Journal of clinical and diagnostic research

Implications of the Revised Consensus Body Mass Indices for Asian Indians on Clinical Obstetric Practice

Nuzhat Aziz, Sailaja Devi Kallur, Praveen Kumar Nirmalan

Background: The body mass index (BMI) categories for Asian Indians has been revised based on consensus guidelines. The revised guidelines categorize overweight as a BMI of 23.0 – 24.9 and obesity as a BMI=25. Aim: To determine the change in prevalence of overweight and obese pregnant women, and maternal and fetal associations with overweight and obese pregnant women classified using the revised consensus guidelines for BMI in Asian Indians. Materials and Methods: A retrospective analysis of case records of pregnant women between January 2010 and December 2012 at a tertiary care institute in India. BMI was classified using the revised consensus guidelines for Asian Indians and the World Health Organization (WHO) criteria. The strength and direction of associations with maternal and fetal outcomes was explored with a multivariate regression model. Results: The prevalence of obesity increased from 11.81% with the WHO criteria to 43.11% with the revised consensus guidelines and led to the re-classification of 1,345 (18.47%) pregnant women from a low risk category to a high risk category.Gestational hypertension, gestational diabetes and large for gestational age babies was associated with overweight or obesity (both Indian and WHO guidelines). Obesity (both Indian and WHO guidelines) was also significantly associated with caesarean sections (adjusted OR 1.23 and 1.51 respectively). Conclusion: The use of the revised guidelines led to a larger classification of high risk Asian Indian pregnant women. Retention of adverse associations of overweight and obesity support adoption of the revised guidelines in obstetric management of Asian Indians.

Immunohistochemical Analysis of P53 and PRB in Esophageal Squamous Cell Carcinoma

Biswajit Dey, Vandana Raphael, Yookarin Khonglah, Kyrshanlang Giri Lynrah

Background:Esophageal squamous cell carcinoma (ESCC) is one of the fatal cancers with a high incidence rate in Asia. Many genes including p53 and pRb play an important role in its carcinogenesis. Expressions of p53 and pRb proteins have been associated with prognosis of ESCC. Objective:The study was undertaken to analyze the expressions of p53 and pRb with the various clinicopathological characteristics including stage and grade of ESCC. Materials and Methods:We examined 30 biopsy samples of ESCC for p53 and pRb protein expressions using immunohistochemistry. Immunointensity was classified as no immunostaining (-), weakly immunostaining (+), weak immunostaining (++) and strongly positive immunostaining (+++). Results:Significant association was seen between positive p53 expression and tumor size (p=0.042), invasion to adventitia (p=0.009) and lymph node metastasis (p=0.014), and negative pRb expression was associated with invasion to the adventitia (p=0.015) and lymph node metastasis (p=0.003) There was significant association of p53+/ pRb- (n=11) with tumor invasion to adventitia (p=0.001), lymph node metastasis (p=0.0007) and TNM staging (p=0.042). Conclusion:The study shows that p53 and pRb proteins, individually as well as synergistically, may serve as putative prognostic markers in ESCC

Medical Thoracoscopy vs Closed Pleural Biopsy in Pleural Effusions: A Randomized Controlled Study

Nithya Haridas, Suraj K.P., Rajagopal T.P., James P.T., Ravin dran Chetambath

Background: Pleural effusion is a common diagnostic dilemma for the pulmonologist. A histological diagnosis would many a time steer the way to an accurate diagnosis of the aetiologies of pleural effusions. This study has compared two methods for obtaining histological specimens in cases of undiagnosed pleural effusions. Aim: To compare the efficacy of closed pleural biopsy with Abrahm’s needle and medical thoracoscopic biopsy in the diagnosis of undiagnosed exudative pleural effusions at a tertiary care setting. Study Design: Randomized controlled study. Study Period: November 2008–October 2010. Methodology: All patients who were admitted with pleural effusions underwent a clinical workup for pleural effusions. Light’s criterion was used to differentiate between exudative and transudative pleural effusions. Those patients with exudative pleural effusions, who did not have a specific diagnosis, were included in the study. Fifty eight patients were included in the study and they were randomized into 2 Groups of 29 patients each. One group was subjected to medical thoracoscopic pleural biopsy and the other to closed pleural biopsy with Abrahm’s needle. Demographic, clinical and biochemical characteristics, diagnostic yields and the complications among the two groups were compared. Result: Medical thoracoscopy has a diagnostic yield of 86.2% with complication rate of 10.3% compared to 62.1% and 17.2% respectively in closed pleural biopsy group. Conclusion: Medical thoracoscopic pleural biopsy had a better diagnostic yield with a lower complication rate as compared to closed pleural biopsy with Abrahm’s needle.

Phenotypic Characterization and Antifungal Susceptibility Pattern to Fluconazole in Candida species Isolated from Vulvovaginal Candidiasis in a Tertiary Care Hospital

Background: Vaginal candidiasis is a common gynecological finding among women worldwide. This study was carried out to determine the prevalence of vulvovaginal candidiasis (VVC) along with speciation of Candida with special reference to its antifungal susceptibility pattern to fluconazole and also to evaluate the risk factors responsible for VVC in patients attending our tertiary care hospital in Puducherry, India. Materials and Methods: This study was carried out in the tertiary care hospital in Puducherry during the period of August 2010 to September 2012.The study group consisted of 180 women between the age group of 15 to 56 years with the complaints of excessive vaginal discharge, pruritis and pain. Materials used for this study consisted of high vaginal swabs from patients with relevant history, attending Obstetrics & Gynecology department. High vaginal swabs were subjected to direct 10% KOH wet mount microscopy, Gram stain, culture onto Sabouraud’s dextrose agar (SDA) & 5% sheep blood agar and susceptibility testing to fluconazole was performed using E-test. Results: Candida was isolated in 40(22.2 %) women & these consisted of C. albicans 26 (65%), C. glabrata 9(22.5%), C.tropicalis 3(7.5%) & C. parapsilosis 2(5%). Susceptibility test carried out on the 40 isolates revealed that 35 (87.5%) Candida isolates were sensitive to fluconazole, 3 (7.5%) were moderately sensitive and 2 (2.5%) were resistant. Thirty one percent patients had itching as the presenting complaints followed by vaginal discharge (29.4%). Conclusion: The high frequency with which C. albicans was recovered in our study and its susceptibility to fluconazole supports the continued use of azole agents for empirical therapy of uncomplicated candidal vulvovaginitis in the community.

Comparative Evaluation of Shear Bond Strength of Orthodontic Brackets on Pretreatment with CPPACP, Fluor Protector and Phosflur: An In-vitro Study

Sumita Mishra

Objective: The purpose of this study is to evaluate bond strength, bracket tooth interface of Orthodontic brackets that are bonded for fixed Orthodontic treatment procedure on pretreatment with CPPACP, Fluor Protector and Phosflur. The goal is to assess the adhesive remnants following application of these remineralizing agents using Adhesive Remnant Index. Materials and Methods: Two hundred freshly extracted premolar teeth each divided into Control, CPP-ACP, Fluor Protector and Phosflur. Teeth were pretreated with these agents prior to bonding procedure. Shear Bond Strength was tested using a Universal Testing Machine. A jig was attached to upper jaw of the machine. The acrylic block containing the embedded teeth was secured in the lower jaw of the machine such that the bracket base of the teeth parallel the direction of the shear force at a crosshead speed of 1 mm/minute until bracket failure. The force required to dislodge the bracket was recorded. Results: Mean Shear bond strength value is highest for Phosflur (15.3658 ± 2.4546 ) followed by Fluor Protector , CPP-ACP and lowest for Control (7.0462 ± 0.8838 MPa). Conclusion: Phosflur, Fluor protector,CPP-ACP have comparable Shear bond strength values in comparison to control.

Efficacy of Tranexamic Acid in Reducing Blood Loss during Maxillofacial Trauma Surgery–A Pilot Study

Abu Dakir, Balakrishnan Ramalingam, Vijay Ebenezer, Prakash Dhanavelu

Purpose: Tranexamic acid (TXA) is prescribed for short term management of haemorrhage. It is also administered prophylatically in surgeries where blood loss is anticipated. Tranexamic mouth washes are also used in oral surgical procedures for patients with coagulopathies. The purpose of this study was to assess the efficiency of the usage of tranexamic acid on reduction of haemorrhage in maxillo mandibular trauma cases. Materials and Methods: Twelve consecutive male patients, between the ages 20-40 years, with multiple fractures of the facial bones, were included in this study. Six patients were administered either IV tranexamic acid (10 mg/kg- Group 1)and another six placebo (IV normal saline- Group 2) just before induction of anaesthesia. All patients were operated by the same surgical team, using the same standard techniques and the same anaesthetist and the same drugs were used during the surgery. Hypotension was induced for further reduction of intra operative blood loss. Intra and post-operative blood loss, operation time, transfusion of blood products, pre- and post-operative haemoglobin, number of days of hospitalisation and blood count were recorded for both groups. Results: Tranexamic acid significantly reduced the volume of blood loss during the surgery when compared with the control group (489.17± 106.7 mL vs 900.83 ± 113.7 mL). Considering the duration of operation and the treatment groups only, the mean total blood loss in the control group was 411.67 mL more than that in the tranexamic acid group. None of the patients of the TXA group required blood transfusion post-operatively. There was no difference in the length of hospital stay between the 2 groups. Two of the patients of the saline group required blood transfusion post-surgery due to significant drop in haemoglobin. The average drop in haemoglobin was 2 ± 1.4 in the tranexamic group and 4 ± 1.09 in the saline group. Conclusion: Pre-operative intravenous bolus administration of tranexamic acid at 10 mg/kg reduces blood loss compared with placebo during the surgery.

Assessment of Thickness of Palatal Masticatory Mucosa and Maximum Graft Dimensions at Palatal Vault Associated with Age and Gender – A Clinical Study

Ramesh KSV, Swetha P, Krishnan V, Mythili R, Rama Krishna Alla, Manikandan D

Background: Periodontitis is a multifactorial inflammatory disease which leads to alveolar bone loss, followed by exposure of root surfaces, which results in an unaesthetic appearance. Palatal masticatory mucosa is widely used as a donor tissue for root coverage procedures, to achieve an aesthetic appearance and to meet patient’s needs. Obtaining sufficient volume of tissue without injuring the vessels is necessary. Aim: Purpose of this study was to determine thickness of palatal masticatory mucosa in association with age and gender in healthy subjects who were aged 14–59 years. Materials and Methods: Thirtysix healthy subjects were included under two groups (aged 14-29 years and 30-59 years). Each group consisted of 9 males and 9 females. Transgingival probing was done by using a UNC-15 (University of North Carolina) periodontal probe under LA (local anaesthesia) and measurements were taken from 15 different sites on palatal masticatory mucosa. Maximum available length and height of the palatal vault were also measured. All measurements were made by using a Boley gauge to the nearest millimetre. Results: Students t-test was used to determine the difference in mucosal thickness between two groups. Two –way ANOVA test was used to measure the height of palatal vault between the groups. The results showed that younger age group had thinner palatal masticatory mucosa of thickness which was between 2.3 mm to 2.65 mm and that younger females had thinner mucosa than males. The mean height which was measured from second premolar area to the second molar area was significantly greater in men (14.03 mm) than in women (13.25 mm). Conclusion: Palatal masticatory mucosa was thicker in older age group than in younger age group and it was thin in females as compared to that in males. The most appropriate donor site for carrying out grafting procedures is distal canine to mid palatal aspect of 1st molar area, with minimum height of 5mm to 8mm in the premolar area in all cases.

Clinical Study of Acute Childhood Diarrhoea Caused by Bacterial Enteropathogens

Vyas Kumar Rathaur, Monika Pathania, Aparna Jayara, Neeraj Yadav

Objective: There are not a large number of studies in India which can enlighten us regarding acute childhood diarrhoea and far lesser in number when it comes to its bacterial enteropathogenesis. The present study is specially targeted to determine the prevalence of various bacterial enteropathogens causing acute childhood diarrhoea and to find out their respective pattern of clinical features. Method: All children under 12 years of age enrolled between 1st June, 2012 and 31st July 2012, in the Outpatient department, Inpatient department of pediatrics section and casualty of hospital, who presented with acute diarrhoea. Data collected by mean of study questionnaire. Stool sample were processed for bacteriological analysis. In 280 samples bacteria were isolated with the help of microscopy, culture and biochemical reactions. The isolates obtained were tested for antimicrobial sensitivity over Mueller Hinton agar by Kirby Bauer-disk diffusion method. Results: Out of 280 children frequency of diarrhoeagenic bacteria isolated from the samples showed that Escherichia coli was recorded as the predominant bacteria with 44.2% of prevalence followed by Shigella, Salmonella, Klebsiella and Campylobacter with 28.2%, 13.6%, 7.8% and 6.1% respectively. Patients falling in the age group of 1-3 years. were the major sufferers of diarrhoea due to all etiologies except Klebsiella which mainly had impact on the patients below six months. Fever and vomiting were predominant symptoms. All 100% patients with Salmonella as etiology presented with fever. The maximum number of patients had frequency of diarrhoea less than five times a day (52.5%). And among the patients who presented with frequency of more than 10 times a day Salmonella was a major causative agent found. Maximum patients presented with some dehydration (67.1%) and the patients who presented with severe dehydration Salmonella was identified as a major etiological agent. Majority of isolated bacterial agents were resistant to Co-trimoxazole and Shigella being highly resistant enteropathogen isolated. Salmonella spp. were least resistant isolates. None of the isolates were resistant to Cefotaxime, Cefuroxime and Azetronam. Conclusion: Results of study reveal that Escherichia coli is a predominant bacterial enteropathogen causing diarrhoea and Salmonella is a major contributor to the diarrhoea causing severe dehydration and to the clinical features like fever, vomiting and more than 10 times of frequency of stools. Shigella is among highly resistant isolates while Salmonella isolates had least resistance to majority of antibiotics.

Transinguinal Preperitoneal Technique of Inguinal Hernioplasty – A Better Alternative to Lichtenstein Procedure

Rubik Ray, Manoranjan Kar, Mrityunjay Mukhopadhyay

Introduction: The Lichtenstein technique is currently one of the popular methods in practice as it provides very good results consistently. However many patients suffer from wound indurations’ and chronic wound pain which are often underreported. The transinguinal preperitoneal technique (TPT) avoids these complications by placing the mesh in preperitoneal plane by open approach. Materials and Methods: In this study, 71 patients were randomized into two groups one, of which one underwent the Lichtenstein repair and the other preperitoneal repair by TPT. All the patients were followed up for two years. Results: Patients in TPT group had less pain in immediate post-operative period (p - .005), less wound induration and chronic pain on follow-up. Patients were also able to return to work early (p =0.036) . Average duration of operation was slightly longer compared to Lichtenstein technique (p < .0061) .There was no recurrence in either group on 2 year follow-up. Conclusion: This study shows that TPT provides a better alternative to Lichtenstein technique with decreased incidence of wound complications and chronic groin pain, while having a similar recurrence rate. Preperitoneal mesh placement by open approach in TPT is also easier and eliminates the need for laparoscopy.

Extended Reverse Sural Artery Flap’s Safety, Success and Efficacy - A Prospective Study

Ramesha KT, Prakashkumar MN, Shankarappa M

Background: One of the challenges in reconstructive surgeries, faced by a majority of surgeons, is the soft tissue defect management around the lower-third of the leg, plantar and dorsal feet. Due to the sensitive location and other related difficulties, only limited options are available in this region. A durable flap is the preferred option for coverage of such defects. Objective: To evaluate the safety, success and efficacy of the extended reverse sural artery flap which was harvested, with extension to proximal-third of the leg. Methodology: This prospective study was conducted at Department of Plastic Surgery, on 18 consecutive patients with soft tissue defects and exposed bones, tendons and joints of distal-third of leg and foot. We harvested medium to large sized reverse sural artery flaps with extensions to the upper third of the calf, to cover the defects found in the distal tibia, ankle, heel, foot, and sole. Results: A majority of flaps provided a good coverage for defects. Two cases developed marginal necrosis of flaps in the distal border, which was treated with use of secondary skin grafts. Four flaps developed venous congestions. In other patients, minor Complications such as rupture of suture inset, development of ulcer over insensate flap, (since only one pt developed ulcer and another one patient developed inset rupture and graft loss occurred. In 16 cases, the final outcome was unaffected by any complications. Conclusions: Extension of reverse sural artery flap to the proximal third of the leg was safe and reliable and it was efficiently used to treat patients with large and far wounds of distal leg, foot and sole.

Variations in Innervation of Muscles in Anterior Compartment of Arm – A Cadaveric Study

Parminder Kaur, Rajesh Kumar, Anjali Jain

Aims and Objective: Study was undertaken to observe the variation in the innervation of muscles in the front of arm. The results were compiled. Embryological basis and clinical applications of encountered variations were tried to explain with the help of available literature. Material and Methods: Thirty upper limbs from fifteen cadavers were dissected to observe the contents of front of arm. Musculocutaneous nerve, median nerve and innervation of the muscles of front of arm were observed. Results: Variations were observed in 13% of cases. Commonly seen variation was the absence of musculocutaneous nerve and innervation of muscles of front of arm by branches of median nerve. This variation was seen bilaterally in 3.3% of cases and unilaterally in 6.6% cases. Bilateral presence of this variation in one out of fifteen cadavers is rare finding. Variation is more common on right side as compared to the left side. Conclusion: Bilateral absence of musculocutaneous nerve and innervation of muscles of front of arm from the branches of median nerve is a rare variation. Knowledge of such anatomical variations is of interest to the anatomist and clinician alike. Variations assume significance during surgical exploration of the axilla and can even fail nerve block of infraclavicular part of brachial plexus. Surgeons who perform procedures involving neoplasm or repairing trauma need to be aware of these variations.

Comparative Evaluation of Four Phenotypic Tests for Detection of Metallo-ß-Lactamase and Carbapenemase Production in Acinetobacter baumannii

Aparna Shivaprasad, Beena Antony, Poornima Shenoy

Introduction: Acinetobacter baumannii is an emerging multi-drug resistant opportunistic pathogen that causes a variety of nosocomial infections. In recent years, carbapenem resistance in A.baumannii has increased due to Ambler class B Metallo ß-lactamases or class D OXA Carbapenemases. Objective: The present study was undertaken to detect and compare the various phenotypic methods for MBL production in nosocomial A.baumannii isolates. Materials and Methods: One hundred sixty eight A.baumannii isolates were subjected to disc diffusion assay. Imipenem resistant isolates were subjected to 4 different phenotypic tests. MBL screening was done by Imipenem-EDTA double disc synergy test, Imipenem-EDTA combined disc test, Modified Hodge test and MBL E-test. Results: Out of 168 A.baumannii isolates, 85 (50.59%) were imipenem resistant. Among these 85 isolates, 57 (67.05%) were MBL positive by DDST, 69 (81.18%) by CDT, 85 (100%) by MHT and all these 85 isolates were confirmed to be MBL positive by MBL E-test method. Conclusion: Combined disc test, Modified Hodge test & E-test are equally effective to detect MBL production. However, considering the cost constraints of E-test, simple MHT and CDT can be used. They are easy, economical and can be incorporated into routine testing in laboratories to monitor the emergence of MBLs in MDR A.baumannii.

Efficacy of Postoperative Prophylactic Antibiotic Therapy in Third Molar Surgery

Rohit S, Praveen Reddy B

Introduction: Surgical extraction of mandibular third molar is the most frequently performed procedure in oral surgery. This procedure is associated with significant postoperative sequelae such as trismus, swelling, pain and infection. The need of antibiotic therapy during the removal of mandibular third molar has been a contentious issue. Method: This study investigated a regimen by using amoxycillin and metronidazole in one group and without using antibiotics in the other. Both the groups were assessed postoperatively on the 1st, 2nd, 5th, 7th and 10th days by the same observer for post operative mouth opening (interincisal distance), presence of a purulent discharge at the site of surgery, pain and swelling. Result: Overall, no statistically significant difference was seen between both the treatment groups when interincisal distance, pain, swelling and purulent discharge were considered. Conclusion: The results of this study failed to show any advantage which was associated with the routine postoperative use of antibiotics in asymptomatic third molar surgeries.

Comparative Study of Biofilm Formation in Pseudomonas aeruginosa Isolates from Patients of Lower Respiratory Tract Infection

Shivani Saxena, Gopa Banerjee, Rajiv Garg, Mastan Singh

Background: This study assessed biofilm formations of P.aeruginosa which was isolated from patients with Lower Respiratory Tract Infections (LRTIs). Objective: This study was conducted to compare different methods of biofilm formations seen in P. aeruginosa which was obtained from LRTI patients. Materials and Methods: In this cross-sectional study, we investigated a total of 80 P. aeruginosa isolates obtained from LRTI patients by different methods. Tube method (TM), tissue culture plate (TCP) method and modified tissue culture plate (MTCP) method. They were subjected to biofilm detection methods. Results: The MTCP method produced a higher accuracy ratio than TCP method. In terms of sensitivity and specificity, the MTCP method was considered to be superior to TM. We observed a higher antibiotic resistance in biofilm producing bacteria than in non-biofilm producers. Conclusion: In our study, MTCP was found to be more sensitive and specific method for biofilm detection than TCP and TM.

Effects of Occupational Tobacco Exposure on Foetal Growth, among Beedi Rollers in Coastal Karnataka

Chetan Mandelia, Sonu H Subba, Yamini

Introduction: Though there is ample evidence on adverse effects of tobacco exposure caused by smoking during pregnancy on foetal outcomes, there is lack of studies done on the effects of exposure caused by transdermal absorption, as is seen among beedi rolling women. Therefore, this study was planned, to assess the effect of maternal exposure to tobacco, in the form of beedi-rolling, on the birth weight and other neonatal anthropometric measurements. Materials and Methods: A cross sectional study with controls was conducted, with 102 beedi rollers forming the study group and an equal number of matched controls (control group) (total 204). Data was collected by using a pre-tested questionnaire and anthropometric examinations of the neonates were carried out within 48 hours of their births. Results: Mean birth weight of the newborns was 2.66 (SD=0.32) among those who were born to beedi rolling women and it was 2.63 (SD=0.38) kg among the control group. Crown heel length was 48.09 centimeters (SD=1.93) in the study group and it was 48.12 cm (SD=1.92) in the control group. Beedi rolling beyond the 7th month of gestation and for more than six hours per day was associated with a small but insignificant decline in birth weight and crown heel length. Conclusion: Beedi-rolling was found to be relatively safe during pregnancy but it could produce adverse effects if it was continued into the third trimester and for longer durations. This study can make the beedi rollers as well as their employers aware of harmful over-exposure to beedi rolling and help them in preventing it.

Comparison of In-vitro Activities of Linezolid and Vancomycin against Staphylococcus aureus Isolated from A Tertiary Care Hospital

Sachin Kishore, Deepika Verma, ME Siddique

Background:Methicillin resistant Staphylococcus aureus (MRSA) has emerged as one of the commonest cause of hospital acquired infections worldwide. Vancomycin is the antibiotic of choice for treatment of MRSA, but due to slow increase in vancomycin minimum inhibitory concentration (MIC) (vancomycin creep),Vancomycin has become a suboptimal therapeutic option in critically ill patients. Linezolid has emerged as an alternative drug in the treatment of such cases. Aim:To compare in vitro activities of linezolid and vancomycin against Staphylococcus aureus , in order to help in formulating a better treatment. Method:200 strains of Staphylococcus aureus were isolated from different clinical specimens between April 2010 to March 2011. Antibiotic sensitivity testing was performed by Kirby Bauer disc diffusion method and MICs of vancomycin and linezolid were determined for all 200 strains by agar dilution method by following CLSI guidelines. Results:Among 200 strains, MIC for linezolid was 4 µg/ml for 3 strains, MIC was 2 µg/ml for 71 strains, and MIC was 1 µg/ml for 126 strains, while for the same 200 strains of Staphylococcus aureus , MIC of vancomycin was 4 µg/ml for 8 strains, it was 2 µg/ ml for 103 strains and it was 1 µg/ml for 89 strains. Conclusion:Linezolid and vancomycin had similar in-vitro efficacies for Staphylococcus aureus in disc diffusion method, but the number of strains with higher ranges of MICs of vancomycin (1-4 µg/ml) were more as compared to those which had higher ranges of MICs for linezolid. So, we suggest that linezolid can be a good alternative for the treatment of multidrug resistant Staphylococcus aureus as compared to vancomycin.

NSAIDs and Bleeding in Periodontal Surgery

Aim: To evaluate and compare the clinical effects of ibuprofen and diclofenac sodium on bleeding during periodontal surgery. Materials and Methods: Thirteen medically healthy men and women of mean age 37.5±17.67 (mean age± standard deviation) were selected for the study. All the subjects were divided into three groups: control (C) and test groups (T1) and (T2). Each subject of T1 group and T2 group was given ibuprofen and diclofenac sodium respectively, prior to surgery. Bleeding times of patients were recorded prior to performance of periodontal flap surgical procedures. Results: It was found that there was increased bleeding time and increased peri-operative bleeding when ibuprofen and diclofenac sodium were taken prior to surgery and this was statistically significant. (2.5538 (T1), 1.8385 (T2) versus 1.2385 (C) minute, p= .001) (mean blood loss) and (62.0325 ± 9.0594 (T1), 51.082 ± 9.792 (T2) versus 37.4992 ± 5.99 (C) millilitre, p = .000). Conclusion: The findings of this study suggested that pre-operative administration of ibuprofen and diclofenac sodium could increase bleeding time and peri - operative blood loss.

Impact of an Educational Intervention on Increasing the Knowledge and Changing the Attitude and Beliefs towards Organ Donation among Medical Students

Umesh Yamanappa Ramadurg, Akash Gupta

Introduction: Organ transplantation saves thousands of lives worldwide. Organ transplantation is a boon to the medical profession, as it helps in saving the lives of many diseased people. Globally, the prevalence of knowledge on organ donation was found to range from 60% to 85%, on using different knowledge variables. Knowledge, attitude and actions are interrelated and previous studies have shown that culture and religion were important external influences which affected the decision making process. So, students require further information on the organ donation process and they need opportunities to examine their own beliefs and attitudes, which can be addressed through educational interventions. Objective: Purpose of the study was to investigate the knowledge, attitude and belief on/towards organ donation and the impact of an educational intervention on them. Methods: An educational interventional study with pre structured questions being administered to study subjects. Results: In the present study, a total of 70 students consented to participate and all the 70 attended the pre-test and post-test after the classroom teaching. Among the 70 participants, 35(50%) were males and 35(50%) were females. A majority of the subjects were Hindus 64(91.4%) and only 3(4.30%) were Muslims. Sixty seven (95.7%) of the students had heard of the term, ‘organ donation’. Most common reason given by the participants for organ donation was that it was done to save someone’s life [61 (87.11%)]. Among the 70 study subjects, only 19(27.10%) knew about the organs that could be donated, whose number increased to 56(80%) after providing the educational intervention. The difference which was observed in their knowledge before and after providing the educational intervention was found to be statistically significant (t= 39.315, p< 0.0000). The awareness of the legislation regarding organ donation was poor. Thiry one(444.3%) subjects were unaware about the existence of laws which were related to organ donation and its process. Conclusion: The study emphasizes the need of an intervention which incorporates the knowledge, motivational messages, facts and figures, to bring necessary changes in the perceptions and intentions of the students regarding organ donations.

HLA-DR/DQ Genotypes in Kurd Patients with Rheumatoid Arthritis: Relation to Disease Activity

Dhia J. Al-Timimi, Mohammad T. Rasool, Dhia M. Sulaiman

Background: Specific alleles present at the HLA-DR/DQ loci seem to be associated with disease activity of rheumatoid arthritis. Aim: In the present study, our aim was to investigate the distribution of HLA-DR/DQ alleles among Kurd patients with rheumatoid arthritis and to ascertain their relationship with disease activity. Materials and Methods: Sixty five patients with rheumatoid arthritis (RA) and 65 apparently healthy subjects participated in the study. Diagnosis and disease activity were confirmed. Blood analyses, including those of laboratory markers of disease activity, were done. The 28 joint disease activity score (DAS-28) was calculated. HLA-DR/DQ typing was performed by polymerase chain reaction (PCR).The association between HLA-DR/DQ genotypes and disease activity was determined. Results: The most frequent alleles which were identified in RA patients were HLA-DRBI*01(23.1%) and HLA-DQBI*6(34.6%), whereas in healthy subjects, they were HLA-DRBI*11(17.7%) and HLA-DQBI*03(35.4%). Patients with active disease had high frequencies of HLA-DQBI*6 (40.0%) as compared to those with moderate disease activity (16.7%); OR=3.33. Patients with severe RA had increased frequencies of HLA-DQBI*6 (56.3%) as compared to those with mild RA (10.0%); OR = 11.57. Patients with positive rheumatoid factor (RF) and positive Anti-citrullinated peptide antibody (Anti-CCP), also had high frequencies of HLA-DQBI*06 (38.4% and 39.4%) as compared to frequencies of 11.1% and 15.4% which were seen in patients with negative rheumatoid factor and negative anti-CCP (OR= 4.98 and3.10) respectively. Conclusion: HLA-DQBI*06 was found to be more common in Kurd patients and it was significantly associated with disease activity; this may indicate a high risk for developing a more progressive type of the disease.

Evaluation of Diuretic Activity of Alcoholic Extract of Roots of Cissampelos Pareira in Albino Rats

Background: In congestive heart failure, nephritis, toxemia of pregnancy, premenstrual tension and hypertension associated with oedema diuretic compounds are much helpful to relieve these conditions. Aims: To study the diuretic activity of alcoholic extract of roots of Cissampelos pareira by Lipschitz method in albino rats. Methods and Material: Five groups of Albino rats were used to evaluate the diuretic activity of alcoholic extract of roots of Cissampelos pareira by using metabolic cages. The group I serves as normal control received vehicle (2% CMC in normal saline), group II with Furosemide (10 mg/Kg, p.o), Groups III, IV and V with low (100 mg/kg), medium (200 mg/kg), and high (400 mg/kg) doses of alcoholic extract of roots of Cissampelos pareira respectively. Immediately after the alcoholic extract of roots of Cissampelos pareira treatment all the rats were hydrated with saline (15 ml/kg, p.o) and 2 animals placed in each metabolic cage, kept at 21°C±0.5°C. No food and water was made available to animals for 5 hour. The total volume of urine collected with each metabolic cage was measured at the end of 5 hour. Various parameters like total urine volume and concentration of different ions i.e.; Sodium, Potassium , Chloride in the urine were measured. Results: In this model when compared to control group the alcoholic extract of roots of Cissampelos pareira treated groups at different dose levels (100,200 and 400 mg/kg) have noted with significant increase in the urine volume and also significantly enhanced the excretion of Sodium, Potassium and Chloride ions in urine. Conclusion: Results showed that single dose administration of standard Furosemide and alcoholic extract of roots of Cissampelos pareira significantly (p<0.05*, p<0.01**, p<0.001***) increased the urine output along with an increase in elimination of Sodium, Potassium, and Chloride ions. Alcoholic extract of roots of Cissampelos pareira 400 mg/Kg produced a comparable diuretic activity with standard Furosemide.

Assessment of Obesity, Overweight and Its Association with the Fast Food Consumption in Medical Students

Introduction: Obesity is a condition in which excess body fat accumulates, which leads to various adverse effects on health, particularly cardiovascular diseases (CVDs), which reduce life expectancy and/or increase health problems. Fast food consumption is one of the factors which have been reported as a cause of obesity. Body mass index (BMI) is used to assess obesity and overweight, which can be calculated by using the formula, weight in kg, divided by square of height in metres. Aim: This study focused on the relationship of body mass index with fast food consumption, associated soft drink consumption and physical activity. Methods: Descriptive cross-sectional study was conducted in Department of Biochemistry, SBKS MI and RC, and Sumandeep Vidyapeeth. This study was approved by the ethical review board .One hundred and forty seven medical students from 1st year MBBS course were included in this study. Self-structured questionnaire was used, which contained several data like information on age, height, weight, education level. The formula used for calculating BMI was, weight in kg, divided by square of height in metres (Kg/m2). Results: In our study, out of 147 students, a total of 138 students (more than 90%) used to have fast food. Among these, a total of 47 students (34.05%) were pre-obese and obese. Out of 147 students, 87 students (59.18%) were in normal weight range, while 13 (8.84%) students were underweight. Statistical Analysis: Data was compiled in an Excel worksheet and it was analyzed for percentages and proportions. Chi-square and Pearson’s correlation test were also applied wherever they were applicable and Alpha error was set at a 5% level. Conclusion: In our study, a significant relationship was found between BMI and fast food consumption, less physical activity, and intake of soft drinks.

A Randomized, Double-blind, Placebo-Controlled Study of Efficacy of Oral Acyclovir in the Treatment of Pityriasis Rosea

Satyaki Ganguly

Background: Pityriasis rosea is an acute self-limiting skin disorder of unknown aetiology. Recently human herpes virus 6 and 7 has been hypothesized to be the cause of pityriasis rosea. Objective: To determine the efficacy of acyclovir, an anti-viral drug, in the treatment of pityriasis rosea. Materials and Methods: A randomized, double-blind, placebo-controlled study of efficacy of oral acyclovir in the treatment of pityriasis rosea was conducted on 73 patients. Thirty eight randomly selected patients were started on oral acyclovir. Thirty-five patients were prescribed placebo. The patients as well as the chief investigator were unaware of the therapeutic group to which patients belonged (acyclovir or placebo). Patients in both the groups were evaluated clinically after 7 and 14 days following the first visit and the data were analysed. Results: Follow up data of 60 patients was available and these were included in the statistical analysis. 53.33% and 86.66% of the patients belonging to the acyclovir group showed complete resolution on the 7th day and 14th day respectively following the first visit compared to 10% and 33.33% of patients from the placebo group. The findings were statistically significant. Conclusion: The study showed that high dose acyclovir is effective in the treatment of pityriasis rosea.

Reliability of Third Molar Development for Age Estimation by Radiographic Examination (Demirjian’s Method)

Sushil B Naik, Swapnil N Patil, Seema D Kamble, Tushar Mowade, Pavan Motghare

Introduction: Dental age estimation methods are of particular value because teeth are highly resistant to mechanical, chemical, or physical impacts and time. Teeth are the strongest parts in the human body and are therefore very resistant to external influences, such as extreme temperatures, explosions, and other extreme conditions, which make them available for extensive postmortem periods. Aim: To correlate chronological age with dental age using Demirijian’s method. Materials and Methods: The study was carried out on 100 digital orthopantamograms (OPG) of patients in the age group of 7 to 24 years. During the analysis, Magnify’ and Ruler’ tools were used. Mandibular right third molar was used for entire study. Data collected was analysed by using SPSS software. Results: Development of third molar in all stages was found slightly earlier in males than in females, when chronological age was compared with dental age using Demirjian method. 88% subject showed statistically significant linear correlation between chronological age and developmental age using Demirjian’s method. Conclusion: This is too general and well known as given by other studies as well. Please modify and present better. Demirijian’s method is a reliable guide for age estimation in age group of 7 to 24 years of age.

Alpha-1 Antitrypsin, a Diagnostic and Prognostic Marker of Vernal Keratoconjunctivitis

Introduction:A major chunk of ocular allergies in humans involve the conjunctiva, of which Vernal Keratoconjunctivitis (VKC) appears to be more common. VKC, a chronic allergic conjunctivitis, frequently affects young males and is characterized by intense inflammation of the limbal and/or tarsal conjunctiva. The etiology and immuno- pathogenesis of VKC still remain unclear. Alpha-1 antitrypsin (AAT), a member of serine proteinase inhibitor (SERPIN) superfamily, is an acute phase protein whose concentration in blood increases in response to inflammation. AAT deficiency is one of the many factors that may be involved in several abnormalities such as liver disease, emphysema, inflammatory joint diseases and inflammatory eye diseases. In the present study, the role played by this protein in VKC was analyzed in a selective case/control study to assess its diagnostic and prognostic value. Materials and Methods:The case control study included 50 patients of VKC reporting to Ophthalmology out patient department (OPD). Age and sex matched 40 healthy subjects served as control. Serum AAT level of both the cases and controls were evaluated and compared. Moreover the serum AAT levels of the patients at presentation were compared with their serum AAT level after three weeks post treatment. Result:Levels of AAT in the serum of VKC patients at presentation (2.80 ± 0.42 mg/ml) were significantly higher as compared to controls (2.31 ± 0.21 mg/ml) whereas no significant difference was observed between the serum level of post treatment VKC patients (2.48 ± 0.26 mg/ml) and controls. Conclusion:AAT is a potent acute phase protein whose concentration rises significantly in VKC, irrespective of the age and sex of the patient. Moreover, the serum level of AAT declined significantly post treatment; therefore it might be used as a prognostic marker.

Effect of Air Abrasion Preconditioning on Microleakage in Class V Restorations Under Cyclic Loading: An In-vitro Study

Background:Microleakage in class V Glass Ionomer Cement(GIC) or composite restorations at enamel or cementum margins has been cited as a reason for their failure. Air abrasion has been used to precondition tooth surface for increasing retention of such restorations. This study is done to evaluate the effect of preconditioning with air abrasion on microleakage in class V GIC and composite restorations. Materials and Methods:Class V cavities were prepared in 40 freshly extracted teeth. They were categorised into following four groups (n=10) depending on cavity preconditioning and restoration. Group I: 10% polyacrylic acid and GI (Ketac molar TM 3M ESPE); Group II: AA and GI; Group III: 35% Phosphoric acid and micro filled composite (MC) (Heliomolar, Ivoclar Vivadent); Group IV: AA and MC. Each group was further divided into subgroups A (no loading) & B (cyclic loading). Microleakage at occlusal and gingival margins was evaluated using methylene blue dye penetration method. Statistical analysis was done using Kruskal-wallis test and Mann-Whitney U test. Results:Microleakage at cementum margins was higher than at enamel margins in all the groups. Preconditioning with AA resulted in increased micro leakage. Conclusion:AA as a preconditioning agent was ineffective in producing superior tooth-restoration bonding.

"Evaluation of Friction in Orthodontics Using Various Brackets and Archwire Combinations-An in Vitro Study”

AIM: The aim of this study was to compare frictional resistance which was produced between conventional brackets (0.022 slot Otho-Organiser) and self ligating brackets (active Forestadent and passive Damon III) by using various arch wire combinations (0.016 Niti, 0.018 Niti, 0.017 x 0.025 SS and 0.019 x 0.025 SS). Materials and Methods: An experimental model which consisted of 5 aligned stainless steel 0.022-in brackets was used to assess frictional forces which were produced by SLBs (self ligating brackets) and CELs (conventional elastomeric ligatures) with use of 0.016 nickel titanium, 0.018 nickel titanium, 0.017 X 0.025”stainless steel and 0.019 X 0.025”stainless steel wires. Statistical Analysis: One way ANOVA test was used to study the effect of the bracket type, wire alloy and section on frictional resistance test . Results: Conventional brackets produced highest levels of friction for all bracket/archwire combinations. Both Damon III and Forestadent brackets were found to produce significantly lower levels of friction when they were compared with elastomerically tied conventional brackets. Conclusion: SLBs are valid alternatives for low friction during sliding mechanics.

Evaluation of Clinical Outcomes after Abdominal Rectopexy and Delorme’s Procedure for Rectal Prolapse: A Prospective Study

Hemanth Makineni, Poornachandra Thejeswi, B.K. Shivprasad Rai

Background:Complete rectal prolapse is characterized by protrusion of full thickness rectal wall through the anal orifice. Despite its rarity more than 100 surgical procedures have been described and there are no good evidence based recommendations for selection of a surgical procedure. This study was conducted to evaluate the clinical outcomes of commonly used procedures for rectal prolapse at our hospital. Materials and Methods: Twenty seven patients presenting with complete rectal prolapse between May 2011 to May 2013 were included in this prospective study. Patients underwent either Abdominal rectopexy or Delorme’s procedure after evaluation, based on clinical judgment of experienced surgeons. Patient charac teristics, complications, post-operative length of hospitalization and clinical outcomes were assessed. Patients were followed up for a mean duration of 14 months. Results: Seventeen patients underwent Abdominal rectopexy (Posterior mesh rectopexy), ten patients underwent Delorme’s procedure. No postoperative mortalities or major complications were noted. Post operative morbidity (minor) was 17% in Abdominal rectopexy group and 10% in Delormes group 0%. Incontinence improved in all six patients (100%) in rectopexy group, four patients (80%) in Delorme’s procedure group. Two patients (11%) in rectopexy group reported increase in constipation post operatively. There was one recurrence in Delorme’s procedure group with no recurrences in Abdominal rectopexy group. Conclusion: The treatment of rectal prolapse should be individu - alized to achieve best results. Abdominal rectopexy can be safely applied in most of patients with minimal post operative increase in constipation and recurrence by using posterior mesh rectopexy technique. Delorme’s procedure can be performed with minimal morbidity and shorter hospital stay and good functional results with acceptable recurrence rate. Delorme’s can be considered as an alternative to rectopexy not only in patients unfit for laparotomy but also in individuals with a short prolpase, avoiding a laparotomy.

A Drug Utilization Study of Cognition Enhancers in Dementia in a Tertiary Care Hospital in Mumbai

Karan Thakkar, Shaurya Suman, Gauri Billa

Background: Cognitive decline is one of the important factors undermining the quality of life in geriatric patients. Although the WHO has declared ‘Dementia’ as a priority health condition. Cognitive neuropharmacology is still in its infancy and there is no general consensus on the use of cognition enhancing (CE) drugs in humans. Since drug utilization data of CEs in dementia are scarce, we conducted a study to describe the observed patterns of CE drug use, compare it to the current recommendations and conduct a preliminary cost analysis. Methods: A prospective cross sectional drug utilization study of 100 prescriptions of patients of both sexes and all ages suffering from dementia attending the Neurology and Psychiatry clinics was undertaken as per the WHO – DUS and the STROBE guidelines. Results: In all, the 100 prescriptions contained 322 drugs, out of which, 168 were CE drugs. 38.2% of the drugs were prescribed by generic names. Donepezil, Memantine, Piracetam, Rivastigmine and Gallantamine were prescribed to 76%, 34%, 8%, 6% and 0%, respectively. The PDD/DDD ratio of Donepezil and Memantine were 1.36 and 0.94, respectively. The average cost per prescription was INR 626.29 or USD 9.5. Conclusion: Principles of rational prescribing were followed. Donepezil and Memantine were the most commonly prescribed drugs and hence should be included in the hospital drug schedule. Piracetam should not be prescribed because of doubtful benefits and high cost. Antipsychotics should be used in geriatric dementia patients very judiciously. A major part of the total cost per prescription was borne by the patient.

Orthodontic Treatment: Need and Demand in North Karnataka School Children

Chaitra K, Naveen Reddy, Suga Reddy, Vanishree

Objectives: To assess the normative need, demand and knowledge of/for/on orthodontic treatment in Karnataka school children who were aged 12-16 years. Method: A simple random selection of a sample of 1000 students who were aged 12-16 years was made. Informed consents were obtained from each subject. The dental health component (DHC) and aesthetic component (AC) of the index of orthodontic treatment need (IOTN) and the index of complexity, outcome and need (ICON) were assessed by using the index. The knowledge and demand on/for orthodontic treatment were assessed by using a questionnaire. Results: The survey population showed 49.3%, 44.4%, and 7.1% of samples needed definite orthodontic treatment need on basis of DHC, ICON, AC respectively. In terms of treatment need, boys were more likely to seek orthodontic treatment need than girls. There was fair agreement between operator and students. A high percentage of students clearly expressed a ‘definite need’ of orthodontic treatment. Only 40% of children had some knowledge on orthodontic treatment. Conclusion: The present study showed that the awareness, need and demand for orthodontic treatment were less among school children. So, we need to enlighten the students regarding aesthetics among children.

Faecolith Examination for Spectrum of Parasitic Association in Appendicitis

Sunil Kumar Jada, Karthika Jayakumar, Priyadarshi Soumyaranjan Sahu, Vinoth R

Background: The appendix is a vestigial organ which is infiltrated by faecal material, microbes and parasites. The most important aetio-pathology of appendicitis is obstruction of its lumen, by a faecolith. This results from accumulation and inspissation of faecal matter around vegetable fibres. The cause for appendicitis is numerous and one among them is parasitic infestation. Aims: To analyze the faecolith present in the appendectomy specimen for parasites and to compare the results in fresh and preserved specimens. Materials and Methods: Patients with acute/chronic appendicitis were subjected for surgery and the appendectomy specimens were collected in saline and formalin suspensions, for preservation purposes. The lumen was washed with normal saline and contents were collected and wet mount preparations were examined under low and high power microscopy. Results: Among 100 specimens 48 faecolith analyses proved to be positive for parasitic association, giving 48% positivity, which is quite high. The commonest isolate was Ascaris lumbricoides followed by mixed infection. In our study we observed that saline preparations were easy for handling and we were also able to demonstrate the undistorted morphology of parasite better than formalin preserved specimens. Conclusion: This study reveals the importance of analyzing the appendectomy specimen for understanding the etiopathogenisis of appendicitis in spite of having a negative stool microscopy. A post surgical analysis of appendectomy specimen may surprise you with different etiological agents as confirmed by our study.

Evaluation of Direct Tube Coagulase Test in Diagnosing Staphylococcal Bacteremia

Sandeep Thirunavukkarasu, Rathish K.C.

Background: Blood Stream Infections (BSIs) are one of the most common nosocomial infections encountered in a hospital. It occurs 2 to 7 times more often in ICU patients than in ward patients and is associated with high rates of mortality and morbidity. Staphylococci is the most commonly encountered blood culture isolates for which, rapid and reliable methods for detection are warranted. Aim: To study the efficiency of direct tube coagulase test (DTC) in comparison with slide/tube coagulase test for early detection of Staphylococcal bacteraemia. Materials and Methods: This was a prospective study conducted in a tertiary care hospital, between January 2009 to December 2009. Two sets of blood cultures were obtained from each patient with a suspicion of Staphylococcal bacteremia. Both, direct tube coagulase test and conventional biochemical tests were done on the samples, to identify the species. Statistical Analysis Used: Cohen’s kappa coefficient of agreement was used to detect the differences between the two modes of detection. Results: Ninety four samples (out of 460) yielded the growth of Gram positive cocci in clusters. The commonest isolates were Staphylococcus aureus (42.5%), Staphylococcus epidermidis (36.2%), Staphylococcus haemolyticus (8.6%), Staphylococcus cohnii (4.3%). Cohen’s kappa coefficient which implies the extent of agreement of the results between the Direct Tube Coagulase test and conventional methods, was 95.6% along with sensitivity of 95.5% and specificity of 100%. Conclusion: Direct Tube Coagulase test (DTC) can be used for early detection of Staphylococcal bacteremia. It shows an almost perfect agreement with conventional coagulase test.

Comparative Study of Genotoxicity in Different Tobacco Related Habits using Micronucleus Assay in Exfoliated Buccal Epithelial Cells

Background: Oral cancer is one of the most debilitating diseases afflicting mankind. Consumption of tobacco in various forms constitutes one of the most important etiological factors in initiation of oral cancer. When the focus of today’s research is to determine early genotoxic changes in human cells, micronucleus (MN) assay provides a simple, yet reliable indicator of genotoxic damage. Aims and Objectives: To identify and quantify micronuclei in the exfoliated cells of oral mucosa in individuals with different tobacco related habits and control group, to compare the genotoxicity of different tobacco related habits between each group and also with that of control group. Patients and Methods: In the present study buccal smears of 135 individuals with different tobacco related habits & buccal smears of 45 age and sex matched controls were obtained, stained using Giemsa stain and then observed under 100X magnification in order to identify and quantify micronuclei in the exfoliated cells of oral mucosa. Results: The mean Micronucleus (MN) count in individuals having smoking habit were 3.11 while the count was 0.50, 2.13, and 1.67 in normal control, smoking with beetle quid and smokeless tobacco habit respectively. MN count in smokers group was 2.6 times more compared to normal controls. MN count was more even in other groups when compared to normal control but to a lesser extent. Conclusion: From our study we concluded that tobacco in any form is genotoxic especially smokers are of higher risk and micronucleus assay can be used as a simple yet reliable marker for genotoxic evaluation.

Retrospective Audit of the Widal Test for Diagnosis of Typhoid Fever in Pediatric Patients in an Endemic Region

Ralte Lalremruata, Sanjim Chadha, Preena Bhalla

Introduction:Although typhoid fever is confirmed by culture of Salmonella Typhi , Widal test is widely used in India but little information exists about its reliability. Materials and Methods:We examined the performance of Widal test in our hospital for diagnosis of typhoid fever in children. Hundred consecutive pediatric in-patients for whom, the Widal test was requested were grouped into four categories: widal positive and clinically consistent with typhoid fever (Group 1; n=42), widal negative but clinically consistent (Group 2, n=12), widal positive but not clinically consistent (Group 3, n=12) and widal negative and also not clinically consistent (Group 4, n=34). The results were analyzed by the test performance criteria, namely, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using culture-confirmed typhoid fever cases as the “true positives”. Results:We found that 7/100 patients had culture-proven typhoid fever. Using a cut off = 50 for O agglutinins or = 100 for H agglutinins, the Widal test gave a sensitivity of 71.43%, specificity of 47.31%, and a positive predictive value of 09.25% and a negative predictive value of 95.65%. Conclusion:The Widal test is an easy, inexpensive and relatively non-invasive but is not reliable in our set up because of a low PPV. There is a need for a more efficient rapid diagnostic test for typhoid fever.

Sialochemical Analysis: A Portal for the Oral Diagnostician

Annette Milton B., Ajay Bhambal

Background:Depressive disorders, worldwide, may rank second by the year 2020. In India; about 10 million people suffer from depressive disorders, the prevalence rate being recorded as 31.2 for every 1000 individuals. A significant impairment of all personal hygiene may occur due to a depressive episode which in turn may result in altered biochemical composition of some important salivary parameters. The present study was done to assess the relationship and bring about a comparison of certain selective sialochemical alterations between normal and subjects with depressive disorders. Settings and Design: The present study was a hospital- based clinical cross-sectional study which was conducted in Bhopal, the heart of Madhya Pradesh, India. The survey period extended over a period of one year and two months, from May 2009 to July 2010. Material and Methods: Unstimulated whole saliva was analysed biochemically for a - amylase, calcium, sodium, potassium, total proteins and urea. The data obtained in this study were statistically analyzed by using Unpaired Student’s t–test. Results: Salivary calcium and total protein levels were found to be statistically significant among all three groups (p< 0.0001). Salivary amylase levels between Groups II and III and between Groups I and III (p< 0.0001) was statistically significant while the salivary urea levels between Groups I and Group II and between Groups I and III were found to be statistically significant (p< 0.0001). However, there was no statistical difference in their sodium and potassium levels. Conclusions: It was observed that drugs do affect the salivary composition. It was observed that cyclic antidepressants pro - duced significant alteration in the sialochemical constituents of saliva as compared to TCAs and TeCAs.

Technetium-99m Bone Scan and Panoramic Radiography in Detection of Bone Invasion by Oral Carcinoma

Anshuman Suresh Jamdade, Ani John

Objective: The correct extension of cancer in the bone is usually remains undetected on static imaging which may lead to inadequate or over excision. The conventional radiography as well as other anatomical imaging modalities like computed tomography, magnetic resonance imaging often fails to detect functional changes in the bone. However, bone scinitigraphy is highly sensitive in detecting earlier changes in the bone but lack anatomical definition. The purpose of the study was to evaluate the accuracy of combining technetium-99m bone scan and panoramic radiography (Tc scan/PR) over using single diagnostic modality in detection of jaw bone invasion by oral carcinomas. The accuracy of these imaging modalities either alone or in combination were determined by comparing with the histopathological findings. Materials and Methods: Twenty patients with biopsy-proven oral malignant tumors were randomly selected from Oral Medicine and Radiology department over a period of two years. All patients were investigated preoperatively by Tc scan and PR. Lewis – Jones’s designed diagnostic criterion was applied on Tc scan/PR to evaluate bone involvement by cancer. To test the accuracy of Tc scan, PR and Tc scan/PR, their results were compared with the histopathological findings of resected specimen. Result: Hybrid Tc scan/PR had higher specificity, accuracy and positive predictive value (83.3%, 94.7%, 92.8%) than Tc scan alone (50%, 84.2%, 81.2%) and higher sensitivity and negative predictive value (100%, 100%) than PR (69.2%, 55.5%). Conclusion: Combination of Tc scan and PR was more accurate in detecting jaw bone invasion by oral squamous cell carcinoma than Tc scan and PR alone.

Intravenous Iron Sucrose and Oral Iron for the Treatment of Iron Deficiency Anaemia in Pregnancy

G.D. Abhilashini, Haritha Sagili, Reddi Rani

Purpose:The aim of this study was to compare the efficacy and safety of intravenous iron sucrose and oral iron administration for the treatment of iron deficiency anaemia in pregnancy. Materials and Methods: Hundred women with gestational age between 30 and 34 weeks with established iron deficiency anaemia with Haemoglobin-6-8g/dL were randomised to receive either oral ferrous sulphate 200 mg thrice daily or required dose of intravenous iron sucrose 200 mg in 200 ml NS on alternate days. Haemoglobin, haematocrit, mean corpuscular volume, reticulocyte count were measured at recruitment and on 2nd week, 4 th week and at 37 weeks. Adverse drug reactions were also noted in both the groups. Results were analyzed by student’s t-test and chi-square test. Results:Haemoglobin values varied significantly with time between the two groups at second week, 4 th week and at term (p<0.005). The mean difference in mean corpuscular volume from the recruitment value was not significant at 2 nd week. When compared to iron sucrose group, oral iron group had significant gastro-intestinal adverse effects. Conclusion: Intravenous iron sucrose treated iron deficiency anaemia of pregnancy faster, and more effectively than oral iron therapy, with no serious adverse drug reactions.

Incidence of Multidrug Resistant Pseudomonas Aeruginosa Isolated from Burn Patients and Environment of Teaching Institution

Indu Biswal, Balvinder Singh Arora, Dimple Kasana, Neetushree

Context: Pseudomonas aeruginosa is an important pathogen which causes nosocomial infections in immunocompromised patients, especially in hospitalized burn patients. In recent times, it has emerged as a widespread Multi Drug Resistant (MDR) pathogen which requires antibiotic susceptibility testing on a regular as well as a periodic basis. Aim of the study: The present study was undertaken to determine the antibiogram of P. aeruginosa which was isolated from inpatients and environmental sources, and to type the strains, based on their antibiogram patterns. Settings and Design: A prospective study was undertaken with 525 samples (blood and wound swabs) which were taken from 60 patients who were admitted to Vardhman Mahavir Medical College and Safdarjang hospital with burn injuries and with 101 samples which were obtained from environmental sources viz. surgical instruments, dressings, suction devices, sinks, antiseptic solutions, etc. Materials and Methods: The strains were cultured and identified by standard microbiological techniques and Kirby- Bauer disc diffusion antibiotic susceptibility testing was done for each. Statistical analysis: Chi -squire tests were done and p- values of less than 0.05 were considered to be significant. Results: Fifty six strains and two strains, respectively, of P. aeruginosa were isolated from inpatients and environmental samples (one strain from sink and one strain from door wall, among the two) respectively. In total, 58 (81%) P. aeruginosa strains were found to be resistant to aminoglycosides, 41-70% were resistant to beta-lactams - piperacillin, ceftazidime, and aztreonam, 34.5% were resistant to piperacillin-tazobactam, 12.06% were resistant to ciprofloxacin and 13-19% were resistant to carbapenems. All strains were sensitive to colistin. P. aeruginosa was resistant to three of the four ‘in-use’ drugs i.e. piperacillin+tazobactam, imipenem, ceftazidime, and gentamicin, which was taken as MDR, which depicted MDR percentage as 36.2 (21/58). Conclusion: Strategies of optimal prescribing, including control of antibiotic usage, coupled with periodic studies on MDR P. aeruginosa infections in burn patients, appear to be leading priorities which help in improving therapeutic gains in such patients.

Antibiotic Prescribing in Various Clinical Departments in a Tertiary Care Teaching Hospital in Northern India

Kumar Abhijit, Pushpawati Jain, Prerna Upadhyaya, Shipra Jain

Background:Antibiotic resistance is not only a problem for the individual patient; it also reduces the effectiveness of established treatment and has become a major threat to public health by increasing the complexity and cost of treatment and reducing the probability of a successful outcome. Aim:A Prospective cross sectional study was carried out with the aim of identifying prescription pattern of antibiotics in a tertiary care teaching hospital in Northern India. Materials and Methods:A total of 300 prescriptions were collected, collated and analysed from the indoor patients of MG hospital, Jaipur from the department of Medicine, Surgery and Orthopaedics. The prescribing and dispensing details of antibiotics from each prescription were recorded in the tabular form as mentioned in Data Acquisition form. Comparison of antibiotic prescribing practices among all the three departments was made by using Percentage method. Results:Majority of prescriptions (51%) with single drug was prescribed in Medicine department, followed by 16% in surgery and only 2% in Orthopaedics. Prescriptions with 3 drugs were prescribed mostly in Orthopaedics (66%) followed by 46% in Surgery and 10% in Medicine. 51% prescriptions in Orthopaedics department were of Ceftriaxone+ Sulbactam+ Amikacin. Thirty four percent prescriptions in Medicine department were of Ceftriaxone. 18% prescriptions in Surgery department were of Ceftriaxone+ Sulbactam+ Tobramycin. Conclusion: This study clearly highlights the practice of Poly- Pharmacy and injudicious usage of antibiotics in hospital settings. The Government of India is planning to revise the antibiotic policy issued in 2011 and put a ban on over the counter availability of third generation antibiotics. General public awareness and sensitization of doctors and revision of clinical drug policy is the need of the hour to bring the changes at all possible level for the longterm and better clinical outcome in medical practice.

Evaluation of Plasma Fibrinogen Degradation Products and Total Serum Protein Concentration in Oral Submucous Fibrosis

Background: Oral submucous fibrosis (OSMF) is a potentially malignant disorder with a multifactorial etiology. Malnutrition is a major problem for the inhabitants of most countries where OSMF is prevalent. Recently, a new direction in the etiopathogenesis was provided by the identification of fibrinogen degradation products (FDP) in the plasma of OSMF patients. Aims and Objectives: To assess the role of FDP in the etiology of OSMF and to correlate with the nutritional status by evaluating the total serum protein level. The study also determines to evaluate the correlation between the levels of plasma FDP with respect to the staging and grading of OSMF. Correlation between the levels of Total Serum Protein (TSP) with respect to the staging and grading of OSMF was also evaluated. Materials and Methods: The study included 30 cases clinically and histopathologically diagnosed as oral submucous fibrosis. The FDP levels were assessed using both qualitative and semi quantitative method as supplied by ‘Tulip Diagnostics (P) Ltd. Total Serum Protein (TSP) estimation was done by Biuret method using Liquixx Protein kit by Erba, Manheim. Results: The study indicates that in qualitative assessment of FDP only 14 subjects showed the presence of FDP levels>200ng/ml. In semiquantitative assessment there is no significant association between varying clinical stages and histopathological grades and FDP levels. Total serum Protein level showed a marginal increase in all subjects. The study revealed a positive correlation between FDP and TSP in all OSMF subjects. Conclusion: A larger sample size which would be a better representation of the population and the use of different methods which have higher sensitivities and specificities to evaluate FDP level and detailed fractional analysis of protein along with immunoglobulin profiling would facilitate in attaining more conclusive results.

Resistance Pattern of Pseudomonas aeruginosa in a Tertiary Care Hospital of Kanchipuram, Tamilnadu, India

Background: Pterygospinous and pterygoalar ligaments present at the cranial base may sometimes get ossified leading to the formation of complete or incomplete bony bars in relation to foramen ovale. These are of clinical importance because these may obliterate the foramen ovale causing mandibular neuralgia. They may cause trouble in performing thermocoagulation and anaesthesia for trigeminal neuralgia. They may pose surgical difficulty in approaching the retro and parapharyngeal spaces and hence the anatomy of these bony bars is very important. Materials and Methods: The present study was conducted in 100 dry human skulls of unknown sex to know the incidence, side, degree of ossification (complete/ incomplete) and relation of the pterygospinous and pterygoalar bars to the foramen ovale. Results: Pterygospinous and pterygoalar bars were seen in 41 skulls which were classified into Type I (26.83%), Type II (58.54%) and Type III (14.63%) based on the presence of pterygospinous bar, pterygoalar bar or both together. Pterygospinous bars were seen in 17 skulls of which, one skull (5.88%) had complete and 16 skulls (94.12%) showed incomplete bars. Out of the 30 skulls with pterygoalar bars, complete bar was seen in one (3.33%) and incomplete in 29 skulls (96.67%). These bars were seen more on the left side of the skull than on the right. They were in close relation to the foramen ovale; the pterygospinous bar was inferior or medial to foramen ovale and pterygoalar bar was lateral, inferior or medial to the foramen ovale. Conclusion: The presence of the pterygospinous and pterygoalar bars cause variety of symptoms due to neurovascular entrapment and also obstruct surgical approaches to the base of skull. Hence the anatomical knowledge of these osseous bars is essential for anaesthetists, radiologists, dentists and neurosurgeons to increase the success of diagnostic evaluation and surgical approaches to the cranial base.

Public Report on Health: Development of a Nutritive Value Calculator for Indian Foods and Analysis of Food Logs and Nutrient Intake in six States

The Public Report on Health (PRoH) was initiated in 2005 to understand public health issues for people from diverse backgrounds living in different region specific contexts. States were selected purposively to capture a diversity of situations from better-performing states and not-so-well performing states. Based on these considerations, six states – the better-performing states of Tamil Nadu (TN), Maharashtra (MH) and Himachal Pradesh (HP) and the not-so-well performing states of Madhya Pradesh (MP), Uttar Pradesh (UP) and Orissa (OR) – were selected. This is a report of a study using food diaries to assess food intakes in sample households from six states of India. Method: Food diaries were maintained and all the raw food items that went into making the food in the household was measured using a measuring cup that converted volumes into dry weights for each item. The proportion consumed by individual adults was recorded. A nutrient calculator that computed the total nutrient in the food items consumed, using the ‘Nutritive Value of Indian Foods by Gopalan et al., was developed to analyze the data and this is now been made available as freeware (http://bit.ly/ncalculator). The total nutrients consumed by the adults, men and women was calculated. Results: Identifying details having been removed, the raw data is available, open access on the internet http://bit.ly/foodlogxls.The energy consumption in our study was 2379 kcal per capita per day. According to the Summary Report World Agriculture the per capita food consumption in 1997-99 was 2803 which is higher than that in the best state in India. The consumption for developing countries a decade ago was 2681 and in Sub-Saharan Africa it was 2195. Our data is compatible in 2005 with the South Asia consumption of 2403 Kcal per capita per day in 1997-99. For comparison, in industrialized countries it was 3380. In Tamil Nadu it was a mere 1817 kcal. Discussion: The nutrient consumption in this study suggests that food security in the villages studied is far from achieved. It is hoped that the new Food Security Ordinance will make a dent in the situation. The calculator for computing nutrients of foods consumed which we developed based on the ICMR defined nutrient values for Indian foods has been made available as freeware on the internet. This is with the hope that more such studies can be carried out at the household level.

Effect of Slow and Fast Pranayama Training on Handgrip Strength and Endurance in Healthy Volunteers

Background: Pranayama has been assigned very important role in yogic system of exercises and is said to be much more important than yogasanas for keeping sound health. Also different pranayamas produce divergent physiological effects. Aim: To study the effect of 12 weeks training of slow and fast pranayama on handgrip strength and endurance in young, healthy volunteers of JIPMER population. Settings and Design: Present study was conducted in the Department of Physiology, JIPMER in 2011-12 (1.06.11 to 1.04.12). Materials and Methods: Total of 91 volunteer subjects were randomised into slow pranayama (SPG) (n=29), fast pranayama (FPG) (n=32) and control groups (CG) (n=30). Supervised pranayama training (SPG - Nadisodhana, Pranav pranayama and Savitri pranayama; FPG - Kapalabhati, Bhastrika and Kukkuriya pranayama) was given for 30 minutes thrice a week for 12 weeks to both slow and fast pranayama groups by certified yoga trainer. Hand grip strength (HGS) and endurance (HGE) parameters were recorded using handgrip dynamometer (Rolex, India) at baseline and after 12 weeks of pranayama training. Statistical Analysis Used: Longitudinal changes in each group were compared by using Student’s paired t-test. Delta changes in each group were analysed by ANOVA with Tukey post-hoc analysis. Results: In SPG significant improvement occurred only in HGE parameter from 83.95±45.06 to 101.62±53.87 (seconds) (p<0.001) whereas in FPG, significant improvement was observed in HGS from 33.31±9.83 to 37.9±9.41 (Kilograms) (p=0.01) as well as in HGE from 92.78±41.37 to 116.56±58.54 (seconds) (p=0.004). Using Students unpaired t-test difference between the groups in HGS is found to be 1.17±5.485 in SPG and in FPG is 4.59±7.26 (p=0.39); HGE difference in SPG is 1.77±21.17 and in FPG is 2.38±43.27 (p>0.05). Conclusion: Pranayama training decreases sympathetic activity, resulting in mental relaxation and decreased autonomic arousal thereby, decreasing force fluctuations during isometric contraction. This is reflected as improvement in HGS and HGE.

Attitude of Dental Practitioners Towards their Colleagues: A Justifiable Criticism

Ravishankar T.L., Tasneem S. Ain, Vaibhav Tandon, Owais Gowhar

Aim: A cross-sectional, questionnaire based study was conducted in Moradabad, U.P., India, to assess the attitude of dental practitioners towards their colleagues. Materials and Methods: Eleven-item, close-ended, validated questionnaire was formulated. The responses of 60 registered dental practitioners were recorded. Results: Majority of the respondents were well versed with ethical obligations towards their colleagues but only few of them were aware of all the principles mentioned in Codes of dental ethics, DCI, India. Conclusion: Dentists face ethical problems/dilemmas while dealing with their duties towards colleagues and their patients. Adopting of ethical ways in practice was independent of gender, qualification and experience of practice. It is recommended that dental ethics should be emphasized upon during the formative years of dental education.

Comparison of Propofol and Ketamine versus Propofol and Fentanyl for Puerperal Sterilization, A Randomized Clinical Trial

Nalini KB, Anusha Cherian, Hemavathi Balachander, Yashavantha Kumar C

Background: Puerperal sterilization requires a rapid recovery of the mother so that she can take care of her child. Propofol with fentanyl (PF) is an option, but is associated with intraoperative hypotension, respiratory depression and an unsatisfactory postoperative recovery profile. Propofol with ketamine (PK) appears to be an alternative in terms of haemodynamic stability and analgesia. Materials and Methods: This randomized clinical trial involved 60 patients who were scheduled to undergo puerperal sterilization, who belonged to American society of anaesthesiologists (ASA) physical status 1. Patients were randomly allocated to receive either ketamine – propofol infusion in a concentration of 8mg/ml each (group PK) or fentanyl 2µg/kg intravenously, followed by an infusion of propofol in a concentration of 8mg/ml (group PF). In both the groups, the infusion was started at 300ml/hr till patient lost consciousness. Subsequently, the rate was set at 1.5ml/ kg/hr for group PF and at 0.75ml/kg/hr for group PK. After the initial 10 minutes, the infusion rate was reduced to 1ml/kg/hr for group PF and to 0.5ml/kg/hr for group PK. Blood pressure and saturation were the primary outcomes which were measured. Results: Patients from group PF recorded a significant drop in the systolic blood pressure from the 5th minute, in diastolic pressure from the 10th minute and transient oxygen desaturation, as compared to group PK. Patients in group PK had adequate surgical conditions and better recovery profiles in terms of pain and sedation. Conclusion: The combination of ketamine and propofol is a safe and possibly superior alternative to propofol – fentanyl combination in patients who undergo puerperal sterilization, in terms of haemodynamic stability and respiratory depression.

Prevalence of Malocclusion and Need for Early Orthodontic Treatment in Children

Background: With the advent of functional appliances and orthopedic appliances the elimination and correction of skeletal and dental discrepancies has been much reduced. Most orthodontists agree that elimination of oral habits and orthopaedic treatment of class 3 malocclusion and posterior cross bites deserve treatment at an early age. Early treatment was proposed along the lines of “catch them in the young”, and “you see it, you treat it” is the main ideology of early orthodonticc treatment (EOT). Furthermore, the majority of children have habits driving the malocclusion. Mouth breathing, tongue thrusting and incorrect swallowing patterns are all known causes of malocclusion and poor facial growth. Aims: To evaluate the prevalence of dental feature that might result in malocclusion and need for early orthodontic treatment. Settings and Design: Groups of 532 school going children were selected and complete case history was taken and were categorized based on the type of malocclusions, dental features that can predetermine need for early orthodontic treatment. Statistical analysis used. Results: The results shows the increase in prevalence of malocclusion and the dental features that gives clues for an orthodontist to frame up his treatment modalities not just for corrective orthodontics but for also preventive and interceptive orthodontics. Conclusion: Angle’s Class I malocclusion is most commonly seen malocclusion followed by class II division 1 malocclusion followed by Angles class II division 2 malocclusion. In angle’s class I malocclusion, incidence of crowding is more followed by proclination of anterior teeth. There is no significant difference between incidence of malocclusion in males and females. The children who needed immediate orthodontic care were more than the children who doesn’t need an orthodontic treatment. Need for increase of awareness programs is required in order to educate the people about the early orthodontic treatment.

Virulence, Speciation and Antibiotic Susceptibility of Ocular Coagualase Negative Staphylococci (CoNS)

Background: Coagulase negative Staphylococci (CoNS) are common inhabitants of human skin and mucous membranes. With the emergence of these organisms as prominent pathogens in patients with ocular infections, investigation has intensified in an effort to identify important virulence factors and to inform new approaches to treatment and prevention. Aim: To isolate CoNS from ocular specimens; to study the possible virulence factors; speciation of coagulase negative staphylococci (CoNS) which were isolated from ocular complications; antibiotic susceptibility testing of ocular CoNS. Materials and Methods: The specimens were collected from the target patients who attended the Microbiology Laboratory of a tertiary care eye hospital in Coimbatore, Tamilnadu state, India. The isolates were subjected to tube and slide coagulase tests for the identification of CoNS. All the isolates were subjected to screening for lipase and protease activities. Screening for other virulence factors viz., slime production on Congo red agar medium and haemagglutination assay with use of 96-well microtitre plates. These isolates were identified upto species level by performing biochemical tests such as phosphatase test, arginine test, maltose and trehalose fermentation tests and novobiocin sensitivity test. The isolates were subjected to antibiotic susceptibility studies, based on the revised standards of Clinical and Laboratory Standards Institutes (CLSI). Results: During the one year of study, among the total 260 individuals who were screened, 100 isolates of CoNS were obtained. Lipolytic activity was seen in all the isolates, whereas 38 isolates showed a positive result for protease. A total of 63 isolates showed slime production. Of 100 isolates, 30 isolates were analyzed for haemagglutination, where 4 isolates showed the capacity to agglutinate the erythrocytes. The results of the biochemical analysis revealed that of the 100 isolates of CoNS, 43% were Staphylococcus epidermidis. The other isolates were identified as S. xylosus (n=8), S. captis (n=16), S. haemolyticus (n=10), S. saccharolyticus (n=2), S. hominis (n=5), S. saprophyticus (n=6) and S. intermedius (n=1). On the other hand, 9 isolates were not identified. In the antibiotic susceptibility analysis, it was found that most of the isolates were sensitive to vancomycin, amikacin and linczolid and resistant to cefatoxime, oxacillin, bacitracin and nalidixic acid. Conclusion: S. epidermidis was found to be predominant in causing the ocular complications. Slime production, heamagglutination, protease and lipase activities could be the putative virulence factors of CoNS. Antibiotic susceptibility patterns of CoNS against antibacterial agents revealed maximum resistance to beta lactam groups, and the resistance was found to be higher to oxacillin, and lowest to vancomycin.

Prevalence and Recognition of Alcoholism in Emergency Department Patients

Murali Krishna, Dharma Rao Vanamali

Introduction: Alcohol addiction is very common in India, and is a major risk factor and etiology of many acute medical and surgical emergencies. Alcohol addiction history is frequently missed by medical team in emergency department. The present study is to investigate the prevalence of alcoholism among emergency department patients and to determine its rate of recognition by the medical team. Materials and Methods: It is double blind cross-sectional study done in a 750 bedded tertiary care hospital (Mamata general hospital, Khammam). The study population consisted of all patients admitted in the emergency room and who stayed in the hospital for a minimum period of 24 hours between 1st March 2013 and 30th April 2013. Results: Total of 144 patients were interviewed, 62 (43.05%) were identified as alcoholics in emergency department by treating doctors. On reviewing the records additional 11 (7.63%) were identified as alcoholics, out of which 2 (1.38%) were fulfilling the criteria for severe alcoholism. Conclusion: Alcoholism is often not investigated and diagnosed on hospital admission. Standardized diagnostic tool will improve the identification of alcoholic patients. This is the first step to reduce alcohol consumption and offer appropriate treatment to these patients.

Molecular Characterization of Carbapenem Resistant Isolates of Acinetobacter baumannii in An Intensive Care Unit of A Tertiary Care Centre at Central India

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

Significance of Radiological Variables Studied on Orthopantamogram to Predict Post-Operative Inferior Alveolar Nerve Paresthesia after Third Molar Extraction

Sachin Pathak, Nitin Mishra, Madhur Kant Rastogi, Shalini Sharma

Context: Removal of impacted third molar is a procedure that is often associated with post-operative complications. The rate of complications is somewhat high because of its proximity to the vital structures. Inferior alveolar nerve paresthesia is one of the common complications of impacted their molar surgery. This is due to intimate relationship between roots of mandibular third molar and inferior alveolar canal. To access the proximity of inferior alveolar canal to third molar many diagnostic methods are suggested but in conventional radiography orthopantamogram is considered as the best. There are many findings onorthopantamogram that are suggestive of close proximity ofnerve to the canal. In this study authors reviewed seven radiographic findings related to proximity of roots to the inferior alveolar nerve as seen on orthopantamogram and try to find a relationship between these radiographic variables and presence of post-operative paresthesia. Study Design: The study containd 100 impacted third molars need to be removed. Presence of radiographic findings onorthopantamogram were noted and analyzed, to find a relationship with occurrence of post-operative inferior alveolar nerve paresthesia. Materials and Methods: This study comprises of 100 impacted third molar teeth indicated for extraction. Cases were randomly selected from the patients, needs to undergo extraction of impacted mandibular third molar. After extraction cases were evaluated for occurrence of inferior alveolar nerve paresthesia. Stastical Analyisis: Data was transferred to SPss 21 software for frequency calculation, and two tailed p-values were obtained betweens these variables and post-operative paresthesia, by applying Fischer’s exact test (GRAPH PAD SOFTWARE) Results: Out of seven, four radiological findings that are grooving of roots, hooked roots, bifid roots and obliteration of white line are significantly related to post-operative paresthesia while bending of canal, narrow canal and darkening of tooth roots over the canal are not significantly associated with post-operative morbidity of facial nerve.

Underlying Kidney Disease and Duration of Hemodialysis: An Assessment of Its Effect on Oral Health

Background: Dental health among the patients undergoing haemodialysis therapy has been found to be debilitated and gets worsened with the increased duration of hemodialysis.Hence the present study aimed to assess the effect of duration of hemodialysis and the underlying kidney disease on the dental health status of patients. Settings and Design: A cross-sectional study was conducted on 400 patients and 400 controls selected through stratified random sampling method from five zones of Delhi, India. Materials and Methods: The patient group was divided into following five groups in order to evaluate influence of duration of hemodialysis therapy on dental status of the subjects-a) = three months b)four to six months c)seven to nine months d) ten to twelve months and e) more than twelve months. Dental health was assessed using WHO dentition status and treatment needs, community periodontal index, oral hygiene index, prosthetic status and needs. Statistical Analysis Used: Student t-test, Chi-square test, one-way analysis of variance (ANOVA) and Pearson’s correlation was used to determine the difference in clinical parameters among the subgroup and between the patients and controls. Results: Positive correlation was found between the frequency of dialysis and maximum CPI scores (p-value=0.018). 81.25% of patients and 74.75% of the controls had CPI score 2. Loss of attachment scores in patients was higher than the healthy controls (p-value 0.035). Mean OHI scores for the patients was 5.15±1.975 and for controls was 5.01±2.213 (p=0.635). Mean DMFT score of patients and controls was 3.552 and 3.559 respectively (p=0.937). 23%of controls showed presence of dental prosthesis in comparison to only 14.5 % of patients (p=0.05). Type of underlying kidney disease and duration of hemodialysis had significant influence on O.H.I scores and Prosthetic needs. Conclusion: Dental health status was found to be debilitated among the hemodialysis patients and got worsened with the duration of hemodialysis and the type of underlying kidney disease mainly due to oral health negligence contributing to morbidity and potential mortality. Further emphasis on the effective implementation of oral health promotion programme for medically compromised patients is thus advocated.

Comparative Evaluation of Various Tests for Diagnosis of Concurrent Malaria and Typhoid Fever in a Tertiary Care Hospital of Northern India

Deepika Verma, Sachin Kishore, M.E. Siddique

Background: Malaria and Typhoid are two major infectious diseases, still prevalent in most of the tropical countries including India. Millions of individuals residing in these endemic cases contact these diseases either concurrently or as acute infection superimposed on a chronic one. Aim: Diagnosis and comparative evaluation of various tests for diagnosis of Typhoid-Malaria co-infection in patients suffering from febrile illness. Materials and Methods: Around 800 patients of both Out Patient Department (OPD) and In Patient Department (IPD) were referred to microbiology lab for Widal test/ Typhi dot IgG/IgM and Malaria card test between July 2012-September 2012. Patients found to be suffering from co-infection were further confirmed for typhoid by blood culture. Those patients who were found sterile on blood culture were further confirmed by stool culture. Patients positive by Malaria card test (either antibody or antigen or both) were confirmed by peripheral blood smear examination for malaria parasite by both thick and thin smear examination. Result: 68 (8.5%) patients were found to be suffering from co-infection by the above tests. Blood culture revealed 15 (22%) bacterial pathogens in the widal positive patients out of which 6(8.8%) were Salmonella Typhi and 3 (4.41%) were Salmonella Paratyphi A. Stool culture revealed 8 (11.7%) S. Typhi and 5 (7.35%) S.Paratyphi A cases. Out of 68 patients positive by Malaria card test, only 36 (52.94%) showed Malaria parasite in peripheral blood smear also. Thus the number of confirmed cases of co-infection was found to be only 1.6%. Conclusion: The interpretation of Widal test and Malaria card test, when diagnosing concurrent malaria and typhoid fever, must therefore be done with a lot of caution. Negative or positive Widal agglutination test is neither definitive nor completely informative. Similarly erroneous interpretation of Malaria card test (especially Antibody detection card test) result may lead to prolonged treatment and economic burden on patient.

Does CD34 Staining Reflect the Angiogenic Process in the Bone Marrow? An Analysis of a Series of Chronic Myeloid Leukemia Patients

Krishnan Kulumani Mahadevan, Debdatta Basu, Swarup Kumar

Backgorund: Angiogenesis is associated with growth, dissemination and metastasis of tumours. Measurement of Microvascular Density (MVD) is a quantitative method of assessment of angiogenesis and would give a proportional co relate of the angiogenic process in tumours. The aim of this study is to measure the MVD by using CD34 staining in various phases of Chronic Myeloid Leukemia (CML) and type of CML (Granulocytic/Granulocytic Megakaryocytic) (G/GM) and to co-relate micro vascular densities with the grade of fibrosis. Material and Methods: Bone marrow biopsy specimens of 30 CML patients and 20 non-CML (controls) cases that required bone marrow biopsy were subjected to CD34 staining and H&E staining. The mean MVD in CD34 slides was assessed by selecting hot spots and MVD was measured in these fields in high power (40 x magnification) and the mean MVD was calculated by taking the average of four hot spots per field. Grade of fibrosis and phase of CML, type (G/GM) were assessed in H&E slides. The controls were matched with respect to age and gender. Results: Among 30 patients with CML, 21 were in chronic phase, five in accelerated and four in blast crisis. A normal distribution was obtained for MVD of both CML cases and controls using tests for normality. Comparison of mean MVD between CML and controls by student t-test showed a significant increase in MVD of CML cases (p = 0. 00026). However, no significant difference in MVD between the three phases viz, Chronic, accelerated and blast crisis phase (p = 0. 302) was obtained by using one way ANOVA. Comparison of Grade of fibrosis with MVD using independent t-test showed no significant difference in MVD between low (Grade1&2) and high grade (Grade 3&4) (p = . 805). No significant difference in MVD was obtained between G and GM types of CML using independent t-test (p = 0. 381). Conclusion: The study shows that there is a significant increase in MVD in CML cases than controls but no significant difference in MVD could be demonstrated between different phases of CML, histological types of CML and grades of fibrosis in CML.

Cyclin D1 Gene Expression in Oral Mucosa of Tobacco Chewers”–An Immunohistochemical Study

Maharudrappa Basnaker, Srikala SP, Satish BNVS

Objective: The objective of the present study was to evaluate the expression of cyclin D1 in normal oral mucosa of both non tobacco habituated and tobacco habituated individuals histologically and also compare and correlate cyclin D1 expression with histopathologically confirmed cases of oral squamous cell carcinomas. Study Design: The present study involved 20 cases of tobacco habituated individuals with normal oral mucosal tissue and 20 histopathologically confirmed cases of squamous cells carcinomas. Twelve cases of non tobacco habituated individuals served as control group. Chi-square analysis was used to determine statistical significance. Results: Fifty percent of control cases, 70% of squamous cell carcinoma cases and 80% of tobacco habituated individuals of clinically normal mucosa showed cyclin D1 positivity. Thirteen cases with tobacco chewing habit, with clinically normal mucosa, showed dysplasia, out of which seven were mildly dysplastic and six were moderately dysplastic. A larger percentage of cyclin D1 expression was observed in lower grade dysplasias (53.8%) than higher grade dysplasias (46.1%). However statistical analysis showed no significant association between groups. Chi-square value was <7.82 for p=0.05. Conclusion: The finding of cyclin D1 expression in 80% of tobacco users with clinically normal mucosa indicates that the mutation of cyclin D1 occurs early, even before clinical changes are apparent. This finding appears to be previously unreported. The presence of dysplasia in the same group and cyclin D1 expression in 84.6% of dysplastic cases show that the patients are susceptible for further changes, including progression to higher grades of dysplasia and development of carcinoma. Relatively lower expression of cyclin D1 positivity (70%), in oral cancer patients, when compared with tobacco users with clinically normal mucosa (80%) is indicative of increased traverse of the cell through the cell cycle, which may occur early in tumor progression. Cyclin D1 immunoreactivity was detected in all the three study groups.

Study of Incidence and Prevalence of Musculoskeletal Anomalies in A Tertiary Care Hospital of Eastern India

Introduction:Congenital anomalies or malformations are anatomical. Structural or functional defects present at birth leads to physical and mental disabilities. With the advent of newer drugs, infectious diseases have taken the backseat and congenital defects have emerged as an important cause of neonatal morbidity and mortality. In India, anomalies of musculoskeletal system have been most commonly reported. Aims and Objectives:With this in view, the present study was carried out to find the incidence and types of musculoskeletal defects in a tertiary care hospital in Eastern India. Various maternal factors were also correlated and analyzed. The purpose of this communication is to report these defects so as to help doctors and parents to prevent unexpected fetal loss and better parental counseling. Materials and Methods:This study was done in the Department of Obstetrics and Gynecology in association with Department of Paediatrics of a tertiary care hospital in Odisha from for a period of 1 year. The newborns were examined within 1 st three days of delivery for congenital malformations. The study group included all live borns along with still borns after 28 weeks of gestation or those dead babies whose weight was about 1kg. A thorough physical examination from head to toe was done to look for musculoskeletal defects within 24hrs of delivery. Observation and Results:Out of total 7268 babies delivered, 116 babies were found to have anomalies. Thirty two of these had musculoskeletal defects. Talipes equinovarus was the commonest anomaly observed followed by polydactyly. The ratio of male babies with musculoskeletal defects to female babies was found to be 1.28:1.The malformed babies were mainly born to term mothers (77.6%), who were mostly unbooked (62.5%) and belonged to lower or middle class. But no significant relationship could be established between these factors and defects. Most mothers were in the age group of 20- 35 years and there was no history of drug addiction, smoking, trauma or irradiation that could be related to the occurrence of congenital malformations. Conclusion:It is concluded that better maternal care and improved standards of living have very little effect on the overall frequency of congenital malformations. For the better future of neonates an early recognition of correctable lesions is essential, which calls for a systematic approach to the study of musculoskeletal defects.

Primary Abdominal Pregnancy in the Uterosacral Ligament with Haemoperitoneum: A Near Miss

Sirisha Rao Gundabattula, Manjula Pochiraju

Primary abdominal pregnancy has a higher mortality rate than other ectopic gestations. Delayed diagnosis can be associated with catastrophic haemorrhage. This report describes a spontaneous conception which occurred in the uterosacral ligament in a woman with no known risk factors for an ectopic pregnancy. Extrauterine pregnancy was diagnosed by ultrasound and laparoscopy was performed secondary to haemoperitoneum, which revealed a pregnancy implanted in the right uterosacral ligament. The rarity of this condition signifies the need for reporting all cases to facilitate future research and clinical management.

Molariform Mesiodens in Primary Dentition: A Case Report

Indira MD, Kanik a Singh Dhull, Sujatha R, Praveen Kumar PS, Gayatri Devi BM

Spontaneous Perforation as a First Presentation of Ileal Gastrointestinal Stromal Tumour (GIST) with Synchronous Breast Sarcoma

Gastrointestinal Stromal Tumours (GIST’s) are the most common mesenchymal neoplasms of the gastrointestinal tract. Majority of the GISTs are asymptomatic and often diagnosis is incidental. Synchronous second malignancies have been reported in patients with GIST. We report a case of 50-year-old female presenting with features of hollow viscous perforation, found to have ileal GIST with perforations along with a synchronous breast sarcoma. GIST with spontaneous perforation as its first clinical manifestation is rare. Synchronous occurrence of an ileal GIST with a breast sarcoma is unique and deserves reporting. This case report highlights the varied nature of clinical presentation of the GIST and also stresses on the importance of extensive search for the synchronous second malignancies in the extra abdominal sites as well.

Anterior Deep Bite Malocclusion Treated with Connecticut Intrusion Arch: Biomechanical Consideration

Safiya Sana1, Abhishek Bansal, Laique Sami, Roopali Tapashetti, Shashank Gaikwad

Most Class II division 2 malocclusion manifest a severe deep bite, the orthodontic correction of deep overbite can be achieved with several mechanisms one such mechanics is true intrusion of anterior teeth. Deep overbite correction by intrusion of anterior teeth affords a number of advantages which includes simplifying control of the vertical dimension and allowing forward rotation of mandible to aid in Class II correction. It also aid in correction of a high gingival smile line. This case report presents the patient of a 14-year-old boy with Class II division 2 subdivision malocclusion treated with connecticut intrusion arch and also highlights the biomechanical aspect of this appliance. Intrusion of anterior teeth is difficult. An appropriate, effective and clinically manageable biomechanical system is required. The treatment approach shown in this case can treat the deep overbite precisely with incisor intrusion. The article shows the versatility of Connecticut Intrusion Arch and by applying the sound biomechanical principles we can execute the planned mechanics with minimal side effects.

Group Distal Movement of Teeth Using Micro–Screw–Implant Anchorage– A Case Report

Biju Kalarickal

This case report describes a case of orthodontic tooth movement of a 29-year-old female patient utilizing maxillary posterior edentulous area. Micro-implants were placed at buccal edentulous spaces and inter-radicular space for retraction of entire maxillary dentition. An overjet reduction of 8mm and good posterior occlusion were achieved.

Torsion of Para-Ovarian Cyst Resulting in Secondary Torsion of the Fallopian Tube: A Cause of Acute Abdomen

Jaya Kundan Gedam, Disha Andhiwal Rajput, Minal V. Bhalerao

A 32-year-old woman presented with abdominal pain in the left lower quadrant, of one day’s duration. Ultrasonography of the abdomen revealed a cystic structure in the right adnexa, probably with torsion. Computerized tomography of abdomen and pelvis showed a large pelvic cyst which arose most likely from the left ovary. An urgent laparotomy was done, which however showed a twisted para-ovarian cyst with a twisted fallopian tube on the left side. The para-ovarian cyst was removed along with left sided fallopian tube and the patient made an uneventful recovery. Torsion of a para-ovarian cyst and fallopian tube is rare, but it should be considered in the differential diagnosis of acute abdomen in women who are in the reproductive age group.

Ameloblastoma Arising from A Dentigerous Cyst- A Case Report

NVV Satya Bhushan, Naga Malleswar Rao, M. Navatha, B. Kiran kumar

We are reporting a case of an ameloblastoma which arose in the wall of a dentigerous cyst. The clinical ,radiographic and histological characteristics were similar to those of dentigerous cysts, as were seen on doing an incisional biopsy. Enucleation was done intraorally under local anaesthesia. Post-operative excisional biopsy revealed strands and cords arising from the cystic lining, which are suggestive of ameloblastic changes.

Oral Manifestations of Hypothyroidism: A Case Report

Rupesh Gupta, Kashish Goel, Jitender Solanki, Sarika Gupta

Hypothyroidism can be due to thyroid failure (primary hypothyroidism) or pituitary or hypothalamic disease (secondary hypothyroidism). A 20-year-old female patient reported with a complaint of the presence of milk teeth in mouth since 10-12 years. Intraorally, multiple retained decidious and missing permanent teeth were present. Macroglossia was evident. Skeletal and dental malocclusion (class II) secondary to hypothyroidism was the clinical diagnosis. A comprehensive treatment plan was formulated. We present this case so as to make the oral health professionals aware of this condition efficiently.

Non- healing Scalp Ulcer Accompanying Chronic Arsenicosis: A Case Report

Agnik Pal, Indranil Banerjee, Sukanta Sen, Santanu Kumar Tripathi

Arsenic, an environmental toxin, significantly contributes to the development of several health problems. Epidemiological studies done across the globe have reported that a prolonged arsenic exposure has been associated with characteristic skin lesions, neuropathy and an increased risk of skin, lung, liver (angiosarcoma), bladder, kidney and colon cancers. In present study, we are reporting a case of a 60-year-old male, who presented with a large (5cm x 4cm) painless ulcer in fronto-parietal area of scalp, with occasional oozing of blood. X-ray of skull (AP and lateral view) revealed granular well-outlined osteolytic lesions in right fronto-parietal skull vault, which raised a suspicion of malignancy. An incisional biopsy was taken and histopathology revealed no evidence of malignancy. A benign, non-healing skin ulcer is rarely seen in a setting of chronic arsenicosis. His skin examination showed characteristic fine freckles of spotted pigmentary changes i.e. classic rain-drop pigmentations which were present all over the body, particularly on trunk, palms and soles. Arsenic levels seen in hair and nail of the patient were 1.23 micrograms/gram and 3.26 micrograms/gram respectively, which were in accordance with WHO suggested diagnostic criteria of chronic arsenicosis.

Usefulness of 3D CT in Diagnosis of Cervical Rib Presenting as Supraclavicular Swelling of Short Duration

Shruti Chandak, Ashutosh Kumar

This is a unique case of cervical rib since the patient presented as a firm neck swelling of short duration which was clinically palpable as a superficial neck mass and referred for FNAC for the same. Since FNAC did not yield any positive result, the patient was then referred for CT which showed bilateral cervical ribs with pseudoarticulation with the 1st thoracic rib on the right side which is quite rare. The clinical importance of our case is to keep in mind a differential diagnosis of cervical rib in firm to hard clinically palpable posterior triangle neck masses. It is also important to diagnose cervical ribs in patients undergoing CT of the neck since they are under reported as determined in previous studies.

Diagnosis and Clinico-Radiological Presentation in an Aggressive Maxillary Brown Tumour

Abhishek Ranjan Pati, Mubeen, Vijayalakshmi KR, Chandravir Singh

Brown’s tumour is an uncommon focal giant cell lesion which arises as a result of the effect of increased parathyroid hormone on bone tissues in hyperparathyroidism. The mandible is the predominantly affected site in the maxillofacial area and a maxillary involvement is rare. The severity of the lesion, caused by a Brown’s tumour, may lead to evident osteolysis and gross deformity in the maxillofacial region, which suggests the need for making an early diagnosis and giving prompt treatment. We are reporting a male patient who presented with a massive painful swelling in the right maxilla as the first manifestation of primary hyperparathyroidism, caused by a parathyroid adenoma.

Diffuse Osteoradionecrosis of Temporal Bone as a Late Complication of Adjuvant Radiotherapy to Parotid Bed: A Case Report

Sisha Liz Abraham, Sivaraman Ganesan, Elizabeth Mathew Iype, Vijay Jagan

Localized osteoradionecrosis of bony external auditory canal has been described as a late complication of external beam radiotherapy which is delivered to parotid bed after surgical resection of parotid malignancies. Diffuse osteoradionecrosis of temporal bone is rarely seen in such a setting and it is usually caused by resection of part of the bone for surgical clearance, followed by post-operative radiotherapy. This condition warrants aggressive treatment, in order to avoid potentially life threatening intracranial complications. In this report, we are presenting an uncommon case of extensive osteoradionecrosis which involved the entire temporal bone, in a patient who was treated for mucoepidermoid carcinoma of parotid twelve years ago, with total conservative parotidectomy and adjuvant radiotherapy.

Retrocaval Ureter: An Innocent Bystander

Gosavi VS, Hombalkar NN, Dhandore PD, Mody NB, Bankar SS

Retrocaval ureter is a rare congenital anomaly, with the ureter passing posterior to the inferior vena cava. Though it is a congenital anomaly, patients do not normally present with symptoms until the 3rd and 4th decades of life, which result from a hydronephrosis. We are presenting a case of 45-year-old lady who had right flank pain and dysuria, which were associated with right hydroureteronephrosis. Diagnosis was confirmed by doing Intravenous Pyelogram(IVP) and patient underwent an open surgical repair of the anomaly.

A Case of Peritoneal Free Floating Calcified Fibromyoma

Ramaiah Sahadev, Preethan K Nagappa

Giant peritoneal loose bodies are rare and few reported cases are found in literature. These are commonly found in the pelvis. Preoperatively these cases are diagnosed accidentally on abdominopelvic evaluation. We report one such case in a male patient who presented to us with acute gangrenous cholecystitis. We had diagnosed the lesion accidentally on a routine ultrasound of the abdomen and pelvis as a calcified leiomyoma of sigmoid colon. On laparoscopy, it was freely floating in the peritoneal cavity without any kind of peritoneal attachment or attachment to any intraperitoneal organ. The peritoneal loose body was removed by a small abdominal incision. Histopathologically the lesion was reported as benign calcified fibromyoma. Small peritoneal loose bodies are relatively common but a large peritoneal loose body is very rare.

Primary Treatment of Kawasaki Disease with Corticosteroids

Swati Singhal, Devendra Mishra, Sumod Kurien, Monica Juneja

Kawasaki disease (KD), is the leading cause of acquired heart disease in children in the developed world. The use of aspirin and intravenous immunoglobulin as the initial therapy in KD is the standard of care, as they reduce the incidence of coronary artery aneurysms, the major cardiac morbidity from this disease. The place of corticosteroids in the initial therapy is: however, controversial. We describe the course of a one-year-old child with Kawasaki disease who was treated with aspirin and corticosteroids as the initial therapy, and discuss pertinent issues.

Localized Multiple Cemental Excrescences: A Rare Presentation of Hypercementosis

Nadeem Jeddy, Radhika T., Krithika C., Saravanan R., Ramachandran Prabakar

Hypercementosis is an abnormal thickening of cementum which may be generalized or localized. Localized hypercementosis is usually characterized by nodular enlargement of apical third of root. Hypercementosis in the form of multiple cemental spikes distributed throughout the entire length of root is a very rare finding. In this article, we report such a rare manifestation of localized hypercementosis affecting right maxillary third molar in a 24-year-old male. This finding was an accidental observation following a difficult extraction procedure as the spikes were not evident in the orthopantamogram. It is imperative that every dental practitioner be aware of several presentations of hypercementosis and ensure that such an entity is considered in the differential diagnosis of difficult extraction procedures as an Intraoral Periapical (IOPA) radiograph or even an Orthopantamogram (OPG) could not differentiate the root morphology.

Bilateral Supernumerary Teeth in Deciduous Dentition-A Rarity

Sonu Acharya, Chiranjit Ghosh, Pradeep Kumar Mondal

Supernumerary teeth are considered as one of the most significant dental anomalies during the primary and early mixed dentition stages. They are of great concern to the dentists and parents because of the eruption, occlusal, and esthetic problems they can cause. Supernumerary teeth occur more frequently in the permanent dentition but rarely in primary dentition and more often seen in males. A supernumerary tooth in the primary dentition can cause ectopic or delayed eruption of permanent central incisors which will further alter occlusion and may compromise esthetics and formation of dentigerous cysts. Here we discuss a case of bilateral supernumerary teeth in deciduous dentition in a female child

Body Stalk Anomaly Complicated by Ectopia Cordis in the First Trimester

Shibata Y., Terada K., IG arashi M., Suzuki S.

The most serious conditions seen in body stalk anomaly may be the cases which are complicated by ectopia cordis, which is characterized by the abnormal location of the heart outside the thorax. We encountered four cases of body stalk anomaly, which were complicated by ectopia cordis, which were diagnosed in the first trimesters of pregnancy. In three of these cases, ultrasound scans revealed foetuses with large anterior abdominal wall defects, with their hearts extending outside their thoracic cavities. Their mothers, along with their husbands opted for termination of their pregnancies. In 1 other case, an ultrasound scan revealed a dead foetus, with gastroschisis. Based on the current cases, we suggest that the diagnosis of ectopia cordis caused by body stalk anomaly can be made during the first trimester of pregnancy.

Complete Pentalogy of Cantrell (POC) with Phocomelia and Other Associated Rare Anomalies

Sunil V Jagtap, Dhirajkumar B Shukla, Akash Jain, Swati S Jagtap

We are reporting a rare case of Complete Pentalogy of Cantrell (CPOC) with phocomelia and other associated anomalies such as encephalocoele, craniofacial defects, limb defects and a flexion deformity, with club foot in right lower limb. Antenatal ultrasonography done in a 20 year old primigravida revealed multiple thoraco-abdominal and CNS anomalies in a foetus with an average gestational age of 18.2 weeks. Foetal autopsy done following termination of the pregnancy revealed a combination of defects, based on which the diagnosis of Complete Pentalogy of Cantrell with associated anomalies was given. To the best of our knowledge, this is the first case of Complete Pentalogy of Cantrell with phocomelia which has been seen in the world.

Incidental Detection of Intra-Cranial Lipoma in Patient with Quadriparesis

Quraishi SMS, Hussain Iqbal KM

Magnetic Resonance Imaging (MRI) of brain is a non-invasive investigation which is performed frequently now-a-days in clinical neurological practice. Many incidental findings may be seen on MRI brain scans, which may be of little clinical significance. Knowledge on these entities is important, for a clinician to limit unnecessary further evaluations. Here is a description of a case of an incidentally detected, posterior peri-callosal, intracranial lipoma (a rare entity) which had occurred in a patient with quadriparesis, followed by a brief discussion on the types of intracranial lipomas and their clinical significances. A 65-year-old male presented with weakness of both upper limbs and lower limbs of 6-months duration. On examination, his tone was found to be spastic, his deep tendon reflexes were exaggerated and he had bilateral plantar extensor. A provisional diagnosis of spastic quadriparesis was made. Magnetic Resonance Imaging of cervical spine revealed spondylosis with cord compression at the level of C4-C6 vertebral level, which explained the cause of quadriparesis. Interestingly, MRI of his brain revealed a homogenously hyperintense lesion which was noted in T1 weighted images (A), at posterior part of corpus callosum, around the splenium. The lesion was hypointense in T2 (B) images and hyper intense in FLAIR (C) images, which was suggestive of a peri-callosal curvilinear lipoma. Patient was referred to neurosurgery department and he got operated for cervical spondylosis, with significant clinical improvement after surgery.

Dancing Eyes Dancing Feet Syndrome-A Report of Two Cases

P Jasminekalyani, S Saravanan, Sriramakrishnan V, Radha M

Opsoclonus Myoclonus (OMS) is a rare neurological disorder which appears to be the result of an autoimmune dysfunction. It is an extremely rare condition, affecting as few as 1 in 10,000,000 people every year. It affects 2 to 3% of children. Opsoclonus Myoclonus, which manifests itself as post infectious encephalopathy, occasionally along with HIV infection, post Streptococcal infection, West Nile virus encephalitis and Rickettsial infection, most often presents as a paraneoplastic syndrome, which is especially caused by occult neuroblastoma which is commonly seen in childhood and occurs in adults in relation to breast cancer and small cell lung cancer. In this study, two adult post infectious cases which had rare manifestations, have been presented. The cases were managed by using corticosteroids.

Multicentric Aggressive Mammary Fibromatosis with Cytological Features and Review of Literature

Fibromatosis is a fibroblastic lesion composed of uniform fibroblasts and collagen with an infiltrative growth pattern but lacking malignant cytological features. It is a rare entity and is even more unusual when found in the breast. Multicentricity in fibromatosis has been reported in 10% cases. Multicentricity in breast cancer has been defined as the presence of two or more tumor foci within different quadrants of the same breast. Considering this definition of multicentricity for fibromatosis, we herein report a case of recurrent multicentric aggressive mammary fibromatosis and its cytological features with review of literature because of limited literature of FNAC in mammary fibromatosis.

Pulmonary Infection Caused by Achromobacter xylosoxidans in a Patient with Carcinoma of Epiglottis: A Rare Case

Priyamvada Roy

Achromobacter xylosoxidans is an aerobic, motile, oxidase and catalase positive, non-fermenting, gram negative bacillus. It is an opportunistic pathogen which is responsible for various nosocomial and community-acquired infections. However, there are only very few reports of pulmonary infections caused by this bacterium in cancer patients. We are presenting a case of a patient with carcinoma of epiglottis, who developed pulmonary infection caused by Achromobacter xylosoxidans. According to the available literature, this is the first case of pulmonary infection caused by Achromobacter xylosoxidans, which was detected in a cancer patient in India. Since Achromobacter xylosoxidans demonstrates resistance to many classes of antimicrobials, vigilant and efficient microbiological work-ups and surveillances are needed, to diagnose infections caused by this rare pathogen in clinical settings.

Coexistence of Glomangioma and Yolk Sac Tumour in a Child: A Case Report

Dogan Kose, Hatice Toy, Engin Gunel, Umran CaliSkan, Yavuz Koksal

Glomus tumours (GTs) primarily arise from glomus bodies that are located in the dermis layer of skin. However, they can be encountered ectopically in most parts of the body. As a result of researches done in a 17-month-old male patient who prssented to us with complaint of an increasingly growing swelling, he was diagnosed with a yolk sac tumour. Chemotherapy was started and then, he was operated. GT was found inside the tumoural mass. Our patient, who is the first case according to our knowledge, where the concurrence of yolk sac and glomus tumours was reported, has been discussed in the light of literature.

Dilaceration and Eruption Disturbances in Permanent Teeth: A Sequelae of Trauma to Their Predecessors-Diagnosis and Treatment Using Cone Beam CT

Mahesh R, Kanimozhi iG, Sivakumar M

Alterations in the morphology of permanent teeth following trauma to their predecessors is a challenging task for diagnosis and it may require advanced imaging techniques. Newer imaging modalities have replaced the conventional radiological procedures, as they allow 3D reconstruction images and views which are free of superimposition. Cone Beam CT (CBCT) offers a three-dimensional view, which the conventional two-dimensional dental radiography fails to provide. The current article highlights the advantages of CBCT which are seen in evaluation of the morphological variations and eruptive disturbances in the permanent teeth, as sequelae to trauma in their predecessors.

Balantidiosis: A Rare Accidental Finding in the Urine of A Patient with Acute Renal Failure

Ankit Khanduri, Sapna Chauhan, IVA Chandola, BS Mahawal, VK Kataria

Balantidium coli is the only ciliated protozoan which is known to infect human and nonhuman primates. Route of infection is faecal-oral route. It is actively motile and causes mostly asymptomatic infections, or it may develop dysentery which is similar to that which is caused by Entamoeba histolytica. Here, we are describing a case of an accidental finding of B.coli in the urine of a patient who presented with acute renal failure, based on its characteristic morphology and motility which were seen on light microscopy. This is the third case of Urinary Balantidiosis which has been reported from India.

Retroperitoneal Approach for Dissection of Inflamed Pelvic Viscera in Acute Pelvic Inflammatory Disease- Case Report

Nidhi Sharma, Deepa Ganesh, Jayashree Srinivasan, Jayakumar S, Renu Mathew

Tubo-ovarian abscesses can rupture spontaneously after a manual examination or an accidental trauma. A critically ill patient with septic peritonitis will only deteriorate if timely surgical removal of pus is not done. The operation of choice is removal of free pus, together with the abscess, the uterus, the tubes and usually, the ovaries. Anatomy is distorted, dependable landmarks are obscured and tissues are thick and oedematous. Loops of densely adhered intestine are difficult to separate. If an intra peritoneal approach is used, it is likely that the fragments of ovary will be left behind. This can subsequently cause signs and symptoms of ovarian remnant syndrome. Injury to the serosa of distended bowel occurs inadvertently, thus increasing the morbidity which results from the procedure. We are hereby presenting a unique case of a ruptured tubo-ovarian abscess where a retroperitoneal approach was used.

Implant Supported Mandibular Overdenture: A Viable Treatment Option for Edentulous Mandible

Dipti Lambade, Pravin Lambade, Sham Gundawar

The prosthetic management of the edentulous patient has long been a major challenge. Complete maxillary and mandibular dentures have been the traditional standard of care. However, most of the patients report problems adapting to their mandibular denture due to a lack of comfort, retention, stability and inability to masticate. Implant-supported overdentures have been a common treatment for edentulous patients for the past 20 years and predictably achieve good clinical results. Implant supported overdentures offer many practical advantages over conventional complete dentures and removable partial dentures. These include decreased bone resorption, reduced prosthesis movement, better esthetics, improved tooth position, better occlusion, increased occlusal function and maintenance of the occlusal vertical dimension. This article presents a design and fabrication technique of the implant-retained overdenture that uses four freestanding mandibular implants.

Giant Cervical Spine Osteochondroma in an Adolescent Female

N. Huda, M. Julfiqar, Ajay Pant, Tariq Jameel

Osteochondroma or osteocartolaginous exostosis is by far the most common benign bone tumour, which accounts for 35% to 50% of benign bone neoplasms and 10% to 15% of all primary bone tumours. Osteochondroma represents a developmental enchondromatous hyperplasia which leads to formation of cartilage capped bony protrusions on bony surfaces. We present a case report of a 14-year- old female, who presented to us with a hard, gradually progressing, large painless swelling, over the left side of her neck. Swelling was nontender, extending from dorsal to ventral aspect, measuring 6 x 8 cm. Therefore, we are interested in introducing our case to medical fraternity, in which a giant lower cervical spine osteochondroma was seen in an adolescent female patient.

Traumatic Spigelian Hernia: A Rare Clinical Scenario

Aravinda P.S., Sudipta Saha, Gyan Saurabh, Manoj Andley, Ashok Kumar

Traumatic Spigelian hernia is a rare clinical entity with variable clinical presentation and requires a high index of suspicion for prompt diagnosis and the management. Delay in the diagnosis can lead to incarceration or strangulation of bowel loops and subsequent morbidity. Here, we are reporting a case of traumatic Spigelian hernia followed by blunt trauma to the right lower abdomen. The herniated bowel loop was gangrenous and perforated. There was spillage of fecal matter into the adjoining parietal layer. Patient underwent exploratory laparotomy with resection of gangrenous bowel loop and ileostomy was performed. Post-operative course was uneventful.

Osteochondroma of the Ventral Scapula Causing Scapular Static Winging and Secondary Rib Erosion

P Sivananda, B Kailash Rao, P Varun Kumar, G Santhosh Ram

An osteochondroma is a benign tumour of bone, which is located mainly in the metaphysis of long bones. It does not commonly occur in the scapula. On the ventral surface of the scapula, it can produce various manifestations due to mass effect. We are reporting a rare presentation of an osteochondroma at superomedial angle of ventral aspect of the scapula in a 31-year-old female. She initially presented with a painful shoulder and radiating pain in the arm. The scapular mass produced pseudo winging of the scapula and erosion of the ribs on the same side. The patient was successfully managed by open excision, using a parascapular approach. The patient had no evidence of recurrence at one year’s follow-up and is currently able to carry on her day to day activities without any discomfort.

Syringocystadenoma Papilliferum: An Unusual Presentation

Ranjan Agrawal, Parbodh Kumar, Rahul Varshney

Syringocystadenoma papilliferum is a benign hamartomatous adnexal tumour. Most of the patients present with solitary lesions in the head and neck region at birth or in early childhood. Multiple lesions are rarely seen and those which arise outside the head and neck region are even more uncommon. A case of syringocystadenoma papilliferum with multiple verrucous lesions and which was located in the right flank, an unusual site, has been presented.

Pre-surgical Alveolar Molding in A Newborn Patient with Complete Unilateral Cleft Lip and Palate-A Report

Shilpi Tiwari, B Nandlal, Sudhakar Reddy

Clefts of the lip, alveolus and palate (CLAP) are the most common congenital malformations seen in the head and neck region. Children with CLAP face a vast variety of problems like feeding difficulties, hearing loss (ear infections), missing or malformed teeth and speech defects, along with psychosocial stigma which influences the social development and rehabilitation of such patients. Management of CLAP has been recognized as a unique challenge for parents as well as medical team. Pre-surgical alveolar molding has shown promising results in solving the problems which are associated with CLAP, to a great extent. We are reporting a case of a newborn patient with complete unilateral cleft lip and palate, who had inability in suckling and nasal regurgitation of oral fluids since birth, which were aided by providing a Pre-surgical alveolar molding to facilitate feeding and also to improve future facial appearance. This article highlights the effectiveness of alveolar molding appliance which was used to direct growth of the alveolar ridges and lips in the pre surgical treatment of cleft lip and palate. As a result of this appliance, the primary surgical repair of the nose and lip which was done, healed under minimal tension, thereby reducing scar formation and improving the aesthetic results.

Tuberculous Otitis with Proteus mirabilis Co-Infection: An Unsuspected Presentation Encountered in Clinical Practice

Tuberculosis, a contagious bacterial disease which is caused by Mycobacterium tuberculosis, primarily involves the lungs.Though Pulmonary tuberculosis (PTB) is the commonest clinical presentation, there is a need for alertness towards uncommon presentations which involve other organs. Tuberculous otitis media (TOM) is one such rare presentation seen in paediatric practice. It is characterized by painless otorrhoea which fails to respond to the routine antibacterial treatment. TOM usually occurs secondary to PTB. Here is a case of tuberculous otitis media with Proteus mirabilis co-infection, with no evidence of PTB. In the sample of ear discharge obtained from the patient, acid fast bacilli were demonstrated on direct microscopy after Ziehl-Neelsen staining. Culture done on Lowenstein-Jensen medium demonstrated slow-growing Mycobacterium. Bacteriological culture and identification helped in isolating Proteus mirabilis. PCR, followed by Line- Probe Assay for early identification and susceptibility testing to primary drugs, was done. Further, patient tested negative for the Mantoux test. Patient was enrolled in National Tuberculosis programme- RNTCP. This case emphasizes on one of the less common presentations of a common disease. A high clinical suspicion and laboratory confirmation are required for appropriate patient management.

Recurrent Aggressive Angiomyxoma of The Vulva – A Rare Presentation

We describe here a case of a 38-year-old lady presenting with a about 5x4cm in size swelling on the left labia majora. She had similar type of swelling 2 years back which was treated surgically. FNAC report of the present mass revealed angiomyxoma. In view of its’ recurrent nature wide local surgical excision of the mass was done. Histopathology report confirmed the diagnosis of angiomyxoma. The lady is under follow up and there is no further recurrence till date.

Indian Tick Typhus – An Uncommon Cause of Hepatitis: A Case Report

Rahul Gupta, Virendra Singh

Although viruses remain the most common cause of hepatitis, other causes like rickettsial hepatitis are also well known. However, this aetiology has not been well recognized and it has been rarely reported in the Indian literature. Here, we are discussing a case of acute hepatitis, its clinical presentation, diagnosis and treatment, which was later found to be caused by Indian tick typhus (a spotted fever group rickettsia), which was diagnosed on the basis of serology and its clinical response to doxycycline. Further literature review has been done, to discuss various clinical presentations and prevalence of rickettsial infection in this part of the world.

Ethical and Legal Aspects of Conducting Clinical Trials in Alcohol Withdrawal Syndrome

Vikram Reddy K, Harsha R

Alcohol Withdrawal Syndrome (AWS) is a condition where the patients will be mentally unstable initially and where later, with therapy, they gradually return to normalcy. As AWS comprises two stages; a mentally unstable state and a normal state of mind, the ethical and legal issues behind recruitment of these subjects become a little ambiguous in a clinical trial. This study was taken up to clarify the uncertainty regarding the biphasic states of minds (i.e. unstable mind and sound mind) of the subjects who were involved in a clinical trial done on AWS. Law and ethics regarding the clinical trials which involve psychiatric subjects need to be strengthened and amended from time to time, in order to protect the interests of both patients and physicians.

A Study of Oral Stereognostic Proficiency in Dentulous and Edentulous Persons

Maya Veersingh Dalaya

Stereognosis means the ability of a person to recognize the shape and surface characters of an object using tactile sensations, without looking at them. The purpose of this study was to determine and compare the oral stereognostic levels of different age groups having full complement of teeth, for edentulous patients with and without prosthesis and also for denture satisfaction. In this study, oral stereognosis was tested with the aid of small metallic pellets referred as test forms, which had surface alterations as well as alterations in basic shape. The seven test forms were cube forms of 5mm x 5mm x 5mm & plaster replicas of these forms were five times larger which served as visual aid to the patient during tests. To start, each subject was given sufficient time to get acquainted with general shapes and surface characters of test form by visual inspection of plaster replicas. One of the metallic test form was randomly selected & placed on the subject’s tongue and asked to indicate the identification by pointing at the appropriate plaster replica. In this study inverse relationship was found between stereognostic level and age of the subject. The stereognostic scores of dentulous subjects were higher than edentulous. There were no significant differences in edentulous persons with or without denture. Stereognostic score was low in most satisfied denture wearers and was high in dissatisfied denture wearers.

Nanosurface – The Future of Implants

GK Thakral, Rashmi Thakral, Neeraj Sharma, Jyotsana Seth, Pallavi Vashisht

Nanotechnology is a relatively newer field of science that is finding enormous scope in the dental & medical science. Use of endosseous dental implant surfaces having nano-scale topography is fast becoming part of modern implantology. The purpose of this review is to discuss and understand the role of nanoscale surface modification of titanium materials for the purpose of improving various phases of implantology including osseointegration. Nanotechnology equips bioengineers with newer ways of interacting with relevant biological processes. On the other hand, the field of nanotechnology provides means of understanding and achieving cell specific functions. An understanding of the role of nano-topography leads to the significant osseointegration modulations by nanoscale modification of the implants surface. Use of nanotechnology to modify the topography of titanium endosseous implant can drastically improve cellular and tissue responses that may benefit osseointegration and dental implant procedures.

Ampicillin Rise Fall and Resurgence

Dwarikadhish Kaushik, Mudit Mohan, Dhammraj M Borade, Onkar C Swami

Antimicrobial resistance (AMR) is a global problem. AMR has posed new challenges in treatment of infectious diseases. Antimicrobials are losing efficacy due to development of resistant pathogens. It has lead to re-emergence of certain infectious diseases. Treatment of such diseases has undergone changes with use of alternative antimicrobials and drug combinations. Pathogens are likely to develop resistance to alternative antimicrobials also and risk of infections with nonexistent treatment is real. Salmonella showed widespread resistant to ampicillin which resulted in use of alternative antimicrobials like fluroquinolones and cephalosporins in the treatment of enteric fever in last two decades. Unfortunately there are growing reports of resistance to these antimicrobials. Interestingly there are numerous reports of ampicillin regaining activity against salmonella. Speculatively lack of exposure of salmonella to ampicillin for long time resulted in the loss of plasmid mediated resistance in the pathogen. There may have been emergence of de novo ampicillin susceptible strains. This is assuring in the era where problem of AMR is compounded by the scarcity of new antimicrobial development.

Unicystic Ameloblastoma of the Mandible– Report of Two Cases with Review of Literature

Saravanakumar B1, Parthiban J, Aarthi Nisha V, Sarumathi T, Prakash CA

Ameloblastoma is classified into solid/multicystic, extraosseous/peripheral, desmoplastic and unicystic types based on the clinical appearance by WHO (2003). Unicystic ameloblastoma is the 2nd and far less frequent growth pattern seen in intra-osseous ameloblastoma. It tends to occur in younger population and constitutes approximately 6% of ameloblastomas with no sexual or racial predilection. Here in, reporting 2 cases of cystic ameloblastoma in the mandible, in varying age groups.

Cost Effective Suction and Drainage using Mucus Sucker

Shankar Ram HS, Ullal Anand Kini, Sagar HC, Loka Vijayan SK

Mandibular Bilateral Fourth Molars - A Rare and Interesting Occurrence

Spoorthi Ravi Banavar, Prashanthi Chippagiri

Pneumopericardium Secondary to Oesophageal Stent Invasion

Creticus P Marak, Parijat S Joy, Achuta K Guddati

HIV 2: A Benign Onlooker or A Subtle Threat?

Ekadashi Rajni Sabharwal, Shweta Gupta, Gaurav Dalela

HIV-2 infection, originally discovered in West Africa, has now been found in many countries throughout the world including India. Despite it being a long acquaintance with the virus, not much is known about it conclusively. The present study was conducted at the ICTC of a tertiary care hospital catering to the needs of Jaipur and adjoining districts, to find the prevalence of HIV 2 among ICTC attendees. A total of 8190 clients accessed ICTC services during the study period, out of which 135 were HIV-seropositive, giving a prevalence of 1.64%. There was only a single positive case for HIV 2, giving a seroprevalence of 0.01% and none was reactive for antibodies of both HIV-1 and HIV-2. We suggest that in low prevalence areas like ours, assays capable of detecting both HIV 1 and HIV 2 must continue to be used to make our understanding of the deadly virus better and also make our combat more effective.

Cost-analysis of the WHO Essential Medicines List in A Resource-Limited Setting: Experience from A District Hospital in India

The World Health Organization (WHO) has been publishing the essential medicines list (EML) since 1977. The EML includes the most efficacious, safe and cost-effective drugs for the most relevant public health conditions worldwide. The WHO performs a cost-effectiveness analysis within each therapeutic group, but very little is known about which therapeutic groups are costliest for hospitals that adopt the WHO EML concept. In this study, we have described the annual consumption of medicines in a district hospital in India, that limited the list of available drugs according to the WHO EML concept. Only 21 drugs constituted 50% of the hospital spending. Anti-infective medicines accounted for 41% of drug spending, especially antiretrovirals which were used to treat HIV infection. Among other therapeutic groups, insulin had the highest impact on the hospital budget. We identified medicines used in perinatal care, which included anti-D immunoglobulin and lung surfactants, that were used rarely, but bore a relatively high cost burden. The results of this study indicate that in district hospitals adopt the WHO EML, antiretrovirals and antibiotics were the top therapeutic groups for the drug hospital budgets.