Journal of clinical and diagnostic research

Digital Cephalometric Tracings by PRO-CEPH V3 Software for Comparative Analyses of Vertical Dimension in Edentulous Patients

Background: Several methods, some physiological, some radiographical and some merely based on experience are taken upon by the practitioner to get him/her close to VDO in the edentulous patients. No single method can however claim to be the perfect answer. Lateral cephalograms have been a standard mode of determining the vertical dimensions in dentate and edentulous patients since the past. Due to unavoidable manual errors, there are chances of variations in the radiographic method too. Advancement in the digital technology has made recording jaw relations faster, simpler and more precise. Aim: This study compared the vertical dimension of occlusion in edentulous patients recorded by using three different physiological methods with the aid of digital cephalometric tracings using indigenously developed PRO-CEPH V3 software. M aterials and Methods: For the present study a total of 50 dentulous and 25 edentulous patients were selected through inclusion and exclusion criteria. A lateral cephalometric radiograph was taken for all the 50 dentulous subjects at Maximum Intercuspation (VDO) whereas three lateral cephalometric radiographs were obtained for all edentulous patients at the VDO following three different techniques- the Niswonger’s method, Phonetics method and Swallowing threshold method. Cephalometric tracings were carried out using indigenously developed PRO-CEPH V3 software. Linear and angular measurement were made and analysed. Conclusion: The indigenously developed software PRO-CEPH V3 is capable of making both the linear and angular measurement and therefore provide with relative credibility information regarding the possible VDO in the edentulous patients through cephalometric radiography.

Comparative Analysis of Canal Centering Ability of Different Single File Systems Using Cone Beam Computed Tomography- An In-Vitro Study

Rolly S. Agarwal, Jatin Agarwal, Pradeep Jain, Anil Chandra

Background: The ability of an endodontic instrument to remain centered in the root canal system is one of the most important characteristic influencing the clinical performance of a particular file system. Thus, it is important to assess the canal centering ability of newly introduced single file systems before they can be considered a viable replacement of full-sequence rotary file systems. Aim: The aim of the study was to compare the canal transportation, centering ability, and time taken for preparation of curved root canals after instrumentation with single file systems One Shape and Wave One, using cone-beam computed tomography (CBCT). Materials and Methods: Sixty mesiobuccal canals of mandibular molars with an angle of curvature ranging from 20o to 35o were divided into three groups of 20 samples each: ProTaper PT (group I) – full-sequence rotary control group, OneShape OS (group II)- single file continuous rotation, WaveOne WO – single file reciprocal motion (group III). Pre instrumentation and post instrumentation three-dimensional CBCT images were obtained from root cross-sections at 3mm, 6mm and 9mm from the apex. Scanned images were then accessed to determine canal transportation and centering ability. The data collected were evaluated using one-way analysis of variance (ANOVA) with Tukey’s honestly significant difference test. Results: It was observed that there were no differences in the magnitude of transportation between the rotary instruments (p >0.05) at both 3mm as well as 6mm from the apex. At 9 mm from the apex, Group I PT showed significantly higher mean canal transportation and lower centering ability (0.19±0.08 and 0.39±0.16), as compared to Group II OS (0.12±0.07 and 0.54±0.24) and Group III WO (0.13±0.06 and 0.55±0.18) while the differences between OS and WO were not statistically significant Conclusion: It was concluded that there was minor difference between the tested groups. Single file systems demonstrated average canal transportation and centering ability comparable to full sequence Protaper system in curved root canals.

Influence of Ultrasonic Irrigation and Chloroform on Cleanliness of Dentinal Tubules During Endodontic Retreatment-An Invitro SEM Study

Mahak Jain, Anurag Singhal, Anuraag Gurtu, Vineet Vinayak

Background: Ultrasonic irrigation has been proved for its remarkable cleaning efficiency in the field of endodontics. But its role in endodontic re-treatment has been understated. There is not much data available to understand the effect of ultrasonic irrigation for the evaluation of cleanliness of dentinal tubules when it is used with or without chloroform, a gutta percha solvent during endodontic retreatment. Aim: To compare the influence of ultrasonic irrigation with syringe irrigation on cleanliness of dentinal tubules after gutta perch removal for endodontic retreatment with or without the use of chloroform a gutta percha solvent using scanning electron microscope (SEM). Materials and Methods: Freshly extracted 45 human mandibular premolar teeth for periodontal and orthodontic reasons were taken and were occlusally adjusted to a working length of 19 mm. The root canals of all teeth were prepared chemo mechanically to a master apical file size 40 and were divided in various groups. In Group 1 (n = 5; control group), the canals remained unfilled. In Groups 2 and 3 (n = 20 each), the canals were filled using lateral compaction with gutta-percha and AH plus sealer, removal of root fillings was undertaken after 2 weeks using Gates Glidden drills and H files without chloroform in Group 2 and with chloroform in group 3. The specimen of Group 2 and 3 were further divided into two subgroups I and II (n=10). In subgroup I, irrigation was done using side vented needles and sodium hypochlorite. In subgroup II irrigation was done using passive ultrasonic irrigation with sodium hypochlorite. Thereafter, the roots were split and the sections were observed under SEM. The number of occluded dentinal tubules /total number of dentinal tubules were calculated for the coronal, middle and apical third of each root half. Statistical analysis was performed using one-way ANOVA followed by Tukey’s test using standardized technique. Result: Results indicated that the cleanest dentinal tubules were found in the control group (Group 1 where the canals were unfilled) followed by the non chloroform group with ultrasonic irrigation (Group 3 subdivision II) followed by chloroform group with ultrasonic irrigation (Group 2 subdivision II), the non chloroform group with syringe irrigation (Group 3 subdivision I) and least cleanliness was found in the chloroform group with syringe irrigation (Group 2 subdivision I). Conclusion: Under the limitations of this study it could be concluded that both ultrasonic and syringe irrigation showed cleaner canals when chloroform was not used. Irrigation when done with ultrasonics leads to cleaner tubules than syringe irrigation. Hence, mechanical methods of retrieval in conjunction with use of passive ultrasonic irrigation should be a part of retreatment protocol.

Comparison of Efficacy of Clonidine versus Ondansetron for Prevention of Nausea and Vomiting Post Thyroidectomy: A Double Blind Randomized Controlled Trial

Setty Nagendra Gupta Shilpa, Sampangiramaiah Shailaja, Selvaraj Shanthini Hilda

Background and Aim: Postoperative nausea vomiting (PONV) is the most common symptom in patients post thyroidectomy. Literature search shows conflicting results regarding use of clonidine in PONV prophylaxis. We undertook this randomized controlled double blind trial to compare the efficacy of clonidine with dexamethasone versus ondansetron with dexamethasone for PONV prophylaxis in these patients. Materials and Methods: In this prospective study, 60 consecutive patients posted for thyroidectomy from August 2013 to July 2014, were randomly assigned to two groups, ondansetron (N= 30) (Group A) and clonidine (N= 30) (Group B). Patients received either oral ondansetron 8mg or oral clonidine 150µg as premedication. At the end of surgery, both groups received dexamethasone 8mg intravenously. They were monitored for occurrence of PONV and sore throat for next 24 h. Ramsay sedation scores and total time of analgesia was noted. The primary end point was incidence of PONV in post operative for 24 h. Pearson’s chi square test and Students t tests were performed using SPSS for windows version 20 (SPSS Inc., Chicago, IL). Results: Baseline characteristics of patients were comparable. A higher proportion of patients in clonidine group developed PONV than ondansetron (36.7% vs 30%; p=0.03). Clonidine group patients experienced early nausea and vomiting (1-2hrs of postoperative period), compared to ondansetron group patients (6-12 h). Ramsay sedation scores at arrival were higher in clonidine group compared to ondansetron group (2.1 ± 0.3 versus 2.0; p=0.003). Total time of analgesia was higher with use of clonidine than ondansetron (919.5 ± 622 mins versus 642 ± 631 mins; p=0.09). Moderate sore throat was seen in 2 out of 30 patients in both groups. No major adverse events were observed in either group. Conclusion: Ondansetron with dexamethasone group was more effective in controlling PONV after thyroidectomy compared to clonidine with dexamethasone group. However, ramsay sedation scores and total time of analgesia were higher with clonidine than ondansetron.

Seroepidemiological Survey of Chikungunya in and Around the Regions of Bijapur (Vijayapura - North Karnataka)

Bharath Mudurangaplar, Basavaraj V. Peerapur

Background: Chikungunya is a debilitating, non-fatal, mosquito borne viral fever caused by Chikungunya virus (CHIVA). The disease is transmitted to humans by the bite of Aedes aegypti and Aedes albopictus mosquitoes. Severe outbreaks of Chikungunya have been reported in several countries of Africa and Asia. Chikungunya fever is characterized by fever with sudden onset, arthralgia, rash, headache and myalgia. However, arthralgia is painful and long-lasting, affecting primarily the peripheral joints. Objectives: To find out the prevalence of Chikungunya fever in and around the regions of Bijapur district. Materials and Methods: The study was conducted from April 2011 to December 2014. Five hundred serum samples were collected from cases with pyrexia and arthralgia. Serum samples were tested for Chikungunya antibodies by Chikungunya IgM ELISA. Results and Conclusion: Out of 500 samples 33 samples were confirmed positive for Chikungunya IgM antibodies. The prevalence rate of Chikungunya was 6.6% with maximum number of cases in the year 2013 (8.5%) and age group 15 to 40 (8.3%). Females (6.9%) were more affected than males. Thus, continuous sero-epidomological surveillance is needed for the control of Chikungunya fever.

ABER Assessment in Pre-school Children with Developmental Speech and Language Impairment

Bharati Mehta, V. K. Chawla, Manish Parakh, Bharti Bhandari, Anoop Singh Gurjar

Introduction: Developmental speech and language disorders (DLD) constitute a group of disorders when children with normal intelligence and hearing fail to develop language in an age-appropriate manner. There is no definite or surrogate neurophysiologic laboratory marker to quantitate the extent of speech and language impairment. The current study was designed to evaluate the abnormalities in Auditory Brainstem Evoked Responses (ABER) in children with speech and language impairment who do not have a hearing deficit or autism. Materials and Methods: ABER recording was done in a cohort of 94 children (age 2-8 y) with DLD without overt hearing deficit or autism. The mean latencies for waves I, II, III, IV and V along with inter peak latencies for I-III, I-V, III-V and amplitude ratio of wave V/I was measured after click stimulus with intensities 110 db until 40 db and compared to age appropriate normograms. Results: The peak latencies for waves I, III & V, inter-peak latencies I-III & I-V, III-V and wave amplitude ratio V/I was found within normal limits in both ears of all the children when compared to age appropriate normograms. Conclusion: The current study therefore emphasizes the fact that ABER may not be used/recommended as diagnostic or prognostic tool in children with speech and language impairment without autism or hearing deficit. The results and the recommendations of this study will definitely reduce the burden on electrophysiologist, laboratories and also save time and financial resources.

In Vivo Autofluorescence Spectroscopic Study and Evaluation of DNA Damage By Comet Assay in Smokers

M Rajmohan, R Murali Naidu, D Thamaraiselvi, Deepasree Mani

Context: Tobacco is known environmental factor to alter the chemical composition of cells and the structure of DNA. Cellular level changes of smoker’s mucosa are assessed by autofluorescence spectroscopy and the DNA damage can be evaluated by single cell gel electrophoresis (comet assay). Aim: To substantiate the changes in the autofluorescence due to smoking with that of early DNA damage without any clinical change. Materials and Methods: Group I consists of 20 individuals with normal mucosa and Group II consists of 40 individuals with smoking habit. Only males were included in this study and their age ranging from 25 to 35 years. In vivo fluorescence spectra from both groups were obtained by using hand held fiber optic probe attached to Varian Cary Eclipse fluorescence spectrophotometer and comet assay was carried out for normal and smokers by their peripheral blood. Statistical Analysis Used: Independent-Samples t-test was used for statistical analysis. P-value was obtained to discriminate the statistical differences between the two groups. Results: The averaged excitation and emission spectra of normal and smoker’s mucosa showed significant differences statistically. In comet assay, the mean tail length of smoker group was higher than the normal group. The results showed statistically significant differences (p = 0.05). Conclusion: These techniques will be very useful for monitoring of very early changes of mucosa before clinical manifestation of the lesion in high risk smokers and thus prevents the occurrence of premalignant disorders and early invasive carcinoma.

Cadaveric Study of Profunda Femoris Artery with Some Unique Variations

Sangeeta jitendra Rajani, Minal K Ravat, Jitendra K Rajani, Amul N Bhedi

Background: Profunda femoris artery is the largest branch of femoral artery and chief supply of the thigh. It is useful for various clinical procedures like arteriography, ultrasonography and Doppler imaging and haemodialysis. Hence, accurate anatomical knowledge is very important for the clinicians. Materials and Methods: Thirty three properly embalmed cadavers (17 males and 16 females) were selected for the study. Femoral artery, Profunda femoris artery and its branches were exposed and their distances of origin were measured. Results: In present study of profunda femoris artery, we found posterolateral and lateral aspect of origin was common (71.21%) than posterior and posteromedial aspect of origin (24.24%). The site of origin of profunda femoris artery was between 21-40 mm on right side and 11-40 mm on left side. In 14 limbs (21.21%), we found high origin of profunda femoris artery (distance < 10mm). In two limbs (3.03%) Profunda femoris artery was originating from medial side of femoral artery and it coursed superficial to femoral vein. As per various literatures this is rare. In one female cadaver, on left side, we noted high origin (5mm away from mid inguinal point) of profunda femoris artery and site of origin was from anterolateral aspect of femoral artery and all the superficial branches of thigh took origin from it, while on right side of same cadaver findings were normal. In 13 limbs (19.69%) profunda femoris artery took origin as a common stem along with one of circumflex arteries while in three limbs (4.54%) trifurcation was observed, that is origin of profunda femoris and two circumflex arteries from single site. In four limbs (6.06%), superficial branches of femoral artery took origin from profunda femoris artery instead of femoral artery. Conclusion: In present study posterolateral and lateral side of origin is noted as common site of origin of profunda femoris artery. Rare variation like medial side origin of profunda Femoris artery was observed and it coursed on femoral vein. Very high incidence of high level of origin of profunda femoris artery was found. In one of the high origin limb profunda femoris artery originated from anterolateral side and all superficial branches of thigh took origin from it. Such variation is unique. Hence, this study will help the clinicians to avoid iatrogenic complications and also help them in various clinical procedures like puncture of femoral artery for interventional radiology.

Prevalence of Intestinal Parasitic Infection Among Inhabitants and Tribes of Chelgerd, Iran, 2008-2009

Introduction: Although a notable development in treating and controlling of parasitic infections in recent years has occurred but, these infections are still counted as important problems in many countries. Aim: The aim of this study is to determine the prevalence of intestinal parasitic infections in the inhabitant and tribe populations who were referred to central health care of Chelgerd, Iran. Materials and Methods: This descriptive cross-sectional study was carried out from April 2008 to October 2009 in Chelgerd, Iran. A total of 655 samples of feces from inhabitants and tribes were collected and each sample was examined by Direct smear, formol- ethyl acetate concentration and Trichorom staining. Results: Out of 655 stool samples, 367(56%) patients revealed at least one intestinal parasite (pathogenic /non-pathogenic protozoa/helminth), 233(67.7%) in tribes and 134(43%) in inhabitants. There was significant difference between infected inhabitants and infected tribes (p=0.001). Although the intestinal parasitic infections were more in female than male it was not statistically significant (p=0.52). There was no significant difference in various age groups. Common intestinal parasitic infections which were detected in both the populations were Giardia intestinalis (28.2%) and Blastocystis hominis (27.5%). Conclusions: We found that the prevalence of intestinal parasitic infections was higher in the tribe than inhabitant populations. Prevalence of intestinal protozoa infections was much higher than the helminthic infections. These findings reflect poor sanitary conditions in this region. They should be educated and provided better facilities to get rid of intestinal parasitic infections.

CT Perfusion Dynamics of Intracranial Tuberculomas

Ravindra Bhimrao Kamble, Jayakumar Peruvumba N., Ravishankar Shivashankar

Aims: To study perfusion characteristics of intracranial tuberculomas and analyze changes with anti tubercular treatment. Materials and Methods: Nineteen patients of histologically proven intracranial tuberculomas were included in the study of which 9 were not on antitubercular treatment and ten were on antitubercular treatment (6 patients on treatment for less than 2 months and 4 were more than 6 months). All patients underwent CT perfusion (CTP) and CTP parameters like rCBV and rCBF were obtained from entire lesion, center and capsule of lesions and compared. Results: CTP parameters like rCBF and rCBV were significantly low in all the three ROIs in the group not on treatment compared to that of on treatment ; rCBF and rCBV of entire lesion (p=0.018 and p=0.005 respectively), capsule (p=0.045 and p=0.010 respectively) and center of the lesion (p=0.020 and p=0.009) respectively). Tuberculomas on antitubercular treatment of more than six months showed reduced rCBF and rCBV in entire lesion (p=0.01 & p=0.01 respectively), capsule (p=0.04 & p=0.03 respectively) and center (p=0.08 & p=0.05 respectively) compared to those on treatment for less than two months. Similarly tuberculomas on treatment for six months did not show significant difference in rCBF and rCBV compared to tuberculomas who were not on treatment. Tuberculomas on treatment for less than two months showed statistically increased rCBF and rCBV in entire lesion (p=0.01 & p=0.04 respectively), capsule (p=0.03 & p=0.01 respectively) and center (p= 0.03 &=0.01) compared to those not on treatment. Conclusion: Intracranial tuberculomas not on treatment and those on treatment for around six months show low perfusion and tuberculomas on treatment for less than two months show high perfusion. These findings suggest that serial perfusion profiles of tuberculomas on treatment could possibly be seen as surrogate markers of response to treatment.

Effectiveness of Insulin Glargine on Recovery of Patients with Diabetic Ketoacidosis: A Randomized Controlled Trial

Jalil Houshyar, Amir Bahrami, Akbar Aliasgarzadeh

Background: Diabetic Ketoacidosis (DKA) is a major hyperglycemic emergency in diabetes mellitus (DM). The basic treatment is injection of Regular insulin (RI). This study was aimed to investigate the effects of insulin Glargine (GI) on recovery of patients with DKA. Materials and Methods: A randomized clinical trial conducted on 40 patients (twenty patients in each group) with DKA. Both groups received standard treatment for DKA. Experimental group was given 0.4U/kg of GI within three hours of initiation of IV insulin infusion. Results: The mean duration of acidosis correction time and recovery from DKA was 13.77±6.10 and 16.91±6.49 h in the intervention and control groups respectively (p=0.123). The mean dosage of RI until recovery from DKA was 84.8±45.6 in the intervention and 116.5±91.6 units in control groups (p=0.17). Hypokalemia occurred in three patients in intervention and four patients in control groups. In 35% of samples in intervention group and 51% in controls blood sugar was more than 10 mmol/l for 24 h after discontinuation of the insulin infusion (p=0.046). The mean duration of hospitalization was 5.1±1.88 in intervention and 5.9±2.19 d in control group (p=0.225). Conclusion: Adding GI to the standard treatment of DKA reduced average time of recovery from DKA, without incurring episodes of hypoglycemia and hypokalemia. This also reduced in the time of recovery from DKA, amount of required insulin and the duration of hospitalization. It seems that the non-significant difference in the time of recovery from DKA be related to the small sample size and study design. Further studies are recommended.

Expression of Proliferating Cell Nuclear Antigen (PCNA) in Oral Submucous Fibrosis: An Immunohistochemical Study

Roopavathi Keshav, Umashree Narayanappa

Background and objectives: Expression of Proliferating Cell Nuclear Antigen (PCNA) well-correlates with the cell division. The suprabasal expression of PCNA is considered to be a marker of dysplastic oral mucosa indicating a special proliferative cellular state in those lesions. Oral submucous fibrosis (OSMF) is considered to be a premalignant condition with potential to get transformed into oral squamous cell carcinoma (OSCC). The present study was done to assess the PCNA expression in different grades and in different layers of epithelium of OSMF and to compare the expression of PCNA in OSMF with OSCC. Materials and Methods: A group of 40 histopathologically diagnosed, formalin fixed, paraffin embedded tissue samples were included in study. The study group was further divided into 2 groups; 30 OSMF and 10 OSCC. Theses samples were collected from Department of Oral and Maxillofacial Pathology, Government Dental College and Research Institute, Bangalore. The samples were subjected to immunohistochemical method using indirect immunoenzyme LSAB method. Results: All 40 cases showed positivity for PCNA. The percentage of positive cells was more in basal and suprabasal layer both in OSMF and OSCC, whereas the greater percentage of positive cells was seen in the superficial layer of OSCC. All OSMF cases showed positive expression in basal and suprabasal layer and only 77% of cases showed positive PCNA expression in the superficial layer with variable immunoreactivity and 23% did not show any positive staining in the superficial layer. The percentage of positive cells and the intensity of staining increased as the disease severity increased in OSMF. Conclusion: Increased proportion of cells expressed PCNA staining which are in proliferative layers of OSMF. This biomarker provides an insight into the biological behaviour of the condition that substantiates its potentially malignant nature and may also provide an intermediate end point in chemotherapeutic trials.

Abdominal Tuberculosis: A Diagnostic Dilemma

Seema Awasthi, Manoj Saxena, Faiyaz Ahmad, Ashutosh Kumar, Shyamoli Dutta

Background: Abdominal tuberculosis (TB) is the sixth most common form of extra-pulmonary site of infection after lymphatic, genitourinary, bone and joint, miliary and meningeal TB with a rising incidence in recent years. TB can affect any part of the gastro-intestinal (GI) tract including anus, peritoneum and hepato-biliary system. The clinical manifestations of abdominal tuberculosis are non-specific and mimic various GI disorders and cause delay in diagnosis and management. Aim: To evaluate the various clinical, radiological and microbiological findings of abdominal tuberculosis and to define the role of histopathological examination in establishing the diagnosis in resource poor settings and to analyze the compliance and response to anti-tubercular treatment. Materials and Methods: A five year retrospective study (January 2010 to December 2014) was done in a tertiary teaching hospital in Northern India and all the cases diagnosed as abdominal tuberculosis during the study period, were included. The relevant clinical informations, laboratory results, microbiological and radiological investigations were recorded. Histopathological examination of all the resected / excised specimens was done and Ziehl-Neelsen (ZN) staining to detect the tubercular bacilli and Periodic acid-Schiff (PAS) stain to rule out fungal infection was done in all the cases. Results: Out of 48 cases with abdominal tuberculosis, the average age of presentation was 27.4 years with a slight male predominance (Male:Female=1.4:1). Abdominal pain (100%) was the most common presenting symptom followed by anorexia (98%), fever (88%) and intestinal obstruction (88%). The ileum was the most common site of involvement. All the 45 resected / excised tissue specimens (34 cases of intestinal resection and 11 cases of intesinal, omental and lymph nodes biopsies) showed epithelioid granulomas along with necrosis (in 38 cases) and Langhans giant cells (in 42 cases). Acid Fast Bacilli (AFB) positivity was seen in 5 tissue specimens only. All patients were put on anti-tubercular treatment and majority showed good response to therapy. Conclusion: Abdominal tuberculosis should be considered as a differential diagnosis in patients with vague GI symptoms. Study of histopathological findings can aid in the diagnosis in the settings where advanced molecular methods of diagnosis are not available, leading to early diagnosis and management.

Clinical Implications of Preformed Archwire Selection on the Treatment of Angle Class I/II division 1 Malocclusions in Thais

Kittipong Dacha, Pornrachanee Sawaengkit, Jiraporn Chaiwat, Montip Tiensuwan

Introduction: The dental arch forms were compared of untreated Class I and Class II div 1 malocclusions to those of non-customized preformed archwires manufactured by American Orthodontics, G&H, Highland, Ormco, RMO, and 3MUnitek. Arch forms of post-treatment Class II div 1 malocclusions treated by four 1st premolar extractions are also compared. Materials and Methods: Four metrics of archform shape and size (canine and 1st molar depth and inter-canine and inter 1st molar width) were measured on dental casts of 40 Class I and 22 Class II div 1 patients. These same metrics were also used to describe preformed archwire forms. Results: Non-customized preformed wires all showed significantly narrowed mandibular arch forms. This was true for maxillary archwires, with four exceptions. The Highland Natural Arch form, G&H True form I, and RMO natural preformed archwires showed both inter-canine and 1st molar widths statistically the same as mean dental arch widths in both the untreated and post-treatment Class II groups. In Class I patients, these three archwires showed only inter-canine widths equivalent to dental measurements. The Highland Progressive archwire matched only the 1st molar width in the untreated Class II group. Conclusion: None of these archwires – if used unadjusted, will produce a significant expansive force in either the maxillary or mandibular arch. Three maxillary non-customized preformed archwires showed both inter-canine and 1st molar arch widths statistically the same as Thai Class II div 1 dental arch dimensions. Using them to treat this malocclusion should minimally affect both pre and post-treatment maxillary arch form.

Comparison of Two Therapeutic Regimes, Lenalidomide with Dexamethasone and Thalidomide with Dexamethasone, in the Treatment of Multiple Myeloma at a Tertiary Care Hospital in India

Background: Multiple myeloma accounts for 1% of all neoplastic disorders and 10% of all haematological malignancies. Drugs like thalidomide, lenalidomide and bortezomib have emerged as active drugs in the treatment of multiple myeloma.There are few studies which have compared thalidomide-dexamethasone (thal/dex) and lenalidomide-dexamethasone (len/dex) in the treatment of multiple myeloma in Indian scenario Aim: To compare the efficacy and the adverse events observed with thalidomide-dexamethasone and lenalidomide-dexamethasone in the treatment of newly diagnosed cases of multiple myeloma. Settings and Design: Observational Study conducted in tertiary care centre. Materials and Methods: The case record files of patients from the year January 2006 to July 2011 with diagnosis of multiple myeloma were studied. Statistical Analysis: Primarily Descriptive. Results: There was no significant difference in between thal/dex and len/dex treatment groups with respect to efficacy and safety in our study. Conclusion: Studies with larger sample size and a longer follow up to compare efficacy and safety of thal/dex and len/dex in treatment of multiple myeloma are required to be carried out to provide significant results.

A Study on Prevalence of Phenyl Thiocarbamide (PTC) Taste Blindness Among Obese Individuals

Introduction: Taste blindness to the phenylthiocarbamide (PTC) is an inherited trait that is shown to influence our food and dietary preferences which in turn influence our body weight. Obesity is a global epidemic issue known to be on rise among the developing countries. Relating taste perception to obesity, the present study was undertaken to assess the prevalence of phenylthiocarbamide (PTC) taste blindness among obese individuals. Materials and Methods: Three hundred and fifty individuals of age group 20-40 y were recruited from the local community for the present cross sectional study. Anthropometric measurements were taken and BMI was calculated. Subjects were classified as underweight, normal, overweight and obese based on their BMI. Normal, overweight and obese individuals were then asked to taste the commercially available PTC test papers and classified as non tasters and tasters of PTC. Results: Out of 350 individuals, mean age group of 30±6.02 y, based on their BMI they were divided into 4 groups, Group A-underweight (16%), Group B-normal (35%), Group C-overweight (28%) and Group D-obese (21%) individuals. In group B, 28% were non tasters of PTC and 65% were tasters. In group C, 82% were non tasters and 13% were tasters and in Group D, 81% were non tasters and 19% were tasters of PTC. The PTC non taster phenotype individuals showed higher BMI as compared with the tasters’ phenotype. Conclusion: Exploring the novel connections between taste perception and obesity would help us to gain a control over the global epidemic-Obesity, which is the crux factor for various other health problems. The study advocates the usage of PTC tasting as a reliable indicator of weight gain susceptibility.

Concentration of Fluoride in Cow´s and Buffalo´s Milk in Relation to Varying Levels of Fluoride Concentration in Drinking Water of Mathura City in India– A Pilot Study

Aim: To estimate fluoride concentration in drinking water, cow’s milk and buffalo’s milk and to correlate the concentration of fluoride in cow’s milk and buffalo’s milk with varying levels of fluoride concentration in drinking water. Materials and Methods: Ten households having both cows and buffalo's were selected by convenience in each of the 3 zones (below optimum fluoride <0.7 ppm (parts per million), optimum fluoride 0.7-1.2 ppm and above optimum fluoride areas > 1.2 ppm). From these selected households, 200 ml of fresh milk of both cows and buffaloes was collected along with 200 ml of drinking water for estimation of fluoride concentration by using a fluoride ion selective electrode method. The data was analysed using SPSS, version 11.5 for windows. Results: The mean fluoride concentration of drinking water, cow’s milk and buffalo’s milk in three different fluoride zones was 0.89±0.39, 0.09±0.07, 0.09±0.08 respectively. Pearson’s correlation found a statistically significant correlation between fluoride concentrations in cow’s and buffalo’s milk with varying levels of fluoride concentration in drinking water in zone B and zone C. However, this correlation was not statistically significant in zone A. Conclusion: With an increase in fluoride concentration in drinking water there was an increase in concentration of fluoride in cow’s and buffalo’s milk. We conclude that this association is seen in conjunction to not only a single factor but rather due to culmination of several other aspects. So, there is a need to elucidate the other factors that might be contributing to this increase and dental fluorosis.

A Study on Longevity of Immune Response after Vaccination with Salmonella Typhi Vi Conjugate Vaccine (Pedatyph™) in Children

Background and Objectives: Owing to the limitations of the conventional polysaccharide vaccines, global efforts have been made to develop conjugated polysaccharide vaccines for typhoid. Duration of immune response induced by these vaccines is critical to define the efficacy and frequency of required booster dose. This study was done to determine the duration of immune response following vaccination with Salmonella Typhi Vi conjugate vaccine (Pedatyph™) in children and to assess the booster effect of second dose of conjugate typhoid vaccine. Materials and Methods: Forty children were recalled from a cohort of 400 children, who received one dose or two doses of PedaTyph™, 30 months after vaccination. Ten non-vaccinated children were also recalled. Their serum samples were assessed by ELISA for anti Vi antibody. Results: Significantly high titers of anti-Vi polysaccharide IgG antibodies were present in vaccinated children even after 30 months of vaccination as compared to non-vaccinated children. Geometric mean titers (GMT) with 95% confidence intervals were 14 (4.8-29.8), 17 (7.4-33) and 6.4 (0.8-12) µg/ml for single dose, two doses and control group respectively. The children in two doses group had higher antibody titers as compared to single dose group. However, the difference was not significant. Interpretation and Conclusion: PedaTyph™ was found to induce long term immune response as evidenced by presence of significant anti-Vi polysaccharide antibodies after 30 months of vaccination. No significant advantage of two doses regimen over one dose was found. Hence one dose vaccination with PedaTyph™ is suggested.

The Association Between Psychological Factors and Orofacial Pain and Its Effect on Quality of Life: A Hospital Based Study

Anil Kumar nagarajappa, Neha Bhasin, Sreedevi reddy

Objective: To examine the hypothesis that psychological factors of psychological distress and perception of unhappiness in childhood are associated with self reported orofacial pain and to examine whether such patients have a poorer perception of their oral health related quality of life and if so then to what extent. Materials and Methods: A cross-sectional hospital based study was conducted in Hitkarini Dental College and Hospital, Jabalpur amongst 400 cases and 400 controls. Patients were included based on Locker and Slade’s criteria. Patients were asked to complete 27 items Questionnaire which included the General Health Questionnaire to assess for psychological distress and Oral Health Impact Profile-14 for evaluating impact on quality of life. Bivariate and logistic regression analyses were performed to determine the degree of association between psychological factors, unhappy childhood and quality of life. P-value of less than 0.05 was considered statistically significant. Results: An increased propensity to report orofacial pain was seen for those individuals with higher levels of Psychological Distress and with perception of Unhappiness in Childhood. These individuals also reported with poorer perception of their oral health related Quality of Life. Conclusion: The present study has shown relationship between Orofacial Pain, Quality of Life and Psychological Factors.

A Comparative Evaluation of Shear Bond Strength Between Two Commercially Available Heat Cured Resilient Liners and Denture Base Resin with Different Surface Treatments

Background: Soft denture liners are widespread materials used in prosthetic dentistry. Their mechanical properties have to meet several key requirements such as adequate bond to denture base resins in order to provide right function of masticatory system and oral hygiene. Aim: To evaluate and compare the shear bond strength between two commercially available liners and polymethyl methacrylate (PMMA) denture base resin with different surface treatments. Materials and Methods: The two soft denture liners - Luci-Sof (silicone based liner) and Super-Soft (acrylic based liner) and a polymethyl methacrylate denture base resin (Trevalon) were chosen for the study. A total of 80 samples were made, 40 each for each of the two materials under investigation. The 40 samples were further divided into four groups, containing 10 samples each. Group I: Consisted of an untreated surface of polymethyl methacrylate which acted as the control. Group II: The surface of polymethyl methacrylate surface was sandblasted. Group III: The polymethyl methacrylate surface was treated with monomer. Group IV: The lining material was processed with acrylic resin dough. The samples after thermocycling for 500 cycles with temperatures from 5° ± 1°C to 55° ± 1°C and a 60 sec dwell time were subjected to shear loading on universal testing machine at crosshead speed of 20mm/sec. A Scanning Electron Microscope and stereomicroscope analysis of the bond interface between the liner and the denture base was conducted for all the groups of the two materials under study. Statistical Analysis: Data was analyzed using independent samples t-test, analysis of variance (ANOVA) and Post-Hoc Analysis. A significance level of a = 0.05 was used for statistical analyses. Results: The bond strength was significantly different between Super- Soft and Luci-Sof (p<0.05) for all surface treatments. The scanning electron microscopy observations showed that the application of surface treatments modified the surface of the denture base resin. Conclusions: Super-Soft exhibited significantly higher bond strength than Luci-Sof. It was observed that Super-Soft when packed with the pre-polymerized samples produced highest bond strength values among all the groups for both the materials under study. The lowest bond strength was achieved for pre-polymerized samples when packed with Luci-Sof.

Reliability of Panoramic Radiographs in the Localization of Mandibular Foramen

Karthikeya Patil, Mahima V Guledgud, Preeti Tomar Bhattacharya

Objective: The present study evaluated the reliability and accuracy of panoramic radiographs in the localization of mandibular foramen. Materials and Methods: Twenty five Indian dry human adult mandibles constituted the study material. Ten measurements were carried on each of them to evaluate the location of mandibular foramen with respect to adjacent anatomic landmarks. Panoramic radiographs were then made of the mandibles. Same distances were measured on the traced images of the radiographs. Paired t-test and Pearson’s correlation test were applied to evaluate the accuracy and reliability of panoramic radiographs in localization of mandibular foramen. Results: The mean distances measured on dry mandibles and panoramic radiographs showed statistically significant difference (p<0.05). There was strong positive correlation between the measurements on dry mandible and panoramic radiographs. Conclusion: The panoramic radiographs can serve as a guide in locating the anterosuperior point of mandibular foramen on panoramic radiographs.

Evaluation of the Analgesic Activity of Standardized Aqueous Extract of Terminalia chebula in Healthy Human Participants Using Hot Air Pain Model

Chiranjeevi Uday Kumar, Venkata Kishan Pokuri, Usharani Pingali

Background: Pain affects millions of people worldwide, opioid analgesics have been used for chronic painful conditions. Due to their adverse effects, safer alternatives would be beneficial. Terminalia chebula, with proven analgesic action has been evaluated in the hot air pain model for its analgesic activity. Aim: To evaluate analgesic activity and safety of single oral dose of Terminalia chebula using hot air pain model in healthy human participants. Setting and Design: Randomized, Double blind, Placebo controlled, Cross over study. Materials and Methods: After taking written informed consent to IEC approved protocol, 12 healthy human participants were randomized to receive either single oral dose of two capsules of Terminalia chebula 500 mg each or identical placebo capsules in a double blinded manner. Thermal pain was assessed using hot air analgesiometer, to deliver thermal pain stimulus. Mean Pain Threshold time and Mean Pain Tolerance time measured in seconds at baseline and 180 minutes post drug. A washout period of two weeks was given for cross-over between the two treatments. Results: Terminalia chebula significantly increased mean pain threshold and tolerance time compared to baseline and placebo. Mean pain threshold time increased from 34.06±2.63 seconds to 41.00±2.99 seconds (p<0.001) and mean pain tolerance time increased from 49.67± 3.72 seconds to 57.30±3.07 seconds (p<0.001). The increase in mean percentage change for pain threshold time is 20.42% (p<0.001) and for pain tolerance time is 17.50% (p<0.001). Conclusion: In the present study, Terminalia chebula significantly increased Pain Threshold time and Pain Tolerance time compared to Placebo. Study medications were well tolerated.

Exploring Factors that Influence Smoking Initiation and Cessation among Current Smokers

Which is A More Debilitating Disorder Schizophrenia or Dysthymia? - A Comparative Study

Shaunak A. Ajinkya, Pradeep R. Jadhav, Shruti Rajamani

Introduction: Schizophrenia and Dysthymia are debilitating disorders that affect general health and functioning. Studies show that both vastly affect the quality of life (QOL) of patients and cause great amount of disability. Objective: To evaluate and compare the QOL and Disability between patients with Schizophrenia and Dysthymia. Materials and Methods: A cross sectional, observational, comparative study was done in a randomly chosen sample of 30 outpatients each of schizophrenia and dysthymia. QOL was assessed using WHOQOL-BREF scale and disability was assessed using the Indian Disability Evaluation and Assessment Scale (IDEAS). Results: Patients of schizophrenia showed greater disability and poorer QOL than patients of dysthymia. The ‘Social Relationships’ domain of the WHOQOL-BREF scale was the worst affected domain in both groups of patients. Patients with dysthymia also did significantly (p=0.040) better in the ‘Psychological’ domain; while patients with schizophrenia were significantly (p=0.029) better in the ‘Physical Health’ domain. Patients with schizophrenia showed greater disability than patients with dysthymia in all the 4 domains of the IDEAS, significantly in the areas of Self care (p<0.001) and Communication-Understanding (p<0.001). Conclusion: Schizophrenia is a more debilitating disorder than Dysthymia. This assumes significance when planning rehabilitation models for these disorders.

Primary Small Cell Carcinoma of The Esophagus – An Eight Year Retrospective Study

Introduction: Primary small cell carcinoma of the esophagus is a rare and aggressive tumor. Patients present with metastatic disease and have a poor clinical outcome. The objective of the study was to correlate clinical and histopathological features of primary small cell carcinoma of the esophagus diagnosed and treated at our hospital. Materials and Methods: A retrospective study of 11 patients diagnosed with primary small cell carcinoma of the esophagus in Kasturba Hospital, Manipal between 2006 and 2014 was done. The histopathological and immunohistochemical features were correlated with clinical and endoscopic findings. Results: Eleven patients were diagnosed to have small cell carcinoma of esophagus with a male preponderance. Common presenting symptoms were dysphagia and weight loss. Majority of the patients showed mid esophageal ulceroproliferative growth. Biopsy findings were consistent with the characteristic morphology of small cell carcinoma and demonstrated immunoreactivity to neuroendocrine markers. In addition, few cases also showed adjacent squamous dysplasia/carcinoma. Most of the patients presented with metastatic disease, liver being the most common site. These patients were treated by chemotherapy and radiotherapy. Conclusion: Esophageal small cell carcinomas are aggressive tumors with high rates of distant metastasis. Presence of squamous dysplasia /squamous cell carcinoma in the adjacent mucosa supports the hypothesis that this neoplasm arise from pleuripotent stem cells. Presence of the latter is also useful to rule out spread from lung primary.

Does Hollowing of Complete Denture Enhance Retention? – A Pilot Study

Introduction: Prosthetic rehabilitation is an extremely challenging task in extreme resorption cases of the maxillary denture-bearing area. Reducing the weight of a maxillary obturator has been seen as beneficial. But whether reducing the weight of conventional complete denture also increases retention or not, is still very dubious. The aim of this pilot study was to determine the effect of maxillary denture weight on denture retention and stability. Materials and Methods: For this study, a total of 10 patients were considered for the pilot study (06 female and 04 male) with an average age of 70 y. Each patient was provided with two sets of maxillary complete dentures, one hollow labeled as A and one conventional maxillary denture labeled as B. Results: It was shown that mean values for retention using MKIS for retention for hollow dentures (A) was 7.8 and for conventional dentures (B) it was 8.2 and the stability for maxillary dentures was more with conventional dentures (B) than hollow maxillary dentures (A) and it was significant as p-value was 0.015 (p<.1). Conclusion: The denture retention and stability, chewing and comfort values of conventional dentures and hollow dentures were slightly better for conventional dentures.

Effect of Infertility on Sexual Function: A Cross-Sectional Study

Ashraf Direkvand-Moghadam, Ali Delpisheh, Azadeh Direkvand-Moghadam

Introduction: Sexual dysfunction is an important psychological disorder that may increase in infertile couples. Aim: To evaluate the effect of infertility on sexual function in women attending in private and public institutions in Ilam during 2013. Materials and Methods: In a cross - sectional study evaluated the sexual function among 384 women attending in health care centers of Ilam western of Iran during 2013. Participants were divided in two groups, fertilities and infertilities women. Data was collected by trained research midwives using demographic and FSFI questionnaires. SPSS software Package 16 was used to analyse the data of this project. Differences were regarded statistically significant with an alpha error of 0.05. Results: The mean age was 29.29 ± 6.7 years in fertile and 31.74 ± 8.07 in infertile women. Significant difference was reported in mean age between fertile and infertile women (p=0.014). The Mean± SD of all demissions of female sexual function was difference between fertile and infertile women. Sexual function was lower in infertile women. Conclusion: All dimensions of sexual function were lower in infertile women in compared with fertile women. Further research should be done on this subject and ways to address such problems should be found.

Rapid Detection of Mycobacterium tuberculosis in Sputum Samples by Cepheid Xpert Assay: A Clinical Study

Deepak Arora, Neerja Jindal, Renu Bansal, Shilpa Arora

Background and Objective: Tuberculosis (TB) is one of the commonest opportunistic infection and the leading cause of death in HIV patients in developing countries. HIV infection is a well recognised risk factor for both activation of initial infection and reactivation of latent infection. This study was done to find out the co-prevalence and the trend of HIV infection among tuberculosis patients and to determine the prevalence of MDR Tuberculosis in HIV positive patients using Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA, United States). Materials and Methods: The sputum samples are received from five districts of Punjab. Sputum samples of the patients with symptoms suggestive of pulmonary tuberculosis including both new cases and on treatment are received from the various district and civil hospitals of five districts. Sputum specimen was processed for TB detection by Cartridge Based Nucleic Acid Amplification testing (CB-NAAT) using Xpert MTB/RiF assay technology. Results: The study period is from October 2013 to September 2014. A total of 907 patients with symptoms suggestive of pulmonary tuberculosis including both new cases and on treatment. Out of these patients 733 were reported MTB detected. Out of these 907 patients 29 were reported HIV positive and out of 733 patients 19(2.5%) were reported positive for (HIV +TUBERCULOSIS). Of these 19 cases 16(84.21%) cases were sensitive to rifampicin (RIF) and 3(15.78%) cases were showing resistance to rifampicin (RIF) Drug. Conclusion: Co-existence of HIV and tuberculosis is high and there is high Prevalence of MDR tuberculosis in HIV patients.

Types, Risk Factors, Clinical symptoms and Diagnostic Tests of Acute Adult Meningitis in Northern Iran During 2006-2012

Masoumeh Bagheri-Nesami, Farhang Babamahmoodi, Attieh Nikkhah

Background: Acute bacterial meningitis is a medical emergency condition that requires prompt diagnosis and treatment and otherwise associated with serious morbidity and mortality. Aim: The aim of this study was to assess types, risk factors, clinical symptoms and diagnostic tests of meningitis in hospitalized patients of Mazandaran University of medical sciences hospitals during 2006-2012. Matherials and Methods: This is a retrospective descriptive study. Following approval of the ethics committee of Mazandaran University of Medical Sciences, records of adult patients diagnosed with acute meningitis from 2006 to 2012 were extracted from Mazandaran Provincial Health Center and patients attending hospitals affiliated to Mazandaran University of Medical Sciences. Statistical analysis: Data were analyzed with SPSS-16 using descriptive statistics (frequency, mean, standard deviation, and median). Results: In this study, of the 137 patients with meningitis, 73 (53.9%) were viral, 61 (46%) bacterial, 1 (0.7%) fungal, and 2 (1.4%) unknown. The majority of risk factors in patients were head trauma, upper respiratory infection, and drug addiction. The most common clinical signs were headache, fever, nausea and vomiting, and stiff neck. Conclusion: In this study, the incidence of meningitis was much lower than any other country. It could be due to geographic variation or incomplete recording of patient's data. It is recommended to perform a longitudinal study during the coming years on patients with meningitis.

Relationship Between Second to Fourth Digit Ratios and Benign Prostatic Hyperplasia in Aging Men

Introduction: Benign prostatic hyperplasia (BPH) is the most common prostate disease, characterized by benign enlargement of the prostate gland in aging men. Testosterone is said to be the major factor in development of BPH. The relative length of 2 nd and 4 th digit (2D:4D) is a marker for prenatal androgen exposure. A low 2D:4D ratio is associated with a high prenatal androgen exposure. The main objective of this study was to assess the causal relationship between the 2D:4D ratio and incidence of BPH. Materials and Methods: Thirty five patients with BPH were compared with 35 non BPH subjects and 35 controls recruited from general population for measures of 2D:4D ratio. BPH status was determined by clinical & radiological evaluation. Both hands of all the participants were scanned and their second and fourth digit lengths were measured and the ratio calculated. Results: In the present study, 2D:4D ratio was lower in BPH patients compared to non BPH subjects in both hands. Compared with controls, BPH patients had lower 2D:4D ratio in the right hand, but the difference between the groups in left hand 2D:4D ratios was not significant. Compared with controls, non BPH subjects had higher 2D:4D ratio in the left hand, but the difference between the groups in right hand 2D:4D ratios was not significant. Conclusion: Results of the present study indicate that individuals with lower 2D:4D ratios are at a higher risk of developing BPH and those with higher 2D:4D ratios are at a lower risk of developing BPH compared to the general population.

Association Between Gingival Crevicular Fluid Leptin Levels and Periodontal Status – A Biochemical Study on Indian Patients

Aim: The present study was carried out to evaluate and compare the gingival crevicular fluid (GCF) concentrations of leptin in periodontally healthy and diseased subjects, to compare GCF leptin levels with respect to Body Mass Index (BMI) among the study groups and essentially to obtain an insight into leptin’s possible role in the initiation and progression of periodontal disease. Materials and Methods: A total of 60 subjects; both males and females, based on their body mass index were selected for the study. They were categorized into three groups of 20 subjects each, based on their periodontal status, as follows: Group I (clinically healthy periodontium); Group II (gingivitis); Group III (chronic periodontitis). GCF samples of 1 µl were collected extra-crevicularly using black color-coded 1-5 µl calibrated volumetric microcapillary pipettes from one site in each person, and samples were analyzed for leptin using a commercially available ELISA kit. Results: The concentration of leptin in GCF of patients in Group I (2272.25 pg/mL) was statistically higher (p < 0.001) than in those of Group II (1421.86 pg/mL) and Group III (1160.67 pg/mL). No statistically significant difference was found when comparing the mean values of leptin between BMI groups in each study group. Conclusion: As periodontal disease progressed, there was a substantial decrease in the gingival crevicular fluid leptin concentration. This suggests a protective role of leptin with regard to periodontal health.

Morphometric Analysis of Axis and Its Clinical Significance -An Anatomical Study of Indian Human Axis Vertebrae

Mukesh Singla, Prabhat Goel, Mohd Salahuddin Ansari, K.S.Ravi, Satyam Khare

Background: The atlas and axis vertebra have unique shape and complex relationship with vertebral artery. Fracture of dens of axis accounts for 7-27% of all cervical spine fractures, but surgeries in these regions are highly risky because of the reported incidences of vertebral artery injury. Aim and Objectives: The study was designed to measure morphometric data of human axis vertebra, of Indian origin. The different anatomical parameters on dry specimen of human axis vertebrae were established and the results were compared with other studies. Materials and Methods: Thirty intact human axis vertebrae were measured with digital vernier caliper and mini-inclinometer. Various linear and angular parameters of axis were observed. Results: The mean distance from the midline of body to the tip of transverse process of axis was 29.32 mm on right side and 29.06mm on left side. The mean distance from the midline of body to the lateral most edge of superior articulating facet was 22.8 mm on right side and 22.6 mm on left side. The mean value of anterior and posterior height of axis was 34.33±2.69mm and 30.56±2.78mm respectively. The anterior and posterior height of body of axis was 19.67 mm and 16.67mm respectively. Mean A-P and transverse diameter of inferior surface of axis was 15.42mm and 17.7mm respectively. Mean transverse diameter and mean A-P diameter of odontoid process was 9.32 mm and 10.1 mm respectively. Mean anterior and posterior height of the odontoid process was 14.66 mm and 13.89mm respectively. Mean of dens axis sagittal angle (angle between an axis that was imagined to pass longitudinally through the dens axis and the vertical line on a sagittal plane) was 13.23 degree. The shape of superior articulating facets of C2 varies from oval to circular. In the present study, 84% of SAF were oval and 16% were circular. Inferior articulating facets were circular in shape in 90% cases, and oval in 10% vertebra. Mean pedicle width was 10.07mm on right side and 10.52mm on left side. Mean transverse diameter of vertebral canal was 22.37±1.73mm. Mean of A-P diameter of vertebral canal at inlet was 18.31±2.05mm and mean of A-P diameter of vertebral canal at outlet was 14.84±1.63mm. Conclusion: These results obtained from this study may be helpful for the surgeons in avoiding and minimizing complications such as vertebral artery injury, cranial nerve damage and injury to other vital structures while doing surgery around cranio-vertebral region.

Comparative Analysis of Clinical Factors Associated with Ocular Surface Squamous Neoplasia in HIV Infected and Non HIV Patients

Ruchi C. Kabra, Isha A. Khaitan

Introduction: Ocular surface squamous neoplasia (OSSN) refers to a spectrum of conjunctival and corneal epithelial disease ranging from dysplasia to invasive carcinoma. HIV infection is an important risk factor postulated for the development of disease. Aim: To compare and to find out any statistically significant difference in patient demographics, clinical features and pathological findings in HIV infected and non-HIV infected histologically proven cases of ocular surface squamous neoplasia (OSSN). Materials and Methods: In the present retrospective case study, data from indoor case records and ocular pathology records of histologically proven cases of OSSN was obtained. The data was then tabulated under various clinicopathological headings in HIV affected and non HIV affected groups. A chi-square test was applied to compare data of two groups and look for any significant difference between two groups. A p-value less than 0.05 was considered significant. Results: Amongst the total of 48 patients, 11 were HIV positive and 37 were HIV negative. Age of the patients ranged from 14-66 years in HIV and 22-66 years in non HIV group with a preponderance of younger age patients in HIV positive group. 54.5% patients with lesion having base more than 5mm were observed at the time of presentation in HIV positive population as compared to 21.6% in non HIV cases. Feeder vessels were seen in all HIV patients and a significantly greater degree of fornicial involvement was noted in comparison with non-HIV group. Histopathological analysis showed 63.63% of cases to be of invasive carcinoma amongst the HIV positive group and 54.05% of invasive carcinoma in non HIV group. Conclusion: Younger age and aggressive looking tumour at presentation should caution ophthalmologist to look for an undiagnosed HIV infection in OSSN patients.

The Attitudes of Dentists Towards the Prescription of Antibiotics During Endodontic Treatment in North of Saudi Arabia

Azhar Iqbal

Objective: The use of antimicrobial agents has been increased, leading to bacterial resistance. Therefore the health professionals should have a sound knowledge about the prescription of antibiotics to overcome the increasing bacterial resistance. The main objective of this study was to evaluate the attitudes of dentists towards the prescription of antibiotics during endodontic treatment in north of Saudi Arabia. Materials and Methods: This was a survey based descriptive cross-sectional study. This study has been done among the dentists of northern region of Saudi Arabia. A questionnaire was designed, regarding pattern of prescription of antibiotics by the dentists in the north of Saudi Arabia and the use of antibiotics in the treatment of different endodontic conditions during endodontic treatment. This questionnaire was distributed among 200 dentists in the north of Saudi Arabia. This study will encourage the dentists of the northern region of Saudi Arabia to be up to date about the current and prospective guidelines for the prescription of antibiotics and follow these guidelines for the antibiotic prescription. Results: The collected information was analysed by using a computer software SPSS version 18. Majority of the dentists were male accounting for 86%. The age range for 68% of the respondents was 25-35 years. Most of the dentists were having just a basic dental qualification i.e. 65.60%. Out of the total responding dentists, 50% were working in the ministry of health. 77% of the respondents prescribed the antibiotics for necrotic pulp with acute apical periodontitis; swelling present; mod/ severe preoperative symptoms. Out of the total responding dentists, 45.2% prescribed amoxicillin and clavulanic acid combination as the drug of choice. Conclusion: It is concluded from the present study that the dentists should know the scientific basis for the prescription of antibiotics during endodontic therapy. They should follow and should not neglect the current guidelines for antibiotic prescriptions. There should be community awareness programmes for the dentists regarding the misuse of antibiotics and antibiotic resistance so that they can play a role in controlling these global problems.

Adjunctive Effects of A Piscean Collagen-Based Controlled-Release Chlorhexidine Chip in the Treatment of Chronic Periodontitis: A Clinical and Microbiological Study

Introduction: PerioChip a bovine origin gelatine based CHX chip has shown beneficial effects in the management of Chronic Periodontitis. A new fish collagen based CHX chip similar to PerioChip is currently available; however this product has not been thoroughly researched. Aim: The aim of the present study was to evaluate the effectiveness of a new Piscean collagen-based controlled-release chlorhexidine chip (CHX chip) as an adjunctive therapy to scaling and root planing (SRP). Settings and Design: The study was conducted as a randomised, split-mouth, controlled clinical trial at Krishnadevaraya College of Dental Sciences, Bangalore, India. Materials and Methods: In a split–mouth study involving 20 sites in 10 patients with chronic periodontitis, control sites received scaling and root planing and test sites received scaling and root planing (SRP) and the intrapocket CHX chip placement as an adjunct. Subgingival plaque samples were collected from both control and test sites at baseline, 11 days and 11 weeks and the anaerobic colony count were assessed. Clinical parameters that were recorded at baseline and 11 weeks were gingival index, Plaque index, Probing pocket depth (PPD), and Clinical attachment level (CAL). Plaque index was recorded additionally at 11 days. Results: In the test group there was a statistically significant reduction in the total anaerobic colony count, gingival index and plaque scores from baseline as compared to control sites at all time intervals. An additional 0.8mm reduction in mean probing pocket depth was noted in the test group. Gain in Clinical attachment level was comparable in both groups. Conclusion: The adjunctive use of the new collagen-based CHX chip yielded significant antimicrobial benefit accompanied by a reduction in probing depth and a clinical attachment level gain as compared to SRP alone. This suggests that it may be a useful treatment option of nonsurgical periodontal treatment of chronic periodontitis.

Cost Analysis of Commonly used Combination of Drugs in Primary Open Angle Glaucoma

Background: Glaucoma is second cause of blindness in the world. The financial burden on the patient during long-term treatment is immense and affects the compliance to medications, thus visual morbidity. Objective: To analyse economic impact of three commonly used drug combinations (Dorzolamide + Timolol = DT; Brimonidine + Timolol = BT; Latanoprost+Timolol = LT) in primary open angle glaucoma. Materials and Methods: This observational, prospective study was undertaken at M & J Institute of Ophthalmology, Civil Hospital, Ahmedabad, a western regional institute of Ophthalmology. A total of 257 patients were included in the study. Only101 patients could complete the 6 month follow-up, of which 35, 34 and 32 patients belonged to DT, BT and LT group respectively. Cost of drug, details of the transportation were noted at every visit. Total cost incurred per patient/eye was calculated. Cost effectiveness was calculated by cost per mm Hg IOP (Intra-Ocular Pressure) reduction. Results: Treatment with DT, BT & LT group consumed 8.6%, 4.6% and 7.7% of the per annum income of the family, respectively. Cost of medications per annum (in INR)/eye for DT, BT & LT group were 2562 ± 15.74, 1544 ± 32.06, 3876 ± 73.68 (Mean±SEM) respectively. Additional cost of travelling was different for patients coming from Ahmedabad (Locals) and outsiders (patients coming outside Ahmedabad, India). Outsiders has to bear the brunt of higher transport charges, where they spent an average of Rs. 914, 856 & 933 per annum (5 follow-ups), whereas, Locals spent an average of Rs. 104, 112, 100 for DT, BT & LT group respectively. Conclusion: Treatment with BT was found to be most cost-effective among three groups. Drug therapy takes substantial amount from per annum income of family and was an important compliance factor in the treatment of POAG.

Imaging and Serological-Evidence of Neurocysticercosis Among Patients with Seizures in Odisha, an Unexplored Eastern Coastal Province in India

Introduction: Neurocysticercosis being a potential to human transmitted disease, is the major cause of seizures and a public health problem in tropical countries. Though India is known to be highly endemic, there are many provinces where reports are still unavailable thereby underestimating its actual burden. Materials and Methods: Anti-Cysticercus IgG antibodies in sera from cases presenting with seizures were screened by ELISA in a preliminary study in Odisha state which is a province in Eastern coastal India that was never explored before. Patients presenting with recent onset of seizures within age group 5 to 50 years, either local residents of Odisha or inhabitants from other parts of the country living for at least one year period in the study area were included. Results: The present study showed 43.75% cases with seizures to be confirmed neurocysticercosis (NCC) based on serology and brain imaging. However, statistically no association was established between anti-Cysticercus antibody detection and radio imaging characteristics (location, number of lesions, and stage). Conclusion: This is the first study in Odisha presenting a series of cases with serological evidence of exposure to the parasite along with imaging characteristics which was consistent with NCC. It is recommended that NCC must be considered for a differential diagnosis in each active epilepsy case irrespective of prior prevalence information in all unexplored provinces in India and other endemic regions; also a compulsory reporting is warranted in order to aid in quantifying its actual burden.

Comparative Effects of Clonidine and Adrenaline with Lignocaine during Maxillary Infiltration Anaesthesia for Dental Extraction

Samson Jimson, Sree Ranjani S, Sthithaprajna Lenka, Sudha Jimson

Introduction: Lignocaine is a commonly used local anaesthetic in dental practice. Many practitioners use adrenaline (epinephrine) as additive with lignocaine, and some have used clonidine, instead of adrenaline. Both having benefits and limitations. Aims: Hence a study was undertaken in our department to evaluate the advantages and disadvantages of using (plain lidocaine local anaesthetic) versus (lidocaine with adrenaline as additive) versus (lidocaine with clonidine as additive). Study Design: Randomised, prospective, double blind study. Materials and Methods: Seventy five patients requiring extraction of maxillary molar teeth who fall under ASA I category were included and randomly divided into group – I (n=25) (Lignocaine), group – II (n=25) (Lignocaine ± Adrenaline) and group – III (n=25) (Lignocaine ± Clonidine). The observations recorded were, time of onset of anaesthesia, hemodynamic parameters, blood loss during procedure and duration of post operative analgesia. Statistical Analysis:The statistical analysis was carried out using SPSS 16 software. Results: A statistically significant difference was seen in blood loss, being higher in group I and duration of anaesthesia, being shortest in group I. There was no statistical difference between the three groups amongst other parameters. Conclusion: Adrenaline at 10 µg/ml and clonidine at 15 µg/ml can be safely used as additives with lignocaine, in maxillary infiltration anaesthesia for dental extraction; with addition of either of these two drugs, having an equal advantage over use of plain lignocaine; in terms of lower blood loss and longer duration of anaesthesia; but, with no difference in the onset of anaesthesia and with no significant hemodynamic changes.

Fast Food Consumption Pattern and Its Association with Overweight Among High School Boys in Mangalore City of Southern India

Context: Fast foods are quite popular among children owing to taste, appearance and hype created by mass media. However, the increased incidence of lifestyle disorders seen now-a-days at an early age could be attributed to fast foods. Aim: This study was done to assess the awareness of health hazards, consumption pattern of fast foods and to find out its association with overweight among high school students. Settings and Design: This cross-sectional study was done among boys of 3 private schools in Mangalore city in March 2012. Materials and Methods: Data was collected using a semi-structured self-administered questionnaire. Statistical Analysis: Chi-square test, one-way ANOVA and binary logistic regression analysis was used for analysis. P-value = 0.05 was considered as statistically significant association. Results: Mean age of boys was 13.5±0.9 years. Out of 300 participants, 41(13.7%) were overweight and 8 (2.7%) were obese. 292(97.3%) were fast food users of which 42(14.4%) consumed it every day. Majority of participants were introduced to fast foods through television commercials 193(64.3%). 73(57%) developed this habit as they were bored with home food. Awareness of harmful effects of fast food consumption was known to 186(62%) students and this was found to be associated with the perceived need to control its usage (p<0.001). Parental consumption of fast foods was found to influence fast food consumption among children (p=0.024). As many as 68(22.7%) and 206(68.7%) children were not eating vegetables and fruits respectively every day. Increased frequency of fast food consumption in a week was found to be associated with overweight or obesity among children after adjusting the effects of confounders (p=0.003). Conclusion: Awareness on health hazards of fast foods needs to be taught at schools so as to minimize its consumption. Parents have to set an example themselves by not eating fast foods and improving home food to support discouragement of fast foods. This would minimize life style disorders among children to a greater extent.

Manipal Cervical Scoring System by Transvaginal Ultrasound in Predicting Successful Labour Induction

Neha Bajpai, Rajesh Bhakta, Pratap Kumar, Lavanya Rai, Shripad Hebbar

Introduction: Induction of labour (IOL) nowadays is a common procedure in obstetric practice. The success of IOL largely depends upon “favourability” or “readiness” cervix which is traditionally assessed by manual examination and Scored as Bishop Score. However, this method is limited by subjectivity and reproducibility and though done in all the patients prior to IOL, several studies have demonstrated poor correlation between Bishop Score and outcome of labour. Objective: To evaluate the role of preinduction transvaginal ultrasonographic (TVS) cervical assessment in predicting labour outcome and to compare its performance against Bishop Score in patients undergoing induction of labour (IOL). Setting: A tertiary medical college hospital in Southern India. Design: Prospective observational and investigational study. Materials and Methods: Transvaginal ultrasound was performed in 131 patients who underwent labour induction at term with intact membranes and live fetus. Bishop Score was assessed by pervaginal examination and was compared with preinduction TVS cervical Score (parameters being cervical length, funneling, position of cervix and distance of presenting part from external os). Labour was induced within one hour of cervical assessment. The labour induction was considered successful if patient could get into active labour i.e., onset of regular uterine contractions (at interval of 2-3 minutes) and cervical dilatation of 4 cm or greater within 24 hours of induction. Results: Labour induction was successful in 86.9% of patients. At cut off Scores of = 4, TVS cervical Score performed better than Bishop Score (Sensitivity 77% vs. 65%, Specificity 93% vs. 86%). ROC analysis indicated that Area Under Curve (AUC) was more for TVS Score (0.90, 95% CI 0.84 – 0.95), compared to Bishop Score. It was found that an increase in cervical length and distance from the os by 1 mm from their means were associated with an increase in odds for failure of induction and there by caesarean delivery by 6.5% and 11% respectively. Conclusion: In women experiencing labour induction, transvaginal ultrasound score comprising of five different parameters indicated success of induction better than Bishop Score. Further, two of its components (longer cervical length and increased distance of presenting part from external os) demonstrated significant and independent prediction of the likelihood of failure of induction and risk of operative delivery.

Estimation of Salivary Glucose and Glycogen Content in Exfoliated Buccal Mucosal Cells of Patients with Type II Diabetes Mellitus

Rathy Ravindran, Deepa Moothedathdathu Gopinathan , Sunil Sukumaran

Background: Diabetes mellitus is a common metabolic disorder which shows an increasing incidence worldwide. Constant monitoring of blood glucose in diabetic patient is required which involves painful invasive techniques. Saliva is gaining acceptance as diagnostic tool for various systemic diseases which can be collected noninvasively and by individuals with limited training. Aim: The aim of the present study was to analyse the possibility of using salivary glucose and glycogen content of buccal mucosal cells as a diagnostic marker in Type II Diabetes mellitus patients which can be considered as adjuvant diagnostic tool to the gold standards. Materials and Methods: Sample consists of 30 study and 30 control groups. Saliva was collected by passive drool method.Intravenous blood samples were collected for glucose estimation. Exfoliated buccal mucosal cells were collected from apparently normal buccal mucosa, smeared on dry glass slide and stained with PAS. Blood and salivary glucose are estimated by Glucose Oxidase endpoint method. For Glycogen estimation, number of PAS positive cells in fifty unfolded cells was analysed. Results: The results of the present study revealed a significant increase in the salivary glucose level and the number of PAS positive buccal mucosal cells in the diabetics than in the controls. The correlation between the fasting serum glucose and fasting salivary glucose and also that between fasting serum glucose and PAS positive cells was statistically significant. But the correlation between the staining intensity and fasting serum glucose was statistically insignificant. Conclusion: With the results of the present study it is revealed that salivary glucose and PAS positive cells are increased in diabetics which can be considered as adjuvant diagnostic tool for Diabetes mellitus.

Immunization in Patients with Rheumatic Diseases: A Practical Guide for General Practitioners

Piyush Ranjan, Avinash Chakrawarty, Archana Kumari, Jitendra Kumar

Patients with rheumatic diseases are susceptible to various infections throughout the course of the disease. The increased risk of infections can be attributed partly to the aberrant immune system and partly to the effect of immunosuppressive drugs used in the treatment of the disease. Immunization appears to be an excellent strategy to prevent infections in such patients. However, the effect of vaccines in these patients is modified due to disease per se and/or immunosuppressive drugs. Biological agents, that frequently increase the susceptibility to infections, are now being initiated earlier in the course of the disease and also for new indications. Thus, concerns regarding safety, efficacy and potential adverse effects of vaccines in these patients are more complex than in any other immunosuppressive conditions. Different patients show different amount of immunosuppression in response to disease modifying drugs. Besides, there is lack of adequately powered randomised controlled trials investigating the efficacy of a vaccine in terms of actual prevention of the disease. Pneumococcal and influenza vaccines are the most studied vaccines and they are strongly recommended in rheumatic patients. In general, live vaccines should be avoided among patients receiving high doses of immunosuppressive drugs. However, they may be given to patients receiving low dose steroids and methotrexate. Non-live vaccines may be administered as per the recommendations of national guidelines. There is necessity to increase awareness among patients and doctors towards promoting the appropriate and judicious use of vaccines in the patients with rheumatic diseases.

Surgery for Colorectal Cancer in Elderly Patients: How Could We Improve Early Outcomes ?

Background: Age is one of the causes behind the undertreatment of elderly colorectal cancer patients. The increase of mortality among elderly colorectal cancer (CRC) patients is due to competing causes of death occurring in the early post operative period. The purpose of this study was to evaluate the risk factors for post operative mortality and morbidity among elderly CRC patients. Materials and Methods: A retrospective descriptive chart review was performed on consecutive patients older than 70 y with CRC. We have collected data of 124 patients who were admitted from January 2001 to January 2010. Demographic characteristics, operative and postoperative informations were retrospectively analysed. Results: Early postoperative morbidity, operation related to morbidity and mortality were observed in 44 (35.5%), 9 (7.3%) and 20 (16.1%) cases, respectively. No other factors but ASA score (p = 0.002 and 0.005 in univariate and multivariate analyses, respectively) and emergency operations (p<0.001 and 10-3 in univariate and multivariate analyses, respectively), were found to be risk factors of mortality. The results of multivariate analyses indicated that anaemia (p=0.021) and rectal cancer (p=0.015) had significant impact on the risk of anastomotic leakage. On the other hand, diabetes mellitus and rectal cancer were indicators that correlated with the width of hospitalization. Conclusion: Elderly CRC patients should no longer be undertreated only because of their age. They should be exposed to more aggressive management than they are currently receiving. Careful preoperative evaluation, followed by medical optimization and planning of perioperative care could improve outcomes of colorectal surgery for elderly patients.

Assessment of Quality of Life (QOL) in Obsessive Compulsive Disorder (OCD) and Dysthymic Disorder (DD): A Comparative Study

Introduction: There is paucity of data on Quality of Life (QOL) in non-psychotic mental disorders. Aim: To assess the Quality of Life (QOL) in Obsessive Compulsive Disorder (OCD) and compare it with Dysthymic Disorder (DD). Materials and Methods: This hospital based cross-sectional study was conducted in 30 patients each diagnosed to have OCD and DD during October 2009 to September 2011 in a medical institution in Davanagere, Karnataka, India. DSM-IV-TR (Diagnostic statistical manual-IV-Text Revised) criteria was used for diagnosis of OCD and DD. Yale Brown Obsessive Compulsive Scale (Y-BOCS) and WHO QOL BREF (brief form) scales were used. Data was analysed by independent sample t-test. Results: Overall QOL score was 51.07(SD=11.47) and 50.91(SD=7.41) in OCD and DD groups respectively. QOL score was comparatively low in psychological domain with score of 44.12(SD=14.14) and 45.10(12.35) in OCD and DD respectively. There was no significant difference in the QOL score of the two groups with respect to socio demographic variables in OCD group, but it was different with respect to place of residence in DD group (p<0.05). In Q1(perception on quality of life) and Q2 (perception on quality of health) domain, QOL score was marginally higher than average in both the groups. In Y-BOCS scale, no statistical significant association was found between severity of OCD and QOL score in each of the domains (p>0.05). Conclusion: Overall QOL score was average and there was no significant difference of QOL score between the OCD and DD groups implying that both these non-psychotic mental disorders may have same influence or effect on QOL of the subjects. Further analytical studies will explore the associated factors of QOL in OCD and DD.

Toothbrush Handles Individually Adapted for Use by Elderly Patients to Reduce Biofilm on Complete Dentures: A Pilot Study

Introduction: Reduction of biofilm on dentures is important for maintaining denture wearers’ health. Objective: The aim of this study was to assess the effectiveness of toothbrush handles individually adapted in reducing of biofilm on dentures. Materials and Methods: Study participants were 16 residents of the condo for the elderly, denture wearers, functionally independent and without cognitive impairment. Participants were randomly divided into two groups: Group 1 (adapted toothbrush handles) and Group 2 (conventional toothbrush). Biofilm from the inner surface of the basal area of the denture was observed using 5% erythrosine. Images obtained before starting the use of toothbrushes, after 7 and 21 days were sent for computer analysis. Results: The average amount of biofilm on the first day was considered severe in both groups. At the end of the experiment, the average biofilm coverage in Group 1 was 44.7% (13.1% reduction) and in Group 2 it was 48.6% (4.8% reduction). However, the Friedman analysis of variance test showed that the reduction was statistically significant (p< 0.05) only in Group 1, demonstrating the effectiveness of the adapted brushes. Conclusion: The findings of this pilot study indicated that for the reduction of biofilm on dentures the adapted toothbrush handles were superior to the conventional type.

Effect of Prolonged Use of Mobile Phone on Brainstem Auditory Evoked Potentials

Naveenta Gupta, Darshan Goyal, Rajiv Sharma, Khushdeep Singh Arora

Correlation Study Between HCV Genotypes Distribution Pattern and Viral Load in a Tertiary Care Hospital in Kolkata, India

Background: Hepatitis C virus infection is a leading cause for chronic liver disease. It has wide population specific genotype variability. Genotype knowledge and viral load assessment are equally important for designing therapeutic strategies and as predictors of treatment outcome among hepatitis C (HCV) infected patients. Materials and Methods: Between June 2012 and 2013 an observational study was conducted among 350 chronic hepatitis patients visiting Calcutta National Medical College, Kolkata, India. Among them, 110 anti-HCV antibody positive cases were diagnosed and subjected to viral RNA extraction, viral genotyping and viral load quantification using polymerase chain reaction (PCR) based techniques. Statistical Analysis: Statistical analysis was done with IBM SPSS Statistics software, version 20. p-value <0.05 was regarded as statically significant. Results: Among 66 HCV RNA positive cases, genotypes 1a, 3a and 3b were observed among 18 (27%), 44(67%) and 4(6%) cases respectively. Genotype 3a had higher viral load than patients infected with genotypes 1and 3b. However, no statistical significance was observed for viral load among the various HCV RNA genotypes. Conclusion: Genotype 3a accounted for the highest number of cases with positive HCV RNA. However, no statistically significant difference existed for viral load among the various HCV RNA genotypes in this study.

Serological Analysis of Alpha-synuclein and NF-?B in Parkinson’s Disease Patients

Vineeta Gupta, Ravindra Kumar Garg , Sanjay Khattri

Introduction: Several investigations have been made to determine the level of alpha-synuclein in the peripheral blood of Parkinson’s disease patients, but the results were very contradictory and inconclusive. Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-?B) was also found to be involved in Parkinson’s disease, but there is a lack of studies investigating NF-?B in Parkinson’s disease patients. As far as our knowledge goes, no study reported the level of NF-?B in serum of Parkinson’s disease patients. In this context, present study was designed to make a baseline study in order to evaluate the levels of total alpha-synuclein and NF-?B in serum of Parkinson’s disease patients. Materials and Methods: Serum samples were collected from Parkinson’s disease patients (n=97) and healthy controls (n=97). Their levels were determined by using Enzyme linked immunosorbent assay. Results: The levels of total alpha-synuclein (patients=5.79±2.24 ng/ml, controls=6.20±1.61 ng/ml; p=0.14) and NF-?B (patients=1.38±0.99 ng/ml, controls=1.65±1.00 ng/ml; p=0.71) were lower in Parkinson’s disease patients than controls, but the differences were not statistically significant. This difference was also failed to reach significance between males (alpha-synuclein (p)=0.70, NF-?B (p)=0.84) and females (alpha-synuclein (p)=0.06, NF-?B (p)=0.77) in both the groups as well as within the groups. The levels of total alpha-synuclein and NF-?B were also not associated with Parkinson’s disease severity (alpha-synuclein (p) = 0.84, NF-?B (p) = 0.73). Conclusion: A non-significant difference in the levels of total alpha-synuclein and NF-?B between Parkinson’s disease patients and controls suggested that these are not valuable biomarkers for Parkinson’s disease, more specifically in Indian population.

Quantitative Assessment of Calcium Profile in Whole Saliva From Smokers and Non-Smokers with Chronic Generalized Periodontitis

Megha Varghese, Shashikanth Hegde, Rajesh Kashyap, Arun Kumar Maiya

Background: Measures of in vivo calcium status are important in understanding the mineralization capacity as it is an essential mineral component of both teeth and bone; and also play a vital role in the lipid profile and hormonal balance. Aim: To evaluate the existence of any disturbances in calcium metabolism and absorption induced by smoking, by quantitatively assessing the variations in the salivary calcium level between smokers and non-smokers with periodontitis and relating to their periodontal status. Materials and Methods: A total of 50 male patients were selected and categorized as Group I (smokers with chronic generalized periodontitis) and Group II (non-smoker/ non-tobacco users with chronic generalized periodontitis). Clinical parameters such as Calculus Index and Community Periodontal Index were assessed. Subsequently two ml of unstimulated whole saliva was collected and subjected to biochemical analysis for the estimation of salivary calcium which was carried out in the next 20 min. Results: Salivary calcium levels were significantly higher in Group I (2.2700) compared to Group II (1.7260). Higher calculus index and CPI index score were also seen in Group I when compared to Group II. Conclusion: Elevated salivary calcium level among the Group I emphasize the decreased calcium absorption efficiency among the smokers. High salivary calcium content hardens plaque more rapidly, indirectly influencing the level of oral hygiene.

Evaluation of Oral Changes Among Tobacco Users of Aljouf Province, Saudi Arabia

Mohammed Ahmed AlJabab, Abdallah Ahmed Aljbab, Santosh R Patil

Objective: To know the prevalence of tobacco associated changes among male population of Aljouf province of Saudi Arabia. Materials and Methods: This study included 536 male subjects with positive history of tobacco habits. All the participants were asked to fill a questionnaire regarding the habit details and were examined clinically for the oral changes. Results: Majority of the subjects used tobacco in smoked form (69.0%). Out of the 536 patients with tobacco smoking and chewing habits 72% showed changes in oral mucosa. Smokers melanosis (43.28%) was the most commonly observed oral change followed by leukoedema (27.05%) and smoker’s palate (22.76%). Leukoplakia (3.17%) was the most commonly seen premalignant lesion. Conclusion: The study confirms the fact that use of tobacco can be positively correlated to the occurrence of various benign, premalignant and malignant oral changes. This study aids in creating awareness among the public regarding the deleterious effects of tobacco and may motivate them for cessation of tobacco use.

Ergonomic Microscope: Need of the Hour

Background: Prolonged use of conventional microscope develops musculo-skeletal injuries like chronic pain syndrome, including shoulder, neck, back aches & fatigue. Since the problems go unnoticed, the injuries can lead to some serious permanent damages. This further leads to a compromise in the health and welfare of the person and the institute. Hence, an understanding about the ergonomics is the need of the hour in this postmodern era. Inspite of few studies and surveys about ergonomics, there is still a steep rise in the musculoskeletal disorders. Aim of the Study: The aim of our study was to gauge the general awareness of pathologists, microbiologists and oral pathologists towards ergonomics in their profession. Materials and Methods: A cross-sectional survey based study was designed, which included a questionnaire. The questionnaire included multiple choice questions with four alternatives. Professionals (pathologists, microbiologists and oral pathologists) were included in the survey. Teaching faculty (Professors, Associate Professors and Lecturers) and Post graduate students formed the study group. Results and Observations: The response to the questionnaire was 100%. Less than 50% of oral pathologists were aware of the importance of ergonomics in their profession. The most common site affected was neck and back. One of the drastic observations was that, Oral Pathologists suffered from a combination of problems affecting neck, back, eyes, headache, shoulders, arms and wrists. Conclusion: Increase in our understanding regarding ergonomically designed microscopes can increase our efficiency and in turn improve our general well-being. With improvements in ergonomics, professionals would be able to modify and optimize their working conditions. Certain guidelines need to be followed by the professionals to reduce chances of musculoskeletal disorders.

Effect of Peracetic Acid as A Final Rinse on Push Out Bond Strength of Root Canal Sealers to Root Dentin

Naresh Gaddala, Chandrasekhar veeramachineni, Muralidhar Tummala

Background: Smear layer which was formed during the instrumentation of root canals hinders the penetration of root canal sealers to root dentin and affect the bond strength of root canal sealers to root dentin. Final irrigant such as demineralizing agents are used to remove the inorganic portion of the smear layer. In the present study, peracetic acid used as a final rinse, to effect the bond strength of root canal sealers to root dentin. Aim: The purpose of the present study was to evaluate the efficacy of peracetic acid as a final irrigant on bond strength of root canal sealers to root dentin. Materials and Methods: Sixty six freshly extracted human single rooted mandibular premolars were used for this study. After decoronation the samples were instrumented with Protaper upto F3 and irrigated with 5.25% NaOcl. The teeth were then divided into three groups based on final irrigant used: Group-1(control group) Canals were irrigated with distilled water. Group-2: Canals were irrigated with peracetic acid. Group-3: Canals were irrigated with smear clear. Each group was further divided into three subgroups (n=30) based on the sealer used to obturate the canals. Subgroup-1: kerr, Subgroup-2: Apexit plus, Subgroup-3: AH PLUS. Each sealer was mixed and coated to master cone and placed in the canal. The bonding between sealer and dentin surface was evaluated using push out bond strength by universal testing machine. The mean bond strength values of each group were statistically evaluated using Two-way ANOVA followed by Tukey post-hoc test. Results: Significant difference was found among the bond strength of the sealers. But, there is no statistically significant difference between the groups irrigated with peracetic acid and smear clear compared to control group. AH Plus showed highest bond strength irrespective of the final irrigant used. Conclusion: Peracetic acid when employed as final irrigant improved the bond strength of root canal sealers compared to control group but not statistically significant than smear clear.

An In-Vitro Comparison of Micro Leakage Between Two Posterior Composites Restored with Different Layering Techniques Using Two Different LED Modes

Nikhil Relhan, K.C. Ponnappa, Ashima Relhan, Anurag Jain, Priyanka Gupta

Aim: Composite resins have undergone various advances since their introduction, but their polymerization shrinkage remains a problem. Shrinkage can cause debonding of the restoration and can contribute to postoperative sensitivity, secondary caries, marginal staining and eventual failure of the restoration. So, our aim is to compare the effect of two different placement techniques and two different curing modes in reducing the marginal microleakage of two different composites in Class II cavities, where oblique and horizontal placement techniques and ramp & pulse curing modes of LED are used during the restoration. Materials and Methods: Standardized slot preparations were prepared in 80 human multi-rooted teeth. The teeth were randomly divided into four groups. Group A and B: Restored with Filtek P60 (3M, ESPE), Group C and D: Restored with Filtek P90 (3M, ESPE). All groups were further divided into sub-groups on basis of placement technique and curing mode. The samples were stored in distilled water, followed by thermocycling and immersed in 2% methylene blue. The samples were sectioned and evaluated for microleakage at the gingival margin with an optical stereomicroscope. Results: P60 composite when placed in the cavity with oblique incremental technique and cured with ramp mode of LED showed highest mean microleakage. There is no significant difference between horizontal and oblique placement technique (p=0.80); Pulse-curing and the ramp-curing mode (p=0.62). Conclusion: In restoring deep class II cavities, the use of a low-shrink composite with the oblique placement technique and ramp curing mode of LED is recommended to overcome the problem of marginal microleakage

Comparative Evaluation of Marginal Discrepancy in Tooth Colored Self Cure Acrylic Provisional Restorations With and Without Reinforcement of Glass Beads: An In-Vitro Study

Context: This invitro study was conducted to compare and evaluate marginal discrepancy in two types of tooth colored self cure provisional restorative materials {DPI&UNIFAST TRAD} before and after reinforcement of glass beads. Aim: The aim of the present study was to evaluate and compare marginal discrepancy in two types of provisional restorative materials (DPI and UNI FAST TRAD) before and after reinforcement with Glass beads. Materials and Methods: Tooth shaped resin copings were fabricated on custom made brass metal die. A total of 60 resin copings were fabricated in which 30 samples were prepared with DPI and 30 samples with UNIFAST material. Each group of 30 samples were divided in to two sub groups in which 15 samples were prepared with glass bead reinforcement and 15 samples without reinforcement. The marginal discrepancy was evaluated with photomicroscope {Reichet Polyvar 2 met} by placing the resin copings on custom made brass resin coping holder. Results: Measurements obtained were statistically analysed by unpaired t-test to know any significance between two variables. Unreinforced DPI specimens had shown lower marginal discrepancy (442.82) than reinforced specimens (585.77). Unreinforced UNIFAST specimens have shown high values of marginal discrepancy (592.83) than reinforced specimens (436.35). p-value between reinforced and unreinforced specimens of DPI (p=0.0013) and UNIFAST (p= 0.0038) has shown statistical significance. Conclusion: This in-vitro study revealed that unreinforced DPI specimens have shown lower marginal discrepancy than reinforced specimens and unreinforced UNIFAST specimens have shown higher values of marginal discrepancy than reinforced specimens.

Bilateral Infraorbital Nerve Block Versus Intravenous Pentazocine: A Comparative Study on Post-operative Pain Relief Following Cleft Lip Surgery

Gurpreeti Grewal, Kamakshi Garg, Anju Grewal

Background and Objectives: Infra orbital nerve block is utilized for postoperative pain control in children undergoing cleft lip repair. This study was conducted to compare the effectiveness, advantages and disadvantages of infra orbital nerve block and opioids for postoperative pain relief following cheiloplasty. Materials and Methods: Sixty paediatric patients aged 3 months – 13 years undergoing cheiloplasty were selected by simple random sampling and were divided into two groups. All the children received standardized premedication with midazolam, were operated upon under general anaesthesia and the block was performed at the end of surgery before reversal. Group B patients were administered bilateral infra orbital nerve block with 0.25% Bupivacaine (upto 2 mg/kg). Group O patients received Pentazocine 0.5 mg / kg IV. Postoperatively, the heart rate and respiratory rates were recorded every 15 minutes for the first 60 minutes, half hourly till 4 hours and then at 12 and 24 hours. Behavioural assessment for pain / discomfort was done at intervals of ½, 1, 2, 3, 4, 12 and 24 hours. Need for supplementary analgesics and duration between the administration of block/opioid and the first dose of supplementary analgesics were noted. Side effects such as nausea and vomiting, pruritus, respiratory depression and bradycardia during each of these periods were noted. Results: Both the groups were comparable for age, sex, weight and operative time with no statistical difference. The mean duration of analgesia for infra orbital nerve block was 357.5 minutes i.e. 5 hours 58 minutes and that for opioid was 231 minutes i.e. 3 hours 51 minutes which was significantly lower than the hours of analgesia provided by the block. Further, at the 4th hour, 76.6% of the patients in Group O required supplementary analgesics, in contrast to only 16.6% in Group B. The incidence of nausea and vomiting and pruritus was also higher in Group O. Conclusion: The results indicate that bilateral infra orbital nerve block provides effective analgesia in the postoperative period, lasting for 6 hours in comparison to 3½ - 4 hours following the administration of intravenous Pentazocine, with no major untoward effects.

Impact of Health Education on The Knowledge, Attitude and Practices of Teachers Regarding Reproductive Health of Adolescents of Amritsar, Punjab

Context: Teachers play an important role in guiding the adolescents. Adolescents are ill equipped to deal with the impending changes in their body which makes them vulnerable to STDs, HIV/AIDS and premarital sex. This study attempts to study the impact of reproductive health education on the knowledge, attitude and practices of teachers, about which only a few studies are available. Aims: To study the impact of health education on the knowledge, attitude and practices of teachers regarding reproductive health of adolescents. Settings: Senior Secondary schools of Amritsar and Department of Community Medicine, Government Medical College, Amritsar, Punjab, India. Study participants: Male teachers of senior secondary schools of Amritsar teaching class 9th-12th. Study design: Educational intervention study. Sampling method: Purposive sampling. Materials and Methods: The study was started with 155 teachers (teaching class 9th -12th) who willingly participated from 50 senior secondary schools of Amritsar district. It was carried out in three phases. In first phase, after taking informed consent, the teachers filled a pretested questionnaire which was followed by an interactive session on reproductive health in second phase. In third phase, to study the impact of the interactive session and the sustainability of knowledge gained, they were again administered the same questionnaire after a period of 3 months. Statistical Analysis: Microsoft Excel, SPSS, Chi-square test. Results: Maximum 74 (47.7%) teachers were aware of the psychosocial problems of adolescents. Majority 110 (71%) of the teachers had only partial knowledge about pubertal changes. 117 (75.5%) teachers were unaware about genital hygiene. Only 33 (21.3%) teachers had adequate knowledge about different STDs. 91 (58.7%) and 54 (34.8%) of teachers had adequate knowledge about routes of transmission and prevention of AIDS respectively. Only 37 (23.9%) teachers were imparting sex education to students. After intervention significant favorable changes were seen in their knowledge, attitude and practices regarding most of above mentioned topics. Conclusion: Although the baseline knowledge of teachers in most aspects of reproductive health of adolescents was found to be low, significant favourable changes were observed after health education.

Management of A Rare Case of Communicating Internal-External Inflammatory Resorption

Suraj Arora, Gurdeep Singh Gill, Priyanka Saluja, Vikas Setia

The present case describes the successful management of a rare case of communicating internal-external resorption in which both internal and external resorption seem to develop independent of each other. The case report highlights the importance of correct diagnosis and need of revision of classification system of resorptive defects.

Effect of Contrast Inversion Enhancement on the Accuracy of Endodontic File Length Determination in Digital Radiography

Nastaran Farhadi, Ali Shokraneh, Mojdeh Mehdizadeh

Objective: The aim of this ex vivo study was to evaluate the accuracy of endodontic file length measurement on digital periapical radiographs after application of contrast inversion digital enhancement. Materials and Methods: Forty single-rooted single-canal mature permanent human teeth with canals measuring 20-24 mm in length were used in this study. ISO #08 K-files were placed in the root canals of the teeth. The file lengths were measured with a digital caliper as the gold standard. Standard periapical digital images were obtained with the Digora storage phosphor plates and Digora Optime scanner as the original images. The contrast inversion option of Scanora software program version 5.1 was used to produce enhanced images. Three radiologists and three endodontists measured file lengths on the original and enhanced images. The measurements were compared using repeated measures ANOVA and Bonferroni tests (a=0.05). Results: There were significant differences between the measurement accuracy of the original and enhanced images (p<0.05). The enhanced images exhibited longer measurements compared to the original images. However, the two sets of digital radiographs provided significantly longer measurements compared to the gold standard (p<0.05). Conclusion: The contrast inversion tool of Scanora software program decreases measurement accuracy of the length of small endodontic files on digital periapical radiographs. It is suggested that contrast inversion should not be used in determining the lengths of small endodontic files.

Coronary Artery Disease Risk Factors, Coronary Artery Calcification and Coronary Bypass Surgery

Introduction: Atherosclerosis is an intimal disease which affects large and medium size arteries including aorta and carotid, coronary, cerebral and radial arteries. Calcium accumulated in the coronary arterial plaques have substantial contribution to the plaque volume. The aim of our study is to investigate the relationship between coronary artery disease (CAD) risk factors and coronary arterial calcification, and to delineate the importance of CACS in coronary artery bypass surgery. Materials and Methods: The current study is retrospective and 410 patients admitted to our clinic with atypical chest pain and without known CAD were included. These individuals were evaluated by 16 slice electron beam computed tomography with suspicion of CAD and their calcium scores were calculated. Detailed demographic and medical history were obtained from all of the patients. Results: In our study, we employed five different analyses using different coronary arterial calcification score (CACS) thresold levels reported in previous studies. All of the analyses, performed according to the previously defined thresold levels, showed that risk factors had strong positive relationship with CACS as mentioned in previous studies. Conclusion: Coronary arterial calcification is part of the atherosclerotic process and although it can be detected in atherosclerotic vessel, it is absent in a normal vessel. It can be concluded that the clinical scores, even they are helpful, have some limitations in a significant part of the population for cardiovascular risk determination. It is important for an anastomosis region to be noncalcified in coronary bypass surgery. In a coronary artery, it will be helpness for showing of calcific field and anostomosis spot.

Prevalence of Enterotoxin Genes and spa Genotypes of Methicillin-resistant Staphylococcus Aureus from a Tertiary Care Hospital in China

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA)is a major nosocomial pathogen that causes a variety of infections. MRSA has evolved resistance to multiple antibiotics. Genetic background and virulence differs in different geographic regions. The present study was aimed to investigate the prevalence of enterotoxin genes and spa genotypes of hospital-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) isolated from a tertiary care hospital of Jiangsu province, China. Materials and Methods: HA-MRSA isolates from August 2013 to April 2014 at a tertiary care hospital of China were collected. We investigated antimicrobial pattern, spa types, SCCmec types and the presence of 14 virulence genes. Results: Eighty HA-MRSA isolates were collected. Results from SCCmec typing revealed that 73.8% were type II; 13.8% were type III; 12.5% were type V. There were 19 different spa types. Spa type t2460 was the most common (35.0%), followed by t002 (11.3%). CC5 was the predominant MLST CCs type (50%). The most frequent toxin genes were sea, seb, sed, sel, sen and seo (100.0%). None of the investigated isolates carried the sec or tst. Conclusion: Genotypic and virulence evaluation of the isolated HA-MRSA revealed that the isolates with CC5 and SCCmec II were the predominant type and highly homological. The virulence profiles mainly existed in the genes of sea, seb, sed, sel, sen, seo and ser. The prevalence of t2460 was an outbreak and the predominant spa type.

BIS Targeted Propofol Sparing Effects of Dexmedetomidine Versus Ketamine in Outpatient ERCP: A Prospective Randomised Controlled Trial

Background: Endoscopic Retrograde Cholangio Pancreatography (ERCP) is routinely performed under propofol sedation. Adjuvant drugs have improved the quality of propofol sedation while minimizing complications. The aim of the study was to compare the propofol consumption, recovery and hemodynamic profiles of dexmedetomidine versus ketamine against a placebo control with BIS targeted in the sedative range for outpatient ERCP procedures. Materials and Methods: The study comprised of 72 patients undergoing ERCP, who were randomly allocated into one of the 3 groups: Group Dexmedetomidine (n =24) receiving a bolus and infusion of dexmedetomidine (1µg/kg and 0.5µg/kg/hr); Group Ketamine (n = 24) receiving a bolus and infusion of ketamine (0.25mg/kg and 5µg/kg/min) and Group Control (n =24) receiving saline placebo as a bolus and infusion with variable propofol boluses administered in all groups targeting BiSpectral Index between 60-70. Results: The total propofol consumption was significantly lower in both Dexmedetomidine (162.5 ± 71.7 mg ) and Ketamine groups (158.3 ± 66.89 mg) when compared with Control group (255.83 ± 114.12 mg)(p=0.001) .Time taken (minutes) to achieve Modified Aldrette Score (MAS) >9 and Observer Assessment of Alertness and Sedation (OAAS) score >4 was significantly prolonged in Dexmedetomidine group (MAS 16.6 ± 3.18 and OAAS 16.67 ± 2.82) compared to Ketamine (MAS 10 ± 4.17 and OAAS 8.75 ± 3.68) and Control (MAS 7.5 ± 3.29 and OAAS 6.88 ± 2.47) (p<0.001). Hemodynamic profiles were comparable although patients in dexmedetomidine had a statistically significant lower heart rate (p< 0.001) although without clinical significance. Conclusion: Low dose ketamine with background propofol boluses resulted in lesser propofol consumption, with earlier recovery and favourable hemodynamics when compared with Dexmedetomidine and control group in outpatient ERCP.

Gingival Biotype Assessment in a Healthy Periodontium: Transgingival Probing Method

R. G. Shiva Manjunath, Anju Rana, Arijit Sarkar

Background: Gingival biotype is the thickness of the gingiva in the faciopalatal dimension. It has a significant impact on the outcome of the restorative, regenerative and implant therapy. It has been suggested that a direct co-relation exists with the susceptibility of gingival recession followed by any surgical procedure. So, the study was aimed to assess gingival biotype in different age groups of males and females using transgingival probing method. Materials and Methods: Gingival thickness (GT) was evaluated in 336 patients including males and females of different age groups. The latter was based on the transparency of the periodontal probe through the gingival margin while probing the buccal sulcus. Final data collected was then used for statistical analysis. Results: A significant difference was found between males and females with males showing thick biotype. Out of the total samples 76.9% of males showed thick biotype compared to 13.3 % of females which was statistically significant. Conclusion: This was probably one of the few attempts to correlate gingival biotype with different age groups in males and females. A clear thick gingiva was found in more than two-third of the male subjects whereas majority of female subjects showed thin biotype. Also, it was seen that in females, the gingival biotype varies with age unlike in male.

Evaluation of Correlation of Blood Glucose and Salivary Glucose Level in Known Diabetic Patients

Introduction: Diabetes mellitus is a chronic heterogenous disease in which there is dysregulation of carbohydrates, protein and lipid metabolism; leading to elevated blood glucose levels. The present study was conducted to evaluate the correlation between blood glucose and salivary glucose levels in known diabetic patients and control group and also to evaluate salivary glucose level as a diagnostic tool in diabetic patients. Materials and Method: A total number of 250 patients were studied, out of which 212 formed the study group and 38 formed the control group. Result: Among 250 patients, correlation was evaluated between blood glucose and salivary glucose values which on analysis revealed Pearson correlation of 0.073. The p-value was 0.247, which was statistically non significant. Conclusion: Salivary glucose values cannot be considered as a diagnostic tool for diabetic individuals.

Choroid Melanoma – A Rare Case Report

Samarth Shukla, Sourya Acharya, Manisha Dulani

Uveal tract encomprise melanomas of the iris, ciliary body and the choroid. The choroid melanomas are more frequent to occur in comparison to iris and ciliary body melanomas. Choroid melanoma though rare, is the most common occurring intraocular malignancy amongst the adults. Incidence of occurrence of choroid melanoma is around 20 per million cases per year globally. The uveal tract pigment producing melanocytes are the origin for the melanoma in the eye. Melanomas tend to commonly arise from sixth decade of age with increasing incidence with progressive age. We present a rare case choroidal melanoma, in a 65-year-old adult, who presented with three months history of headache and gradual dimunision of vision, his investigations revealed clinical diagnosis of choroid melanoma , an enucleation was carried.

Multidisciplinary Approach in Management of a Large Cystic Lesion in Anterior Maxilla - A Case Report

Abhinav Diwan, Moushmi Chalakka Rayil Bhagavaldas , Vivek Bagga, Akshay Shetty

Management of large cystic lesion requires a multidisciplinary approach. In this case report a large radicular cyst is managed by conventional root canal treatment with triple antibiotic paste followed by surgical enucleation. In this case, patient presented with a 4 cm symptomatic swelling of the palate adjacent to teeth 21, 22 and 23. The swelling was soft on palpation and the overlying mucosa was of normal color. Radiographically, a well-defined unilocular radiolucency with corticated margins was seen. A full-thickness flap was reflected and revealed a large cyst-like lesion that had perforated the lingual cortical plate. The lesion was enucleated and submitted for microscopic examination. The biopsy report confirmed the diagnosis as radicular cyst.The patient was recalled after 6 months, and no symptoms or signs were noted. Radiograph showed the healing lesion.

Focal Choroidal Excavation in Best Vitelliform Macular Dystrophy: Case Report

Focal choroidal excavation (FCE) was first reported as a choroidal posteriorly excavated zone without any scleral change. Choroidal excavation also divided into conforming and nonconforming type. Numerous reports demonstrated association between FCE and other disease such as choroidal neovascularization and central serous choroidoretinopathy. Here, we report a rare case of FCE in a patient with Best disease. The patient was diagnosed by spectoral domain optical coherence tomography (SD-OCT). To the best of our knowledge, our patient is the second report of choroidal excavation in Best vitelliform macular dystrophy.

Multiple Sclerosis Like Condition in a Patient of Hepatitis C after Treatment with Interferon Alpha: A Case Report

Pyar Ali Fazil, Syed Mustafa Ali, Mustafa Zaboli, Syed Raza Shah

Hepatitis C virus affects millions of people around the world. The primary therapy comprises of interferon alpha and ribavarin. The most common side effects of this treatment include flu like symptoms and psychiatric issues. One of the rare complications of the combined therapy is the development of demyelinating lesions in the central nervous system. Our case report presents a 35-year-old man who was a known case of Hepatitis C presenting to us with altered level of consciousness and decreased vision. He had been treated as per the standard therapy for Hepatitis C infection with interferon alpha and ribavarin. During the course of this therapy, he developed significant loss of vision. This was in fact due to serious and rare complication of the treatment which was demonstrated on the MRI as demyelinating lesions in the deep periventricular white matter bilaterally. Visual Evoked Potential study was performed which concluded bilateral dysfunction of the optic pathway. The treatment of Hepatitis C with interferon alpha and ribavarin may present with a wide array of adverse effects which includes a rare complication of central nervous system demyelination as well. Research suggests that early treatment of Multiple Sclerosis (MS) is beneficial in the long run with a better prognosis and minimal changes on MRI of the patient. Therefore this complication of the treatment should be kept in mind as one of the main differential diagnosis. By finding the extent of the inflammation, and consequently doing an MRI alongside a lumbar puncture, can serve to diagnose a rare condition mimicking multiple sclerosis while treating with interferon alpha.

Neglected Thorn Injury Mimicking Soft Tissue Mass in a Child: A Case Report

Thorn injuries are common especially in rural areas. The diagnosis of such in children is always missed. An untreated retained thorn may cause late soft tissue and osseous complications. Herein, we report a case of neglected thorn injury mimicking soft tissue mass in an 11-year-old male child. The presence of the thorn was confirmed with ultrasound scan and computerized tomography. The child was successfully managed with removal of thorn with excision of foreign body granuloma.

A Bitendinous Palmaris Longus: Aberrant Insertions and Its Clinical Impact - A Case Report

S. Iqbal, Raiz Iqbal, Faiz Iqbal

Palmaris longus, phylogenetically a retrogressive muscle, exhibits significant anatomical variations compared to other muscles of the upper extremity. It is of great surgical importance because, it is the first option tendon for graft procedures in various cosmetic, plastic and reconstructive surgeries. It has also been widely used in various tendon transfer procedures in treating facial paralysis, ptosis correction, lip augmentation and digital pulley reconstruction. We report a rare variant pattern of Palmaris longus with duplicated tendons and with multiple insertions to thenar and hypothenar muscles, fasciae and the flexor retinaculum along with its normal continuation as palmar aponeurosis. Variations in its insertions not only contribute, but also augment the various pathological processes such as Dupuytren’s contracture, Carpal tunnel and Guyon’s syndromes. So it is of utmost importance for surgeons, physicians and radiologists, to be aware of these variations, well in advance.

Rhinosporidiosis: A Chronic Tropical Disease in Lateral Pharyngeal Wall

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi. It predominantly affects the mucous membranes of the nose and the nasopharynx. Clinically the lesion presents as a pink or red pedunculated polyp in one or both nostrils. Diagnosis can be made by aspiration cytology and examination with May-Grunwald-Giemsa, hematoxylin and eosin, Periodic acid-Schiff and mucicarmine staining. Definitive diagnosis is by histopathology of the specimen. We report a case of Rhinosporidiosis at the lateral pharyngeal wall which is a very rare site for Rhinosporidiosis to occur; was treated by diathermy excision of the mass and cauterization of the base and oral Dapsone to prevent recurrence of the disease.

Peripheral Primitive Neuroectodermal Tumour of the Maxilla and Paranasal Sinuses: A Rare Clinical Presentation

C.L. Krithika, S. Sathasivasubramanian, c. Ponranjini Vedeswari

Peripheral Primitive Neuroectodermal Tumours (pPNET) are rare aggressive tumours of neural crest cell origin. These tumours are more common in children and young adults. This is a unique report of one such presentation in a 23-year-old lady occurring in the left side posterior maxilla and Paranasal sinuses along with imaging characteristics, histopathologic features, immunohistochemical aspects and management. Though these tumours are rare, they should be considered in the differential diagnosis of rapidly growing soft tissue masses in young adults. Precise diagnosis with timely management is necessary for good prognosis.

Case Presentation of a 23-Month-Old Herpes Simplex Virus-infected Girl with Brain and Oesophageal Involvement

Karam-Ali Kasiri, Noushin Rostampour, Abolfazl Khoshdel

Herpes simplex virus (HSV) is the most common identifiable cause of serious or life threatening sporadic, endemic encephalitis. Typical HSV encephalitis in patients outside neonatal age is caused by HSV-1. A 23-month-old girl was referred to our hospital with a three-day history of fever, listlessness, slurred speech, and suspicious oesophageal foreign body impaction. Laboratory evaluations showed white blood cell count of 10900 /mm3 with 65% neutrophils. Upper endoscopy revealed diffuse severe ulceration in middle to distal third of oesophagus and no foreign body was found in oesophagus or stomach. Parenteral acyclovir was prescribed for herpes encephalitis in addition to antibiotics for central nervous system infection. Chest X-ray and brain MRI was unremarkable. Lumbar puncture revealed normal protein and glucose with 10 white cell count. She developed a raising liver enzyme tests. Total and direct bilirubin was 1.2 mg/dc and 0.2 mg/dc respectively. Because of neurological symptoms, acyclovir was adopted for our patient from the beginning. The girl did not respond to medication and died after 28 days. Progression of her disease prior to referral appears to contribute to the administered treatment inefficacy. Severe rapid progression of disease prior to referral and potential resistance to acyclovir could cause treatment failure.

Metastatic Small Cell Carcinoma of Lung To Pancreas Mimicking As Acute Pancreatitis: A Case Report

Small cell carcinoma (SCC) of lung is a highly malignant tumour and is notorious for early and widespread metastasis at the time of presentation. However, metastasis to pancreas occurs uncommonly. Metastatic lesions comprise of 3% of all pancreatic malignancies. We hereby present a rare case report where patient presented with symptoms of acute pancreatitis & diagnosed with SCC of lung, retrospectively. This case emphasize that acute pancreatitis can be a manifestation of malignancy and fine needle aspiration cytology can play a diagnostic role in such cases.

Multidisciplinary Management of An Unusual Isolated Alveolar Bone Infection- A Rare Case Report

Pimpale Sandeep K, Dixit Mala B, Kulkarni Rahul S, Ramugade Manoj M

Restoration of proximal defect of tooth is of paramount importance as its improper restoration usually results in fracture of the restoration or deteriorated periodontal health. The article reports a case with a discreet mass of alveolar bone necrosis closed to the overhanged amalgam restoration in the proximal box of the maxillary molar. As a result of this improper proximal restoration it led to deep periodontal pocket and subsequent alveolar bone necrosis which was managed successfully with combined Endodontic-Periodontic treatment. This article highlights the unfortunate sequelae of bone necrosis as a consequence of an incorrect or overlooked dental treatment and its comprehensive management.

Foray of Cytologically Diagnosed Intramuscular Sarcocystosis- A Rarity

Sarcocystosis is an uncommonly encountered zoonotic coccidial protozoal infestation of human beings. The sarcocystis species is known to produce intestinal and muscular infestations in humans. We report a rare case of a 35-year-old female with an intramuscular swelling in the lumbar region diagnosed cytologically as “Intramuscular Sarcocystosis” and subsequently confirmed on histopathology. This case highlights the role of fine needle aspiration cytology in the identification of Sarcocystis and its role in differentiating it from other intramuscular parasites which is of immense value in precise diagnosis and appropriate patient management.

Malignant Peripheral Nerve Sheath Tumour of Small Intestine Presenting as Ileo-Ileal Intussusception - A Rare Tumour with Unusual Complication

Diwakar Pandey, Ankur Verma, Azaz Akhtar, Ashish Arsia, Nain Singh

Malignant Peripheral Nerve Sheath Tumours (MPNST) arises from a peripheral nerve or exhibit nerve sheath differentiation on histology. Proximal portions of the upper and lower extremities and the trunk are the most common sites of occurrence. Around 50% are associated with Neurofibromatosis Type 1 (NF1) with incidence of two to five per cent in patients with NF1. The estimated incidence in general population without NF1 is 0.0001% of which gastrointestinal MPNST are extremely rare. A 45-year-old lady without pathological antecedent for NF1 was admitted with pain in right lower abdomen and multiple episodes of vomiting for 3 months. Preoperatively intussusception was diagnosed in the small bowel with USG and CECT abdomen showing characteristic target sign. On laparotomy Ileo-ileal intussusception (proximal ileum telescoping into distal ileum) was found 2 feet proximal to ileo-caecal junction with surrounding inflammed mesentery and presence of intraluminal tumour as lead point. Resection of involved segment of ileum along with its mesentery was done followed by ileo-ileal anastomosis. Histopathology was suggestive of high grade MPNST. Postoperative course and follow up for last 10 month is uneventful. This case is unique in terms of a rare tumour presenting with unusual complication and only one case had been reported so far in western literature.

Chronic Granulomatous Disease

Shreya Agarwal

Chronic Granulomatous Disease (CGD) is an inherited immunodeficiency disorder characterized by defective functioning of NADPH oxidase enzyme in the phagocytes. This leads to recurrent infections by catalase positive organisms and later, granuloma formation in multiple organs. This condition usually presents in the age group of 2-5 y and is uncommon in neonates. In this case report, we describe a rare case of CGD in a 40-day-old male child who initially presented with a history of erythematous pustular rash on left forearm and refusal to feeds. He remained unresponsive to regular antibiotics. CT chest and abdomen revealed multiple ill-defined lesions suggestive of granulomas or developing abscesses. Immunodeficiency workup showed negative Nitroblue Tetrazolium test and positive Dihydrorhodamine test (flow cytometry). A diagnosis of CGD was then made and treated accordingly. The aim of this report is to highlight the fact that although it is rare for CGD to present at such an early age, but in a neonate with multiple granulomas or abscesses, it should be considered as a differential and worked up accordingly. Early diagnosis and treatment can significantly improve the prognosis.

Solitary Angiokeratoma: Report of Two Uncommon Cases

Vijaya Chowdappa, Aparna Narasimha, Amoolya Bhat, Smitha S. Masamatti

Angiokeratomas are rare benign vascular skin lesions arising in isolation or in groups of multiple lesions, as solitary cutaneous forms or generalized systemic forms. They are ectasias of dermal capillaries with an acanthotic and hyperkeratotic epidermis. They can occur in both healthy individuals and in those with underlying systemic disease due to inherited enzyme deficiency or other acquired predisposing factors. The identification and reporting of these lesions is important as patients with these lesions should be evaluated to rule out underlying pathogenic conditions. We report two rare cases of isolated solitary cutaneous angiokeratoma occurring in two patients.

Odontogenic Myxoma of the Maxilla- A Rare case Report

Odontogenic myxoma (OM) is an uncommon, benign, locally invasive, non-metastasizing neoplasm arising from the odontogenic ectomesenchyme that usually occurs in the tooth bearing areas of the jaws. These lesions arouse special interest as they pose high diagnostic challenge. Here, we present a rare case of OM of the maxilla in an 18-year-old male. The clinical, radiographic and histopathological features of the lesion are discussed in this paper.

Transient 2nd Degree Av Block Mobitz Type II: A Rare Finding in Dengue Haemorrhagic Fever

Ashwini Kumar Nigam, Omkar Singh, Ayush Agarwal, Amit K Singh, Subhash Yadav

Dengue has been a major problem as endemic occurs almost every year and causes a state of panic due to lack of proper diagnostic methods and facilities for proper management. Patients presenting with classical symptoms are easy to diagnose, however as a large number of cases occur every year, a number of cases diagnosed with dengue fever on occasion presents with atypical manifestations, which cause extensive evaluation of the patients, unnecessary referral to higher centre irrespective of the severity and therefore a rough idea of these manifestations must be present in the backdrop in order to prevent these problems. Involvement of cardiovascular system in dengue has been reported in previous studies, and they are usually benign and self-limited. The importance of study of conduction abnormalities is important as sometimes conduction blocks are the first sign of acute myocarditis in patients of Dengue Hemorrhagic Fever in shock. We present here a case of 2nd Degree Mobitz Type II atrioventricular AV block in a case of Dengue Hemorrhagic fever reverting to the normal rhythm in recovery phase and no signs thereafter on follow up.

Novel Use of Prf and Pdt in the Management of Trauma Induced Root Resorption and Infrabony Defect

Root resorption is a common squeal of traumatic injury to the dentition. Its progression can be minimized by early diagnosis and appropriate treatment. This case report presents the diagnosis and management of a case of trauma induced trio of apical root resorption, intraradicular root resorption and infrabony defect in maxillary central incisor. The main aim in treating such cases of resorption is to limit the inflammatory response at the periapical region so as to halt the resorptive process. To allow faster regeneration of the periodontal tissues, Platelet rich fibrin (PRF), a second generation platelet concentrate was used as an apical matrix over which MTA plug was given. The periodontal defect was managed with the help of localized antimicrobial photodynamic therapy (aPDT).

Multiple Adverse Effects of Systemic Corticosteroids: A Case Report

Divya S., Kavitha Pawar, Pratibha Nadig, Almelu Haran

Corticosteroids are among the effective treatments available for many medical conditions. Adverse effects such as osteoporosis, cataract and muscle weakness are widely recognized on long term administration and have considerable public health implications. Many reports are available that have dealt with individual adverse effects.Here, we report a case of a 55-year-old female, with systemic glucocorticoid induced bilateral cataract, osteoporosis, diabetes mellitus and hypothalamic pituitary axis (HPA) suppression. These were induced through self –medication. She presented to the hospital for the treatment of acute exacerbation of bronchial asthma.

Novel Cytogenetic Aberrations in a Patient of Chronic Myeloid Leukemia with Blast Crisis

Bhoumik Shah, Smeeta Gajendra, Ritu Gupta, Atul Sharma

Chronic myeloid leukaemia (CML) is a clonal haematological disease which is characterized by a diagnostic karyotypic abnormality t (9;22)(q34;q11) called as Philadelphia (Ph) chromosome. Occurrence of additional chromosomal abnormalities besides the Ph chromosome is defined as clonal evolution (CE) and considered to be a marker of disease progression. A 67-year-old male who was initially evaluated at a private hospital where a diagnosis of acute promyelocytic leukaemia was made on bone marrow aspirate with ambiguous RT-PCR report referred to our centre for further evaluation and treatment. On conventional karyotyping, Ph chromosome along with translocations t(5;13)(q12;p13), t(15;20)(q22;p13) and monosomy 13 was observed in all 20 metaphases. A final diagnosis of CML-myeloid blast crisis with complex cytogenetics was made. Patient succumbed to death within one month of initiation of imatinib therapy.

Giant Renal Mixed Epithelial and Stromal Tumour in A Young Female: A Rare Presentation

Sidhartha Kalra, Ramanitharan Manikandan, Lalgudi Narayanan Dorairajan

Mixed epithelial and stromal tumour of the kidney (MESTK), is a rare kidney tumour. About 100 cases so far have been reported in the literature. Although MESTK mostly presents in perimenopausal age group some rare cases in young females have been reported. We report a rare presentation of a 25 cm size giant MESTK arising from the left kidney in a young female in the absence of any clinically detectable hormonal abnormalities and successfully managed by nephron-sparing surgery.

A Safe Alternative in Neurofibromatosis for Lower Limb Surgeries: Combined Femoral and Sciatic Nerve Block

Mohammed Shahid, Bon Sebastian

Neurofibromatosis (NF) is a neurogenetic disease with multiple systemic involvement. In this case report we describe the successful management of a patient with NF posted for lower limb wound debridement with multiple neurofibromas over the back and face causing difficulty in spinal anesthesia and general anaesthesia. Combined femoral and sciatic nerve block was used as a safe alternative anaesthetic approach.

Papillon-Lefevre Syndrome In An Adolescent Female: A Case Study

Papillon-Lefevre Syndrome (PLS) is a rare inherited autosomal-recessive condition with one-third of the patients’ showing consanguinity of the parents. Lesions are characterised by palmar-plantar hyperkeratosis and hyperhidrosis. Early onset of periodonditis, severe periodontal destruction in both primary and permanent dentitions, and calcification of the duramater form the three important features of this disease. Here, we present a case of a 14-year-old female who presented to the Department of Oral Medicine and Radiology with a complaint of mobility of the teeth since four months. Oral examination of the patient showed generalised mobility of the teeth. General physical examination of the patient showed dry scaly skin on dorsum of bilateral feet, hands, and knee. The patient had familial history positive for consanguinity. The patient was medically diagnosed as positive for PLS. The patients with PLS show combination of dermatological and dental lesions and it requires the dentist to assume a more prominent role in early treatment and rehabilitation. There is a need for symbiotic and synergetic approach between the two specialties for effective management of this rare disease.

Disseminated Congenital Neuroblastoma – An Autopsy Case Report

Jyotsna. V. Wader, Sujata. S. Kumbhar, Dhirajkumar B Shukla, Sonu Mavi

Neuroblastoma is the most common malignant tumour in the neonatal age group. The tumour is derived from neural crest cells of adrenal gland medulla or sympathetic ganglia. Disseminated congenital neuroblastoma is very rare. We hereby report a case of congenital neuroblastoma with multiple metastases diagnosed on autopsy in a fetus of 23 weeks gestational age. Autopsy revealed enlarged bilateral adrenals, large fusiform mass in the right humerus, mass in the lower lobe of left lung and posterior chest wall. Diagnosis of disseminated congenital neuroblastoma was given after histopathological and immunohistochemical examination. We are reporting this case for its rare presentation of disseminated form of congenital neuroblastoma sparing liver.

Signet Ring Dermatofibroma, a Rare and Confusing Variant

Asmaa Gaber Abdou, Nancy Youssef Asaad

Dermatofibroma is a common cutaneous benign fibrohistiocytic tumour, which is usually diagnosed without difficulty. In this report we demonstrated a signet ring variant of dermatofibroma as a rare variant of this common neoplasm together with the possible differential diagnosis.The presence of signet cells in cutaneous neoplasm does not necessarily means malignancy. Signet ring dermatofibroma is a rare variant eliciting differential diagnostic problems which can be solved by careful histopathological examination, searching for the classic areas and the help of immunohistochemistry.

Scrub Typhus with Acute Respiratory Distress Syndrome (ARDS) and its Management in Intensive Care Unit: A Case Report

Scrub typhus is zoonotic disease caused by Orientia tsutsugamushi (O tsutsugamushi). It is transmitted to humans by the bite of trombiculid mite larvae (chiggers). It is a re-emerging infectious disease in India. Clinical manifestations include fever, headache, anorexia, myalgia, eschar, adenopathy and maculopapular rash. Complications of Scrub typhus develop after first week of illness. Complications include meningoencephalitis, jaundice, myocarditis, ARDS and renal failure. Eschar and rash may be unnoticed or absent. Thorough physical examination, identification of eschar/rash throws light in thinking about scrub typhus, treating and preventing further complications. Here, we report a case of scrub typhus with Acute Respiratory Distress Syndrome (ARDS) and its management with non invasive ventilation in the intensive care unit.

Extraskeletal Chondroma of the Gluteal Region Along with Sporadic Neurofibroma - An Unusual Presentation

Asmita Parihar, Nirupma P. Khan, Vivek Agrawal

Extraskeletal or soft tissue chondroma is a benign cartilaginous tumour that predominantly involves the hands and feet. We present a rare case of gluteal extraskeletal chondroma in a 55-year-old Indian female. She presented with right gluteal mass measuring 5 cm in greatest dimension. The diagnosis was provided through histopathological examination of completely excised tumour mass. The patient also had sporadic neurofibroma in the supraclavicular region. Such a unique association has not been reported till date in the English literature. We describe the clinical and histopathological characteristics of our case, emphasizing the first reported association of extraskeletal chondroma and sporadic neurofibroma.

Case Report — Pyknodysostosis

S.C. Sanjay, Keshava Murthy, Anil Kumar Shukla, N. Krishnappa

Pyknodysostosis is an extremely rare lysosomal storage disease of the bone. Osteosclerosis of the skeleton is due to a decrease of the bone turnover. A plethora of clinical and radiological findings are observed. Patients are short statured with acroosteolysis and dense bones and develop multiple spontaneous bone fractures. A female patient presented with frontal bossing, small and thick fingers and toes. The classical clinical and radiological findings confirmed it as pyknodysostosis.

Uncommon Surgical Causes Of Right Lower Quadrant Pain In Children. Single Center Experience.

Right lower quadrant pain is one of the major reasons of children reference at the emergency department. The most common surgical cause, which needs appropriate management, is acute appendicitis. The purpose of this study is to reveal uncommon surgical causes found during surgery in children who were misdiagnosed as acute appendicitis in our department during the last 10 y. Data of patients who have undergone appendicectomy during a ten year period (since Feb 2004 until Mar 2014) were collected retrospectively. Eight hundred twenty children have undergone appendicectomy in our department. In six children another uncommon cause of the symptoms was revealed during surgery. In one patient the cause was a duplication cyst of the terminal ileum, in two patients an omental torsion, in one patient a meckel diverticulum torsion, in one patient a splenic rupture and in one patient a retroperitoneal tumor. All of the patients were successfully managed during the first operation. The possibility of other uncommon causes of right quadrant abdominal pain should always be kept in mind, especially when there is a negative appendicitis. However, the transaction of further paraclinical examinations – ultrasonography or computed tomography- preoperatively is under discussion. Nevertheless a thoroughly taken case history is undoubtedly always necessary.

Sarcomatoid Carcinoma of Anterior Maxilla: A Case Report and Immunohistochemical Analysis

Vishwaprakash Shetty, Anshum Datta, Nidhi Marya, Sahil Handa, Vishesh Yadav

Sarcomatoid carcinoma is a rare and peculiar biphasic malignant neoplasm that occurs mainly in the upper aerodigestive tract. Sarcomatoid carcinoma is an unusual biphasic tumor composed of both malignant epithelial and malignant mesesnchymal component in association with, and usually dominated by, an abundant dysplastic-appearing spindle cells. This tumor consistently poses a significant diagnostic challenge to pathologists. Despite of several immunohistochemical, electron microscopic and genetic studies, precise histogenesis of sarcomatoid carcinoma is quite controversial. Here we are describing a case of sarcomatoid carcinoma in a 40 yr old male patient with special emphasis on immunohistochemical analysis. Here, we are describing a case of sarcomatoid carcinoma in a 40-year-old male who presented with a small swelling & pain in hard palate along with immunohistochemical analysis.

Nasopalatine Duct Cyst Associated with a Mesiodens: Misdiagnosis or Missed Diagnosis?

Nasopalatine duct cyst ( NPDC) is described as most common non-odontogenic developmental cyst of the jaws. Despite being common, its clinical and radiographic presentation could be varied and it can sometimes be a diagnostic challenge. This paper presents an unusual case of an infected NPDC associated with an impacted inverted mesiodens and a history of trauma that misled the clinical diagnosis.

Acute Kidney Injury and Quadriparesis Due to Rosuvastatin Induced Rhabdomyolysis- A Case Report

Kamlesh S. Suthar, Aruna V. Vanikar, Hargovind L. Trivedi

Statins as lipid lowering drugs, are safe and effective in reducing cardiovascular disease risk, but rarely produce myopathy like myalgia, myositis or rhabdomyolysis. We report the case of Rosuvastatin induced rhabdomyolytic acute renal failure and quadriparesis in a 67-year old male, a known case of type-2 diabetes mellitus and with a history of coronary angioplasty four months back. He was on antihypertensive, oral hypoglycemic and antiplatelet medications with Rosuvastatin 40mg/day. He was admitted with altered sensorium, breathlessness, vomiting, muscle weakness and decreased urine output and had raised serum creatinine, creatinine phosphokinase and myoglobin. After ruling out all other causation for rhabdomyolysis, we stopped Rosuvastatin and started supportive management and hemodialysis. Patient showed gradual recovery in renal function and quadriparesis. Patient was discharged with good urine output and on antihypertensive, hypoglycemic drug and diet restrictions for lipid control. He recovered completely and had normal renal function with well controlled lipid level on follow up of 6 months after discharge. Thus, prompt diagnosis of Rhabdomyolysis due to Rosuvastatin in absence of other aetiology and the multidisciplinary management can prevent further complication with favorable outcome.

Complete Denture in a Microstomia Patient

Ashish Satpathy, Anil K. Gujjari

Microstomia is the term used to describe a condition of reduction in the size of oral aperture which can be either acquired or congenital and affects the quality of life. Dentists occasionally come across patients with constricted oral openings. Limited oral opening makes access to the oral cavity for any dental procedure difficult. It’s the duty of a dentist to provide every possible care to the patient with microstomia. This paper describes the treatment of a microstomia patient requiring complete dentures using sectional dentures. The cause of microstomia in the indexed patient was developmental in nature as all other causes of related conditions were ruled out. Finally upper and lower complete denture with sectional components were given to the patient after modification in conventional steps of its construction.

Psychogenic Lingual Paresthesia

M.S.Bhatia, Navneet Kaur Bhatia, Navleen Kaur Bhatia

Oral paresthesias are common in clinical practice but they often go unnoticed and untreated. Psychogenic oral paresthesia is an unpleasant sensation of tingling or pricking or a feeling of swelling or burning, with spontaneous onset.It can result due to local, systemic, psychogenic or idiopathic causes. Among psychogenic causes; anxiety disorder and depression are common. We describe a 32-year-old patient presented with lingual paresthesia and features suggestive of depression. He responded to an antidepressant, fluoxetine 40 mg /day.

Lumbar Apophyseal Ring Fracture- A Case Report

Ravi Kumar T.V., Raghavendra Rao, Daksh Gadi, Amit Grover

Posterior apophyseal ring fracture is a rare condition typically seen in adolescent age group because the ring apophysis and the adjacent vertebral body does not fuse completely and may separate at the cephalad or caudal edge. It usually simulates disc herniation in adolescents and children but disc lesion is very commonly associated with PRAF. The condition although is rare but a high index of suspicion should be there during evaluation of any adolescent patient with low back ache as it is often missed on conventional radiography. Multiple treatment options have been described in literature, both conservative and surgical. We hereby report a case of posterior apophyseal ring fracture with a calcified disc adherent to the dura for which decompression alone without discectomy was found to be an effective treatment.

Bindi Tuberculosis – Lupus Vulgaris Associated with Bindi Use: A Case Report

Gyanshankar Mishra, Sushil Rathi, Jasmin Mulani

Cutaneous lesions are relatively uncommon manifestations of tuberculosis (TB). A 40-year-old female presented with skin lesion over the forehead since two months. She used to apply bindi over the same area since past 25 years. Based on skin biopsy and other ancillary investigations, she was diagnosed as a case of lupus vulgaris and initiated on anti TB medications following which, the lesion regressed. Thus, we herein report the first case of cutaneous tuberculosis (lupus vulgaris) associated with long term use of bindi.

Aesthetic Rehabilitation of Subgingival Fractures with Forced Eruption: Case Reports

Juhi Ansar, Prateek jain, Preeti Bhattacharya, Deepak kumar Agarwal

Aesthetic rehabilitation of sub-gingival crown fractures of the maxillary anterior tooth present extreme challenges to the dental surgeon. The prognosis of traumatized tooth depends on accurate diagnosis and physiological status of the involved tooth. This paper discusses two different cases of subgingival fracture of maxillary anterior tooth that was managed by two different technique of forced eruption. After endodontic management and forced eruption, esthetic rehabilitation was completed by placing post and core, and all ceramic crown. The final result was successful and resulted in good esthetics and secured periodontal health.

Auditory Hallucinations with an Unusual Content

Susan Solomon, Ramanathan Singaravelu

Recurrent hair pulling resulting in hair loss, in the absence of a medical or another mental disorder is a diagnostic feature of trichotillomania. It is commonly seen in depression and many other psychiatric disorders. Trichotillomania rarely occurs as a co morbid condition in patients with schizophrenia. Even rarer is recurrent hair pulling in response to psychotic symptoms in schizophrenia. We present the case of a young adult male who presented with recurrent hair pulling due to command auditory hallucinations and discuss the salient differentiating features of hair pulling seen in our patient and hair pulling in patients with trichotillomania.

Imaging Diagnosis of Herlyn-Werner-Wunderlich Syndrome- An Extremely Rare Urogenital Anomaly

Shibani Mehra, Komal Chamaria, Uc Garga, Ankur Kataria, Ashim Ahuja

Herlyn-Werner-Wunderlich (HWW) syndrome is a very rare congenital anomaly of the urogenital tract resulting from maldevelopment of both Mullerian and Wolffian ducts. It is characterized by the triad of uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis. It generally presents at puberty shortly following menarche with the symptom of acute pelvic pain. Management of these cases is surgical and consists mainly of vaginoplasty with excision of the vaginal septum in order to release the obstruction and prevent the long term complication of recurrent pyocolpos and infertility. We report here a case of Herlyn-Werner-Wunderlich syndrome in a 13-year-old adolescent girl, emphasizing the role of imaging in the accurate and prompt diagnosis of this rare developmental urogenital anomaly. Only a few hundred such cases have been reported in literature till date.

Frog Appliance- An Innovative Treatment Option for the Replacement of Missing Teeth in An Epileptic Child

Raghavendra M Shetty, Anita Goyal, Hanumanth Reddy, Arun B Sajjnar, Sonal Jain

Epilepsy is a chronic neurological disease which may result in various oro-facial injuries among which fracture of crown and avulsion of tooth are commonly reported. Challenges come in growing epileptic children where fixed prosthesis could not be delivered and it demands a fixed semi-permanent prosthesis that needs strength along with esthetics. The present paper reports an innovative appliance which has fulfilled fore mentioned criteria; with the appliance named-frog appliance.

Hemangiomatous Ameloblastoma- A Case Report of a Very Rare Variant of Ameloblastoma

Ameloblastoma is a true benign odontogenic neoplasm with many classical histological variants, common being follicular and plexiform types. Hemangiomatous amelobalstoma is a very rare variant that shows unique histopathologic characteristics varying from conventional ameloblastoma. We present a rare variant of ameloblastoma in a 35-year-old female patient with a swelling over left mandibular region, showing mixed radiolucent-opacity, which on enucleation histopathologically revealed ameloblastomatous areas with extensive vascular component.

Agnathia Holoprosencephaly and Situs Inversus in A Neonate Born to an Alcoholic Mother

Dibyajyoti Goswami, Giriraj Kusre

Agnathia, holoprosencephaly and situs inversus complex is an extremely rare form of congenital malformation. Though a few cases have been reported from other parts of the world, to the best of our knowledge none has been reported from India so far. Maternal alcoholism is regarded as an important factor causing holoprosencephaly. Disruption of the Shh gene signaling pathway is also said to be a factor for the occurrence of holoprosencephaly as well as left right asymmetry. Though several factors are suspected as a cause of this deformity, the precise aetiopathogenesis is still under debate. Lack of knowledge might be due to paucity of data from cases due to its rarity. Hereby, we are presenting a case of agnathia, holoprosencephaly and situs inversus born at 32 wk of gestation by an alcoholic mother. Externally the child had agnathia and cyclopia. There was no mandible or any oral cavity. It was accompanied by noticeable limb deformity. Internally there was holoprosencephaly, situs inversus totalis with several visceral abnormalities. To the best of our knowledge this is the first case of agnathia, holoprosencephaly and situs inversus complex to be reported in an indexed literature from India. This report also strengthens the association of maternal alcoholism with occurrence of holoprosencephaly.

Gingival Fibromatosis with Distinctive Facies – A Three Generation Case Report

Sachin Kanagotagi, Sunil Sidana, Sneha Rajguru, Ashvini Padhye

Hereditary gingival fibromatosis (HGF) is a rare disorder characterized by progressive and varying degrees of gingival overgrowth. Oral manifestations may vary from minimal involvement of only tuberosity area and the buccal gingiva around the lower molars to a generalized gingival enlargement. It can occur as an isolated disorder but can be one feature of a syndrome. Although the clinical and histopathological characteristics of HGF are well known and described, the pathogenic mechanism remains unknown. The goal of this article is to describe a family with three generations afflicted with a syndromic form of HGF known as gingival fibromatosis with distinctive facies, and discuss the diagnosis and treatment of the disease.

Erasmus Syndrome in a 42-Year-Old Male: A Rare Case Report

Subrata Chakrabarti, Koushik Pan

Erasmus syndrome is a rare entity in which systemic sclerosis develops following exposure to silica with or without silicosis. Few case reports are available in literature. We report here a case of Erasmus syndrome in a 42-year-old manual labourer. The patient presented with arthralgia, Raynoud’s phenomenon, skin tightening and microstomia along with features of Interstitial Lung Disease (ILD) and pulmonary arterial hypertension. Evidence of Interstitial Lung Disease (ILD) with mediastinal lymphadenopathy as well as pulmonary arterial hypertension with vascular reactivity was found in appropriate investigations. Serological markers of systemic sclerosis were strongly positive. After a diagnosis of Erasmus syndrome was made, a combination of drugs including Prednisone, Cyclophosphamide and Nifedipine was instituted this led to moderate improvement in his symptoms over 6 months.

Lymphangiomatous Polyp of Palatine Tonsil in A Child Presenting with Dysphagia and Dysarthria

Yasmeen Khatib, Vinod Gite, Richa Patel, Mohammed Shoeb, Asha Oraon

Pedunculated lymphangiomatous polyps of the tonsil are rare benign lesions that have been described in literature using varied nomenclature. Majority of the cases have been reported in adults with varying clinical symptoms. We report a case of lymphangiomatous polyp of left palatine tonsil in a 14-year-old male child who presented with dysphagia and dysarthria. Clinical examination revealed a large pedunculated polyp arising from upper pole of left tonsil. Patient underwent left tonsillectomy with excision of the polyp. Based on histopathological features a diagnosis of pedunculated lymphangiomatous polyp was made. We discuss the clinical and histopathological features of this lesion with differential diagnosis and short review of literature.

Hyper-fractionated Intensity Modulated Radiation Therapy (HF-IMRT) in Head and Neck Cancer: The Technical Feasibility and Results of a Short Clinical Series

Among various altered fractionation schedules, only hyper-fractionation has proven increased local control in head and neck cancers. MARCH (Metanalyses of Hyperfractionated or Accelerated radiotherapy in Head and neck cancer) concluded that hyper-fractionated radiotherapy in head and cancers had a survival benefit. This study attempts to combine the benefits of hyper-fractionation with the tissue sparing qualities of intensity modulated radiotherapy. Three patients with advanced oro-pharyngeal cancers were treated with HF-IMRT (Hyperfractionated-IMRT) (2 oropharynx, 1 hypopharynx). Two phase treatment planning with phase I prescribed to high risk volume (HRV) and intermediate risk volume (IRV), 60Gy in 50 fractions at 1.2Gy per fraction, 2 fractions/day, 6–8 h apart. The low risk volume (LRV) received 55Gy to the 95% volume at 1.1Gy per fraction in the same 50 fractions. In phase II, HRV alone was prescribed 1960cGy in 20 fractions over two weeks. Total dose to HRV was 7960cGy in 7 wk. No concurrent chemotherapy was given. Treatment was completed as planned (<60 days; break of 11 days was due to radiation toxicity). Only one patient had grade III toxicity. All three required diet modifications, an average weight loss of 3 kg and no hospitalization required during treatment. This pilot study shows the feasibility of an effective hyper-fractionation with IMRT for head and neck cancers. A Phase II trial is required to prove its efficacy.

Congenital Bilateral Mid Ureteral Stenosis: A Rare Finding

Bilateral congenital mid ureteric stenosis is a very rare entity causing hydroureteronephrosis. The pathophysiology and aetiology of this condition is uncertain. Congenital functional obstruction of the mid ureter has only 17 reported cases, that too of unilateral pathology. We report a case of an 11-year-old male child who was presented with left sided lump in abdomen since one year. On bilateral retrograde ureteropyelography (RGP), bilateral mid ureteric stenosis was documented at the level of pelvic brim. Tc99m Diethylene Triamine Pentacaetic Acid (DTPA) scan showed non functioning left kidney and decreased function and retention on right side. We did a left nephroureterectomy and uretero-ureterostomy without tapering over a Double-J stent (DJ), with excision of stenosed segment on right side. Pathological review of the ureteric segments of both sides revealed proximal dilatation with non-specific thickening of the muscular wall of the stenosed segments of ureter. The differential diagnosis must additionally include ureteral valves and fibro epithelial polyps. Important role of intravenous pyelography in such cases must be emphasized to localize the pathology site. In addition, retrograde ureteropyelography is essential in management of this anomaly to delineate the stenosed segment of the ureter preoperatively, so that the surgeon can be well prepared with final plan of management.

A Rare Case of Myxedema Coma with Neuroleptic Malignant Syndrome (NMS)

Siddharth Dixit, Manoj Kumar Dutta, Mayank Namdeo

Myxedema coma or hypothyroid crisis is an endocrine emergency and needs ICU management. Neuroleptic malignant syndrome (NMS) is another medical emergency which needs high degree of clinical suspicion else mortality can be high. There is a paradox in co existence of myxedema coma and NMS. While one is hypometabolic state another is hypermetabolic state and both can be precipitated by antipsychotics use. Hypothermia and flaccidity commonly expected in myxedema coma may mask fever and rigidity of classical NMS contributing to diagnostic problem and treatment delay. Scientific literature on coexistance of myxedema coma and NMS is sparse. We hereby report first case with coexisting myxedema coma and NMS in a patient of schizophrenia treated with antipsychotic, where classical symptoms of NMS were masked by myxedema coma. Prompt diagnosis and effective management by a team resulted in favourable outcome in our patient. This case is reported to alert intensive care physicians to atypical manifestations of NMS in presence of hypothyroidism.

Anaesthesia for a Rare Case of Down’s Syndrome with Morgagni’s Hernia Undergoing Laparoscopic Repair

Nethra H Nanjundaswamy, Vinay Marulasiddappa

Morgagni’s hernia is a type of congenital diaphragmatic hernia and it is rare in children. The association between Down’s syndrome and Morgagni’s hernia in children is also rare. Laparoscopic repair is a preferred surgical approach than open surgical procedures as laparoscopy offers a bilateral view of Morgagni’s hernia, minimal tissue damage and a faster recovery. When children with Down’s syndrome and associated Morgagni’s hernia present for laparoscopic repair, they pose several complex challenges to the anaesthetist due to the involvement of multiple organ systems, difficulties in airway management and effects of laparoscopic surgery on the organ systems. Therefore, such children need a very careful anaesthetic plan, including a thorough preoperative assessment and preparation for a successful perioperative outcome.

Subhallucal Interphalangeal Sesamoiditis: A Rare Cause of Chronic Great Toe Pain

Subhallucal interphalangeal sesamoiditis presenting as chronic great toe pain is a rarely reported clinical entity, being often overlooked and misdiagnosed for other pathologies. By altering the biomechanics of the movements at great toe, the interphalangeal sesamoid is prone to various painful pathologies like trauma, infection, degeneration, osteonecrosis and inflammation. Imaging plays an important role in narrowing down the differentials and guiding for appropriate therapy. Herein, we present a neglected case of hallucal interphalangeal sesamoiditis presenting as a case of chronic great toe pain and discuss the role of Magnetic resonance imaging (MRI) and Computed tomography (CT) scan in its diagnosis.

Splenic Injury in Situs Inversus Totalis – A Surgical Challenge

Bharat Kamath, Ambarish S Chatterjee, Iti Chandorkar

Situs inversus totalis is a rare congenital anomaly in which position of the heart and all abdominal viscera is reversed. Situs abnormalities usually go unnoticed but may be recognized by radiography or ultrasonography as an incidental finding or during evaluation for congenital heart diseases. We present such an extremely rare and to the best of our knowledge the third reported case of an injured spleen in the right hypochondrium, following seemingly trivial blunt trauma in a patient with situs inversus totalis who underwent splenectomy. The presence of associated congenital heart defects, visceral anatomical variations and mirror imaging makes the anaesthetic management as well as the surgical exercise a challenging one in such cases.

Unilateral Obstructive Emphysema in Infancy due to Mediastinal Bronchogenic Cyst-Diagnostic Challenge and Management

Bronchogenic cysts are the most common cystic mediastinal lesion in children. Bronchogenic cyst causing unilateral obstructive emphysema is a rare presentation. We report the case of a one and half month old infant who presented with respiratory distress which was initially suspected as left pneumothorax on frontal chest radiograph but was later found to be due to hyperinflated left lung and hence the possibility of congenital lobar emphysema was considered. CT thorax and limited MRI sections revealed a cystic lesion in mediastinum causing obstructive emphysema and mediastinal displacement. He underwent an emergency thoracotomy and excision of the cyst via an extrapleural approach. Post operatively, rapid improvement of the infant was noticed both clinically as well as radiologically. Cross sectional imaging like CT or MR is required for reaching the correct and early diagnosis in paediatric patients with respiratory distress, when there is diagnostic dilemma based on chest radiograph.

Dentigerous Cyst Associated with Adenomatoid Odontogenic Tumour

Adenomatoid odontogenic tumour (AOT), a tumour composed of odontogenic epithelium, is an uncommon tumour of odontogenic origin that accounts for only 2.2- 7.1% of all odontogenic tumours. Very few cases of AOT associated with Dentigerous cyst (DC) have been reported till date, most cases are in females and have a striking tendency to occur in the anterior maxilla. The present case is that of a 14-year-old female who revealed a large radiolucent lesion associated with the crown of an unerupted canine located in the left maxillary anterior region. The microscopic examination revealed the presence of AOT in the fibrous capsule of a DC. In this paper, we describe the importance of grossing, sectioning and complete examination of the slide to diagnose such hybrid lesions.

Hyperbaric Oxygen Therapy—A Novel Treatment Modality in Oral Submucous Fibrosis: A Review

Oral submucous fibrosis (OSMF) is a chronic, debilitating disease characterized by juxta epithelial fibrosis of the oral cavity and regarded as a potentially malignant disorder. Numerous treatment modalities ranging from various drugs to behavioral therapy have been tried with inconsistent results with varying degrees of success reflecting low predictability, requiring further evaluation and standardization. Novel treatment modality such as Hyperbaric oxygen therapy (HBOT) involves inhalation of 100% oxygen at increased atmospheric pressure usually ranging between 2.0 and 2.5 atmospheres for periods between 60 and 120 min. HBOT which can increase oxygen tension and delivery to oxygen-deficient tissue, is a supplementary therapy to improve hypoxic environment of OSMF and also possesses potent anti-inflammatory properties. This article enlightens on possible beneficial effects of HBOT in the management of OSMF at cellular and molecular level.

Approaches to Arresting Dental Caries: An Update

Gaurav Sharma, Manjunath P. Puranik, Sowmya K.R.

Background: Dental caries is one of the most prevalent chronic oral diseases across the globe that can be both treated and prevented. Preventive management strategies can effectively arrest and even completely reverse the caries process. This article aimed to review the literature on different approaches explored towards arresting caries progression. Materials and Methods: Literature search of publications in Pubmed/Medline was carried out. Total 73 articles including clinical trials, invitro studies, case reports and review articles were reviewed. Results: Twenty-two clinical trials and invitro studies were selected for review. Most studies suggested use of Silver Diamine Fluoride (SDF) as simple and effective caries arresting approach. Fluoride varnish treatment effectively arrests caries by inhibiting demineralization, resulting in highly significant caries reductions. Arginine with an insoluble calcium compound enhances arresting and reversing buccal, coronal and root caries. A few clinical studies have shown that sealants placed in caries fissures can arrest the caries process. Conclusion: Various fluoride containing agents are clinically effective in arresting progression of carious lesion. However, these materials should be used appropriately understanding their scope and limitations to arrest dental caries.

Antioxidants in Endodontics: A Strategic Review

Shyam Patel, Manoj Kumar Hans, Subhash Chander, Amrit Singh Ahluwalia

Over the past few decades, the free radicals and antioxidants have attracted tremendous importance in the field of dentistry. Depending on the level of free radicals in the body, they can either be harmful or helpful. Antioxidants are the substances that interact with and stabilize free radicals thereby protecting cells from the damage caused by free radicals. The indigenous antioxidants may be useful in preventing the harmful effects of oxidative stress. The present article presents a review on the free radicals formation, their role in disease pathogenesis, antioxidants and their potential role in endodontics.

Expression and Significance of Cadherins and Its Subtypes in Development and Progression of Oral Cancers: A Review

Cadherins are a family of transmembranous glycoproteins responsible for calcium-dependent intercellular adhesion. Absence or loss of function of E-cadherin leads to the disappearance of epithelial characteristics of the cells and generates higher invasiveness for extracellular matrices. That is why cadherin expression is considered to be a decisive indicator for differentiation, aggressive behaviour, high proliferation, metastasis, poor prognosis and invasiveness of human carcinoma cells. In this review, the role of cadherin expression was focused on, both in development and carcinogenesis, paying particular attention to mechanisms involved in its down-regulation. The elements common to this process in both physiological and pathological situations was analysed, particularly in relation to one of the most common malignancy, oral squamous cell carcinoma.

Effect of Gabapentin and Pregabalin in Rat Model of Taxol Induced Neuropathic Pain

A.Mangaiarkkarasi, S. Rameshkannan, R.Meher Ali

Background: Chemotherapy induced neuropathy pain remains as a major dose limiting side effect of many commonly used chemotherapeutic drugs. Presently newer antiepileptic agents have been developed with improved safety and tolerability profiles in alleviating neuropathic pain. Objectives: To evaluate the effect of Gabapentin and Pregabalin in Paclitaxel (Taxol) induced neuropathic pain and to compare the effect of these drugs in animal models. Materials and Methods: Rats were randomly divided into four groups of six animals each. Group 1- vehicle, Group 2 – Paclitaxel (2mg/kg), Group 3 - Gabapentin (60mg/kg) with Paclitaxel, Group 4 - Pregabalin (30mg/kg) with Paclitaxel. Pain was induced by intraperitoneal injection of Paclitaxel on four alternate days. After taking the baseline values, the drugs treated groups (group 3 and 4) were administered with respective drugs once a day orally for eight consecutive days along with paclitaxel. All the animals were tested for thermal hyperalgesia and cold allodynia on day 0, 7, 14, 21 and 28 with Radiant heat method and Tail immersion test, Acetone drop method respectively. Results: In Radiant heat method, gabapentin and pregabalin treated animals found to have significant increase in the tail latency period compared to control and paclitaxel treated groups in all periods of observation. Acetone drop test and tail immersion test also showed significant response similar to Radiant heat method. Pregabalin showed highly significant effect when compared to gabapentin group. Conclusion: Both gabapentin and pregabalin produced significant anti-hyperalgesic and anti-allodynic effects in experimental animal models. Pregabalin treated group showed highly significant effect compared to gabapentin treated animals.

Association between Experimental Bacterial Meningitis and Periapical Lesion

Introduction: Mortality and morbidity from bacterial meningitis in African adults is significantly higher than those in better resourced settings. At the same time, the periodontal diseases are highly prevalent and can affect up to 90% of the population. Dental caries in Uganda was recorded in 40% and 62.5% of the children and adults, respectively. We hypothesize that pneumococcal meningitis could interfere in the development of periapical lesion. The aim of this study was to evaluate periapical lesion in Wistar rats subjected to pneumococcal meningitis. Materials and Methods: The animals were divided in control, control/periapical lesion, meningitis, and meningitis/periapical lesion groups. The surgical exposure of molars and the infection of the dental pulp were from the oral environment. Pulp necrosis was induced on the left mandibular first molars during adulthood. Dental pulps were exposed by drilling cavities on the central portion of the occlusal surface with a 1011 HL round bur in high speed to a depth nearly equal to the bur diameter. Animals were subjected to behavioral task and evaluation of the size of periodontal ligament. Data from periodontal ligament space and open field task were reported as mean ± SEM and analysed by Two-way ANOVA and paired Student’s t-test, respectively. Results and Conclusion: Meningitis/periapical increased the periodontal ligament space by 61% when compared with control/periapical. In the open-field task, there were no differences in the number of crossings and rearing movements between training and test session in meningitis and periapical lesion groups demonstrating habituation memory impairment. Bacterial meningitis and periapical lesion may play an important role in development of cognitive impairment.

Dose Dependent Hepatic and Endothelial Changes in Rats Treated with Dexamethasone

Aims and Objectives: To study the effect of dexamethasone on liver and endothelium, and to determine the optimum dose which induces the abnormal changes in liver and endothelium in Wistar rats. Materials and Methods: Albino Wistar rats were divided into 7 groups (n=6). Control group rats received normal saline. Graded doses of dexamethasone (0.5,1,2,4,8 and 16mg/kg/i.p.) was administered to the groups for six days. Liver and aorta were dissected at the end of the study and examined for histopathological changes under microscope. Results: Intraperitoneal administration of dexamethasone (4,8 and 16mg/kg) for six days resulted in fatty changes in liver and same doses have shown thickening of endothelial layers in aorta, in comparison to control group. There were not much significant changes seen in low doses of dexamethasone (0.5, 1 and 2mg/kg). Conclusion: It is concluded that the acute high doses of dexamethasone (4,8 and 16mg/kg) for six days caused hepatic steatosis and showed mild to moderate arteriosclerosis in aorta. These changes may be secondary consequences of insulin resistance. Hence, it can be used as new animal model to screen the various plants and medicines in the treatment of insulin resistance.

Anti-Inflammatory Effect of Selected Dihydroxyflavones

S.Umamaheswari, K.S.Sridevi Sangeetha

Background: The mechanism of inflammation is attributed, to release of reactive oxygen species from activated neutrophils and macrophages. Over production of reactive oxygen species may result in tissue injury by damaging macromolecules. Flavones are the polyphenolic compounds with antioxidant property. This antioxidant property of flavones may have beneficial effect against inflammation. Aim: To study the anti-inflammatory effect of selected dihydroxyflavones (DHF) in albino rats. The prime objective of the present study is to identify safe and effective agents to treat inflammation from among the selected DHF group of compounds. Materials and Methods: The present study was designed to investigate the anti-inflammatory action of four selected dihydroxyflavone derivatives; 2’,3’- dihydroxyflavone and 2’, 4’ -dihydroxyflavones, 5, 3’- dihydroxyflavone and 7, 3’ dihydroxyflavone. The anti-inflammatory activity of selected DHF was studied in rats by carrageenan induced hind paw oedema method. Results: All the selected dihydroxyflavone derivatives showed dose and time dependent inhibition of carrageenan induced paw oedema.

Antioxidant Activity and Teratogenicity Evaluation of Lawsonia Inermis in BALB/c Mice

Background and Aim: Lawsonia inermis is a medicinal plant with abortive properties. There has been no scientific study to evaluate the teratogenicity of this plant. This study was performed to determine the antioxidant activity and the possible side effect of L. inermis hydroalcoholic extract on development of congenital abnormalities in BALB/c mice. Materials and Methods: In this experimental study, 120 female mature BALB/c mice were assigned to four groups and after mating and confirming the vaginal plug, the animals in the first group (G1) were kept with no intervention, and the second (G2), third (G3) and fourth (G4) groups were intraperitoneally (ip) injected with respectively saline (0.3 ml), and 10 and 100 mg/kg of L. inermis extract (for 7 days). On the 19th day, caesarean section was performed on the mice and embryos were examined for abnormalities. Their height and weight were measured. Data were analysed by ANOVA and post-hoc least significant difference tests. Results: There were significant differences between G3 and G4, and G1 (p<0.001); no significant difference was seen between G3 and G4. At 100 mg/kg dose of L. inermis, the parietal bones were absent in 90% of embryos and more extra ribs were observed in both G3 and G4 (p = 0.01). Conclusion: L. inermis may have teratogenicity and should be used cautiously during pregnancy.

Ghent Criteria an Aid to Diagnose Latent Systemic Diseases in Marfan Syndrome

Gomathi Ramlingam, Uma Maheswari T. Natarajasundaram

“Inverted V sign” in Sub-Acute Combined Degeneration of Cord

Achondropasia and Dentigerous Cyst- A Coincidental Finding or any Relationship?

Madhumati Singh, Vijayanand, Mamatha Nanjappa Siddalingappa, Sowmini

Spontaneous Fingertip Endometriosis: A Rare Case Report

Saubhagya Kumar Jena, Lipsa Mishra, Satyanarayan Behera, Soumya Samal

Publishing Case Reports and Case Series in Indian Biomedical Journals - Ethical Issue Often Neglected

Arunava Biswas, Sukanta Sen, Syed Mohammed Naser, Santanu Kumar Tripapathi