05). The relative risk of on admission hypocalcaemia across increasing illness severity was also not statistically significant. Both relative risk of mortality and length of ICU stay were higher in on admission moderate hypocalcaemic patients as compared to normocalcaemic but the difference was not statistically significant. Conclusion: On admission, hypocalcaemia has inconsistent correlation with increasing illness severity in adult intensive care patients. iCa0 of 0.81–0.90 mmol/L appears to have maximum deleterious effect with regard to mortality and length of ICU stay.

A Prospective Analysis of Drug Interactions in Patients of Intensive Cardiac Care Unit

Shipra Jain, Pushpawati Jain, Kopal Sharma, Pushpendra Saraswat

Introduction: Drug-Drug Interaction (DDI) is a serious concern in cardiac patients due to polypharmacy. Aim:The present study was aimed to identify the potential DDI among hospitalized cardiac patients and evaluate the mechanism and severity of such interactions. Materials and Methods: A prospective observational study was conducted in intensive cardiac care unit of a tertiary care hospital for six months. Patients aged 18 years and above and taking two or more drugs were included in the study. Medscape drug interaction checker was used to identify and analyze the pattern of potential DDI. Results: Out of 500 patients, most of the patients were male (78.4%) in the age group of 50-60 years (31%). The most common diagnosis was acute coronary syndrome (57.2%). Out of total 2849 DDI, 2194 (77.01%) were pharmacodynamic, 586 (20.57%) were pharmacokinetic in nature while 69 (2.42%) drug pairs interacted by unknown mechanism. Majority of drug interactions were significant {2031 (71.29%)} in nature followed by minor {725(25.45%)} while serious drug interactions were observed in only 93 (3.26%) drug pairs. A positive correlation was observed between patient’s age and number of drugs prescribed (r=0.178, p<0.001), number of drugs prescribed and potential Drug-Drug Interaction (pDDI) (r= 0.788, p<0.001) and between patient’s age and pDDI (r=0.338, p<0.001). Conclusion: The risk of pDDI was more commonly observed in elderly male patients particularly with antiplatelet drugs like low dose aspirin and clopidogrel.

Study of Nitrosative Stress in ‘Pregnancy Induced Hypertension’

Kapila B Gaikwad, Nitin G Joshi, Sohan P Selkar

Introduction: Hypertension is the most common medical problem encountered during pregnancy. Pregnancy Induced Hypertension (PIH) is also called a disease of maternal endothelium. Nitric-oxide being a potent vasodilator released by endothelial cells, its role has been implicated in PIH. Aim: To study the role of reactive nitrogen species in PIH. Materials and Methods: One hundred and twenty samples were selected for the study. Of these, 60 patients had PIH (case) and the rest without PIH (control). Estimation of serum nitricoxide, serum nitrothiol, serum total thiol was done. Results: The study showed decreased NOx (Mono nitrogen oxide No and No2) levels in PIH as compared to control (p< 0.001). PIH patients had significantly higher levels of S-nitrothiols than control (p<0.01). Thiol levels were decreased in PIH as compared to control (p<0.001) Conclusion: Thus, it is concluded from this study that nitrosative stress represents a point of convergence for several contributing factors potentially leading to the clinical manifestations of pregnancy induced hypertension. The antioxidants are used up while scavenging the free radicals.

Nerve Conduction Study on Sural Nerve among Nepalese Tailors Using Mechanical Sewing Machine

Introduction: The use of new technologies and innovations are out of access for people living in a developing country like Nepal. The mechanical sewing machine is still in existence at a large scale and dominant all over the country. Tailoring is one of the major occupations adopted by skilled people with lower socioeconomic status and education level. Sural nerves of both right and left legs are exposed to strenuous and chronic stress exerted by chronic paddling of mechanical sewing machine with legs. Aim: To evaluate the influence of chronic and strenuous paddling on right and left sural nerves. Materials and Methods: The study recruited 30 healthy male tailors with median age {34(31-37.25)} years (study group), and, 30 healthy male volunteers with age {34(32-36.25)} years (control group). Anthropometric measurements (age, height, weight, BMI and length of both right and left legs) as well as cardio respiratory measurements [Systolic Blood Pressure (SBP), Dystolic Blood Pressure (DBP), Pules Rate (PR) and Respiratory Rate (RR)] were recorded for each subject. Standard nerve conduction techniques using constant measured distances were applied to evaluate sural nerve (sensory) in both legs of each individual. The differences in variables between the study and control groups were tested using Student’s t-test for parametric variables and Mann-Whitney U test for nonparametric variables. A p-value of = 0.05 was considered significant. Results: Age, height, weight, body mass index and leg length were not significantly different between tailors and control groups. Cardio respiratory measurements (SBP, DBP, PR and RR) were also not significantly altered between both the groups. The sensory nerve conduction velocities (m/s) of the right {44.23(42.72-47.83) vs 50(46- 54)} and left sural nerves {45.97±5.86 vs 50.67±6.59} m/s were found significantly reduced in tailors in comparison to control group. Similarly amplitudes (µv) of right sural (20.75±5.42 vs 24.10±5.45) and left sural nerves {18.2(12.43-21.8) vs 32.0(26.5-35.25)} were significantly less in tailors in comparison to control group whereas, latencies (ms) of right sural {2.6(2.2-2.7) vs 2.0(2.0-2.250} and left sural nerve {2.4(2.07-2.72) vs 2.0(2.0-2.0)} were found significantly high in tailors as compared with control group. Conclusion: Operating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left sural nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy.

An Assessment of Osteoporotic Conditions among Users and Non-Users of Warfarin: A Case-Control Study

Aseel Hadi Abdulameer, Syed Azhar Bin Syed Sulaiman, Muhamad Bin Sk Abdul Kader

Introduction: Warfarin is an oral anticoagulant which is associated with a decrease in Bone Mass Density (BMD). Aim: The study aimed to explore the prevalence of osteoporosis conditions in Malaysians with chronic warfarin patients using calcaneal quarter of Quantitative Ultrasound (QUS) machine and to investigate whether long-term sodium warfarin therapy that antagonizes vitamin K is affecting the increasing rate of osteoporosis in Penang and to find the risk factors of getting osteoporosis among warfarin users and its non users. Materials and Methods: A case-control study was conducted among 130 patients using warfarin, attending the outpatient clinic at Hospital Pulau Pinang. A convenience sampling method was used to recruit the required sample. Another 140 subjects were selected from the community as a control group (non-users of warfarin). Results: This study showed that more than three-quarter patients (82%) were at high risk of abnormal BMD. The warfarin users were two times more likely to have a higher osteoporosis risk compared to control group. Moreover, BMD has a negative correlation with age, but has a positive correlation with Body Mass Index (BMI). Patients showed a negative correlation with a higher dose of warfarin intake. Conclusion: This study concluded that osteopenia and osteoporosis are serious problems between users and non-users warfarin in Penang. Therefore, it should be taken into consideration in the Malaysian Health Ministry’s agenda.

Short Term Unscheduled Revisits to Paediatric Emergency Department - A Six Year Data

Introduction: Reviewing the reasons for return visits within 24 hours is a very important method of determining possible problems of emergency health care. Several causes stay behind unscheduled emergency return visits. Therefore, identifying these factors is crucial to set strategies in order to decrease the number of unnecessary visits. Aim: To define the characteristics of the patients returning to the Paediatric Emergency Department (PED) within 24 hours via determining rate, number and demographic data of patients. Materials and Methods: The present study design involves retrospective data collection of patients who returned to PED within 24 hours after being discharged. Data was included over six year period and was collected from July 1, 2010 to June 30, 2016. The data was analysed with SPSS17.0 statistical package for windows. Results: A total of 1994 patients returned to PED within 24 hours from July 1, 2010 to June 30, 2016. The most common group of revisiting patients were toddlers (aged 0-2-year old), n=1168 (58.5%), and the least number represented young adolescents (aged 15-18-year old), n=82 (4.1%). Number of patients returning to PED in 24 hours has significantly increased within years from approximately 90 patients to 720 (p<0.05). This increase in number was observed in all and each age group (from 0-18 years of age) without any exception. Seasonal distribution of the patients showed no significant difference (p>0.05) for each age, but again, presented definite negative correlation with age (the older is the patient group, the less is the number of revisits). The most common time for revisits was 17-24 hours after first discharge from PED, n=1277 (64.04%). Conclusion: The number of return visits is increasing over the years. The younger the patient is, more likely is the risk of unscheduled revisit to PED. Most of the patients returned to PED in 17 to 24 hours after discharge.

Study on the Relation between Colorectal Cancer and Gall Bladder Disease

Siddharth Gosavi, R Rama Mishra, AC Praveen Kumar

Introduction: Colorectal cancer is cancer of the large intestine, the lower part of digestive system which includes the sigmoid colon and rectum. Aim: To study the relation of incidence of colorectal cancer with previous gall bladder disease or post-cholecystectomy status, a relation between gall bladder disease and smoking in particular and the most common region of colon involved in colorectal cancer in gall bladder disease and non-gall bladder disease patients. Materials and Methods: A total of 256 patients with symptoms of rectal bleeding, change in bowel habit, unexplained tiredness, weight loss, pelvic pain, jaundice and abdominal distension were screened by using colonoscopy among whom 30 patients were diagnosed with colorectal cancer. Detailed history was taken with the help of a modified questionnaire and the patients were assessed, examined and the list of investigations such as faecal occult blood test, ultrasound of abdomen and pelvis, colonoscopy, sigmoidoscopy, barium enema, Computed Tomography (CT), Magnetic Resonance Imaging (MRI) of the abdomen and pelvis, tumour markers like Carcinoembryonic Antigen (CEA) and biopsy were collected. Patient pool was categorized into Gall Bladder Disease (GBD) and Non Gall Bladder Disease (NGBD). Proportions test and Fisher’s-Exact test were used to calculate the p-values. Results: Ten patients had previous gall bladder disease (33%) which was significant with a p-value of 0.016 by proportions test. Two patients underwent cholecystectomy, two patients underwent Endoscopic Retrograde Cholangio Pancreatography (ERCP) and the remaining six patients did not take any treatment for their gall bladder disease. Five patients with previous gall bladder disease were found to be smokers with a p-value of 0.091. The average age was 47.2 years in males and 42.2 years in females. Males constituted 66.6% (20 males) of the diseased population whereas, females constituted 33.4% (10 females). Rectal bleeding and altered bowel habits were the commonest symptoms. Confirmation of the disease was proven using CT abdomen and biopsy. Right sided colorectal cancer was common in GBD patients. Left sided colon cancer was common in NGBD patients. Conclusion: This study established a statistically significant risk of colorectal cancer following cholelithiasis though no risk was apparent following cholecystectomy.

The Relationship between Serum Level of Vitamin D3 and the Severity of New Onset Rheumatoid Arthritis Activity

Introduction: Rheumatoid Arthritis (RA) is a systemic inflammatory disease which typically involves wrists, ankles, and finally every joint. Some of studies have reported a reverse relationship between the level of vitamin D and RA severity. Aim: The present study was carried out in order to check the potential relationship between the level of vitamin D and RA severity. Materials and Methods: Ninety-three patients with RA with onset in recent three months (new onset RA), and 31 patients without RA were chosen as the control group. The patients all aged under 75 years and were diagnosed by a rheumatologist. The serum level of vitamin D was measured through blood test by chemiluminescence method by taking a blood sample of 5 cc. The relationship between the average level of vitamin D and disease severity was analyzed based on scoring scale of DAS28 in different groups with RA. The significant level of the above mentioned tests was set at p<0.05. Data analysis was carried out using SPSS 20.0. Results: The results of the present study indicated that there was no significant relationship between the two groups in terms of the serum level of vitamin D. Since the subgroups of the patients are not homogenous in terms of age and based on disease severity, ANOVA and chi-square were used to modify this heterogeneity and compare vitamin D levels in patients based on disease severity. The results indicated that there was a significant difference between the three groups of patients in terms of disease severity, such that disease severity rose with a decrease in the serum level of vitamin D, (p-value <0.001). Conclusion: There was a significant reverse relationship between the serum level of vitamin D and RA severity based on Das Score 28. Therefore, it is recommended that if there is a lack of or insufficient amounts of this vitamin in the body, vitamin D supply needs to be optimized along with other standard medications in order to reduce the RA severity.

Comparative Evaluation of Three Herbal Solutions on the Disinfection of Guttapercha Cones: An In vitro Study

Introduction: Guttapercha (GP) cones are usually supplied in aseptic, sealed packages from the manufacturers, but once exposed to the dental office environment or even by handling; they can be contaminated by a number of microorganisms. Supplementary decontamination of GP cones is critical. As they cannot be sterilized by moist or dry heat, cold sterilization, using disinfectants should be used. Aim: The aim of the study was to evaluate rapid, reliable, convenient and effective method of disinfection of GP cones using readily available herbal solutions such as Aloevera Juice, Amla Juice and Pancha Tulsi. Materials and Methods: Ninety GP cones were selected for the study. Based on the contaminants used, 80 GP cones were divided into two groups: Group A and Group B with 40 cones in each group and the remaining 10 cones which were uncontaminated served as negative control. The cones from Group A were contaminated with Staphylococcus aureus (S. aureus) and Group B were contaminated with Enterococcus faecalis (E. faecalis). The contaminated cones from both groups were subdivided into four groups with 10 cones in each group. Group I cones were disinfected with Aloevera Juice, Group II with Amla Juice and Group III with Pancha Tulsi. The fourth group consisted of GP cones without any disinfection which served as positive control. All the cones were then incubated in thioglycollate media for seven days. The thioglycollate media was subcultured and colony forming units were counted. The data were analyzed by one way ANOVA (analysis of variance) and Post-hoc Tukey test using SPSS 17.0 software. Results: Mean colony forming units were compared in all the groups and there was a statistically significant difference present among the groups (p<0.01). Pancha Tulsi was found to be most effective disinfectant followed by Amla Juice. Conclusion: All the herbal solutions were found to be effective in the disinfection of GP points. However, Pancha Tulsi possesses superior antibacterial activity when compared with Aloevera Juice and Amla juice.

Micronucleus Assay in Urothelial Cells in Cancer Cervix

Suresh Kumar Sundararajan, Pratheepa Sivasankari Natarajan, Kanchana

Introduction: Cancer ranks third among the ten leading global causes of death. To evaluate the genotoxic risks, observed as DNA damages, can be assessed by Micronucleus (MN) test. Aim: To identify the occurrence of MN in normal and cancer cervix and find the correlation between MN and stage of cancer. Materials and Methods: A total of 60 females were included in the study and visual examination of the cervix was done. Based on the examination two groups were formed: A- Normal cervix (n-23) and B- Presence of erosion or growth or ulcer etc., in cervix (n-37). Midstream urine sample was collected and centrifuged from the cases after getting the informed consent. Slides were prepared from the pellet, were fixed in methanol, glacial acetic acid fixative and stained with Giemsa and May Grunwald stain. Statistical analysis was done by student’s t-test and chi-square test. Results: A linear association was noted between the mean MN count and cancer cervix stage. Almost 18.2% of the Group A cases had significant MN count. Sensitivity and specificity of MN count in Group A was 83.8% and 82.6% respectively. The efficiency was 83.3%. Conclusion: A statistically significant MN count was seen in the different stages of cancer cervix. There are cases who had normal findings on visual inspection of cervix but with significant MN count are prone for malignant transformation. MN assay is an easy, non-invasive, cost-effective method and can be used as a screening test for a large population.

Impact of a Structured Tuberculosis Awareness Strategy on the Knowledge and Behaviour of the Families in a Slum Area in Chhattisgarh, India

Janmejaya Samal, Ranjit Kumar Dehury

Introduction: Of different methods of disease prevention, health education and awareness programmes can empower people regarding several aspects of disease management and thereby enabling them in accessing the right treatment, in right time, at right place. Aim: The aim of this study was to assess the impact of a structured Tuberculosis (TB) awareness strategy on the knowledge and behaviour of slum dwellers of Durg, Chhattisgarh, India. Materials and Methods: A TB awareness intervention was implemented in terms of informing the houses of marginalized and vulnerable communities about TB, its symptoms, diagnosis, treatment and Revised National TB Control Program (RNTCP) services and the impact of the same was assessed through a survey questionnaire before and after the implementation of the intervention. Results: Of the knowledge components the improvement was incurred above 90% among the study participants in all components except in two components such as; modes of TB transmission and availability of free treatment facilities. In the behavioural segment, after the implementation of the awareness strategy, 53% and 92% of the respondents reported to visit government health facility for seeking help for their general and TB related problems respectively. Similarly the responses regarding not approaching the government health facility for TB care were changed after the implementation of the awareness strategy and 36% of the respondents said they would prefer to visit government health facility for TB care. Conclusion: Health education activities should be directed to improve the knowledge of slum dwellers regarding the modes of TB transmission and availability of free treatment at public health facilities.

Leishman-Giemsa Cocktail - Is it an Effective Stain for Air Dried Cytology Smears

Introduction: Air dried cytology smears are stained routinely with Romanowsky stains so that the relative cell size, nuclear size, cytoplasmic details, smear background elements and intercellular matrix components are better appreciated. A variety of modified Romanowsky stains are used in cytology. Leishman-Giemsa (LG) cocktail is one of the new staining techniques which can be used for staining the air dried cytology smears. Aim: To evaluate the quality of staining of LG cocktail on air dried smears and to compare the quality of staining of LG cocktail with May Grunwald Giemsa (MGG) which is the most commonly used stain in cytology. Materials and Methods: The present prospective comparative study was carried out with 100 cases and two extra smears were prepared for each case and stained with MGG and LG cocktail stains. The stained slides were blinded and were evaluated for the staining characteristics of the nucleus, cytoplasm and background staining. Based on this, scoring was done by two pathologists independently. Quality Index (QI) was calculated by dividing the scores obtained with the total score possible. Results: LG cocktail stained slides were excellent in cytoplasmic staining, granularity, nuclear morphology, background material staining and overall staining characteristics. QI of LG cocktail was 0.8 while that of MGG was 0.59. Conclusion: Staining of air dried smears by LG cocktail has a good QI. It is also cheaper, requires short duration for staining as compared to MGG. Hence, LG cocktail can be an effective replacement for MGG for staining the air dried cytology smears.

Effect of Intraperitoneal Injection of Saffron on the Treatment of Experimental Endotoxin Induced Uveitis in the Rabbit

Introduction: Saffron with scientific name of “Crocus sativus” from the family “Iridaceae” is a plant without stem and root. Antioxidative and immunomodulatory effects of saffron has been demonstrated in different studies. Aim: To assess the effects of saffron in the treatment on Lipopolysaccharide (LPS) induced uveitis in the rabbit. Materials and Methods: Thirty healthy female New Zealand white rabbits were prepared. LPS induced uveitis was confirmed via slit lamp examination 24 hours after intravitreal injection of Salmonella typhimurium LPS endotoxin in the right eye of all rabbits. Then the animals were randomly divided into two equal groups - group 1 (controls) and group 2 (saffron). After 24 hours of intravitreal injection of LPS, 60 mg/body weight of saffron was injected intraperitoneally for Group 2. On the seventh day after intraperitoneal injection, all rabbits of both groups were euthanized with an overdose intraperitoneal injection of sodium thiopental. Immediately after euthanasia, enucleation of both groups of rabbits was done. Clinical Scoring System (CSS) and pathological severity score of uveitis was assessed for each eye. Results: No statistical difference in the CSS was found in days 3,5, and 7 after intraperitoneal injection of saffron. Also, Pathological Severity Score (PSS) did not show a significant difference between two groups. Additionally, the maximum PSS of both groups was very closed but the number was observed in the saffron group (20%) more than control group (10%). Conclusion: Intraperitoneal injection of saffron was ineffective in the management of experimental uveitis. Further studies with different dosages and follow up and using other routes of administration are needed.

Variability of Iron Load in Patients of Sickle Cell Anaemia (HbSS): A study from Eastern India

Pranati Mohanty, Rabindra Kumar Jena, Sudha Sethy

Introduction: Sickle Cell Anaemia (SCA) is one of the commonest haemoglobinopathies due to a point mutation (A?T) of the b-globin gene. Out of five haplotypes, the Arab-Indian haplotype present in India is one of the least severe phenotype and least studied also. It is characterized by lifelong haemolytic anaemia requiring red cell transfusion leading to iron overload. In contrast, there is very high incidence of deficiency of iron, folic acid and vitamin B12. Aim: Our objective was to access the Iron status of SCA patients and to find its correlation with various parameters like red cell transfusion, haemolysis and serum hepcidin. Materials and Methods: This was a cross-sectional study conducted on 208 patients for a period of five years. Complete Blood Count (CBC), iron profile, haemolytic parameters and transfusion requirement were studied and data compared with 52 healthy controls. Results: Few patients (9.6%) revealed significant iron overload (Serum ferritin > 1000 ng/ml). In majority (80.8%) it was either normal or border line raised (300 to 1000 ng/ml) or iron deficiency was noted in a small fraction (9.6%). Frequency of transfusion is the principal factor which positively correlated with level of iron load (p<0.001) while parameters of haemolysis and serum hepcidin level play an insignificant role in this context (p= 0.0634). Conclusion: This study supports the notion that the presentation of SCA patients in India is of “Viscosity – Vaso-Occlusive Crisis (VOC) phenotype” with high incidence of VOC, low haemolytic rate and transfusion requirement. Iron deficiency may be present in SCA patients requiring Iron supplementation. We suggest further studies to establish the role of hepcidin, ferroportin and other factors that control iron absorption in these patients.

Cervical Conization and the Risk of Preterm Birth: A Population-Based Multicentric Trial of Turkish Cohort

Introduction: Cold Knife Conization (CKC) is one of the most effective methods for the treatment of Cervical Intraepithelial Neoplasia (CIN). Some studies showed a relation between preterm birth and the treatment of CIN; on the other hand, other studies do not show such a relationship. Aim: The present study was conducted with the aim to investigate the pregnancy outcomes of Turkish women regarding demographic characteristics, obstetric history, removed tissue, and residual cervical length after CKC and to determine the effect of removed cervical tissue volume and height on preterm birth. Materials and Methods: This study was a population-based, multicenter trial that was conducted on singleton pregnancies between January 2007 and December 2013. The control group comprised of 38,892 patients who gave birth during this period. On the other hand, patients who conceived after CKC during this period were invited to the hospital and included in the case group (n=20). The course of pregnancy following CKC was studied. Preterm birth rates, risk factors for preterm birth, conisation age, cervical smear and colposcopic biopsy results and the volume and height of the removed cervical tissue of those patients were evaluated. Results: There was no statistically significant difference in preterm birth rates between the case and the control groups. None of our cases had any identified preterm birth risk factor except for one case. The average height of removed cervical tissue was 12.6±5.4 mm and the average length of the residual cervix after birth was 28.7±4.3 mm. Conclusion: Removal of cervical tissue of 12.6±5.4 mm in height and 2.35±2.27 cm³ in volume will not increase the risk of preterm birth of women who do not have any other preterm birth risk factors. If there is no other preterm birth risk factors, term birth is most probably possible after conisation.

Surgical Outcome of Epicanthus and Telecanthus Correction by Double Z-Plasty and Trans-Nasal Fixation with Prolene Suture in Blepharophimosis Syndrome

Introduction: Blepharophimosis Syndrome (BPES) is a complex and rare disease characterized by epicanthus inversus, telecanthus, lateral ectropion, narrowed or shortened interpalpebral fissure distance and ptosis. It is mostly bilateral and may or may not be symmetrical. It is typically inherited as an autosomal dominant trait. In sporadic cases, the disease may occur without a prior family history as a genetic mutation from a deletion or translocation of the FOXL2 gene, which maps to chromosome 3q23. Surgical treatment of this disease poses an oculoplastic challenge due to multiple complex eyelid deformities. Aim: To evaluate the functional and cosmetic outcome of telecanthus and epicanthus correction by a Mustarde’s rectangular double Z-Plasty and trans-nasal fixation using 1-0 prolene suture in BPES. Materials and Methods: This was prospective, interventional study of 16 patients over a period of three years. In this study, all patients had BPES with prominent epicanthus and telecanthus. Mustarde’s double Z-plasty and trans-nasal fixation with 1-0 prolene suture was performed in the first of a two-stage operation. If ectropion was present, the lateral ectropion was corrected by a base-out flap transfer from the upper eyelid to the lower eyelid. After three months, a 2nd stage was undertaken, involving a lateral canthoplasty for horizontal widening of a short palpebral fissure and a tarso frontalis sling with silicone rod for correction of moderate to severe ptosis. Patients were followed up for six months to one year with postoperative ophthalmologic examinations and photographs. Results: Out of 16 patients, 10 were females and six were males. All the patients had bilateral involvement. In this study preoperative Inner Intercanthal Distance (IICD) ranged from 38 mm to 42 mm and the mean IICD was 41.2±0.57 mm. Postoperative IICD ranged from 31 mm to 34 mm. Horizontal Palpebral Fissure Length (HPFL) ranged from 20 mm to 23 mm and the mean value of HPFL was 21.50 mm preoperatively. Postoperative HPFL ranged from 26 mm to 29 mm and had a mean value of 28.50 mm, which was much improved after a combined correction of telecanthus and lateral canthoplasty. The mean preoperative IICD and HPFL ratio was 1.77 and was reduced to a postoperative value of 1.2. The Marginal Reflex Distance1 (MRD-1) test value improved from +1.25 mm to +3.50 mm postoperatively after placement of a tarsofrontalis sling with silicone rod using the Fox's Pentagon technique. In this study, two eyes had minimal unequal correction but were cosmetically and functionally acceptable. Correction of IICD is possible up to 6 mm. No major complication e.g., CSF rhinorrhea was noted in this series and preoperative prominent epicanthal folds were abolished. Conclusion: Here we propose a two-staged procedure involving a combined Mustarde’s double Z-plasty with transnasal fixation using a 1-0 prolene suture with a flap transfer from the upper lid to the lower lid in the first stage and a lateral canthoplasty with a tarsofrontalis sling and silicone rod in the second stage. This technique is effective to correct epicanthus, telecanthus, ptosis and lateral ectropion in BPES with good cosmetic and functional outcome.

Evaluation of Total and Lipid Bound Sialic Acid in Serum in Oral Leukoplakia

Karthik Krishnan, Sivapathasundharam Balasundaram

Introduction: Oral cancer has become the most common cause of cancer related mortality which may be preceded by oral potentially malignant disorders. Altered glycosylation of glycoconjugates, such as sialic acid are one of the most important molecular changes accompanied during malignant transformation in precancerous lesions like Oral Leukoplakia (OL), and correlating them histopathologically with grades of epithelial dysplasia which will serve clinical significance. Aim: The aim of this study was to evaluate the significance of serum Total Sialic Acid (TSA) and serum Lipid Bound Sialic Acid (LSA) as a prognostic serum marker in Oral Leukoplakia. Materials and Methods: Blood samples were collected from 30 patients diagnosed with OL and 30 healthy controls. Serum sialic acid (total and lipid bound) levels were measured using spectrophotometer. Tissue samples were histopathologically typed and were graded for epithelial dysplasia. Data were analysed using Independent t-test and Kruskal Wallis method. Results: Serum levels of both total and lipid bound sialic acids were found to be increased in OL when compared to healthy controls. The mean TSA levels among those in the OL group (45.3±4.2) were significantly greater than healthy controls (29±2.2). On multiple comparison the highest mean TSA level was found in severe OL compared to moderate and mild OL (p<0.05). The mean levels of LSA were found to be statistically non-significant between the groups. Conclusion: The present study showed that the serum levels of both TSA and LSA were found to be increased in OL when compared to apparently healthy controls. We also found that with increasing grades of epithelial dysplasia TSA levels were found to be gradually increasing which was significant for this study serving as an early indicator for the detection of malignant transformation in OL.

Mutations in Hepatitis-B X-Gene Region: Chronic Hepatitis-B versus Cirrhosis

Introduction: Specific mutations in Hepatitis-B Virus (HBV) genome would proceed the development of chronic hepatitis B to more serious consequences like cirrhosis and end-stage liver disease. Aim: This study was designed to detect deletion and insertion mutational patterns in the X-gene region in a population of chronic HBV and related cirrhosis patients. Materials and Methods: Sixty eight chronic HBV patients and 34 HBV-related cirrhotics were recruited from the eligible cases (N=50) referred to the academic hospitals of Gorgan city, Northeast of Iran, between Jan 2011 to Dec 2013. The HBx region was amplified by semi-nested PCR using serum samples and analyzed by sequencing. Results: Our findings showed deletions and insertions in the C-terminal of HBx of the cirrhotic group and 8 bp found in two chronic HBV cases (2.9%). We detected 15 types of deletions in cirrhotic cases such as 1762-1768, 1763-1770, 1769-1773 and T1771/A1775. Conclusion: We found that the frequencies of deletion and insertion mutations in C-terminal of X-gene were more seen in cirrhotic patients comparing to chronic HBV cases in our area of study.

An Assessment of Correlation between Dermatoglyphic Patterns and Sagittal Skeletal Discrepancies

Introduction: Investigators over years have been fascinated by dermatoglyphic patterns which has led to the development of dermatoglyphics as a science with numerous applications in various fields other than being the best and most widely used method for personal identification. Aim: To assess the correlation between dermatoglyphic patterns and sagittal skeletal discrepancies. Materials and Methods: A total of 180 patients, aged 18-40 years, were selected from those who attended the outpatient clinic of the Deparment of Orthodontics and Dentofacial Orthopedics, Mar Baselios Dental College, Kothamangalam, Kerala, India. The fingerprints of both hands were taken by ink and stamp method after proper hand washing. The patterns of arches, loops and whorls in fingerprints were assessed. The total ridge count was also evaluated. Data was also sent to the fingerprint experts for expert evaluation. The sagittal jaw relation was determined from the patient’s lateral cephalogram. The collected data was then statistically analyzed using Chi-square tests, ANOVA and Post-hoc tests and a Multinomial regression prediction was also done. Results: A significant association was observed between the dermatoglyphic pattern exhibited by eight fingers and the sagittal skeletal discrepancies (p<0.05). An increased distribution of whorl pattern was observed in the skeletal Class II with maxillary excess group and skeletal Class II with mandibular deficiency group while an increased distribution of loop pattern was seen in the skeletal Class III with mandibular excess group and skeletal Class III with maxillary deficiency group. Higher mean of total ridge count was also seen in the groups of skeletal Class II with maxillary excess and skeletal Class II with mandibular deficiency. Multinomial regression predicting skeletal pattern with respect to the fingerprint pattern showed that the left thumb impression fits the best model for predicting the skeletal pattern. Conclusion: There was a significant association between dermatoglyphic patterns and sagittal skeletal discrepancies. Dermatoglyphics could serve as a cost effective screening tool of these craniofacial problems.

Prevalence of Distal Caries among Mandibular Second Molar Due to Impacted Third Molar Teeth in Saudi Population

Introduction: A tooth is said to be impacted if it does not reach the occlusal plane even after two-thirds root formation. The aetiology of impacted teeth is varied and multi-factorial. Significant problems associated with impacted teeth include trismus, infection, cervical caries of second molars. Aim: This study was aimed to assess the prevalence of distal caries in second molar teeth due to impacted third molars and to compare with similar studies conducted elsewhere. Materials and Methods: Study included assessment of patients reporting between 2009 to 2014 for dental care at College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia. This is a retrospective cross-sectional study which included a total of 6000 Orthopantomograms (OPGs). The data collected was decoded and entered into excel spread sheet. Descriptive analysis of the data was done and results were displayed as frequency table and graphs. Results: A total of 979 patients had impacted third molars (16.31%). A total of 39% patients with impacted third molars had distal cervical caries in second molar. Mesioangular impaction was the most prominent type. This was closely followed by horizontal impaction causing distal caries in second molars. Age group between 21-28 years and male gender had the higher prevalence of distal caries in second molar teeth due to impacted third molars. Conclusion: A total of 39% of the patients with impacted mandibular third molars had distal cervical caries in second molars. Mesioangular type, male gender, age group 21-28 years were the prominent factors associated with distal caries in second molar teeth due to impacted third molars.

Expression of Angiogenic Factors in Psoriasis Vulgaris

Lakshna Sankar, Dhanalakshmi Arumugam, Sudha Boj, Priyanka Pradeep

Introduction: Psoriasis is a chronic inflammatory skin disease characterized by epidermal hyperproliferation, abnormal differentiation, and inflammatory infiltration in the dermis. The dermal microvascular expansion associated with abnormal orientation and dilatation of capillaries in the biopsies of the psoriatic skin suggest that the disease is dependent on angiogenesis. Aim: To analyze and compare the immunohistochemical expression of angiogenic factors - Vascular Endothelial Growth Factor (VEGF), von Willebrand Factor (vWF) and CD 34 in skin biopsies of psoriasis cases with control skin samples; and to correlate the expression of angiogenic factors with Psoriasis Area and Severity Clinical Index (PASI SCORE). Materials and Methods: This was a prospective case control study conducted over a period of 15 months. Thirty-two psoriasis cases and thirty control skin samples were included in the study. Skin biopsy specimen was taken from clinically diagnosed psoriasis cases who did not receive any treatment. The diagnosis of psoriasis vulgaris was confirmed after microscopic examination. Immunohistochemical expression for VEGF, vWF and CD 34 was studied. Results: VEGF expression in epidermis was significantly higher in cases when compared to control skin (p <0.01). CD 34 expression was significantly upregulated in cases when compared to controls (p<0.01). Von Willebrand factor expression was weak in both the cases and the controls. Significant correlation between the expression of VEGF and PASI score (r=0.944; p<0.01), and expression of CD 34 and PASI score was observed (r=0.942; p<0.01). Conclusion: In the present study, significant overexpression of VEGF and CD 34 was noted in cases when compared to controls. The keratinocytes in the psoriatic skin lesions were recognized as a source of pro-angiogenic cytokines namely the VEGF and other growth factors which promotes angiogenesis in psoriatic plaque. Angiogenesis plays an important role in genesis and development of psoriasis vulgaris. Therefore, development of targeted anti-angiogenic therapy might be beneficial for this chronic disabling dermatological disease.

Prevalence of Carbapenem Resistant Non-Fermenting Gram Negative Bacterial Infection and Identification of Carbapenemase Producing Nfgnb Isolates by Simple Phenotypic Tests

Jane Esther, Diego Edwin, Uma

Introduction: Non-Fermenting Gram negative bacilli (NFGNB) are emerging multi-drug resistant pathogens causing nosocomial infections. In recent years, carbapenem resistance in NFGNB has increased due to a variety of drug resistance mechanisms, the most common being production of carbapenemases. Aim: To detect carbapenemase and metallo-b-lactamase (MBL) production in NFGNBs by four phenotypic tests and to compare the various phenotypic methods for detection of carbapenemase and MBL production in nosocomial NFGNB isolates. Materials and Methods: It is a cross sectional study carried out in the department of Microbiology, Chennai Medical College Hospital and Research Center, Irungalur, Trichy between January 2015 and December 2015. Out of the 598 NFGNB isolated from all the 5402 heterogenous clinical samples that were processed, 52 (8.7%) NFGNB showed resistance or intermediate sensitivity to meropenem as tested by disc diffusion assay. All the 52 isolates were subjected to four different phenotypic tests for carbapenemase and MBL detection, which included Modified Hodge Test (MHT), Meropenem-EDTA Disc Synergy (EDS) test, Meropenem-EDTA Combined Disc Test (CDT) and Growth on CHROMagar KPC. Results: Among the 52 isolates, 29 (55.77%) were MHT positive and 49 (94.23%) were positive for growth on CHROMEagar KPC which were identified as carbapenemase producers. 44 (84.61%) were EDS positive and 46 (88.46%) were CDT positive which were identified as metallo-b-lactamase producers. Conclusion: The presence of these resistant bugs strongly suggests the need to prevent their further spread by implementation of strict infection control measures and regular surveillance to check their outcome. Growth on CHROMagar KPC is the test that has picked up more number of carbapenem resistant isolates as carbapenemase and metallo-b-lactamase producers among the four tests. It is also cheap and easy to perform, making it the most reliable test for routine screening of carbapenemase and MBL producers in clinical laboratories.

Knowledge, Attitude and Practice of Healthcare Managers to Medical Waste Management and Occupational Safety Practices: Findings from Southeast Nigeria

Introduction: Awareness of appropriate waste management procedures and occupational safety measures is fundamental to achieving a safe work environment, and ensuring patient and staff safety. Aim: This study was conducted to assess the attitude of healthcare managers to medical waste management and occupational safety practices. Materials and Methods: This was a cross-sectional study conducted among 54 hospital administrators in Ebonyi state. Semi-structured questionnaires were used for qualitative data collection and analyzed with SPSS statistics for windows (2011), version 20.0 statistical software (Armonk, NY: IBM Corp). Results: Two-fifth (40%) of healthcare managers had received training on medical waste management and occupational safety. Standard operating procedure of waste disposal was practiced by only one hospital (1.9%), while 98.1% (53/54) practiced indiscriminate waste disposal. Injection safety boxes were widely available in all health facilities, nevertheless, the use of incinerators and waste treatment was practiced by 1.9% (1/54) facility. However, 40.7% (22/54) and 59.3% (32/54) of respondents trained their staff and organize safety orientation courses respectively. Staff insurance cover was offered by just one hospital (1.9%), while none of the hospitals had compensation package for occupational hazard victims. Over half (55.6%; 30/54) of the respondents provided both personal protective equipment and post exposure prophylaxis for HIV. Conclusion: There was high level of non-compliance to standard medical waste management procedures, and lack of training on occupational safety measures. Relevant regulating agencies should step up efforts at monitoring and regulation of healthcare activities and ensure staff training on safe handling and disposal of hospital waste.

Effectiveness of Chewable Tooth Brush in Children-A Prospective Clinical Study

Lavanya Govindaraju, Deepa Gurunathan

Introduction: Dental plaque is one of the aetiological factors in causation of dental caries. Effective removal of plaque can reduce the incidence of caries. Various agents for removing plaque has been introduced, of which, chewable brush is a recent advance. There is limited evidence assessing the effectiveness of using chewable brush in children. Aim: The aim of this study was to evaluate the effectiveness of chewable brush in relation to efficiency in plaque removal and reduction in S.mutans counts in saliva. Materials and Methods: Ten children of six-nine years with their first molars erupted were included in the study and the children were supervised for their normal brushing for 7 days. The baseline Oral Hygiene Index-Simplified (OHI-S), Plaque Index (PI) and Decay, Missing Filled Tooth Index (DMFT-I) were noted and the saliva sample was collected from the children. The sample was sent for microbiological examination of S.mutans count and the pH of the saliva was also determined. The children were advised to brush their teeth twice daily for seven days using chewable brush. On the seventh day, the indices were noted again and the saliva sample was collected and sent for microbiological examination. Statistical analysis was done using paired t-test to compare the pre and post-brushing index scores, S. mutans count and salivary pH. Results: There was a significant reduction in the debris index (p<0.001), oral hygiene index (p<0.000), plaque index (p<0.001), pH of the saliva (p<0.037) and S. mutans level (p<0.006) before and after brushing with chewable brush. However, the calculus index remained unchanged (p=0.168). Conclusion: Chewable brush can be used as an effective alternative to manual brushing in children.

Clinico-Radiologic and Spirometric Profile of an Indian Population with Post-Tuberculous Obstructive Airway Disease

Avradip Santra, Pravati Dutta, Rekha Manjhi, Sudarsan Pothal

Introduction: Tuberculosis is a public health problem in developing countries and in spite of receiving adequate anti-tuberculous therapy, patients often continues to have several post-tuberculous sequelae, especially airflow limitation. Aim: To evaluate pulmonary function by spirometry among post-tuberculosis cases with airway obstruction and their relationship with smoking. Materials and Methods: All patients who presented to the pulmonary medicine Outpatient Department (OPD) with symptoms of obstructive airway disease and had completed adequate anti-tuberculous therapy for pulmonary tuberculosis were taken up for study. They were initially evaluated with sputum smear for Acid Fast Bacilli (AFB) and chest X-ray. Patients without evidence of active tuberculosis underwent spirometry and those having post-bronchodilator Forced Expiratory Volume in first second (FEV1)/ Forced Vital Capacity (FVC) FEV1/FVC<0.7 were taken up for final analysis. Spirometric parameters were compared between smokers and non-smokers. Results: Out of 138 finally selected cases, 84.06% were male and 71.01% were within age range of 40-69 years. Significant positive association was found between extent of radiologic lesion and severity of airflow obstruction. Purely obstructive pattern was found in 27.54% cases and 72.46% showed mixed pattern. Patients with mixed ventilatory abnormality had worse pulmonary function and poorer bronchodilator reversibility than patients with pure obstruction. Comparison of post-bronchodilator FEV1, FVC, Peak Expiratory Flow (PEF) and Forced Expiratory Flow (FEF) 25-75 between smokers and non-smokers did not show statistically significant difference. Conclusion: Majority of patients with post-tuberculous obstructive airway disease have associated restrictive component. But smoking did not cause significant alteration in pulmonary function among such patients.

Barriers Encountered by Accredited Social Health Activists (ASHA) in Arthritis Rehabilitation: A Qualitative Study

Sidhiprada Mohapatra, Girish Nandakumar, Senthil Kumaran Dharmaraj

Introduction: Healthy behaviour through education of individuals with arthritis is the mainstay of long term management. Time and access constraints restrict medical professionals from active involvement in arthritis education in the community. Reaching the community through the Accredited Social Health Activists (ASHAs) is the plan of action operational in India. Hence, the factors encountered by ASHAs while delivering arthritis education programs need to be studied. Aim: The aim of the study was to explore the experiences of ASHAs while delivering arthritis education program. Materials and Methods: Qualitative exploratory design employing semi-structured interviews was adapted for the study. The interviews were conducted using focus groups of ASHAs from two geographically similar villages. Inductive analysis of focus group discussions was undertaken to determine themes, categories and codes. Results: Three broad themes were identified from the interviews which influenced the performance of ASHAs. Categories identified show the influence of training, characteristics of ASHAs, geographical features, family characteristics and community attitude. Few problems reported were means of transport, time constraints, multiple tasks, type of incentive and frequency of on-field demonstrations. Conclusion: Providing motivation for altruistic services has always been a challenge to governing bodies. The issues identified in this study can be addressed prior to integrating ASHAs for rehabilitation services.

A Study to Assess the Functional Outcome of Decompression and Posterior Lumbar Interbody Fusion of Low Grade Spondylolisthesis of Lumbar Vertebra

Deepak Hegde, Sameer Mehra, Santhosh Babu, Arjun Ballal

Introduction: Spondylolisthesis is defined as the forward displacement of one vertebra over the vertebra below. It is often accompanied by spinal canal stenosis and compression, which is the cause of all the symptoms. Aim: To assess and study the functional outcome after decompression and Posterior Lumbar Interbody Fusion (PLIF) of isthmic spondylolisthesis of lower lumbar vertebra and to study the complications occurring with this technique. Materials and Methods: A prospective study was conducted in the Department of Orthopaedics in Justice KS Hegde Charitable Hospital, Mangalore, Karnataka, India from March 2015 to August 2016. A total of 15 diagnosed patients with Grade I and II spondylolisthesis of L4-L5 and L5-S1 vertebrae with no neurological deficits, between the age group of 25-50 were included in the study. An initial two months of conservative treatment of back physiotherapy and flexion exercises was tried. Patients who did not improve with the conservative therapy were taken up for surgery with consent. Decompression and PLIF with bone grafting with interbody cage placement and pedicle screw instrumentation was performed. The patients were discharged on postoperative day 10 after suture removal. They were reviewed at postoperative day 10, week six and week 24. The scoring of the functional outcome of the back was done as per the Modified Oswestry low back pain Disability Questionnaire. The statistical analyses were done using the repeated measures ANOVA, SPSS version 20. Results: The mean Modified Oswestry low back pain Disability score preoperatively was noted to be 42.87+/- 3.46 points. The mean Modified Oswestry low back pain Disability score at postoperative day 10 was noted to be 36.93±3.75 points. The mean Modified Oswestry low back pain Disability score at postoperative week six was noted to be 28.47±3.70 points. The mean Modified Oswestry low back pain Disability score at postoperative week 24 was noted to be 24.27±3.01 points. Improvement in the Modified Oswestry low back pain Disability scores was noted during the follow ups. Foot drop was noted in two cases postoperatively which improved during the final follow up with physiotherapy. Conclusion: Decompression and PLIF is noted to produce good to satisfactory functional results in cases of isthmic spondylolisthesis of lower lumbar vertebra.

Utility of Modified Ultrafast Papanicolaou Stain in Cytological Diagnosis

Prachi Sinkar, Surekha Ulhas Arakeri

Introduction: Need for minimal turnaround time for assessing Fine Needle Aspiration Cytology (FNAC) has encouraged innovations in staining techniques that require lesser staining time with unequivocal cell morphology. The standard protocol for conventional Papanicolaou (PAP) stain requires about 40 minutes. To overcome this, Ultrafast Papanicolaou (UFP) stain was introduced which reduces staining time to 90 seconds and also enhances the quality. However, reagents required for this were not easily available hence, Modified Ultrafast Papanicolaou (MUFP) stain was introduced subsequently. Aim: To assess the efficacy of MUFP staining by comparing the quality of MUFP stain with conventional PAP stain. Materials and Methods: FNAC procedure was performed by using 10 ml disposable syringe and 22-23 G needle. Total 131 FNAC cases were studied which were lymph node (30), thyroid (38), breast (22), skin and soft tissue (24), salivary gland (11) and visceral organs (6). Two smears were prepared and stained by MUFP and conventional PAP stain. Scores were given on four parameters: background of smears, overall staining pattern, cell morphology and nuclear staining. Quality Index (QI) was calculated from ratio of total score achieved to maximum score possible. Statistical analysis using chi square test was applied to each of the four parameters before obtaining the QI in both stains. Students t-test was applied to evaluate the efficacy of MUFP in comparison with conventional PAP stain. Results: The QI of MUFP for thyroid, breast, lymph node, skin and soft tissue, salivary gland and visceral organs was 0.89, 0.85, 0.89, 0.83, 0.92, and 0.78 respectively. Compared to conventional PAP stain QI of MUFP smears was better in all except visceral organ cases and was statistically significant. MUFP showed clear red blood cell background, transparent cytoplasm and crisp nuclear features. Conclusion: MUFP is fast, reliable and can be done with locally available reagents with unequivocal morphology which is the need of the hour for a cytopathology set-up.

Posterior Chamber Scleral Fixation of Intraocular Lenses in Post-Vitrectomised Aphakic Eyes

Introduction: The best method of aphakia correction is in the bag implantation of Posterior Chamber Intraocular Lens (PCIOL). When this ideal procedure is not possible due to lack of integrity of posterior capsule or zonules, the other alternatives are broadly categorized into two: extraocular and intraocular. Whereas, the former includes contact lenses and aphakic glasses, the latter ones are further divided into anterior and posterior chamber methods. Anterior Chamber Intraocular Lenses (ACIOL) can be with or without iris claw. At the posterior chamber, fixation of the lenses can be with glue or sutures. When there is combined Pars Plana Vitrectomy (PPV) and lensectomy or if the indication of PPV is dropped nucleus or intraocular lens, a modality of aphakia correction should be devised. Posterior Chamber Scleral Fixation of Intraocular Lenses (PCSFIOL) with sutures is a preferred method because of its low complication profile. However, data on correction of aphakia after combined PPV and lensectomy is limited. To fill in this gap in knowledge, we evaluated the secondary PCSFIOL in aphakic eyes after previous PPV and lensectomy. Aim: To assess the outcome and complication profile of a large series of patients who underwent secondary PCSFIOL implantation with sutures after combined PPV and lensectomy. Materials and Methods: Records of all patients who had undergone secondary PCSFIOL implantation with sutures after combined PPV and lensectomy from 2010 to 2014 were reviewed retrospectively for visual outcomes and complications. Patients’ demographic data, indication for PPV, best corrected preoperative and postoperative visual acuities, complications of surgery, and indications of PCSFIOL and length of follow up were collected and analyzed. Results: A total of 148 eyes of 148 patients (127 males and 21 females) were identified. Mean age at surgery was 32.5+8 years (range 2.5-73 years) with a mean follow up 23+14 months (range 3-114 months). A total of 95.27%, 2.70% and 2.02% of patients had improvement, maintenance and worsening of their final postoperative visual acuities respectively. A total of 32 (21.62%) of 148 eyes had postoperative complications from PCSFIOL with Epiretinal Membrane (ERM) formation being the most common. They all required one form of management or the other. Suture breakage leading to PCSFIOL subluxation or dislocation occurred in four eyes (2.70%). Conclusion: PCSFIOL with sutures is a preferred method in the management of post-vitrectomised aphakic eyes when the capsular or zonular support is not adequate for in the bag implantation of posterior chamber intraocular lenses.

Correlation of Cotinine Levels with Use of Smokeless Tobacco (Mishri) among Pregnant Women and Anthropometry of Newborn

Praveen Ganganahalli, Asha Pratinidhi, Jyotsna Patil, Satish V. Kakade

Introduction: ‘Smokeless tobacco’ is the term used for the tobacco that is consumed in un-burnt form and it can be used orally or nasally. Cotinine, a nicotine metabolite, is used to quantify exposure to tobacco, which readily gains access to foetal circulation. Cotinine is invariably found in coelomic, amniotic and foetal serum when maternal serum cotinine levels exceed 25ng/ml. Aim: To estimate cotinine levels among pregnant women using and not using smokeless tobacco (mishri) and to correlate cotinine level with anthropometry of newborns. Materials and Methods: A hospital based cohort study was conducted at Krishna Hospital, Karad, District Satara, Maharashtra, India. Pregnant women who were using smokeless tobacco (mishri) during pregnancy were analyzed for cotinine levels in blood by using ELISA kit tech and correlated with anthropometry of newborn babies and compared with non users of tobacco. Results: About 480 gm reduction in Birth weight and 6.5 cm reduction in birth length of babies born to mishri users compared to non users of tobacco and also cotinine levels among users were found significantly negatively correlating with anthropometric measurement of newborn babies. Conclusion: A pro-active effort is essential to educate the women about adverse effects of tobacco in general and on the intrauterine growth of the baby in particular.

Correlation of Plasma Neutrophil Elastase Activity and Endogenous Protease Inhibitor Levels with the Severity of Pre-eclampsia

Mamatha Kunder, AV Moideen Kutty, V Lakshmaiah, SR Sheela

Introduction: Pre-eclampsia (PE) is a common maternal syndrome characterized by severe systemic inflammatory response including neutrophil activation leading to uncontrolled activity of elastase. The excessive activity of elastase would lead to destroyal of the integrity of endothelial cells and could exacerbate the pathophysiological symptoms in PE. Thus, assessment of NE activity and its control mechanisms would be of relevance in the determination of severity of PE. Aim: To correlate the activity of plasma NE and its endogenous inhibitors a1-antitrypsin (a1-AT) and a2-macroglobulin (a2-MG) with severity of PE. Materials and Methods: A comparative study was conducted between normotensive pregnant (n=50) and pre-eclamptic (n=50) women. Serum C-Reactive Protein (CRP) was estimated by rapid latex slide and uric acid by uricase method. Plasma elastase was estimated using succinyl tri- L-alanyl-p-nitroanilide as substrate. Plasma a1-AT, a2-MG and NE- a1-AT complex were quantified by ELISA. ANOVA and Pearson’s correlation tests were used to analyze the data. The results were expressed as mean±SD and p-value <0.001 was considered statistically highly significant. Results: The activity of elastase was increased significantly in severe PE (0.62±0.08) in comparison to normal (0.35±0.10) and mild pre-eclamptic subjects (0.37±0.03). The values of a1-AT were significantly less in mild (83.94±25.08) and severe PE (68.58+26.39) in comparison to normal (110.26±42.39). There was a significant rise in the levels of a2-MG in severe PE. However, the complex estimation did not evince any significant changes. Conclusion: The results of the present study indicate a significantly elevated elastase activity, a2-MG levels and decreased a1-AT in severe PE patients. The correlation analyses of PE severity parameters with NE, a1-AT and a2-MG further support the roles of these molecules in the assessment of severity of PE.

The Factor Structure and Psychometric Properties of the Persian Version of the Revised Prenatal Coping Inventory (Nu-PCI)

Mahbobeh Faramarzi, Hajar Pasha, Sorayya Khafri, Shima Heidary

Introduction: Familiarity with coping strategies is essential for stress management during pregnancy. The Revised Prenatal Coping Inventory (Nu-PCI) was developed to assess coping strategies during pregnancy. Aim: This study aimed to assess the factor structure and psychometric properties of the Persian version of the Nu-PCI. Materials and Methods: After forward-backward translation, the Nu-PCI was administered to 210 pregnant women who were enrolled in two teaching referral clinics in the North of the Islamic Republic of Iran (Babol). The participants completed the Persian Nu-PCI and Ways of Coping Questionnaire (WCQ), which was used to determine the validity of the Persian Nu- PCI. To test construct validity of the Persian Nu-PCI, a principal components factor analysis was performed. Results: Principal components analysis with varimax rotation showed a best fitting 3-factor structure similar to the original with three coping subscales: planning-preparation, avoidance, and spiritual-positive coping. The Persian Nu-PCI was internally consistent and within the acceptable range (a=0.89–0.97). The alpha coefficients for the Nu-PCI and the subscales of planningpreparation, avoidance, and spiritual-positive coping were high. Test-retest coefficients for the Nu-PCI and subscales were 0.98–0.99. The Nu-PCI and its subscales correlated with the WCQ in the entire sample and within each trimester. Conclusion: The Persian version of the Nu-PCI and the subscales of planning-preparation, avoidance, and spiritualpositive coping represent the first reliable standardized tool for measuring coping strategies during pregnancy in the Islamic Republic of Iran. Therefore, it can be applied as a quick and accurate preliminary screening tool for evaluating coping strategies throughout pregnancy in clinics and other medical and research settings.

Incidence of Metabolic Syndrome in Patients Admitted to Medical Wards with ST Elevation Myocardial Infarction

Bijilesh Uppalakal, Lekshmi Sankar Karanayil

Introduction: Metabolic Syndrome (MS) consists of a cluster of metabolic abnormalities that confer exaggerated risk of cardiovascular disease. MS is a novel risk factor for Coronary Artery Disease (CAD) and is a rising disease entity in Asia. Incidence of ST Elevation Myocardial Infarction (STEMI) is high in patients with MS. There is limited data on prevalence of MS in patients with Acute Myocardial Infarction (AMI). Aim: To determine frequency of MS in patients admitted with STEMI. Materials and Methods: Hundred Consecutive patients between 25 to 75 years who were admitted with STEMI at Govt medical college Thrissur were included in this prospective study. Subjects were assessed for five-component conditions of metabolic syndrome. Criteria to identify MS were based on a “Consensus statement for diagnosis of metabolic syndrome for Asian Indians”. Presence of three or more of following suggest MS, Waist Circumference (WC)>90 cm in men and 80 cm in women, Blood pressure >130/85 mm Hg, Fasting Plasma Glucose (FPG) >100 mg%, serum triglycerides >150 mg/dl, High Density Lipoprotein (HDL)<40 mg/dl in male and<50 mg/dl in female. Statistical analysis was performed using Epi-Info software. Data expressed as numbers and percents were compared by Chi-square test. Results: Study enrolled 100 patients (males 80, females 20) with a mean age of 58. Frequency of MS in patients with STEMI was 40% (36% of males and 55% of females). Prevalence of components in the MS group was WC >80/90 -31(71%), BP>130/85- 23(58%), FPG >100 - 37(93%), HDL <40 (male)/ 50 (female) - 18(45%), TG >150 -15(37.5%). Conclusion: The present study concluded that there is a remarkably high occurrence of metabolic syndrome and central obesity in patients with ST elevation Myocardial Infarction (MI) in our local population especially in females. Considering this fact the role of specific and targeted intervention for clinical detection and management of MS including lifestyle modifications needs to be addressed.

Relationship of Lifestyle with Academic Achievement in Nursing Students

Introduction: A healthy lifestyle is one of the main factor in maintaining the health of people in society. With regard to the role of youth and students in public health, they must complete and follow a training program on lifestyle related factors. One of the main aim of the training centres is to improve the academic achievement of students. Aim: This study was designed to determine the correlation of lifestyle with academic achievement in nursing students. Materials and Methods: This was a cross-sectional study, wherein all nursing students of School of Borujen Nursing were selected by census sampling. Data gathering tool was Walker’s lifestyle questionnaire which was modified for the purpose of the study. To evaluate the educational status of students, final grade point average was considered as an indicator of academic achievement. To analyze the data, SPSS version 16.0, and descriptive and analytical tests were used. Results: The results indicated that most subjects (61.01%) displayed moderate levels of lifestyle. Pearson's correlation coefficient showed the significant positive relationship between lifestyle and academic achievement (p=0.03 and r=0.628). Conclusion: To improve the academic achievement of students, in addition to the cognitive abilities-perception, their lifestyle should also be considered. Therefore, it is suggested to incorporate lifestyle education in the curriculum of nursing students so as to improve their lifestyle.

Efficacy of Structured Yoga Intervention for Sleep, Gastrointestinal and Behaviour Problems of ASD Children: An Exploratory Study

Kumar Narasingharao, Balaram Pradhan, Janardhana Navaneetham

Introduction: Autism Spectrum Disorder (ASD) is a neuro developmental disorder which appears at early childhood age between 18 and 36 months. Apart from behaviour problems ASD children also suffer from sleep and Gastrointestinal (GI) problems. Major behaviour problems of ASD children are lack of social communication and interaction, less attention span, repetitive and restrictive behaviour, lack of eye to eye contact, aggressive and self-injurious behaviours, sensory integration problems, motor problems, deficiency in academic activities, anxiety and depression etc. Our hypothesis is that structured yoga intervention will brings significant changes in the problems of ASD children. Aim: The aim of this study was to find out efficacy of structured yoga intervention for sleep problems, gastrointestinal problems and behaviour problems of ASD children. Materials and Methods: It was an exploratory study with pre-test and post-test control design. Three sets of questionnaires having 61 questions developed by researchers were used to collect data pre and post yoga intervention. Questionnaires were based on three problematic areas of ASD children as mentioned above and were administered to parents by teachers under the supervision of researcher and clinical psychologists. Experimental group was given yoga intervention for a period of 90 days and control group continued with school curriculum. Results: Both children and parents participated in this intervention. Significant changes were seen post yoga intervention in three areas of problems as mentioned above. Statistical analysis also showed significance value of 0.001 in the result. Conclusion: Structured yoga intervention can be conducted for a large group of ASD children with parent’s involvement. Yoga can be used as alternative therapy to reduce the severity of symptoms of ASD children.

Estimation of Total Length of Femur from its Proximal and Distal Segmental Measurements of Disarticulated Femur Bones of Nepalese Population using Regression Equation Method

Laxman Khanal, Sandip Shah, Sarun Koirala

Introduction: Length of long bones is taken as an important contributor for estimating one of the four elements of forensic anthropology i.e., stature of the individual. Since physical characteristics of the individual differ among different groups of population, population specific studies are needed for estimating the total length of femur from its segment measurements. Aim: Since femur is not always recovered intact in forensic cases, it was the aim of this study to derive regression equations from measurements of proximal and distal fragments in Nepalese population. Materials and Methods: A cross-sectional study was done among 60 dry femora (30 from each side) without sex determination in anthropometry laboratory. Along with maximum femoral length, four proximal and four distal segmental measurements were measured following the standard method with the help of osteometric board, measuring tape and digital Vernier’s caliper. Bones with gross defects were excluded from the study. Measured values were recorded separately for right and left side. Statistical Package for Social Science (SPSS version 11.5) was used for statistical analysis. Results: The value of segmental measurements were different between right and left side but statistical difference was not significant except for depth of medial condyle (p=0.02). All the measurements were positively correlated and found to have linear relationship with the femoral length. Conclusion: With the help of regression equation, femoral length can be calculated from the segmental measurements; and then femoral length can be used to calculate the stature of the individual. The data collected may contribute in the analysis of forensic bone remains in study population.

Malassezia Yeast and Cytokine Gene Polymorphism in Atopic Dermatitis

Introduction: Atopic Dermatitis (AD) is a recurrent chronic condition associated with microorganism and their interaction with the susceptible host. Malassezia yeast is a known commensal which is thought to provoke the recurrent episodes of symptoms in atopic dermatitis patients. Malassezia immunomodulatory properties along with defective skin barrier in such host, results in disease manifestation. Here, we studied Single Nucleotide Polymorphism (SNP) in IL10 and IFN ? genes of the host and its relation with susceptibility to Malassezia infection. Aim: To isolate Malassezia yeast from AD patients and compare the genetic susceptibility of the host by correlating the cytokine gene polymorphism with the control subjects. Materials and Methods: Study was conducted from January 2012 to January 2013. It was a prospective observational study done in Department of Microbiology and Department of Dermatology and Venereology in University College of Medical Sciences and GTB Hospital, Delhi. Sample size comprised of 38 cases each of AD. Skin scrapings were used for fungal culture on Sabouraud Dextrose Agar (SDA) and Modified Dixon Agar (MDA) and isolated were identified as per conventional phenotypic methods. Genomic DNA was extracted from blood samples collected from all study subjects. Cytokine genotyping was carried out by Amplification Refractory Mutations System- Polymerase Chain Reaction (ARMS-PCR) with sequence specific primers. Three SNPs (IL10-1082A/G; IL10-819/592C/T; IFN-?+874A/T) in two cytokine genes were assessed in all the patients and healthy controls. Statistical Analysis: Chi-Square Test or Fisher’s-Exact Test and Bonferroni’s correction. Results: In AD group, Malassezia yeasts were cultured in 24 out of 38 samples and thus the identification rate was 63.1 percent as compared to healthy group, 52.6 percent (20/38). Significant difference in allele, or genotype distribution were observed in IL10-819/592C/T and IFN-?+874A/T gene polymorphism in AD group. Conclusion: Higher isolation rate in cases as compared to control group highlights the implication of Malassezia in AD. Association between specific cytokine gene polymorphism and clinical outcome was found to be significant in study group. The result of cytokine gene polymorphism in the present study demonstrated susceptibility of host to Malassezia infection.

Fungal Profile of Vulvovaginal Candidiasis in a Tertiary Care Hospital

Krishnapriya Kalaiarasan, Rakesh Singh, Latha Chaturvedula

Introduction: Vulvovaginal Candidiasis (VVC) is a common medical health problem of adult women. It is most commonly caused by Candida albicans. But there is a change in fungal profile. Sabouraud’s Dextrose Agar (SDA) is the most common culture medium used where mixed fungal infection may be missed. It can be detected easily by using chromogenic culture medium. Aim: To know the fungal profile of vulvovaginal candidiasis using Candida CHROMagar and antifungal susceptibility pattern in patients attending tertiary care hospital. Materials and Methods: Culture confirmed cases of VVC presented at Department of Obstetrics and Gynaecology of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India, from July 2015 to December 2015 were included in the cross-sectional study. Two high vaginal swabs were collected and inoculated on SDA and Candida CHROMagar (Hi-Media, Mumbai, India). After overnight incubation the colonies were counted and colour of the colonies were recorded from Candida CHROMagar. Candida spp. were identified by sugar fermentation and assimilation tests and other conventional tests. Antifungal susceptibility tests were performed by the disc diffusion method using fluconazole (25 µg) and voriconazole (1µg) as per the Clinical and Laboratory Standards Institute (CLSI - M44-A2) guidelines. Results: A total of 50 culture confirmed (23.7%) cases were detected from 211 clinically suspected VVC cases. Candida glabrata (45.1%) was the most common isolate, followed by Candida tropicalis (23.5%), Candida albicans (17.6%), Candida krusei (9.8%) and Candida parapsilosis (3.9%). One mixed infection of C. glabrata and C. albicans was identified on Candida CHROMagar. Mixed fungal infection was observed in 2% of positive culture and 0.5% of VVC cases. The antifungal susceptibility testing revealed that 15.7% and 9.8% isolates of Candida spp. were resistant and Susceptible Dose Dependent (S-DD) respectively to fluconazole. The increase resistant against fluconazole was because of increased isolation of C. glabrata strains. All strains of Candida spp. were susceptible to voriconazole. Conclusion: C. glabrata was the most common causative agent of VVC in a tertiary care hospital. Chromogenic culture medium facilitates detection of mixed fungal infection. In vitro susceptibility testing should be used to guide the treatment especially in cases of non-albicans Candidiasis.

Gamma Glutamyl Transpeptidase, Smokeless Tobacco, Chronic Periodontitis: Exploring the Link

Arati C Koregol, Nagaraj B Kalburgi, Apoorva U Kamat Wagh, Shivraj Warad

Introduction: Oxidative Stress (OS) is implicated in the pathogenesis of many systemic and oral diseases such as periodontal disease. Smokeless tobacco extract produces apoptosis and causes an imbalance between reactive oxygen species and antioxidants, such as Gamma Glutamyl Transpeptidase (GGT). Epidemiological research implied serum GGT within its normal range to be an early sensitive enzyme related to OS. Aim: To assess how GGT fares as a biomarker in periodontitis subjects with or without the usage of smokeless tobacco and correlate it with clinical parameters. Materials and Methods: Ninety subjects were divided into three groups of healthy, chronic periodontitis, and smokeless tobacco users with chronic periodontitis from the dental outpatient department of P.M. Nadagouda Memorial Dental College and Hospital. Serum samples of patients were collected after obtaining consent and analyzed for GGT. Statistical Analysis was performed using ANOVA, and Pearson’s correlation coefficient. Results: GGT levels were found to be significantly higher in chronic periodontitis patients compared to smokeless tobacco users with chronic periodontitis and healthy subjects. Conclusion: GGT may be used as a quick, easy and precise marker for measuring OS in patients with chronic periodontitis and smokeless tobacco users.

Gender Linked Metric Analysis of Portal Vein: A Sonographic Appraisal

Introduction: Portal hypertension is one of the most mystifying and disconcerting abdominal ailment. Ultrasonography (USG) is an effective diagnostic tool for its prompt management. Knowledge of normal calibre of portal vein in a local setting is essential as literature reports contrasting values in different regions. It helps in early diagnosis of portal hypertension even before it is clinically manifested thereby assisting clinicians and interventional radiologists in pertinent management. Aim: Study was aimed to evaluate the Portal Vein Diameter (PVD) and find its correlation with gender by using USG in North Indian population. Materials and Methods: A total of 300 healthy adults were included in the study. Portal vein diameter was measured in supine position and normal respiration by grey scale USG. The portal vein diameter was correlated with age and gender statistically using independent Student’s t-test and ANOVA. Results:Mean PVD of (9.49±1.03 mm) was observed in the present cross-sectional study. Male showed a significantly higher mean PVD (9.70±1.02 mm) as compared to females (9.10±0.94 mm). Conclusion: Scarcity of information concerning ultrasonographically measured standard portal vein diameter and inconstant values reported in literature necessitates the need for establishing local standard value. In the given subset of population the portal vein diameter was influenced by the gender. The information will be helpful in prompt diagnosis and management of portal hypertension.

Comparative Evaluation of the Efficacy of Probiotic, Herbal and Chlorhexidine Mouthwash on Gingival Health: A Randomized Clinical Trial

Introduction: Due to inherent limitations of Chlorhexidine (CHX), search for an effective and potentially safe anti-plaque agent has led to emergence of alternative products. Aim: The present study evaluated the comparative efficacy of probiotic, herbal and CHX mouthwashes on gingival health of healthy individuals. Materials and Methods: The present study was randomized parallel group controlled trial. A group of 45 healthy subjects in the age group of 18-21 years received complete supragingival scaling at baseline and study variables viz., Oral Hygiene Index – Simplified (OHI-S), Plaque Index (PI) and Gingival Index (GI) were recorded. Subjects were then randomly divided into three groups (15 in each group) and were randomly intervened with three different mouthwashes i.e., HiOra mouthwash, CHX mouthwash and Probiotic mouthwash. Variables were again recorded on the seventh and 14th day after use of mouthwashes and data obtained was subjected to statistical analysis. Results: There was no significant difference in the efficacy of CHX, HiOra regular and probiotic mouthwashes on plaque accumulation, gingival health and oral hygiene status. Conclusion: Herbal and probiotic mouthwashes can prove to be effective alternatives to CHX with minimal side effects.

Breast Biomarkers-Comparison on Whole Section and Tissue Microarray Section

Sneha S Chavan, Savithri Ravindra, MSN Prasad

Introduction: Estrogen Receptor (ER), Progesterone Receptor (PR) and Her2/neu are routinely studied markers for breast carcinoma. Analysis of these biomarkers is traditionally done by Immunohistochemistry (IHC) on whole sections. These markers can also be studied on Tissue Microarray (TMA) sections. Tissue microarray is a technique where core samples from different paraffin blocks are arrayed on a single recipient block which can then be cut to yield a single section with multiple cores in it. Aim: To compare ER, PR and Her2/neu on TMA sections with whole sections and to determine the concordance of results between the two methods. Materials and Methods: A TMA block was constructed by punching out 2 mm cores from appropriately marked paraffin blocks of 53 breast carcinoma cases and embedding them in the recipient block. Immunostaining of TMA sections and whole sections were performed for ER, PR and Her2/neu and the results were compared. Statistical analysis was done using chi square test/Fisher-Exact test. Kappa co-efficient, Jaccard Index and G-Index were computed. Results: Infiltrating Ductal Carcinoma-No Special Type (IDC-NST) was the predominant type of carcinoma and most of the tumours were of Grade II and III. Majority, 38/53 (71.7%) were ER/PR positive and Her2 negative and 9/53 (17%) cases were triple negative. Good concordance between whole sections and TMA sections were noted with kappa value for ER, PR and Her2/neu being 0.671, 0.754, 1.000 respectively which was statistically significant. Conclusion: Immunostaining for ER, PR and Her2/neu done on TMA section using single 2 mm core were comparable with conventional whole section scores. Thus, TMA is a reliable method for evaluating these biomarkers with the advantage of being time and cost effective.

Health-Related Quality of Life of Persons after Rhinoplasty: A Longitudinal Study among Iranian Population

Kazem Hosseinzadeh, Hamid Hamadzadeh, Mansour Khorasani, Maryam Jamshidi

Introduction: Despite the growing number of cosmetic rhinoplasty surgeries in Iran in recent years, there is little information about the effects of this procedure on the subjects’ Quality of Life (QoL). This study examined the QoL after rhinoplasty in subjects without nasal obstruction, who wanted the surgery for aesthetic reasons, three and six months postoperatively. Aim: The aim of this study was to assess the changes of QoL in clients who take rhinoplasty. Materials and Methods: This was a prospective study conducted in Tehran, Iran. Using convenience sampling, 150 subjects who had undergone cosmetic rhinoplasty from June 2013 to June 2014 were invited to participate in the study. Patients’ QoL was measured one week before and three and six months after rhinoplasty, using the Iranian version of the 36-item Short Form (SF-36) questionnaire. Descriptive statistics, Pearson correlation coefficient, one-way ANOVA, paired t-test, and independent sample t-test were used for data analysis. Results: Most of the participants were women (64%), and the mean age was 26.8±5.4 years (range: 18–41 years). The mean QoL scores before and three and six months after rhinoplasty were 67.26±26.01, 68.00±15.7 and 83.65±9.6, respectively. None of the measured demographic characteristics showed any correlation or relationship with the participants’ QoL before and after the procedure (p>0.05). Conclusion: QoL can be considered as a quality indicator of health care systems. This study shows that the persons’ QoL improved six months after cosmetic rhinoplasty.

Evaluation of Correlation between Salivary Calcium, Alkaline Phosphatase and Osteoporosis- A Prospective, Comparative and Observational Study

Introduction: Fixed and/or removable prosthodontics caters to the restorative needs of the largest count of geriatric patients whose rehabilitative procedures depend on the quality and quantity of available bone. The common diagnostic parameters for quantifying bone may involve an invasive blood examination, an expensive bone densitometry procedure or a urine analysis. Sialometry involving the basic biochemistry of saliva analysis may be proposed as an alternative to the conventional investigative protocol and its usefulness may be attributed owing to its non invasive and simpler procedure. Aim: The aim of this study was to compare the salivary calcium and alkaline phosphatase among osteoporotic, osteopenic and normal edentulous subjects. Materials and Methods: A prospective, comparative and observational study was carried out on 80 selected edentulous subjects (40 males and 40 females) aged 55-75 years (30 osteoporotic, 30 osteopenic and 20 control). A sample of saliva was taken for the study. Salivary calcium was measured by Arsenazo reaction; and alkaline phosphatase by the International Federation of Clinical Chemistry (IFCC) method. Statistical analysis was done by unpaired t-test. A comparison was made in the levels of salivary calcium and alkaline phosphatase with that of osteoporosis and osteopenia. Results: The mean salivary calcium and alkaline phosphatase levels were found to be significantly higher in the osteoporotic and osteopenic edentulous subjects as compared to the control group. Conclusion: Salivary calcium and alkaline phosphatase are increased significantly in case of osteoporosis and osteopenia. Hence, screening of salivary samples of patients may be an effective indicator for the detection of underlying disorders of bone metabolism.

Sexual Dimorphism of Maxillary Sinus: A Morphometric Analysis using Cone Beam Computed Tomography

Ayeesha Urooge, Bharati A Patil

Introduction: Age and sex determination in forensic sciences are primary components of any skeletal analysis. As most bones used for sex determination are recovered in incomplete state, it is often necessary to use bones that are recovered intact e.g., the maxillary sinus. Cone Beam Computed Tomography (CBCT) can provide precise information about complex anatomical structures, as it is characterized by rapid volumetric image acquisition with high resolution. Aim: The present study was designed to evaluate the size and volume of Maxillary Sinus (MS) in determining gender by CBCT. Materials and Methods: Bilateral maxillary sinus images (left and right) were acquired for 100 patients (50 females and 50 males) and different parameters (width, length, height, area, perimeter and volume) were measured and evaluated. Mean and standard deviation of both maxillary sinuses measurements were calculated and compared. The data was subjected to discriminative statistical analysis and analysed using unpaired t-test. Results: Comparison between male and female groups showed statistically insignificant differences on both the right and left sides with respect to the maxillary sinus length, height, area, volume and perimeter. However, the female group showed statistically significant higher values for left side MS width (p=0.041) and left side MS width can be used to determine gender with an overall accuracy of 60%. The final result of discriminative analysis shows that the ability of the maxillary sinus to identify gender was 68% in males and 74% in females with an overall accuracy of 71%. Conclusion: Maxillary sinus width can be used as an aid in forensic anthropology for gender determination.

Evaluation of Relative Position of Mandibular Foramen in Children as a Reference for Inferior Alveolar Nerve Block using Orthopantamograph

Introduction: The Mandibular Foramen (MF) is a landmark for administering local anaesthetic solution for Inferior Alveolar Nerve Block (IANB). The position of MF shows considerable variation among different ethnicity, ages and on either sides even within the same individual. Failure to achieve IANB leading to repeated injection of the local anaesthetic solution will not only pose a behaviour problem in children but can also lead to systemic toxic level of anaesthetic solution being administered. Aim: To determine the relative position of the mandibular foramen in 7 to 12-year-old children in relation to the mandibular occlusal plane and the deepest point on coronoid notch. Materials and Methods: Ninety orthopantamograph of 7 to 12-year-old children were selected from the database and were divided into three groups: Group 1 (G1): seven to eight-year-old, Group 2 (G2): 9 to 10-year-old and Group 3 (G3): 11 to 12-year-old. The radiographs were traced on acetate paper, anatomical landmarks were marked and linear measurements were noted from the Mandibular Lingula (ML) to the occlusal plane, and to the deepest point on coronoid notch. The data obtained was tabulated and subjected to statistical analysis. One way ANOVA test followed by Bonferroni post hoc analysis and Student’s paired t-test were used. Results: Mandibular foramen is approximately, 2-3 mm above the occlusal plane and 11.6-13.0 mm from deepest point of coronoid notch for seven to eight-year-old children, 3-4 mm above the occlusal plane and 13.0-13.9 mm from deepest point of coronoid notch for 9-10 year age group and 5.5-6.5 mm above the occlusal plane and 11.9-12.2 mm from deepest point of coronoid notch for children of the ages 11-12 years. The linear distance from the deepest point of coronoid notch to the mandibular lingula showed statistical significance in G2 vs G3 on right side G1 vs G2 and G2 vs G3 on the left side. The variance of this distance for either side showed statistical significance for G1 and G2. Conclusion: The distance from the mandibular lingula to the occlusal plane showed gradual increase in all the three groups, which was statistically significant. The position of the mandibular foramen is not bilaterally symmetrically for any of the considered age groups.

Phytotherapy with Hordeum Vulgare: A Randomized Controlled Trial on Infants with Jaundice

Gholamreza Panahandeh, Abolfazl Khoshdel, Morteza Sedehi, Azam Aliakbari

Introduction: Jaundice is one of the most common causes of admission to hospital in newborns which is often associated with several complications. Aim: The present study was conducted to evaluate the effect of H. vulgare in reducing jaundice. Materials and Methods: In this double-blind, randomized controlled trials 70 term infants hospitalized due to jaundice in 2014 were enrolled. Control group was treated with full-time phototherapy alone using LED except when the infants were breastfed and case group with phototherapy, as per the protocol in the control group, along with and topical H. vulgare seed flour three times a day. Data were analysed using and analysis of covariance (ANCOVA) and paired t-test in SPSS version 16.0. Results: There was a significant difference in mean indirect bilirubin level between the two groups p<0.05, such that the mean indirect bilirubin level was higher in the control group. Furthermore, no significant difference was seen in direct bilirubin level between the two groups at discharge p>0.05. Conclusion: H. vulgare flour can cause decrease in indirect bilirubin. Because the rate of decrease in indirect bilirubin can be effective in preventing severe complications due to bilirubinemia, H. vulgare can be used as a complementary therapy to treat jaundice.

Spiritual Well-Being and Associated Factors with Relapse in Opioid Addicts

Mohammad-Reza Noormohammadi, Masoud Nikfarjam, Fatemeh Deris, Neda Parvin

Introduction: Opioid dependence relapse is a complex and multidimensional problem, and lack of spiritual well-being is a major concern in opioid addicts. Aim: This study was conducted to determine spiritual well-being and factors associated with relapse among opioid addicts. Materials and Methods: This cross-sectional study was conducted from April 2015 to September 2015. According to purposive sampling, 312 eligible addicted patients were enrolled in the study. The patients had at least an attempt of detoxification in the past six months and referred to an outpatient detoxification clinic in Shahrekord (Southwest, Iran). They completed Paloutzian and Ellison's Spiritual Well-being Scale. A researcher-developed questionnaire consisting of demographic characteristics and 20 questions about associated factors with relapse was administered. Data were analysed by version 16.0 (SPSS Inc.,Chicago, IL) using one-way ANOVA, Pearson’s correlation test, chi-square, Friedman test, and student’s t-test. Results: The most important factors associated with opioid dependence relapse consist of relation with an addict friend, unemployment, living expenses, family conflicts, and somatic pain. In the present study, 157 patients had never experienced relapse while the mean of relapse in the rest participants was (3.25±1.53) times. Furthermore, the addicted patients with relapse had significantly lower scores of spiritual well-being and its subscales compared with non-relapse patients (p<0.001). Conclusion: The findings of the present study indicate the necessity of paying attention to spiritual well-being, family and economical, personal, and occupational factors as crucial factors in opiate addiction relapse.

Comparative Evaluation of Colour Stability and Surface Hardness of Methacrylate Based Flowable and Packable Composite -In vitro Study

Introduction: With the advent of new technology in material sciences in recent years, the quality of composite resin restorations has improved; however, discolouration and wear of composite resin materials remains to be a major problem in long-term clinical studies. Aim: The aim of the present study was to compare the colour stability and surface hardness of methacrylate based flowable nano composite with methacrylate based packable nano composite. Materials and Methods: The difference in colour stability and microhardness of the three composites: G aenial Universal Flo (GC India), Filtek Z350XT (3MESPE) and Tetric N Ceram (Ivoclar Vivadent) were evaluated. Forty eight disc shaped specimens were made out of three different resin composite materials which were subdivided into two groups of Colour Stability (CS) and Vickers Hardness (VH). For colour stability, specimens were immersed in staining solution consisting instant coffee for 72 hours, and then specimens were rinsed thoroughly under tap water and subjected to 10 strokes of brushing with a soft-grade toothbrush. The colour measurements were obtained using spectrophotometer and the process was repeated every 72 hours for three weeks. VH was evaluated using microhardness tester (Zwick/Roell Vickers Microhardness Tester). Vickers Hardness Numbers (VHN) were determined from indentations made under 10 N load for 15 seconds by the arithmetic mean of three indentation values randomly performed. One-way ANOVA and Tukey’s post-hoc analysis were applied. Results: Statistically significant difference was found in comparison of colour stability at different time interval in study groups (p<0.001). Filtek Z350XT group showed least discolouration followed by Tetric N Ceram group and highest colour change in G aenial Universal Flo group after immersion for 21 days. Mean microhardness value of Filtek Z350XT (101.62) group was found to be significantly different from Tetric N Ceram group (63.74) (p<0.001*) and G aenial Universal Flo group (56.75) (p<0.001*). Conclusion: Greatest CS and VH was seen in Filtek Z350XT followed by Tetric N Ceram and least values were seen in G aenial Universal Flo.

Patterns of Partial Edentulism and its Relation to Khat Chewing in Jazan Population – A Survey Study

Mohammed Al Moaleem

Introduction: Partial edentulism is a prime indicator of overall oral health in a given country. Khat chewing habit in the south region of Saudi Arabia is widely practiced by a majority of the population. Aim: To determine the frequency of Kennedy’s classes in each arch among different age groups, gender and to find out the relationship between khat chewing and the pattern of partial edentulism. Materials and Methods: The data was collected from 780 subjects reporting to the College of Dentistry, Jazan University, who required removable partial dentures. Clinical intra-oral and radiographic examinations were done. The study subjects were divided into five age groups, 20-29, 30-39, 40-49, 50-59 and = 60 years respectively. Khat chewing hours/day and type of Kennedy’s classes were recorded. The data were entered into a Statistical Package for Social Sciences program and analysed accordingly using Fisher-Exact test. Results: Class III was the highest in all middle age groups followed by Class I. Class III was the highest in males, while in females, Class I was the highest in both arches. Class IV was the lowest in all age groups, both arches, and genders. Among khat chewers Class III was the highest followed by class I in both arches. Class IV was the highest in >12 hours duration in maxilla but in the mandible, Class I and II were the highest in 1-6 hours duration. The obtained p-values were statistically significant (p<0.001) in all tested variables and age groups. Conclusion: Kennedys Class III was the highest followed by Class I, while Kennedy’s Class IV was the lowest in all age groups and both arches regardless of khat chewing durations. In males Class III, was the highest, while in females Class I was the highest in both arches.

Glycaemic and Insulin Response to Equi-Quantity of Selected Common Indian Staples in Individuals with Type 2 Diabetes Mellitus

Neha V Paharia, Kasturi Sen Ray

Introduction: Diet therapy is one of the corner stone’s in the management of diabetes. Keeping the blood sugar level as close to normal is the main focus of dietary management of diabetes. A typical Indian meal is largely composed of Carbohydrates (CHO). Consumption of staple cereals, forms the major source of CHO in the Indian diet. However, CHO metabolism is seen to be completely deranged in a person with type 2 diabetes. It is necessary to select the cereal which has lower postprandial glycaemic impact for subjects with compromised metabolic status. Preference between two main staple cereals rice and wheat as staple food, especially for diabetic group, will depend on the equi-quantity based postprandial glycaemic impact of these cereals. Aim: To identify the cereals, better suited for individuals with diabetes (based on postprandial glycaemic and insulinemic impact of rice and whole wheat Indian flat bread i.e., chapatti). Materials and Methods: After an overnight fast and upto 2 hours for every half an hour, finger tip blood samples for fasting and postprandial blood sugar was assessed. Venous blood for estimation of insulin levels were also collected from enrolled diabetic individuals and paired normal subjects. About 50 gm of test food like boiled rice, whole wheat chapatti and white bread as standard food were given on different occasions. Glucose and insulin levels were measured using glucometer and ECLIA method. Results: Contrary to the popular belief, it was seen that rice exerted a lower peak and lower postprandial glycaemic and insulinemic response in both the study groups. Factors such as co-nutrient, moisture and fiber content all exert an impact on the postprandial glucose and insulin levels. With this the grain structure, particle size and amylose: amylopectin ratio are also important determinants. Conclusion: When foods are considered as a whole and not a single nutrient, rice proves to be a better product for effective management of blood sugars in individuals with type 2 diabetes mellitus.

An Analysis of Dynamic Pulmonary Functions of Hypothyroid Patients

Seethalakshmi Krishna Iyer, Sunil K Menon, Biju Bahuleyan

Introduction: Hypothyroidism is a silent epidemic of our times. In India, the prevalence of hypothyroidism is 11%. The effect of hypothyroidism on respiratory system is debatable with studies suggesting both obstructive and restrictive disease patterns. The symptoms range from mild dyspnoea to life-threatening respiratory failure. This study emphasizes the effect of hypothyroidism on dynamic respiratory functions. Aim: To find out the changes in dynamic respiratory functions (FVC, FEV1, FEV1% and PEFR) in both male and female hypothyroid patients within age group of 18-45 years. Materials and Methods: This cross-sectional study was conducted in Jubilee Mission Medical College, Thrissur, Kerala, India. Total number of 60 newly detected cases of both sexes in 18-45 years age group attending endocrinology outpatient department were enrolled. Patients with previous respiratory diseases and history of smoking were excluded. Proforma was filled up followed by clinical examination. Spirometry was performed using a computerised spirometer ‘microQuark’. The data was analysed by paired t-test and Analysis of Variance (ANOVA) test. Results: The mean of the observed values in all the dynamic pulmonary parameters showed highly significant difference from the predicted mean of the parameters (p<0.001). They also decreased considerably with age, gender and BMI which were statistically significant (p<0.05). Conclusion: The above findings suggest that respiratory abnormality in newly detected cases of hypothyroidism shows a mixed pattern. This highlights that while investigating a patient with respiratory disorder, the thyroid status should always be probed into, as the effects of hypothyroidism can be reversed with proper treatment.

A Study of Morbidity and Cost of Peripheral Venous Cannulation in Neonates Admitted to Paediatric Surgical Intensive Care Unit

Introduction: Peripheral venous access in sick neonates is indicated for administration of fluids, drugs or nutrients. Aim: We conducted an audit of peripheral venous access in neonates admitted to paediatric surgical intensive care unit to study the morbidity, time spent on cannulation and cost with its use. Materials and Methods:< One hundred consecutive neonates requiring hospital admission to paediatric surgical intensive care unit in a period of one year were included in the study. Peripheral venous access was secured in all patients. We conducted an audit for the number of venipuncture sites, wastage of cannulae, cost, time spent on cannulation and morbidity with its use. Neonates were divided into three groups depending on their surgical intervention. Namely, Group A (thoracic procedures), Group B (bowel surgery) and Group C (other surgery and non-operative cases). Results: In Group A, mean venepuncture sites were 10.66, used cannulae were 5.6, wasted cannulae were 4.3, total cost of cannulation was 870 rupees and 93.78 minutes were spent in cannulation per neonate. In Group B, mean venepuncture sites were 7.58, used cannulae were 4.35, wasted cannulae were 2.59, total cost of cannulation was 603 rupees and 59.85 minutes were spent in cannulation per neonate. In Group C mean venepuncture sites were 2.78, used cannulae were 2.9, wasted cannulae were 0.57, total cost of cannulation was 232 rupees and 26.51 minutes were spent in cannulation per neonate. Thrombophlebitis severity was greater in neonates who had longer ICU stay and ventilator dependent days. Conclusion: Peripheral venous cannulation of longer duration is costly, time consuming, and associated with significant neonatal morbidity. It may be worthwhile to consider alternative vascular devices such as peripherally inserted central catheters or central venous catheters in such situations.

A Randomized Placebo- Controlled Double Blind Clinical Trial of Quercetin in the Prevention and Treatment of Chemotherapy-Induced Oral Mucositis

Introduction: Oral Mucositis (OM) is a serious complication of chemotherapy that results in painful debilitating inflammation that sometimes ends in interruption of treatment. Aim: The study evaluated the effect of quercetin (a natural flavonoid) on preventing and treating chemotherapy induced OM in patients with blood malignancies. Materials and Methods: This double-blind, placebo controlled randomized trial was carried out on 20 adult patients who underwent high dose chemotherapy for blood malignancies. Patients were divided into two groups (10 patients in the intervention group and 10 patients in the control group). Patients in the intervention group were administered 250 mg quercetin capsules twice daily for four weeks. Results: Nine out of 20 patients developed OM (three in the intervention group and six in the control group). The incidence of OM was lower in the intervention group although it was not statistically significant (p=0.189). The mean severity of OM was higher in the intervention group (2.6 vs 2). Healing time, age, gender, type of malignancy, drug type and duration of OM were not different in two groups. Conclusion: The incidence of mucositis was lower in the quercetin group, but mucositis was more severe in the intervention group, which may be due to lower oral health status in the intervention group.

Colour Doppler Evaluation of Extracranial Carotid Artery in Patients Presenting with Acute Ischemic Stroke and Correlation with Various Risk Factors

Introduction: Stroke is defined as an abrupt onset of neurologic deficit due to vascular cause. It is one of the leading causes of mortality and morbidity all over the world making early diagnosis and treatment inevitable. Lesions of extra cranial carotid arteries are implicated in majority of cases of acute ischemic stroke. Carotid Doppler is a non-invasive imaging technique, with sensitivity approaching that of angiography. Computed Tomography (CT) plays a major role to assess the site and nature of the lesion in patients with acute ischemic stroke. Aim: To evaluate the role of carotid Doppler sonography in patients presenting with acute ischemic stroke and find association between carotid artery stenosis and risk factors such as diabetes mellitus, hypertension, hyperlipidemia, smoking and age. Materials and Methods: The present study was conducted on 50 patients. CT scan was done to diagnose acute ischemic stroke in patients who presented to emergency medicine with symptoms of acute ischemic stroke. Retrospectively CIMT and plaque characterization were done by gray scale ultrasound. Site and severity of stenosis were assessed on colour Doppler. All these findings were correlated with clinical presentation and risk factors. The collected data was statistically analyzed and multivariant logistic regression (R-value) test of significance was applied by using SPSS 16.0 version software. Results: On carotid Doppler, ICA/CCA PSV ratio was good predictor of stenosis and ratio above three indicates significant stenosis (>60%). Carotid bulb was most common location of plaque formation. Hypertension and diabetes were the most prevalent risk factors for cerebral ischemic stroke. Out of total 50 patients, 32 had hypertension (64%) and 22 had diabetes (44%). Hypertension and hyperlipidemia showed maximum mean R-values (0.275 and 0.048 respectively) and positive correlation with stenosis and increased CIMT in acute ischemic stroke patients. Conclusion: The present study highlights the importance of Doppler sonography in acute ischemic stroke patients through surveillance of atherosclerosis.

The Diagnostic Value of Urine Lipoarabinomannan (Lam) Antigen in Childhood Tuberculosis

Introduction: Diagnosis of Tuberculosis (TB) in children is difficult because the clinical presentation is not specific, the chest X-ray interpretation has low accuracy and sputum sample is difficult to obtain. Antigen detection test such as rapid urine LAM is a non-invasive alternative for diagnosing TB . Lipoarabinomannan (LAM) is the main component of M.tuberculosis cell wall. Aim: To determine the diagnostic value of urinary LAM antigen for diagnosis of childhood TB. Materials and Methods: In the present cross-sectional study, subjects were included using consecutive sampling method. All the children aged 0-14 years Suspected of pulmonary or extra pulmonary TB suffering from cough more than two weeks, fever without clear aetiology, loss of body weight or poor weight gain, fatigue, malaise, chronic lymph node enlargement, spine angulation, joint swelling and had history of contact with positive sputum smear adult TB patient were enrolled in the study. Pulmonary and extra pulmonary diagnosis was based on clinical presentation, Tuberculin Skin Test (TST), chest X-ray, Acid Fast Bacillus (AFB) staining and or sputum culture. Urinary LAM level was measured by using Enzyme-Linked Immunosorbent Assay (ELISA). Cut off value and Area Under the Curve (AUC) were determined using ROC statistical analysis (SPSS 21.0). Sensitivity and specificity was measured from 2x2 cross table. Results: Out of 61 subjects suspected as TB, 49 (80.3%) were eventually diagnosed with TB. Of those diagnosed with TB, 21 (42.9%) were microbiologically confirmed cases either by sputum microscopy (34.7%) or culture (8.2%), whereas 28 subjects were unconfirmed cases (57.1%). The urinary LAM level was higher in subjects with TB (1.80+1.02) mg/l compared to non-TB group (0.46+0.3) mg/l; p<0.001(independent t-test). Urine LAM had 83% sensitivity and 85% specificity with cut off value 0.98 mg/l using microbiological and clinical confirmation as standard reference and 33% sensitivity and 60% specificity with cut off value 1.69 mg/l using microbiological confirmation only. Conclusion: Urinary LAM has good diagnostic value for childhood TB diagnosis.

Study of Serum Total PSA and Free PSA as an Oncological Marker in Breast Tumour

Elteza Tahjiba Jahir, Runi Devi, Bibhuti Bhushan Borthakur

Introduction: Breast Cancer (BC) cases are rising alarmingly all over the world and India is not an exception. This rising trend is due to an increased age at first child birth, decreased breast feeding, and the changing lifestyle mostly in urban India. With the advent of more sensitive methodologies and research works in this field, it has been suggested that Prostate Specific Antigen (PSA) plays an important role in the pathogenesis of breast cancer besides other established tumour markers. Aim: To study the molecular forms of PSA-total and free PSA in benign and malignant tumours and to analyse their association with the tumour burden. Materials and Methods: The present study was conducted in collaboration with Gauhati Medical College and Hospital and Dr B Borooah Cancer Institute, Guwahati, Assam, India. Women in the age group of 18-65 years with recently diagnosed tumour (benign/malignant) in the breast were included in the study. Women taking Oral Contraceptive Pill (OCP), hormone replacement therapy, with past/present history of gynaecological/other malignancy and chronic endocrine disease like diabetes, thyroid disorders were excluded. The case group comprised of 50 female subjects with newly diagnosed Benign Breast Disease (BBD) and 50 subjects with BC, while 50 age matched healthy females without any signs and symptoms of breast discomfort were included in the control group. Laboratory tests done were Serum Total PSA (TPSA), Free PSA (FPSA), Fasting Blood Glucose (FBS), serum urea, serum creatinine and fasting lipid profile. TPSA and FPSA was measured again in both the test groups after 10-14 days of surgery/therapy. Results: A fall in postoperative value of total and free PSA in BC case group was noticed. In Grade I tumours the mean value of total PSA (1.813 ng/ml) and free PSA (1.149 ng/ml) were higher than those with Grade III tumours (TPSA-1.07 ng/ml and FPSA-1.002 ng/ml). Mean value of Fasting Blood Sugar (FBG), total cholesterol and Low Density Lipoprotein (LDL) in BC case group was higher than the control group. Conclusion: From the study, we can conclude PSA as a possible new marker for diagnosis and prognosis of BC.

Acute Rubella Virus Infection among Women with Spontaneous Abortion in Mwanza City, Tanzania

Introduction: Acute rubella virus infection in early pregnancy has been associated with poor pregnancy outcome ranging from spontaneous abortion, stillbirth and multiple birth defects known as Congenital Rubella Syndrome (CRS). Despite its importance the prevalence of acute rubella virus infections is not known among women with spontaneous abortion in most centres in developing countries. Aim: The present study was aimed to determine the seroprevalence of acute rubella infection among women with spontaneous abortion in Mwanza city. Materials and Methods: A total of 268 women with spontaneous abortion were enrolled from four different hospitals in Mwanza city between November 2015 and April 2016. Blood samples were collected; sera were extracted and stored at -80°C until processing. Acute rubella virus infection was diagnosed by the detection of rubella specific IgM antibodies using indirect Enzyme Linked Immunosorbent Assay (ELISA) as per manufacturer’s instructions. Data were analysed by using STATA version 11. Results: The mean age of enrolled women was 26.3±5.6 years. The prevalence of acute rubella virus infection was found to be 9/268 (3.7%, 95% CI: 1-5). Only women residing in urban areas (AOR: 5.65, 95% CI: 1.15-27.77, p=0.035) were found to predict acute rubella virus infection among cases with spontaneous abortion in Mwanza city. Conclusion: About four out of hundred women residing in urban areas with spontaneous abortion in Mwanza are acutely infected with rubella virus highlighting the potential of this virus in contributing to poor pregnancy outcome in this setting.

Anti-C1q Antibody is Associated with Renal and Cutaneous Manifestations in Asian Indian Patients with Systemic Lupus Erythematosus

Introduction: C1q play an important role in clearance of immune complexes and apoptotic cell debris. Impaired clearance leads to exposure of C1 native antigen and development of anti-C1q antibody formation. Anti-C1q antibody is well studied in Systemic Lupus Erythematosus (SLE). Significance of anti-C1q Ab in Indian SLE patients and their clinical manifestations is not clear. Aim: The aim of this study was to investigate associations between anti-C1q antibody and clinical as well as serological markers of SLE. Materials and Methods: Retrospective study of SLE patients fulfilling either American College of Rheumatology (ACR) 1990 or Systemic Lupus International Collaborating Clinics (SLICC) 2012 classification criteria were recruited from inpatients and outpatients services of the Clinical immunology and Rheumatology Department, Christian Medical College at Vellore, India between March 2013 and January 2015. Anti-C1q antibody was assayed by ELISA (Demeditec Diagnostics GmbH, Germany). Logistic regression analysis was performed to find the association of anti-C1q antibodies with serological and clinical parameters in SLE including Lupus Nephritis (LN). Results: Sixty nine patients (54.76%) out of 126 SLE patients had LN. Anti-C1q levels were higher in patients with LN as compared to those without (p<0.05). Anti-C1q antibody was also significantly associated with positive C1q immunofluorescence staining in renal biopsy specimens (p<0.05). Overall, renal Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) {OR 1.35 (1.08-1.69)}, low C4 {OR 3.11 (1.04-9.26)} and mucocutaneous manifestation {OR 4.72 (1.38-16.05)} were independently associated with anti-C1q levels in serum. Conclusion: Renal SLEDAI, low C4 and mucocutaneous manifestations were independently associated with raised anti C1q antibody in SLE patients.

Digging Deeper into the Patello – Femoral Joint: Patello – Femoral Composite – A New Dimension for Overstuffing of Patello – Femoral Joint

Vikram Kishor Kandhari, Mohan M Desai, Surendar S Bava, Roshan N Wade

Introduction: Patello–femoral complications are the most common complications in postoperative Total Knee Arthroplasty (TKA) patients especially overstuffing of Patello – Femoral Joint (PFJ). So, to study the effects of overstuffing of PFJ in postoperative TKA patients we put forth a new dimension - “PATELLO - FEMORAL COMPOSITE (PFC)”. This is the maximum distance between anterior cortical line of femur shaft and the anterior cortex of patella with knee in full extension. Aim: To calculate chances of overstuffing of PFJ in postoperative TKA patients and document the effect of overstuffing of PFJ on the passive knee Range of Motion (ROM) in post- op TKA patients. Materials and Methods: This was a prospective observational study which included 51 consecutive primary TKAs. Preoperative and postoperative (24 weeks) passive knee ROM was measured. Preoperative and postoperative radiological parameters {PFC, Anterior Femur Offset (AFO), Patellar thickness (PT)} was recorded using Computed Tomography (CT) Scanogram image of patient in lateral view with knee in full extension and perfect overlap of both femur condyles, using DICOM format of the CT Scanogram image on the DICOM viewer. Results: The postoperative PFC was more than its preoperative-value in 80.39% TKAs. Patients who had increased postoperative PFC had significantly less preoperative AFO. Female patients in our study had significantly less preoperative AFO compared to males. Thus, we deduced that female patients with lesser preoperative AFO undergoing TKA had increased postoperative PFC than male patients. PFC not only accounted for the overstuffing of the PFJ because of the patellar component, but also because of the femoral component; thus was a better measure of PFJ overstuffing compared to isolated PT. Passive knee ROM in the postoperative TKA patients approximately decreased by 2 degrees for every 1 mm increase in PFC compared to its preoperative-value in the patients with PFJ overstuffing. Conclusion: We conclude that overstuffing of the PFJ in postoperative TKA is present in 80.39% patients. Higher chances of postoperative PFJ over stuffing are present in female patients and those with thinner anterior cortex of distal femur. Postoperative passive knee ROM decreases significantly in patients with postoperative PFJ overstuffing (Every 1 mm increase in the postoperative PFC, passive knee ROM decreased by approximately 2 degrees).

Agreement and Correlation between Arterial and Central Venous Blood Gas Following Coronary Artery Bypass Graft Surgery

Introduction: Arterial blood sampling, used to assess patients in acute conditions, may result in complications such as thrombosis and embolism. However, it can be replaced by venous blood sampling, but there is a dearth of information on this. Aim: To assess the correlation and agreement between the arterial and central venous blood gases analyses in patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery. Materials and Methods: In this cross-sectional study, 100 ICU patients undergoing elective CABG surgery were recruited. 2 mm arterial and a 2 mm venous blood samples were obtained from each patient’s arterial and central venous lines, respectively. To predict Arterial Blood Gas (ABG) values based on central Venous Blood Gas (VBG) values, the linear regression analysis was used and for evaluating their agreement Bland–Altman method was used. Results: In total of 200 samples were obtained. The mean and Standard Deviation (SD) of age was 58.9±9.1 years and 51% of the participants were female. There was a strong correlation between ABG and central VBG values regarding pH, partial Pressure of Carbon Dioxide (PCO2), Bicarbonate (HCO3) and Base Excess (BE) (r= 0.73, r=0.74, r=0.67 and r=0.71, respectively; p<0.001); however, the correlation between the arterial and venous Partial Pressure of Oxygen (PO2) and Oxygen Saturation (SO2) was moderate (r=0.29, p=0.005 and r=0.27, p=0.006, respectively). The Bland–Altman analysis showed an excellent agreement between all the variables (p<0.001). Conclusion: Central VBG analysis cannot replace ABG analysis in measuring exact PO2 status, necessitating arterial sampling in some matters, but with respect to the accuracy of pulse oximetry measurements in determining the exact PO2 status, for the rest of the indices a central VBG rather than an ABG can be utilised for determining patient's acid-base status. Particularly in patients who are hospitalised for a long time and have a central venous catheter in place like patients who have undergone CABG, thus reducing the risk and need for invasive arterial sampling.

Utility of Tru-Cut Biopsy of Breast Lesions - An Experience in a Regional Cancer Center of a Developing Country

Introduction: Tru-cut Needle Biopsy (TCB) is an integral part of triple assessment of breast cancer, which includes clinical assessment, mammography and TCB or Core Needle Biopsy (CNB). The technique is reliable, simple, and reproducible, and inexpensive, which can be adapted even for low-income group of patients and in developing countries. Aim: This study was done to establish the efficacy of TCB of palpable breast lesions in a developing country where mammography is not possible in all cases. Materials and Methods: A retrospective analysis of 892 TCBs was done in AH Regional Cancer Centre, Cuttack, Odisha, India where TCBs were performed in patients presenting to outpatient department with palpable breast lesions. The H&E stained sections were interpreted by pathologists of the same centre. Diagnosis was classified into different categories. Immunohistochemistry (IHC) for Estrogen Receptor (ER), Progesterone Receptor (PR) and Her-2/neu was done and interpreted by Allred scoring system. Results: A total 892 TCBs were analysed with 23 repeat TCBs. There were 13 (1.4%) male patients. A total of 747 cases (83.6%) were diagnosed as malignant, including 735 carcinomas, nine malignant phyllodes tumour, two angiosarcoma and one case of Non-Hodgkin’ Lymphoma (NHL). It was possible to diagnose special histological types such as lobular carcinoma, metaplastic carcinoma and mucinous carcinoma on TCB. A total of 21 cases were diagnosed as carcinoma on repeat biopsy. Eight of the 735 TCBs diagnosed as carcinoma were bilateral breast cancers, hence actual number of carcinoma cases were 727. IHC was done successfully on the paraffin blocks in 260 cases. In this series out of 727 patients of carcinomas 30% were in young, i.e., below 40 years of age, including four cases of carcinoma below 20 years. There were no false positive case in this study giving a specificity of 100% and sensitivity was 97%. Conclusion: TCBs are well tolerated by patients, can be done in OPDs and reduce cost. It is possible to give histological diagnosis of carcinoma, lymphoma, phyllodes tumour and sarcomas on TCBs. The paraffin blocks of TCBs can be used for IHC study which helps the oncologists for preoperative adjuvant therapy.

Comparative Efficacy and Safety of Ebastine 20 mg, Ebastine 10 mg and Levocetirizine 5 mg in Acute Urticaria

Vippan Goyal, Anu Gupta, Onam Gupta, Dhruvendra Lal, Manharan Gill

Introduction: Acute and chronic urticaria can result in severely impaired quality of life from pruritus and associated sleep lessness, as well as anxiety and depression. Various treatment modalities are available out of which second generation non sedating H1 antihistamines e.g., fexofenadine, loratidine, desloratadine, cetirizine, levocetirizine, ebastine etc., are used as the first line treatment. Aim: To compare the safety and efficacy of ebastine 20 mg, ebastine 10 mg and levocetirizine 5 mg in the patients of urticaria Materials and Methods: A longitudinal study was conducted in dermatology Outpatient Department (OPD) of Adesh Institute of Medical Sciences and Research, Bathinda, India. A total of 150 patients between the age group 10-70 years, both men and women having urticaria were enrolled and divided into three groups of 50 each. Group A was given ebastine 20 mg OD, Group B was given ebastine 10 mg OD and Group C was given levocetirizine 5 mg OD. The patients were asked to scale their severity of disease over a period of follow up based on Urticarial Activity Score 7 (Uas 7). Results: The mean age of patients was 32.82 years. The mean UAS 7 score at the end of 4th week was 1.08 with ebastine 20 mg, 1.98 with levocetirizine 5 mg and 3.98 with ebastine 10 mg. In group A, 40 out of 50 patients (i.e., 80%), in Group B 25 out of 50 (i.e., 50%) get UAS7=0 and in Group C, 35 (i.e., 70%) patients who got relieved of symptoms at the end of treatment. When the scores were redefined and categorized under relieved and not relieved, and comparison done between all three groups, then there was a significant difference in the number of patients getting relieved, with p<0.001 (highly significant). Levocetirizine 5 mg had shown more side effects like dryness of mouth and sedation as compare to ebastine irrespective of dosage. The comparison made between the number of patients developing side effects among the groups was highly significant (p<0.001) for all the side effects. Conclusion: Ebastine 20 mg is found to have superior efficacy for treatment of Urticaria as compared to ebastine 10 mg but with levocetirizine 5 mg the results were almost similar. Tolerability of ebastine 20 mg is similar to ebastine 10 mg but with levocetirizine 5 mg there were more side effects and less tolerability.

Management of Cubitus Varus Deformity in Children by Closed Dome Osteotomy

Partap Singh Verka, Ujjwal Kejariwal, Bijendra Singh

Introduction: Supracondylar fractures are the most common elbow injuries in skeletally immature children between 5-10 years of age and cubitus varus deformity is the most common late complication. Cubitus varus or bow elbow or gunstock deformity is the result of malunion occurring as a complication of supracondylar fracture of the humerus. Various type of corrective osteotomies are used of which lateral closed wedge French osteotomy is commomly used which has its own complications like lateral condylar prominence, unsightful scar and limitation of movement. Closed dome osteotomy is a technique which overcomes these complications. This surgery is done with simple readily available instruments in the orthopaedic operation theatre with no special requirements for instrumentation. Aim: This study was done to study the results of closed dome osteotomy for correction of cubitus varus deformity, after malunited supracondylar fracture of humerus in children. Materials and Methods: This study included 25 children of either sex with malunited supracondylar fracture of distal humerus having cubitus varus deformity admitted in orthopaedics department. After appropriate pre operative assessment, closed dome osteotomy was done and post operatively X-ray of patients was taken and carrying angle and Lateral Condylar Prominence Index (LCPI) were calculated. Patients were re-assessed at complete union and results were calculated as per Mitchell and Adams criteria. Results: In our study of 25 patients, 68% were males, 32% were females. Majority (84%) of patients were in the age group of 5-10 years. Carrying angle post operatively was 0-10° valgus in 64% of patients while 36% had 10-20° valgus. LCPI changed post operatively ranging from +5.0% to -10.7%, average -2.75%. Decrease in LCPI had better cosmetic appearance. Range of motion post operatively increased or remained same as previous full motion in 84% of the patients. Union occurred in all patients by eight weeks. Few complications were seen. Results according to Mitchell and Adams criteria were excellent in 88% and good in 12%; while no poor results were recorded. Conclusion: The results obtained in our study concluded that closed dome osteotomy is safe and effective treatment for the correction of cubitus varus deformity with few minor complications.

Evaluation of C-Reactive Protein and Fibrinogen in Patients with Chronic and Aggressive Periodontitis: A Clinico-Biochemical Study

Introduction: Periodontal disease is characterised by chronic infection and inflammation in periodontal tissues leading to destruction of alveolar bone with subsequent tooth loss. Periodontal infections are the result of an interaction between tooth associated microbial biofilms and the host defences. Periodontal pathogens can affect local and systemic immune and inflammatory responses. Aim: The aim of the present study was to evaluate serum C-Reactive Protein (CRP), plasma fibrinogen and peripheral blood levels in healthy subjects, chronic and aggressive periodontitis patients. Materials and Methods: A total of 55 subjects, 27 males and 28 females were selected for the study. Blood samples were taken from healthy controls (n=20) and patients with chronic periodontitis (n=20) and aggressive periodontitis (n=15). The periodontal status of each patient was assessed by recording Oral Hygiene Index-Simplified (OHI-S), Bleeding Index (BI), Probing Pocket Depth (PPD) and Clinical Attachment Level (CAL). The levels of serum CRP were measured using high sensitivity Enzyme Linked Immunosorbent Assay (ELISA) and levels of plasma fibrinogen were measured using Quantitative Immunoturbidimetric assay. Data description was done in the form of mean and standard deviation and analysis of data was done using one way ANOVA (Analysis of Variance) and Students t-test to test the statistical significance between groups. Results: The levels of serum CRP and plasma fibrinogen was increased in patients with chronic and aggressive periodontitis when compared to healthy controls (p<0.001). A positive correlation was found to exist between levels of clinical parameters like OHI-S, BI, PPD and CAL when compared with CRP and fibrinogen as well as with the study groups. Conclusion: The finding of the present study suggests the role of serum as a diagnostic marker in inflammatory conditions and indicates that levels of CRP and fibrinogen may serve as important biomarkers for evaluating the association between periodontitis and cardiovascular diseases.

Effectiveness of A Four-Week Diet Regimen, Exercise and Psychological Intervention for Weight Loss

Tobias Weinreich, Hans-Peter Filz, Ursula Gresser, Barbara M. Richartz

Introduction: Obesity is accompanied by restriction in the quality of life and an increased risk of morbidity and mortality. Cardiovascular, orthopedic, and metabolic disorders are among the possible consequences. In the management of obesity, a combination therapy that includes dietary, exercise, and behaviour modules has proven its worth. Aim: To evaluate the effect of weight-associated parameters, circulation associated parameters, glucose metabolism, body composition and life quality changes within a four-week inpatient rehabilitation program. Materials and Methods: Fifty-two patients underwent a 4-week inpatient rehabilitation program consisting of nutrition therapy, behavioural therapy and exercise therapy modules at the Eleonoren Clinic of Winterkasten, Germany. Results: The mean weight reduction of 52 obese patients 40(76.9%) males, 12(23.1%) females; mean age 46 years; mean Body Mass Index (BMI) 43,79 kg/m²) achieved was 7.1 kg (from 1.20 kg to 17.50 kg), and the BMI reduction was 2.3 kg/m² (from 0.40 kg/m² to 5.40 kg/m²). The excessive weight loss was highly significant (p<0.001). Weight reduction was accompanied by an improvement in the diabetic metabolic state (lowering of fasting blood-glucose 20 mg/dl, postprandial blood glucose 26 mg/dl, HbA1 0.27%). In all 73% of the patients suffered from arterial hypertonia. The significant mean decline of systolic and diastolic blood pressure was 12.8 mmHg and 6.8 mmHg, respectively. The resting pulse was reduced by an average of 11 beats per minute. The Bioelectric Impedance Analysis (BIA) revealed a significant reduction of body fat content (p<0.001). The subjective impression of impaired life quality (SF-36 questionnaire) improved significantly. Conclusion:The study clearly shows that the inpatient rehabilitation program at the Eleonoren Clinic was suitable to enhance the physical and mental state of people with obesity. In a two-year follow-up program the patients should take care of a permanent lifestyle change toward an improved dietary, movement, and health behaviour.

Leptin as a Predictive Marker in Unexplained Infertility in North Indian Population

Introduction: According to WHO, the primary infertility in India is about 3.9% (age-standardized to 25-49 year) and 16.8% (age-standardized to 15-49 year), using the “age but no birth” definition. Several factors which affect fertility include low sperm production in men, poor egg quality and blocked fallopian tubes in women and also hormonal imbalances. Leptin plays a critical role in women’s reproduction and neuroendocrine health. It is used for treating exercise-induced bone loss, eating disorders and infertility. Aim: To evaluate the serum leptin levels in Indians and to ascertain the relationship between serum leptin levels, Unexplained Infertility (UI) and related variables [height, weight, Waist Hip Ratio (WHR), Body Mass Index (BMI)] between obese infertile, non-obese infertile and healthy subjects. Materials and Methods: The present case-control study was conducted at the Department of Obstetrics and Gynaecology, King George’s Medical University (KGMU), Lucknow, India and funded by Department of Science and Technology, New Delhi, India. The study included 229 female participants in the age group of 18-40 years (120 cases and 109 controls) who were randomly selected. The blood samples were collected from the Infertility Clinic, Queen Mary’s Hospital, KGMU, Lucknow, India. All the participants underwent complete physical examination. Initially, the participants were categorized into fertile and infertile groups, they were further divided on the basis of BMI, normal (BMI- 18.5-24.5) and overweight or obese (BMI=25). Leptin level was measured by Active Human Leptin ELISA kit and BMI of all subjects was calculated in kg/m2 (weight in kg and height in m). Results: A highly positive linear correlation (R=0.754, p<0.001) was found between BMI and serum leptin in unexplained infertile women, which indicates a strong relationship between BMI and serum leptin. The variation in serum leptin is explained by the independent variable, BMI. There was a partial positive linear correlation between BMI and serum leptin in the control group. Statistically there was no significant correlation (R=0.109, p=0.258) between BMI and serum leptin in the control group. Conclusion: The present study clearly demonstrates that level of leptin is higher in unexplained infertile than in the fertile group, and also shows that a strong relationship exists between BMI and serum leptin in the obese group. Serum leptin level was significantly higher in obese than non-obese subjects. Thus, leptin is an important factor for normal reproductive function. Obesity, the main cause of infertility may be controlled by regulating the leptin concentration.

Rapid Identification of Vancomycin Resistant Enterococcus Faecalis Clinical Isolates using a Sugar Fermentation Method

Introduction: Vancomycin Resistant Enterococci (VRE) can be found all over the world. Thus, rapid detection of the isolates could be of high importance in the treatment or prevention of the associated disease. Aim: To measure the turanose fermentation in Enterococcus faecalis clinical isolates for rapid differentiation of VRE and Vancomycin-Susceptible E. faecalis (VSE) isolates. Materials and Methods: Forty E. faecalis samples were isolated from 200 clinical samples in Tehran Medical Center, Iran, from October 2012 to December 2012. These isolates were detected according to the standard microbial and biochemical tests. Detection of VRE isolates was originally performed by disk diffusion using 1 µg vancomycin disk, followed by Polymerase Chain Reaction (PCR) amplification of the vanA gene. Finally, the turanose consumption in 1%, 0.7% and 0.5% dilutions was detected by a phenotypic method. Results: Among the 40 E. faecalis isolates, 20 vancomycin-susceptible and 20 vancomycin-resistant E. faecalis were isolated according to the disk diffusion and PCR of the vanA gene. There was a considerable difference between VRE and VSE isolates in 0.7% dilution of turanose. However, there was no significant difference between VRE and VSE in 1% and 0.5% dilutions of turanose. Conclusion: Since detection of VRE isolates is of high importance, especially in nosocomial infections, phenotypic methods may be highly useful for this purpose. In conclusion, our data indicate that VRE isolated from clinical samples could be distinguished from VSE isolates by turanose fermentation at dilution 0.7%.

Comparison of Methods to Assay Liver Glycogen Fractions: The Effects of Starvation

Nastaran Mojibi1, Mehdi Rasouli

Introduction: There are several methods to extract and measure glycogen in animal tissues. Glycogen is extracted with or without homogenization by using cold Perchloric Acid (PCA). Aim: Three procedures were compared to determine glycogen fractions in rat liver at different physiological states. Materials and Methods: The present study was conducted on two groups of rats, one group of five rats were fed standard rodent laboratory food and were marked as controls, and another five rats were starved overnight (15 hour) as cases. The glycogen fractions were extracted and measured by using three methods: classical homogenization, total-glycogen-fractionation and homogenization-free protocols. Results: The data of homogenization methods showed that following 15 hour starvation, total glycogen decreased (36.4±1.9 vs. 27.7±2.5, p=0.01) and the change occurred entirely in Acid Soluble Glycogen (ASG) (32.0±1.1 vs. 22.7±2.5, p=0.01), while Acid Insoluble Glycogen (AIG) did not change significantly (4.9±0.9 vs. 4.6±0.3, p=0.7). Similar results were achieved by using the method of total-glycogen-fractionation. Homogenization-free procedure indicated that ASG and AIG fractions compromise about 2/3 and 1/3 of total glycogen and the changes occurred in both ASG (24.4±2.6 vs. 16.7±0.4, p<0.05) and AIG fraction (8.7±0.8 vs. 7.1±0.3, p=0.05). Conclusion: The findings of ‘homogenization assay method’ indicate that ASG is the major portion of liver glycogen and is more metabolically active form. The same results were obtained by using ‘total-glycogen-fractionation method’. ‘Homogenization-free method’ gave different results, because AIG has been contaminated with ASG fraction. In both ‘homogenization’ and ‘homogenization-free’ methods ASG must be extracted at least twice to prevent contamination of AIG with ASG.

Prevalence of Nutritional Deficiency Anaemia and Its Impact on Scholastic Performance among Undergraduate Medical Students

Introduction: Nutritional deficiency anaemia can lead to development of headache, fatigue, lethargy, apathy, exertional dyspnoea, palpitations and tinnitus and thereby decrease the quality of everyday life to a great extent. Such symptoms may pose a hindrance for students in their academic life and have a negative impact on their career. Aim: To determine prevalence of nutritional deficiency anaemia and its correlation with academic performance among medical students. Materials and Methods: A cross-sectional study was conducted at Adichunchanagiri Institute of Medical Sciences. Two hundred eighty nine healthy undergraduate medical students of both genders were included in this study. A predesigned and pre-structured questionnaire was used as a tool to obtain information regarding demographic profile, dietary habits and academic performance. Haemoglobin level was estimated. Student’s t-test and Chi-square test were employed. Results: Majority of the participants were within the age group of 17-20 years (84.4%). The overall prevalence of anaemia was 15.6% with high rates among female students (93.3%), this gender difference was statistically significant (p<0.001). There was statistically significant difference in Hb% (p=0.009) among high and low performers. There was no association between the anaemic status and students scholastic performance (c2=3.1533, p=0.368). Conclusion: The mean haemoglobin level was higher among low performer, indicating that nutritional anaemia may not \play a major role in educational performance and intelligence in higher education.

Cortical Potentials Prior to Movement in Parkinson’s Disease

Ashlesh Laxman Patil, Sanjay Kumar Sood, Vinay Goyal, Kanwal Preet Kochhar

Introduction: Recording cortical potentials prior to movement (bereitschaftspotentials, BP) offer a good non invasive method for studying activity of motor related cortices in Parkinson’s Disease (PD). Dopaminergic medications provide some symptomatic relief in advanced stages but they do not stop the progression of the disease. Assessing BP may be a good idea to see the response of anti PD drugs. It remains unclear whether the anti PD medications also improve cortical activity prior to movement even in advanced stages of the disease. Aim: In this study we recorded scalp BP in patients with varying grades of severity to study the relationship between disease severity and various components of BP. Materials and Methods: We successfully recorded BP at Cz, C3 and C4 sites during self-initiated 100 right wrist movements in 12 male patients with PD having severity Hoehn and Yahn (H &Y) scale 4 (PD3 group). These potentials were compared with age matched patients with H&Y scale 2 (PD1) and scale 3 (PD2) and also with age matched healthy controls. Results: We found flatter waveforms with increasing severity of disease. Amplitude is first to be affected in mild severity as compared to controls (p=0.011); while with increasing severity early as well as late part of potentials is affected. Such changes are prominently seen at Cz site across the groups. Conclusion: These findings imply that there is increasing defect in cortical activity during movement especially in supplementary motor area with increasing severity in PD in spite of dopaminergic medications. This dynamic nature of dysfunction in supplementary motor cortices must be taken in account while treating advanced cases using newer stimulation techniques.

To Evaluate and Compare Periodontal Disease and Smoking as a Parallel Risk Factor for Systemic Health by Gauging the Serum C-Reactive Protein Levels

Introduction: Physiologic and metabolic changes that occur immediately after a damage or disease are known as Acute Phase Reaction (APR). Acute Phase Proteins (APP) are blood proteins secreted by hepatocytes during APR C-Reactive Protein (CRP) being the important one. Aim: Present study was designed to estimate and compare the levels of the serum CRP in current smokers, former smokers and non-smokers, with and without periodontitis. Materials and Methods: An experimental study was planned on 165 subjects who were divided into four groups. Group 1- nonsmokers with periodontitis. Group 2- smokers without periodontitis. Group 3- smokers with periodontitis. Group 4- former smokers without periodontitis. Healthy controls were not included in the study as the normal range of CRP in health is already established. Periodontal examination was done and serum CRP was measured. After getting the acceptance to be a part of the study, written informed consent was taken from each participant. Data analysis was done by ANOVA and post-hoc tests. Results: Highest level of CRP was found in smokers with periodontitis followed by non-smokers with periodontitis and smokers without periodontitis. Former smokers had minimum CRP compared to the other groups (p-value=0.03). Conclusion: Periodontitis alone and in combination with smoking increases the systemic inflammatory burden and associated cardiovascular risk. This fact should be communicated thoroughly to the general population, general dentist, physicians and cardiovascular specialist to enhance early screening and multidisciplinary treatment.

Maternal and Cord Blood Plasma sEng and TGF-ß1 in Patients with Hypertensive Disorders of Pregnancy: A Pilot Study in a South Indian Population

Introduction: Hypertensive Disorders of Pregnancy (HDP) are one of the most widespread complications of pregnancy that affects both mother and foetus. It has been observed that in Preeclampsia, the release of soluble angiogenic factors from the ischemic placenta into maternal plasma plays a crucial role in the pathogenesis. Aim: To assess the plasma Soluble Endoglin (sEng) and Transforming Growth Factor (TGF-ß1) levels in various types of HDP and to correlate the levels of these markers with the pregnancy outcome. Materials and Methods: A total of 128 pregnant women were recruited and the study was carried out for a period of three years. Cord blood and maternal blood plasma levels of sEng and TGF-ß1 were analysed by ELISA kits in Control Pregnant Women (CPW), Gestational Hypertension (GH), Early Onset Preeclampsia (EOPE), Late Onset Preeclampsia (LOPE), and Eclampsia (E) during third trimester. The Gestational Age (GA) at the time of delivery and Birth Weight (BW) of the baby also were also evaluated. Results: The circulating levels of maternal and cord blood sEng were significantly higher in EOPE and E compared to CPW and GH. However, the maternal and cord blood levels of TGF-ß1 were significantly lower in LOPE and E when compared to CPW and GH. The GA and BW of the baby were found to be significantly lower in EOPE and E compared to CPW, GH and LOPE. Also, a negative correlation was observed between sEng levels with pregnancy outcome; GA and BW. And also, a positive correlation was found between TGF-ß1 and pregnancy outcome. Conclusion: A generalised angiogenic imbalance and poor birth outcomes were observed in HDP. There is a spectrum of biochemical derangements related to angiogenesis in GH, EOPE, LOPE and E.

Assessing the Safety and Clinical Impact of Thoracoscopic Lung Biopsy in Patients with Interstitial Lung Disease

Introduction: The clinical relevance of surgical lung biopsy in Interstitial Lung Disease (ILD) is supported in the literature. Yet most reports reflect institutional or personal bias. Aim: To evaluate the validity of radiologic diagnosis and clinical impact of lung biopsy to help clarify which patient benefit most from biopsy. Materials and Methods: We performed a retrospective analysis of a prospectively managed database. All patients who had a surgical lung biopsy for ILD within a period of four year (2009 to 2013) were included. Data included patient demographics, peri-operative variables and outcomes. Preoperative Computed Tomography (CT) imaging was reviewed by a thoracic radiologist blinded to the original report and pathologic information. Results: A total of 47 patients were included. Lung tissue was obtained via a thoracoscopic approach in all but two that had mini-thoracotomy. Mean operating time was 51.1 minutes (18-123), median hospital stay was two days (1-18). Most (87.2%) of the patients were discharged within 72 hours. Thirty day mortality for elective surgery was 4.5% (2/44). Post-operative complications occurred in about one third of the patients. Complications in elective procedures included pneumothorax (10.4%), re-intubation (5.4%) and prolonged intubation (2.7%). Full concordance of radiographic diagnosis with the final diagnosis was significantly higher when reviewed by a cardiothoracic radiologist (60.5% vs. 21.3%). The preoperative clinical diagnosis was fully concordant with the final diagnosis in only 28.2% of cases. In 13.0% of patients the preoperative diagnosis was incorrect. Malignancy was the final diagnosis in two (4.3%) patients. In 51.1% of the patients, results of the biopsy did alter therapy. Conclusion: Diagnosis of specific ILD by a cardiothoracic radiologist is more specific and accurate and will probably lead to more appropriate therapy. Elective thoracoscopic surgical lung biopsy is a safe procedure, leads to a more accurate diagnosis of ILD and impacts therapy.

Holistic Healing Through Herbs: Effectiveness of Aloe Vera on Post Extraction Socket Healing

Introduction: Advances in the field of alternative medicine has encouraged the use of various natural products for multiple uses in the field of dentistry for treatment of various oral diseases. A natural herbal product is Aloe vera, which has number of benefits with no reported side effects and gaining considerable importance in clinical research. Aim: The aim of this cross-sectional randomized interventional study was to evaluate the effectiveness of Aloe vera in the healing of post extraction sockets. Materials and Methods: A sample size of 40 patients undergoing atraumatic extraction was divided into two groups. Group A-patients were prescribed only analgesics and followed for seven consecutive days and socket healing assessment was done. Group B-Patients were given Aloe vera soaked gel foams, followed up to the third and seventh day by two observers and the socket healing was assessed using the standardized index by Landry, Turnbull and Howley. In addition to healing the common complaint associated with extraction wound, the pain was assessed using numerical rating scale. Data obtained was statistically analysed using Mann-whitney U test, Wilcoxon Signed ranks test and Spearman’s rank correlation method. Results: Control group on the third and the seventh day showed healing of 60% and 70% respectively and the Aloe vera group showed a better result having a healing potential of 70% on the third day and 90% on the seventh day which was statistically significant with a (p-value<0.001). Aloe vera group showed a significant decrease in pain after two hours on the day of extraction followed by second, third and seventh day which was statistically significant (p-value<0.001) and better than the control group. Conclusion: Aloe vera has been proved to have a unique property that is implicated in better healing than other group without any side effects. Aloe vera is economical, effective, powerful nutritional supplement and antioxidant that protects and promotes wound healing.

Children’s Physical Activity Awareness among Mothers in a Saudi Arabian Health Center

Maysah Amer, Ghada Al Arfaj, Abdulaziz A Alodhayani

Introduction: Physical inactivity is a major contributor to the increasing levels of obesity and other serious medical conditions among children and adolescents worldwide. A major factor in this increase is lack of awareness of mothers’ regarding the Physical Activity (PA) of their children. Aim: The current study aimed to identify the degree of knowledge and awareness of Saudi mothers’ regarding their children’s physical activities, which will be useful for improving physical education, health programs, and eventually children's health care. Materials and Methods: A total of 342 mothers attending a vaccination clinic, well-baby, or women’s health clinic participated in the study, in which questionnaire was used to assess the awareness regarding PA. Results: The majority of mothers agreed that they have a crucial role in motivating their children to engage in PA, but was not aware of current recommendations. Conclusion: Awareness of Saudi mothers’ regarding their children’s PA was exceedingly low. Creating awareness of children’s PA is essential.

A Comparison of 2-Methoxyestradiol Value in Women with Severe Preeclampsia Versus Normotensive Pregnancy

John Wantania, Ahsanuddin Attamimi, Rukmono Siswishanto

Introduction: Preeclampsia is a pregnancy complication characterized by high blood pressure and proteinuria. Endothelial dysfunction is a major theory suggested as its aetiology. It is caused by antiangiogenic condition characterized by low Vascular Endothelial Growth Factor (VEGF). An estradiol metabolite, called 2-Methoxy Estradiol (2-ME), is produced with the help of Catechol-O-Methyltransferase (COMT). This substance has an important role in VEGF expression. A 2-ME is suppressed in women with preeclampsia. Aim: To compare 2-ME in women with severe preeclampsia and normotensive pregnancy. Materials and Methods: A total of 80 subjects qualified the inclusion and exclusion criteria, were divided into two groups (40 each): the severe preeclampsia and the normotensive pregnancy. Blood sample was collected and examined with the ELISA 2-ME kit (Cayman). The data were compared and calculated using Fisher-Exact test to examine 2-ME differences between the two groups. Results: Women age, parity, and gestational age showed a non significant difference between both groups. Nonetheless, the BMI before pregnancy and the history of preeclampsia in the past pregnancy showed significant differences. In this study, the 2-ME value was lower in the severe preeclampsia group compared to the normotensive. Conclusion: This study concludes that 2-ME value in severe preeclampsia is lower than normotensive pregnancy. A lower 2-ME value may indicate COMT not producing enough 2-ME which in turn may cause the pre-eclampsia.

Clinical and Cytological Spectrum of Granulomatous Mastitis and Utility of FNAC in Picking up Tubercular Mastitis: An Eight-Year Study

Introduction: Granulomatous Mastitis (GM) is a rare, benign, inflammatory disease of the breast. It is a well known mimicker of malignancy, clinically and radiologically. Patients are often subjected to number of tests for the right diagnosis. Non-specific Granulomatous Mastitis (NGM) and Tubercular Mastitis (TBM) are chief among the various causes of GM. They are important to be diagnosed early as their treatment varies significantly. Fine Needle Aspiration Cytology (FNAC) is simple, patient friendly and primary investigation modality in cases of lump in breast. Aim: To find out the utility of FNAC in differentiating NGM and TBM. Materials and Methods: All cases of granulomatous mastitis diagnosed on cytology over eight years were retrospectively retrieved. The clinical and radiological history was obtained from the patient file. The slides were stained with haematoxylin and eosin stain as well as Leishman stains. Special stains like Periodic Acid Schiff (PAS) and Ziehl Neelsen (ZN) stain were used for fungus and Mycobacterium tuberculosis respectively. Histopathological correlation of the available cases was done. Clinical presentation and cytological morphology of individual cases was studied in detail. Results: Twenty one cases of GM obtained, of which 16 were NGM and five were TBM. Both diseases were common among young reproductive women who presented with unilateral breast lump of varying duration. Almost 25% of NGM and 60% of TBM has clinical suspicion of malignancy. About 30% had radiological suspicion of malignancy. Nearly 62.5% of NGM patients had painful swelling and none of tubercular mastitis patients had pain. About 31% of NGM patients underwent prior abscess drainage and 40% of TBM patients gave history of tuberculosis. Almost 6.25% of NGM and 60% of TBM had axillary lymphadenopathy. Cytologically epithelioid cells were identified in 100% of patients whereas, granulomas were seen in 62.5% and 80% of NGM and TBM smears respectively. Langhans giant cells were frequent among TBM and foreign body giant cell among NGM. Caseous necrosis was seen in 60% of TBM and absent in NGM smears. Conclusion: Though, NGM and TBM is said to have overlapping features, our study highlights few clinical and cytological differences which aid in differentiating the two entities at primary level. FNAC along with special stain must be advocated as the primary tool of diagnosis in cases of GM.

A Clinicopathological Study of Paediatric Liver Tumours in a Tertiary Care Hospital

Esakki Muthuvel, Vimal Chander Chitra Srinivasan

Introduction: Paediatric primary liver tumours are the third largest group of solid abdominal neoplasms in children next to neuroblastoma and Wilms tumour, accounting for about 0.5% to 2% of all paediatric neoplasms, in which hepatoblastoma is the most common. Aim: The present study was done to estimate the incidence of paediatric liver tumours over a period of five years and also, to study the clinical behaviour, alpha-fetoprotein correlation and histopathological features of paediatric liver tumours. Materials and Methods: The details of patients treated for paediatric liver tumours for a period of five years were retrospectively retrieved from the tumour board and medical records. The gross features and all the slides were reviewed and the pathologic diagnosis was confirmed and clinicopathological correlation was then done. Results: A total of 39 paediatric liver tumours were detected during five years, of which 32 (82%) were malignant and seven (18%) were benign with a male to female ratio of 1:1.1. Hepatoblastoma was the most common liver tumour accounting for 28 cases (71.8%), of which 25 cases (89.4%) were of pure epithelial type. The second most common primary tumour was epithelioid haemangioendothelioma with six cases (15.4%) with female preponderance, followed by two cases each of hepatocellular carcinoma and undifferentiated embryonal sarcoma and one case of hepatocellular adenoma. Serum AFP level was increased in hepatoblastoma and in hepatocellular carcinoma, normal in hepatocellular adenoma and embryonal sarcoma. Serum AFP level was increased in few cases of epithelioid haemangioendothelioma. Conclusion: The spectrum of liver tumours in children is different from that in the adults. Hepatoblastoma is the most common paediatric liver tumour, followed by epithelioid haemangioendothelioma. Through better understanding of pathological diagnosis, refined surgical staging, newer and more effective radiological techniques and standardized multimodal therapies, a substantial number of children diagnosed with this highly malignant tumour can expect to survive the disease.

Comparative Evaluation of Antibacterial and Adhesive Properties of Chitosan Modified Glass Ionomer Cement and Conventional Glass Ionomer Cement: an In vitro Study

Introduction: Recent studies have reported the incorporation of modifiers with conventional Glass Ionomer Cement (GIC) to enhance its antibacterial effect. One such modification being the addition of Chitosan (CH). However, these modifiers might affect the physical properties of the restorations. Aim: The aim of the present study was to investigate the effect of modifying the liquid phase of conventional GIC with 10% v/v CH on the antibacterial properties and adhesion to enamel in comparison to conventional GIC. Materials and Methods: The liquid of commercially available restorative GIC (Fuji IX, GC Industrial Corporation, Japan) was modified with 10% v/v CH solution (Everest Biotech, Bengaluru). GIC powders were mixed with the unmodified and the CH-modified liquids at the desired powder/liquid ratio. Fourier Transform Infrared Spectroscopy (FTIR) was used to determine the setting reaction between the conventional and CH modified GIC liquid with GIC powder. For evaluation of the antibacterial properties, biofilms of Streptococcus mutans (S. mutans) were formed on the GIC discs and characterized by Scanning Electron Microscope (SEM). For the characterization of the adhesive properties, the unmodified and CH-modified GICs were bonded to the enamel surface and the microshear bond strength (µSBs) was evaluated. Student’s paired t-test was used to compare the micro-shear bond strength between CH modified GIC and unmodified GIC. Results: Modification with 10% v/v CH solution improved the antibacterial properties of GIC against S. mutans in terms of resistance to biofilm formation which was assessed using SEM. Microshear bond strength of CH modified GIC was 85.40 MPa compared to 46.94 MPa of conventional GIC. This difference was found to be statistically significant. Conclusion: Modifying the liquid phase of a conventional GIC with 10% v/v CH significantly improves the antibacterial property of GIC as well as its adhesion to enamel.

Preventive Training among Medical Interns in Mexico City and Its Association with Needlestick and Sharp Injuries – A Cross Sectional Study

Victor Hugo Garcia, Katja Radon

Introduction: Medical students are a vulnerable group for the acquisition of blood borne pathogens due to their lack of experience. In Europe and Asia preventive training programs have reduced accidental exposures. Aim: The aim of the study was to compare the lifetime prevalence of Needlestick and Sharp Objects Injuries (NSIs) among medical interns who received preventive training versus those without such training in Mexico City. Materials and Methods: In 2013, a cross-sectional study was performed applying an anonymous self-administrated questionnaire. The study population included 467 medical students, male and female, at the end of their internship. The lifetime prevalence of NSI was estimated and compared between students who had received preventive training and those who did not. Results: The overall lifetime prevalence of NSI was 58%. Lifetime prevalence was higher in students without preventive training compared to those who had such a training (68% vs 51%; p value= 0.002). NSI Lifetime prevalence was not associated with sex, age or place of birth. The task most commonly associated with the latest NSI in trained and untrained students was withdrawing blood. Conclusion: NSI are frequent accidents among medical students in Mexico City, especially during blood taking. Training units on how to prevent NSI should be encouraged in Mexican medical colleges.

Effect of Passive, Active and Combined Warm up on Lower Limb Muscle Performance and Dynamic Stability in Recreational Sports Players

Kedar Gogte, Prateek Srivastav, Ganesh Balthillaya Miyaru

Introduction: Warm up is an activity that is done before a sports activity. The warm up can be done actively and passively. The preferred mode is active warm up in athletes. There are inconclusive effects of passive warm up compared with an active warm up on short term muscle performance. The cumulative effect of passive and active warm up on muscle performance and dynamic stability is not known. Aim: To find out the effects of passive, active and combined warm up on lower limb muscle performance and dynamic stability in recreational sports players. Materials and Methods: A randomized crossover study was done on 19 recreational lower limb dominant sports players. Three different warm ups were included in the study passive, active and combined. Active warm up included series of activities like cycling, leg press, jump squats, squat jumps while passive warm up included application of moist heat for a period of 20 minutes on lower limb muscles. Combined warm up included both passive and active warm up. Six different sequences were made from these three warm ups. Subjects were screened and allotted into different the six warm up sequences after sequence randomization with 48 hours wash out period. After every warm up session Vertical Jump Test (VJT) and Star Excursion Balance Test (SEBT) was performed and results were recorded. Study duration was one year and six months. Results: There was no difference noticed in both the outcome measures. Mean and SD values for passive, active and combined warm up are 47.62±9.64, 48.50±10.16 and 48.87±10.70 respectively in Vertical Jump Test (VJT) and 85.43±8.61, 85.17±8.60 and 85.17±8.38 respectively for SEBT. The p-value for mean difference between passive-active, active-combined, combined-passive are 0.67, 1.00, 0.51 respectively, for VJT and 1.00, 1.00, 1.00 respectively for SEBT. Conclusion: All warm ups are equally effective in short term sports performance.

Study on MICs of Tigecycline in Clinical Isolates of Carbapenem Resistant Enterobacteriaceae (CRE) at a Tertiary Care Centre in North India

Vineeta Khare, Prashant Gupta, Fareya Haider, Rehana begum

Introduction: Members of family Enterobacteriaceae are the most common Gram-negative bacteria isolated from clinical samples. Those Enterobacteriaceae which have acquired resistance to all ß-lactams antibiotics including the carbapenems are considered as Carbapenem Resistant Enterobacteriaceae (CRE). These CRE isolates are often resistant to most other classes of antimicrobials as well, making their treatment a great challenge. Tigecycline is one of the last resort antimicrobials against such multidrug resistant bacteria. Decreased tigecycline susceptibility mediated by efflux pump systems is being reported in clinical strains of Enterobacteriaceae. Minimum Inhibitory Concentration (MIC) data would prove useful in managing infections by these multidrug resistant bacteria and optimizing use of tigecycline. Aim: To evaluate the MIC values of tigecycline against carbapenem resistant Escherichia coli and Klebsiella pneumoniae isolates. Materials and Methods: This prospective study was carried out from January 2015 to December 2015 at the Department of Microbiology, Era’s Lucknow Medical College and Hospital (ELMCH), Lucknow, Uttar Pradesh, India. Antimicrobial susceptibility by disk diffusion (Kirby-bauer) was done for 491 E. coli and K. pneumoniae strains isolated from 1606 samples collected from patients admitted in various wards and ICUs. Imipenem, meropenem and ertapenem 10 µg disks were used for testing of sensitivity to carbapenems. In all isolates, Tigecycline 15 µg (Hi-Media) disk was used to screen for tigecycline resistance. In CRE isolates, MICs of tigecycline were determined by E-test (Ezy MIC TM TG strips, Hi Media) and interpreted using European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2016 guidelines. Results: Out of 491 isolates tested, 186 (37.9%) were found to be CRE showing resistance to at least one of the three carbapenems tested and these included 99 E.coli and 87 K. pneumoniae. Sensitivity pattern of these two bacterial isolates shows a high level of resistance to most classes of antimicrobials. MIC testing for tigecycline was carried out in 144 CRE isolates and tigecycline resistance (MIC >2 µg/ml) was seen in 12 (8.3%) isolates (eight K.pneumoniae and four E. coli). Eight other isolates were found to have MIC of 2 µg/ml and thus the overall prevalence of isolates with decreased susceptibility was 20 (13.9%). Conclusion: A high prevalence of carbapenem resistance coupled with high tigecycline MICs in clinical isolates of E.coli and K. pneumoniae highlights the judicious use of a combination of antimicrobials. Routine in vitro sensitivity testing to evaluate the clinical utility of tigecycline against such resistant Enterobacteriaceae is warranted.

Isolated Central Nervous System (CNS) Relapse in Paediatric Acute Promyelocytic Leukaemia: A Systematic Review

Smeeta Gajendra, Rashmi Ranjan Das, Rashi Sharma

Introduction: Extramedullary disease, as a whole, is rare in Acute Promyelocytic Leukaemia (APML). If at all relapse occurs, following sites are involved: Central Nervous System (CNS), skin, testes, mediastinum, gingiva, and ear. Isolated CNS relapses after complete morphological and molecular remission is rarer particularly in children. Aim: To review the literature systematically to find out the incidence of isolated CNS relapse in paediatric APML cases. Materials and Methods: A systematic search of major databases (Medline, Pubmed and Google Scholar) was conducted. We included all types of studies that reported about incidence or prevalence of isolated CNS relapse in children upto 18 years of age with APML. Results: A total of nine studies (with 10 cases of isolated CNS relapse) were included. Majority (70%) was high risk patients, and 60% were =six-year-old. Nearly, 50% were having the mean time to relapse <12 months and most (60%) of them were male. The children who died were having shorter time to CNS relapse (around 12 months), and were older (>6 to 18 years). Conclusion: In the present review, disease in the high-risk group, male sex, younger age (=six-years-old), and Promyelocytic Leukaemia/Retinoic Acid Receptor Alpha (PML-RARA) detection was found to be associated with isolated CNS relapse in children with APML. Cerebrospinal fluid (CSF) examination along with immunophenotyping and Reverse Transcription polymerase Chain Reaction (RT-PCR) for PML-RARA is required for a definite diagnosis and early treatment of patients to improve overall survival.

Herbs in Oral Mucositis

Maryam Baharvand, Soudeh Jafari, Hamed Mortazavi

Oral mucositis is an inflammatory mucosal destruction as a result of chemotherapy and/or radiation therapy, which in severe cases can impair patients’ quality of life. Moreover, mucosal infection and/or systemic involvement due to compromised immunity leads to delay or discontinuation of the treatment. Many strategies and agents have been suggested for the management of this condition. Because of their lower side effects compared to chemical drugs, general interest in evaluating therapeutic effects of herbs has been increased intensively. Herbal plants apply their effect through different mechanisms of action: antioxidant, analgesic, anti-inflammatory, antifungal, antiseptic, and anticarcinogenic activity. Recently, various natural agents in plants have been noticed in mucositis, which may improve the symptoms through different interventions. The purpose of this review is to focus on the preventive or therapeutic use of herbal medicine to alleviate oral mucositis.

Recognition of Small Airways Obstruction in Asthma and COPD - The Road Less Travelled

Desh Deepak, Akhila Prasad, Swapndeep Singh Atwal, Kshitij Agarwal

The small airways, once regarded as the silent zone in the air conducting system of the lungs are now known to be one of the initial sites of involvement in diseases like asthma and Chronic Obstructive Pulmonary Disease (COPD). Identification of the involvement of distal airways in these diseases is often difficult to assess, clinically as well as by conventional pulmonary function tests and therefore, usually remains undiscovered in early stages. Early recognition of their involvement in asthma and COPD and timely management may reduce long term morbidity in these conditions. This article aims to highlight the relatively lesser recognized facts about small airways involvement in asthma and COPD and role of imaging and newer modalities for detection.

A Review on Detection and Treatment Methods of Sleep Apnea

Rajeswari Jayaraj, Jagannath Mohan, Adalarasu Kanagasabai

This paper presents a review on detection and treatment methods of sleep apnea. Sleep apnea is the most common type of breathing-related sleep disorder. It manifests in a variety of behaviours from teeth grinding to night terrors as involuntary night-time events. The most common sleep disorders are narcolepsy, hypersomnia, sleep talking, sleep walking, and bedwetting. Sleep apnea (somnipathy) is a serious sleep disorder that pauses breathing while sleeping. Breathing pauses occur 30 times or more during sleep and it lasts for few seconds to minutes, when normal breathing starts after this pause. Untreated sleep apnea patients stop breathing, which happens up to hundreds of times during sleep that ultimately results in atrial fibrillation, cardiac arousal, stroke, brain tumor and other vascular diseases at the age of 65 that causes death. Smokers are at a greater threat for sleep apnea. Several studies have suggested that a person who smokes more than two packs a day has 40 times the risk of sleep apnea then nonsmokers. This review includes the discussion about detection of sleep apnea from heart rate and respiratory events. The published literature of sleep apnea and methods of treatment are also discussed.

Cardiac Myeloid Sarcoma: Review of Literature

Granulocytic Sarcomas (GS) also called as Myeloid Sarcomas (MS) or chloromas are the representatives of extramedullary infiltrates of immature myeloid cells including myeloblasts, promyelocytes and myelocytes. Primary cardiac malignancies per se are rare and infiltration of cardiac muscles by secondary malignant cells is also an uncommon finding. Out of these cardiac tumors, contribution of Cardiac Myeloid Sarcoma (CMS) is even more smaller thereby limiting our knowledge about this rare entity. Because of its very lower incidence, an exact guideline for diagnosis and management is still missing and usually haematologists around the world are treating CMS based on their clinical acumen. Aim of this review is to briefly discuss the presenting clinical feature, differential diagnosis, diagnostic workup and management based on published articles related to CMS till date.

Orthodontic Therapy for Paediatric Cancer Survivors: A Review

sumita mishra

The paper aims at reviewing the possibilities of orthodontic therapy for paediatric cancer survivors. It is important to understand the fundamental disease, it’s treatment protocols, effects on growing skeleton, dental development, oral cavity and oral mucosa, dental caries, bone, orthodontic tooth movement.

Screening in Public Health and Clinical Care: Similarities and Differences in Definitions, Types, and Aims – A Systematic Review

Introduction: The concept of screening can be many times misleading to many people. This may be partly due to the way screening is described and explained in textbooks and journal articles. Aim: To review prominent public health and epidemiology textbooks, dictionaries, and relevant journal publications for definitions and examples of screening, with the aim of identifying common usages and concepts, as well as sources of potential confusion. Materials and Methods: Commonly available epidemiology and public health textbooks and peer reviewed journals were searched for definitions and examples of screening. The search located seven journal articles, 10 textbooks, and one dictionary. The search platforms used were Pubmed, BIOSIS, EMBASE, Medline-OVID and Scopus under the Epidemiology and Biostatics subject head listed with Life Sciences. Results: Descriptions of screening give varying emphasis to whether it is a test or a program, the aims of screening, the setting in which it is conducted, eligibility criteria, who initiates and who is intended to benefit and whether the condition being screened is an infectious or chronic disease or a riskelevated state. Four essentially different ‘types’ of screening are described, using seven terms and occasionally contradictory examples. The detection of asymptomatic infectious cases is gradually changing from screening to surveillance as part of infection control. Conclusion: Voluntary screening programs rely on high participation to be effective and support and trust of the public are essential for the continued success of the public health profession. Consistent terminology is important for patients, providers and policymakers to understand what screening is and is not. Clear definitions are needed if we are to evaluate and communicate the risks and benefits of screening in public health.

Management of Accidental and Iatrogenic Foreign Body Injuries to Heart- Case Series

Rupesh Kumar, Sandeep Singh Rana, Sanjay Kumar, Deepanwita Das, Monalisa Datta

Accidental and iatrogenic foreign body injuries to heart require immediate attention and its timely management is cornerstone to the life of an individual. We describe in detail five cases of Accidental and iatrogenic foreign body injuries to heart encountered between January 2013 and July 2016. Our series included the following: needle stick injury to the right atrium (1 case) retained catheter fragments in the distal main pulmonary artery (1 case), right ventricle injury during catheterisation study (1 case), right ventricle injury during permanent pacemaker lead placement (1 case), device migration in atrial septal defect closure (1 case). Foreign bodies were removed from the cardiac cavities when the patient presented with features of infection (1 case), cardiac tamponade (2 case), anxiety (1 case), and haemodynamic instability (1 case). The management of accidental and iatrogenic foreign body injuries to heart requires immediate attention. Foreign bodies in the heart should be removed irrespective of their location and symptomatology. Asymptomatic foreign bodies diagnosed immediately after the injury with associated risk factors should be removed; asymptomatic foreign bodies without associated risks factors or diagnosed accidentally after the injury also need surgical intervention to allay fears of anxiety in patient and their relatives, to prevent any late complications and also for medico-legal purpose.