Journal of clinical and diagnostic research

Detection of FUR1 Gene in 5-Flucytosine Resistant Candida Isolates in Vaginal Candidiasis Patients

Sasikala Gopinathan, Anand B. Janagon D, David Agatha, Thenmozhivalli P.R.

Background and Aims: This study was done to detect the prevalence, risk factors for vaginal candidiasis in Chennai and to evaluate different methods for speciation of Candida isolates from vaginal candidiasis patients. This study was also aimed at detecting resistance patterns of Candida spp to common antifungals and at detecting mutant FUR1 genes in 5-Flucytosine (5 FC) resistant isolates. Material and Methods: Two hundred clinically suspected vaginal candidiasis patients were screened for candidiasis and isolated Candida were speciated by standard morphological and biochemical tests (sugar fermentation and assimilation) and by using CHROM agar-Candida medium. Antifungal susceptibility was performed by disk diffusion method (CLSI M44-A) using fluconazole, itraconazole and 5FC disks. Five FC resistant isolates were subjected to PCR for detection of mutant FUR1 genes. Results: A total of 72 (36%) Candida spp. were obtained. Vaginal candidiasis was more prevalent in 31-40 years age group and among those with poor genital hygiene and who wore tight fitting synthetic/nylon underclothes . C.albicans (35), C.tropicalis (8), C.glabrata (21), C.krusei (4) were identified by both carbohydrate assimilation test and by using CHROM agar-Candida medium. C.kefyr (2) and C.parapsilosis (2) could not be identified using CHROM agar-Candida. Resistance to fluconazole, itraconazole and 5-flucytosine was seen in 19.44%, 23.61% and 41.66% of the isolates respectively. Mutant FUR1 gene was detected in all the Candida spp that were resistant to 5FC. Conclusion: C.albicans was the commonest species which caused vaginal candidiasis in Chennai. Though CHROM agar-candida medium is a useful differential isolation medium capable of early presumptive identification of Candida species, it could not identify C.kefyr and C.parapsilosis. Azole resistance was low in C. albicans but it was high in non-albicans Candida spp. Prevalence of primary resistance to 5-flucytosine was high in the strains studied and in all of them, it was mediated by mutant FUR1 gene.

Evaluation of Nested Polymerase Chain Reaction for Rapid Diagnosis of Clinically Suspected Tuberculous Pleurisy

Manmeet Kaur Gill, Sahiba Kukreja, Namrata Chhabra

Background: Early diagnosis of tuberculosis is important in its control. The conventional techniques like smear microscopy and culture suffer from low sensitivity for diagnosis of extra-pulmonary tuberculosis like Pleural Tuberculosis (PTB) due to paucibacillary nature of the fluid. Polymerase Chain Reaction (PCR) is presently seen as a promising alternative to conventional techniques. In this study we have evaluated IS6110 sequence based nested PCR (nPCR) for the detection of Mycobacterium tuberculosis (MTB) DNA directly from clinical samples. The results of PCR were compared with the results of conventional methods like smear, culture and Adenosine Deaminase (ADA) activity. Material and Methods: A total of 50 pleural fluid samples from the patients with history suggestive of tuberculosis were taken. All the samples were processed for Ziehl-Neelsan (ZN) staining for Acid Fast Bacilli (AFB), culture ADA activity and PCR with primers targeting 123bp fragment of IS6110 of MTB complex. Results: A significant difference was seen in the sensitivities of conventional methods and PCR (p<0.05). Out of these 50 samples 3 were positive by smear, culture was positive in 5 samples, 21 samples showed high ADA activity and 29 were positive by PCR with overall 100% sensitivity of PCR using culture on LJ media as gold standard. Conclusions: The combined analysis of nPCR, ADA activity and other lab investigations can be very useful in the rapid diagnosis in cases of PTB.

Candiduria Prevalence and Trends in Antifungal Susceptibility in A Tertiary Care Hospital of Mangalore

Yashavanth R., Shiju M.P., Bhaskar U.A., Ronald R., Anita K.B.

Objective: The incidence of Candida has been on rise worldwide. Urinary tract infections [UTIs] as a result of Candida species are becoming, common in hospitalised patients. Clinicians face dilemma in differentiating colonization from true candiduria. The species identification of Candida is important, as non albicans Candida species are increasing in number and more resistant to antifungal drugs. The aim of the study was to find out the frequency of Candida among uropathogens, their speciation and to determine the susceptibilities to antifungal drugs of Candida species isolated from candiduria. Material and Methods: A total of 2900 urine samples were analysed in a tertiary care hospital. Candida species isolated from urine samples were subjected to speciation using CHROM agar and standard yeast identification protocol. Antifungal susceptibility testing for fluconazole, voriconazole, flucytosine, amphotericin B was carried out using VITEK-2 compact system of Biomerieux. Result:A total of 66[2.27%] Candida species were isolated from 2900 urine samples. Among them non albicans Candida species were predominant [69.7%] compared to Candida albicans [30.3%]. The Candida isolated were more susceptible to amphotericin B [91%] and flucytosine[82%] compared to voriconazole[72.72%] and fluconazole [66.66%]. Conclusion: The present study reiterates the prevalence of Candida species among UTIs and their antifungal susceptibility pattern. Prevalence of non albicans Candida was more than Candida albicans. Non albicans Candida species are more resistant to antifungal drugs compared to C.albicans. Therefore, the species identification of Candida isolates along with their antifungal susceptibility pattern can help the clinicians in better treating the patients with candiduria.

Microbial Profile of Early and Late Onset Ventilator Associated Pneumonia in The Intensive Care Unit of A Tertiary Care Hospital in Bangalore, India

Saroj Golia, Sangeetha K.T., Vasudha C.L.

Introduction: Ventilator-associated pneumonia (VAP), an important form of hospital-acquired pneumonia (HAP), specifically refers to pneumonia developing in a patient on mechanical ventilator for more than 48 h after intubation or tracheostomy. Despite the advancements in antimicrobial regimes, VAP continues to be an important cause of morbidity and mortality. VAP requires a rapid diagnosis and initiation of appropriate antibiotic treatment, as there is adverse effect of inadequate antibiotic treatment on patients’ prognosis and the emergence of multidrug-resistant (MDR) pathogens. Aims: The present study was undertaken to assess the etiological agents of early-onset and late-onset VAP and to know their sensitivity pattern. Material and Methods: VAP data over a period of 12 months (February 2012 -February 2013) in a tertiary care ICU was retrospectively analysed. The patients were stratified by age, sex, duration of VAP (Early/Late onset) and the identified pathogens with their sensitivity pattern. Results: Incidence of VAP was found to be 35.14%, out of which 44.23% had early-onset (<4 days MV) VAP and 55.77% had late-onset (>4 days MV) VAP. The most common organisms isolated in early onset and late onset VAP was Pseudomonas aeruginosa, E.coli and Acinetobacter baumanii. All enterobacteriaceal isolates were extended spectrum beta lactamase (ESBL) producing organisms and all Staphylococcus aureus isolates except one were methicillin resistant. The incidence of Multidrug resistant (MDR) Pseudomonas aeruginosa and Acinetobacter were 40% and 37.5% respectively. Conclusion: Due to the increasing incidence of multidrug-resistant organisms in our ICU, early and correct diagnosis of VAP is an urgent challenge for an optimal antibiotic treatment and cure. Hence, knowing the local microbial flora causing VAP and effective infection control practices are essential to improve clinical outcomes.

Revised Ciprofloxacin Breakpoints for Salmonella: Is it Time to Write an Obituary?

Revathy Girish, Anil Kumar, Sadia Khan, Kavitha R. Dinesh, Shamsul Karim

Objectives: To determine the minimum inhibitory concentration of ciprofloxacin among 50 blood stream isolates of Salmonella enterica. Material and Methods: A total of 50 consecutive isolates of Salmonella enterica were tested for susceptibility to antimicrobials using the Kirby Bauer disk diffusion method. Minimum inhibitory concentrations were determined using Hi-Comb strips. All results were interpreted according to the CLSI guidelines. Results: Of the 50 isolates 70%were Salmonella Typhi, 4% Salmonella paratyphi A, 2% Salmonella paratyphi B and the remaining 10% were identified only as Salmonella species. Using the CLSI 2011 breakpoints for disc diffusion, 86% (43/50) were resistant to nalidixic acid(NA), 22% (11/50) to ciprofloxacin, 12% to azithromycin, 6% to cotrimoxazole, 4% to ampicillin and 1% to chloramphenicol. The MIC50 and MIC90 of ciprofloxacin for S.Typhi were 0.181 µg/mL and 5.06 µg/mL respectively. While the same for S. paratyphi A was 0.212µg/mL and 0.228µg/mL respectively. None of the isolates were multi drug resistant and all were susceptible to ceftriaxone. Using the CLSI 2012 revised ciprofloxacin breakpoints for disc diffusion (>31mm) & MIC (<0.06 µg/mL), 90% (45/50) of these isolates were found to be resistant. Conclusion: MIC’s of ciprofloxacin should be reported for all salmonella isolates and should be used to guide treatment. Blindly following western guidelines for a disease which is highly endemic in the subcontinent will spell the death knell of a cheap and effective drug in our armamentarium. Therefore it will be too premature to declare that “the concept of using ciprofloxacin in typhoid fever is dead!”

Awareness of Mothers and Doctors about Drug Utilization Pattern for Illnesses Encountered during Pregnancy

Nargis Ibrahim Kureshee, Priti Pravin Dhande

Background: Careful consideration of the benefit to the mother and risk to the foetus, is required, while prescribing drugs during pregnancy. Objectives: To assess the pattern of drug utilization during pregnancy and to explore the knowledge, attitude and awareness on drug use by the antenatal mother in a tertiary care hospital setup in western India. Material and Methods: Observational, cross-sectional study involved holding interviews on 501 pregnant women, in OPD and IPD of Obstetrics-Gynaecology Department using a pilot-based questionnaire, was done. Data from prescriptions and case-files were also collected. Drugs were classified pharmacologically and according to teratogenic potential using U.S.FDA classification. Study population was classified according to the trimester of pregnancy and educational and socioeconomic status. Intergroup comparison was done using Chi-square test. Results: Majority of the drugs were from Category A(71.2%) and Category B (16.5%), followed by those from Categories C(9.09%), D(1.12%) and X(0.7%). Category A drugs were significantly used more in first trimester, while Category C and D drugs were used in the last two trimesters (p<0.0001) for pregnancy associated complications. Only 24.55% of the women believed that drug use in pregnancy could be harmful to both mother and baby, while 35.52% believed that drug use could be dangerous throughout pregnancy. Patients’ educational and socio-economic statuses influenced their compliance for nutritional supplements prescribed during pregnancy and their awareness on common contraceptive methods. Higher education and socioeconomic class provided information on safety of barrier contraception during pregnancy. Conclusion: Study revealed careful prescribing behaviour of physicians. Lack of awareness on safety of drugs in pregnancy and contraceptive use advocates a need for educating and counselling women of child bearing ages.

Study of Package Inserts in Southern India

Introduction: Package insert is an officially approved document that accompanies a drug. It is intended to provide information for the safe and effective use of a drug and contains information based on regulatory guidelines. Sometimes, information provided in the package inserts is suboptimal which can led to medication errors. This study was undertaken to assess the presentation and completeness of clinical information provided in the currently available package inserts for anti-diabetic, anti-hypertensive and hypolipedemic drugs in India. Material and Methods: Around 130 package inserts were collected from pharmacies located at different areas of Bangalore. They were analyzed based on criteria mentioned in Schedule D of Drug and Cosmetic act 1945. Results and Observations: Out of 134 package inserts, 64 were anti-diabetics, 40 anti-hypertensives, and 30 hypolipedemics. Out of them, 31 (23.14%) belonged to Grade ‘A’ (including all injectable preparations) and remaining 76.86% to Grade ‘B’. None of the PIs belonged to Grade ‘C’. The inserts were inadequate in many aspects; for example, they had unclear instructions about generic name of other ingredients used, about handling, undesirable effects, pediatric and geriatric use, and guidelines for use of the drugs. Conclusion: This study indicated that information relevant to the safe and effective use of medication was not mentioned in the analyzed package inserts. It is, therefore, recommended to update the existing package inserts based on criteria mentioned in the Schedule D of Drug and Cosmetic Act, 1945.

Effect of Oral Anti-platelet Regimens on Platelet Aggregation using Chronolog Light Transmittance Aggregometry in Coronary Heart Disease Patients: An Observational Study

Kishan P.V., Uday Kumar C., Shobha J.C.,Usharani P., Chandrasekhar E.

Introduction: Coronary heart disease is one of the most common cardiac health problem in India. Anti-platelet therapy is the cornerstone in the management of coronary heart disease. The current study was undertaken to compare the effect of different oral anti-platelet regimens on percentage inhibition of platelet aggregation in coronary heart disease patients using chronolog light transmittance aggregometry. Material and Methods: Blood samples of 215 consecutive patients diagnosed of coronary heart disease (Male: Female ratio- 142: 73) with mean age of 55.2 ±10.3 years, who underwent platelet aggregation test were analysed. Patients were either on aspirin, clopidogrel, prasugrel, cilostazol or a combination of these drugs in different dosages. Of the 215 coronary heart disease patients, 35, 115 and 65 patients were on single, dual and triple anti-platelet drug regimen respectively. Results: The Percentage Inhibition of Platelet Aggregation (%IPA) in patients on dual anti-platelet regimen was highest i.e., 65.14 ± 23.23 as compared to 48.89 ± 22.16 in patients on monotherapy and 62.14 ± 21.64 in patients on triple anti-platelet regimen. Percentage of responders (> 40% inhibition of platelet aggregation) were 54.28%, 73.91% and 64.61% in single, dual and triple drug regimens respectively. Among responders on dual anti-platelet regimen, 64.7% were on aspirin + prasugrel and 35.3% were on aspirin + clopidogrel. The Percentage Inhibition of platelet aggregation in diabetics on dual anti-platelet regimen was 71.69 ± 17.54 as compared to 56.14 ± 23.29 in diabetics on triple anti-platelet regimen. Conclusion: Dual anti-platelet therapy containing prasugrel was found to be more effective than dual anti-platelet therapy containing clopidogrel on background aspirin therapy and triple anti-platelet therapy in terms of percentage inhibition of platelet aggregation in coronary heart disease patients especially those with concomitant diabetes, however this conclusion needs to be further confirmed by large-scale randomized clinical trials.

Seminal Plasma pH, Inorganic Phosphate, Total and Ionized Calcium Concentrations In The Assessment of Human Spermatozoa Function

S .Olatunbosun Banjoko , Fasiu O. Adeseolu

Introduction: Fertilization in humans is dependent on viability of the male spermatozoa among other factors and there have been conflicting reports on the role of pH, calcium and phosphate concentrations in sperm function. This study therefore aimed to investigate seminal plasma pH, inorganic phosphate, total and ionized calcium concentrations relative to spermatozoa function. Material and Methods: Seminal plasma concentrations of pH, total calcium, ionized calcium (Ca++); inorganic phosphate, motility and spermatozoa count were determined in 80 males by standard methods. Results: Forty-nine of the subjects had normal spermatozoa motility (> 60%) and 31 had hypomotility (< 60%). The hypomotility group exhibited lower calcium ion (Ca2 +) concentrations; 0.19+0.01mmol/L compared with normal motility group; 0.24+0.01mmol/L (p<0.001) the latter also had significantly higher inorganic phosphate; 7.83+1.27 while the former had 5.64+1.62mmol/L (p= 0.004). The mean spermatozoa counts for hypomotility and normal motility group were 42.0 ± 13 x 106 , 72.35 + 20 x 106 respectively (p< 0.001). No significant differences were observed in pH, volume of ejaculate and total calcium concentration between the hypomotility and normal motility groups The mean concentrations of pH were 7.51 ± 0.02 and 7.54 ± 0.03 respectively (p= 0.21) and total calcium; 3.10 ± 0.12 and 3.36 ± 0.14mmol/L respectively (p= 0.16 ). There was a significant difference in percentage of abnormal forms in both groups with hypomotile group having 36% compared to mormal motility group with 5% (p< 0.05). Conclusion: Correlations were observed between seminal concentrations of calcium ions, inorganic phosphate, spermatozoa count and motility but not with total calcium concentrations and pH and therefore should be considered in understanding male infertility and preparation of media for sperm preservation for in vitro fertilization.

Evalution of Anaemia in Booked Antenatal Mothers During the Last Trimester

Erli Amel Ivan, Mangaiarkkarasi A.

Background and Aim: Anaemia occurring during pregnancy is an important public health problem in developing countries. In India, anaemia is one of the most common causes of maternal death, accounting for 20% of total maternal deaths. This study was conducted with the aim of evaluating anaemia among booked antenatal mothers during the last trimester, its possible impact on pregnancy and its outcome in antenatal mothers, visiting antenatal clinic in a teaching tertiary care hospital at Pondicherry, India. Material and Methods: This hospital based, descriptive, cross sectional study was conducted in the Department of Clinical Pathology and Pharmacology at Sri Manakula Vinayagar Medical College Hospital in Pondicherry, India. Socio–economic and gestational status data was collected with the help of structured questionnaire from booked antenatal mothers in third trimester. Venous blood was collected for the estimation of Haemoglobin by using Sahli’s Haemoglobinometer and morphological typing of anaemia was estimated by using Leishmann Stain peripheral blood smears. The women were followed-up till delivery and their antenatal, neonatal and other birth outcomes were recorded. Results: Seventy five booked antenatal women, aged 19 - 40 years, with gestational ages of 27– 40 weeks, were recruited for the study. We observed that among 75 antenatal mothers, the Haemoglobin level was less than 10grams% in 83% cases and that it was more than 10 grams% in 17% cases. Iron deficiency anaemia and dimorphic anaemia were recorded in 37% and 19% of the women respectively. High percentage of anaemia was noted in women of higher age group (23–27 years), in those with multi–parity (55%) and low educational levels (100%) and in mothers of low socio–economic status (100%). In the pregnancy outcomes, 85% and 60% anaemic mothers reported maternal and foetal complications respectively. Conclusion: In spite of regular antenatal visits in third trimester, maternal anaemia is still high and it is often associated with low education status, socio-economic status and multi-parity, based on our study. There is a need of health education programmes with respect to haematinics compliance and adequate intake of iron rich diet during pregnancy, to be strengthened for safe maternal and foetal outcomes.

Types and Frequency of Preanalytical Errors in Haematology Lab

Shashi Upreti, Sanjay Upreti, Rani Bansal, Nadia Jeelani, Vinay Bharat

Aim: This study was conducted to evaluate the frequency of the preanalytical errors occurring in a haematology laboratory. Material and Methods: A retrospective study was conducted by collecting and analyzing data in duration of one year in the haematology section of the laboratory. Data for all the preanalytical variables according to the predefined categories were scanned. Both IPD and OPD patients were segregated. Result: A total of 135808 samples were received in haematology lab during this period, out of which in 1339 samples, preanalytical errors were found, which approximately constituted 1 % of all samples. Conclusion: Highest number of samples were rejected due to misidentification, that is 0.35 % and least number were rejected due to dilution of the samples, that is 0.04 %.

Study of Coronary Atherosclerosis by Modified American Heart Association Classification of Atherosclerosis-An Autopsy Study

Viral M. Bhanvadia, Nandini J. Desai, Neeru M. Agarwal

Background: The study was designed to assess the atherosclerotic lesions in coronary arteries in cases subjected to autopsy to grade by applying Modified American Heart Association (AHA) classification, evaluate the atheromatous & vulnerable plaques to find out the to age and sex related prevalence of atherosclerosis in the semi-urban & urban population of Jamnagar, a district in Western India. Material & Methods: Autopsy was conducted on 264 cases whose age ranged from 8-79 years, by the conventional technique; heart was removed & dissected along the direction of blood flow. Microscopic assessment of the three main coronary arteries was done. Result: According to Modified AHA classification of atherosclerosis, maximum number of cases were in the 40-49 years age group. Intimal xanthoma was the most common type in all three coronary arteries. The number of males was 168(64%) and females was 96(36%). 59% males & 52% female were affected from atherosclerosis. An intermediate lesion was noted commonly in young individuals (10-39 years) and older individuals (40-79 years) were 46% & 41% respectively. Pathological Intimal thickening was more common in left anterior descending coronary artery compared to others. Thin fibrous cap atheroma was more common in Left circumflex artery than compared to Left anterior descending artery & Right coronary artery. Conclusion: The study highlights the impact of atherosclerotic lesions in the population of Jamnagar, a district in Gujarat state of Western India. The increased amount of intermediate atherosclerotic lesions found in the young population gives an indication that anti-atherogenic preventive measures and drastic dietary & life style modification need to be implemented in young individuals, this will help to prevent coronary artery disease from causing premature death that lead to huge financial burden on the economy and health sector of India.

Normal Values in Healthy Liver in Central India by Acoustic Radiation Force Impulse Imaging

Babita Raghuwanshi, Niti Jain, Manish Jain

Aim: The aim of this study was to reliably measure and define the normal wave velocity values in a healthy liver by Acoustic radiation force impulse imaging (ARFI) technology in central India. Subjects and Methods: Fifty two healthy volunteers underwent acoustic radiation force impulse imaging tissue quantification and were enrolled in this prospective study. All patients were examined clinically by a clinician and blood samples were drawn and tested for liver function test and viral markers for hepatitis B virus, hepatitis C virus. The healthy volunteers were then examined by a certified sonologist and twenty-four measurements per subject were obtained and evaluations were performed. Statistical comparison of all mean data was performed with Student’s t-test was done. A valueof p < 0.05 was considered significant. A comparative analysis was performed, and interclasscorrelation coefficients were calculated. Results: The sonologist obtained 416 measurements. A statistically significant differencewas found between the mean shear wave velocity values in deep of the right lobe of the liver and the values obtained on the surface of the right lobe (1.2vs1.05 m/s) and between the mean values obtained deep in the right lobe and those obtained deep in the left lobe (1.2vs 1.0 m/s). In almost all cases, the shear wave speeds were between 1 and 2 m/s. Conclusion: Acoustic radiation force impulse imaging quantification of hepatic tissue is more reproducible when applied to the deeper portion of the right lobe of the liver.

Clinico -Bacteriological Study of Chronic Dacryocystitis Cases in Northern Karnataka, India

Aims and objectives: The aim of this study was to identify the organisms responsible and to determine the antibiotic susceptibility pattern of the bacterial isolates from conjunctiva and nasal mucosa in cases of chronic dacryocystitis and comparing with lacrimal sac specimen. Design: Prospective longitudinal study. Methods: A prospective analysis of 44 lacrimal sac contents of patients with chronic dacryocystitis conducted during the period from April 2012 to March 2013. Material was obtained directly from the lacrimal sac while making sac flap during external dacryocystorhinostomy for chronic dacryocystitis. Samples were also collected from ipsilateral conjunctiva and inferior meatus of nose. The specimens were cultured and results analyzed. Statistical Analysis: The results were analyzed by using Chi-square (?2) test. Results: All the patients were in age group of 30 and above. Gram positive bacteria i.e., Coagulase negative staphylococci and Staphylococcus aureus were the most common isolates (71% and 14% respectively). Vancomycin, amikacin, 3rd generation cephalosporins and amoxyclav were most sensitive antibiotics (100%, 89%, 83%, and 78% respectively). Comparison between lacrimal and nasal/conjunctival isolates showed high degree of identicalness between the isolates of two sites (p< 0.05). Conclusion: Majority of the chronic dacryocystitis cases are caused by Coagulase negative Staphylococci and Staphylococcus aureus. Amoxyclav and 3rd generation cephalosporins can be used to treat chronic dacryocystitis. Commensal flora of nose and conjunctiva have a direct role in pathogenesis of chronic dacryocystitis.

Indications of Penetrating Keratoplasty in Southern India

Aim: To study the indications of penetrating keratoplasty in Southern India. Settings and Design: Retrospective study. Material and Methods: Retrospective evaluation of eye bank records from December, 2002 to December, 2012 with respect to indications for penetrating keratoplasty. Results: During the period considered for study, 102 penetrating keratoplasties were performed. The leading indications for penetrating keratoplasty were corneal scarring (60.7%), followed by regrafting (12.7%), spheroidal degeneration (9.8%), aphakic bullous keratopathy (5.88%), pseudophakic bullous keratopathy (2.94%), acute infectious keratitis (2.94%), corneal dystrophy and keratoconus (4.9%). Healed infectious keratitis (72.88%) was the most common subcategory among the eyes with corneal scarring followed by traumatic corneal scars (16.12%). Conclusion: Corneal scarring from healed infectious keratitis are the most common indication for keratoplasty in Southern India.

Enolving Trends: Hyperbilirubinemia Among Newborns Delivered to Rh Negative Mothers in Southern India

Girish N, Santosh S, Keshavamurthy SR

Introduction: Neonatal jaundice is the commonest abnormal physical finding in the new born nursery and hemolytic disease of the newborn (HDN) among babies born to Rh negative mothers is the most formidable etiology. During last few decades considerable evolution has been observed in this entity secondary to development of several novel preventive, diagnostic and therapeutic modalities. Objective: To study the current trends in presentation, management and outcome of hyperbilirubinemia among newborns delivered to Rh negative mothers. Methodology: This observational descriptive study with prospective data collection included one hundred live born term babies born to Rh negative mothers in our hospital. A predesigned proforma was used to record antenatal and postnatal data .Cord blood collected during delivery for assessment of bilirubin,hematocrit and direct coombs test.Serum bilirubin levels were estimated in babies with clinical jaundice and treated for the same if required.All babies were regularly followed up weekly for one month. Chi square test/Fisher Exact test and Student “t” test has been used to find the significant association of jaundice(incidence,treatment) and study characteristics. Results: Out of 100 babies enrolled, 57 babies developed jaundice. Jaundice is 2.7 times more likely associated with babies born to multiparous Rh-ve mothers with p=0.017*. Jaundice is 3 times more likely associated with Rh+ve babies born to multiparous mothers with p=0.020*. Jaundice is 3.97 times more likely associated with Rh+ve babies born to multiparous mothers who have not received Anti-D with p=0.154. Treatment of jaundice is 2.75 times more likely in Rh+ve babies born to multiparous mothers who have not received Anti-D with p=0.162. Duration of phototherapy is significantly more in Rh+ve babies born to multiparous mothers who had not received Anti-D with p=0.0097*.Exchange transfusion was required in two babies. Conclusion: Although the incidence of Rh isoimmunization has declined dramatically over the years ,it is still an important cause of neonatal morbidity and mortality emphasizing the need for more vigorous preventive efforts and up-to-date management skills.

"Neonatal Sepsis”: Bacteria & their Susceptibility Pattern towards Antibiotics in Neonatal Intensive Care Unit

Background: Neonatal sepsis is one of the most common causes of neonatal mortality and morbidity, particularly in the developing countries. Its causative bacteria and their respective sensitivity patterns are different in each hospital and region. The objective of this study was to determine the causative bacteria and pattern of susceptibility to antibiotics in NICU of a tertiary care centre, which in turn may help in implementation of empirical therapy. Material and Methods: This prospective study was carried out at a medical college during the period from 1st April 2011 to 31st March 2013. A total of 364 cases of suspected sepsis were admitted in our NICU during the mentioned period. Out of which, 137 cases were positive for culture. All the neonates of suspected sepsis were screened by using a panel consisting of CRP, ANC, I/T ratio, micro ESR and culture and sensitivity. Results: A total of 137 cultures were found to be positive out of 364 cases. The most common organism isolated was Staphylococcus aureus (37.22%) followed by Klebsiella pneumoniae (27.01%) and Escherichia coli (19.70%). Other organisms were much less in number, which included pathogenic Streptococci, Coagulase negative Staphylococci (CoNS), Pseudomonas, Acinetobacter and Enterobacter species. The gram positive organisms except Streptococci displayed a high degree of resistance to most penicillins and ciprofloxacin but were sensitive to vancomycin, amikacin and cefepime. There was a high incidence of resistance noted with ampicillin, gentamicin and ciprofloxacin amongst most gram negative organisms’ where-in cefepime, amikacin and meropenem were effective in most cases. Conclusion: There is an increasing trend of antibiotic resistance to the commonly used first line drugs. Continuous surveillance for antibiotic susceptibility is needed to ensure proper empirical therapy.

Arterial Blood Carbonic Acid Inversely Determines Lactic and Organic Acids

Christopher Geoffrey Alexander Aiken

Objective: To establish that arterial blood carbonic acid varies inversely with lactic acid in accordance with bicarbonate exchanging for lactate across cell membranes through the anion exchange mechanism to maintain the Gibbs-Donnan equilibrium. Study Design: Over 5 years, lactate was measured on all blood gases taken from neonatal admissions, as well as organic acid whenever electrolytes were required. Results: Arterial blood gases from 63 infants given high calcium TPN were analyzed. Twenty two needed continuous positive airways pressure (CPAP) only and 31 intermittent positive pressure ventilation (IPPV) and surfactant followed by CPAP to treat respiratory distress syndrome in 51 and meconium aspiration syndrome in 2. All survived and were free of infection. Excluded gases were those with high and falling lactate soon after delivery representing perinatal asphyxia, and those on dexamethasone. Strong inverse relations between carbonic and lactic acids were found at all gestational ages and, independent of glomerular filtration, between carbonic and organic acids. Lactate (mmol/L) = 62.53 X PCO2 -0.96(mmHg) r2 0.315, n 1232, p <0.001. Sixty divided by PCO2 is a convenient measure of physiological lactate at any given PCO2. In the first week, 9.13 ± 2.57% of arterial gases from infants on IPPV had lactates above 120/PCO2, significantly more than 4.74 ± 2.73% on CPAP (p<0.05) and 2.47 ± 2.39% on no support. Conclusion: Changes in arterial blood carbonic acid cause immediate inverse changes in lactic acid, because their anions interchange across cell membranes according to the Gibbs –Donnan equilibrium. Increasing PCO2 from 40 to 120 mmHg decreased lactate from 1.5 mmol/L to 0.5 mmol/L, so that the sum of carbonic and lactic acids increased from 2.72 mmol/L to only 4.17 mmol/L. This helps explain the neuroprotective effect of hypercapnoea and highlights the importance of avoiding any degree of hypocapnoea in infants on IPPV.

Spectrum of Perforation Peritonitis

Introduction: Perforation peritonitis mostly results from the perforation of a diseased viscus. Other causes of perforation include abdominal trauma, ingestion of sharp foreign body and iatrogenic perforation. The diagnosis is mainly based on clinical grounds. Plain abdominal X-rays (erect) may reveal dilated and oedematous intestines with pneumoperitoneum. Ultrasound and CT scan may diagnose up to 72% and 82% of perforation respectively. The present study was carried out to study various etiological factors, modes of clinical presentation, morbidity and mortality patterns of perforation peritonitis presented in the RIMS hospital, Imphal, India. Material and Methods:The study was conducted from September 2010 to August 2012 on 490 cases of perforation peritonitis admitted and treated in the Department of Surgery. Initial diagnosis was made on the basis of detailed history, clinical examination and presence of pneumoperitoneum on erect abdominal X-ray. Results: A total of 490 patients of perforation peritonitis were included in the study, with mean age of 48.28 years. 54.29% patients were below 50 years and 45.71% patients were above 50 years. There were 54.29% male patients and 45.71% female patients. Only 30% patients presented within 24 hours of onset of symptoms, 31.43% patients presented between 24 to 72 hours and 38.57% patients presented 72 hours after the onset of symptoms. Mean duration of presentation was 54.7 hours. Overall 469 patients were treated surgically and 21 patients were managed conservatively. Overall morbidity and mortality recorded in this study were 52.24% and 10% respectively.

Isolating Globose Basal Stem Cells from Albino Wistar Rats Using a Highly Specific Monoclonal Antibody

Introduction: Olfactory mucosa which is situated in the roof of the nasal cavity possesses an extremely peculiar and exceptional type of pluripotent stem cells called Globose Basal Cells (GBCs) which help in lifelong regeneration of the olfactory mucosa. Previous literature doesn’t provide much knowledge on the cytological, histochemical and electrophysiological properties of these cells, as they have never been isolated in pure form. Matrial and Methods: Olfactory mucosa was obtained from six Albino Wistar rats by using standardized surgical and chemical separation procedures. GBCs were isolated by using different chemical, surgical and fluorescent techniques. Results: In this research work, we standardized the techniques for isolating these stem cells in pure form from rat olfactory mucosa by tagging them with GBC-III antibody and separating them from other epithelial cells by using Fluorescence Activated Cell Sorter (FACS). GBC-III antibody is a mouse monoclonal IgM antibody which recognizes a 40 kDa surface antigen, which is a laminin receptor surface protein present on the GBCs. It is a highly specific marker for GBCs, unlike the earlier antibodies used, like GBC-I, which were nonspecific markers for GBCs and showed positive reactions, even with Horizontal Basal Cells (HBCs), sustentacular cells (Sus) and duct cells. This study also standardized the techniques for surgically excising the olfactory mucosa from the nasal septum and chemically separating the olfactory epithelium from the lamina propria. Conclusion: GBCs are an important group of cells which can be exploited in future to study and treat neuro-degenerative disorders like multiple sclerosis, brain ischaemia, etc. and spinal cord trauma, as they reside in a niche similar to the microenvironment in the central nervous system and have the similar ectodermal development as the neuronal and non-neuronal cells of the CNS. Moreover, olfactory epithelium is easily accessible for autologous transplantation of GBCs for different CNS disorders.

A Comprehensive Study of the Anatomical Variations of the Circle of Willis in Adult Human Brains

S. Iqbal

Background: Cerebrovascular diseases such as stroke, aneurysms and arterio-venous malformations are very much prevalent in our country. Circle of Willis, as an anastomotic polygon at the base of the brain forms an important collateral network to maintain adequate cerebral perfusion. Changes in the normal morphology of the circle may condition the appearance and severity of symptoms of cerebrovascular disorders, such as aneurysms, infarctions and other vascular anomalies. A possible link between abnormalities of the circle of Willis and the mentally ill patients has been observed. Aim and Objectives: The aim of the present study is to have an intimate knowledge of the variations in the cerebral arterial circle and to clarify the clinical importance of these variations in certain forms of cerebrovascular diseases. So an attempt was made to analyse the anatomical variations of the circle in a random population. Material and Methods: The work was based on fifty adult brains from persons died of diverse causes. The materials were obtained during routine autopsy studies. The base of the brain including the brain stem with intact arterial circle was preserved in 10% formalin for 10 days. The circle of Willis and its major branches were carefully dissected under water using a magnifying lens. The variations were recorded and photographed. Results: Majority of the circles (52%) showed anomalies. Hypoplasia was the most frequent anomaly and was found in 24% of the brains. Accessory vessels in the form of duplications/ triplications of anterior communicating artery were seen in 12% of the circles. The embryonic origin of the posterior cerebral artery from the internal carotid persisted in 10% of the circles. An incomplete circle due to the absence of one or other posterior communicating artery was found in 6% of the specimens. Variations are more frequent in posterior half of the circle. Conclusion: The anatomical variations of the circle of Willis were probably genetically determined, develop in early embryonic stage and persist in post natal life. The amplitude of neck movements, racial, environmental and hemodynamic factors may also modify these variations. These anomalies may alter the occurrence, severity of symptoms, treatment options and recovery from certain cerebrovascular disorders viz., stroke and aneurysms. A detailed knowledge of the vascular variants is useful to surgeons in planning their shunt operations, choice of the patients and also keeps away inadvertent vascular traumas during surgeries.

Placental Morphometry Determines the Birth Weight

Background: Placental morphometry determines the foetal development and adulthood disease pattern. Hence, in the present study the influence of placental weight, volume, surface area, and thickness were studied in different groups of birth weight by sex of the newborn. Materials and Method: Present study was conducted on 164 consecutive singleton deliveries from a teaching hospital of Northern Karnataka, India. Multivariate linear regression models were constructed by maximum likelihood method after checking the linearity. The sensitivity, specificity and predictive values of regression models were computed to exhibit their utility for physicians. Results: Gestational age exhibited positive relationship with birth weight. Placental parameters showed a positive and significant relationship (p<0.001) with birth weight and higher values in males. The birth weight was estimated by regression models using sex of the newborn and placental morphometry; weight (R2=0.474), surface area (R2=0.420), and volume (R2=0.477) at 95% confidence interval. Low birth weight babies in the study were correctly identified by placental weight, surface area, volume and sex of the newborn. Their sensitivity, specificity and predictive values have been specified. Conclusion: Placental morphometry: weight, surface area, volume and sex of the baby determined the birth weight efficiently to initiate the corrective measures for planning better maternal care and to pacify mothers and their relatives.

Plasma Free Fatty Acid Concentrations as a Marker for Acute Myocardial Infarction

Vijay Kumar Roy, Anil Kumar, Prabal Joshi, Jyoti Arora, Ali Mohammad Ahanger

Background: Acute myocardial infarction carries a high mortality among cardiac patients.The discovery of the fact that certain enzymes like CPK, LDH liberated into circulation following necrosis of the myocardial cells came as boon for physicians and patients. There has been a constant search of different parameters for the diagnosis and management of CoronaryArtery Diseases (CAD). Aim: The present study was undertaken to investigate a possible relation between the changes in plasma free fatty acid (FFA) concentration and acute myocardial infarction. Material and Methods: Fifty cases (25 males and 25 females) of acute myocardial infarction were selected for the present study. All the patients were in the age group of 40-70 years. For the control group fifty (25 male and 25 female) subjects of same age group were selected from patient’s relatives and friends. Plasma free fatty acid concentration was estimated by Titrametric method of Trout et al., (1960), a modified version of Dole (1956). Statistical Analysis: The statistical analysis of the data of the present study was done by using SPSS, version 14.0.1 was used. Results: Our study showed a significant increase in plasma FFA in the first 24 hours of acute myocardial infarction with subsequent normalisation on the 7th day.The difference between the first and the seventh day was statistically significant. Conclusion: The FFA were found raised in cases of acute myocardial infarction.On the basis of present study, it is worth to say that estimation of serum free fatty acid should be done routinely at the earliest opportunity in all cases of acute myocardial infarction.

Predictive Value of Serum Sialic Acid in Type-2 Diabetes Mellitus and Its Complication (Nephropathy)

Introduction: Sialic acid levels are increased in type-2 diabetes mellitus and its estimation helps in predicting the occurrence of microvascular complication such as diabetic nephropathy. The present study compared the levels of sialic acid, glycated haemoglobin, serum creatinine and urine microalbumin: in type-2 diabetics without any complications; in type-2 diabetics with nephropathy; and in age and sex matched healthy individual (controls). Results: The study observed an increased level of sialic acid in type-2 diabetics without any complications and type-2 diabetics with nephropathy. Serum sialic acid levels in type-2 diabetics without any complications was 64.44 ± 3.93 mg/dl, in type-2 diabetics with nephropathy was 73.88 ± 4.41 mg/dl, and in controls it was 53.16 ± 3.40 mg/dl. Urine sialic acid levels in type-2 diabetics without any complications was 6.62 ± 0.70 mg/dl, in type-2 diabetics with nephropathy was 8.46 ± 0.97 mg/dl, and in controls it was 4.44 ± 0.62 mg/dl. Correlation of sialic acid levels with glycated haemoglobin and urine microalbumin was statistically significant but with serum creatinine was not statistically significant. Conclusion: Sialic acid is an important component of vascular cell membrane. Their increased levels indicate extensive vascular damage in type-2 DM. Therefore, estimation of sialic acid levels help in early prediction and prevention of microvascular complications occurring due to diabetics, thereby decreasing the mortality and morbidity in them.

Evaluation of 25(OH) Vitamin D3 with Reference to Mmagnesium Status and Insulin Resistance in T2DM

Mahendra Bhauraoji Gandhe, Keerthi Jain, Swapnali Mahendra Gandhe

Introduction: Calcium is a recognized second messenger implicated in insulin secretion. Vitamin D (1,25-dihydroxycholecalciferol, Calcitriol) plays a role in calcium metabolism. This explains the indirect role of Vitamin D in insulin secretion and insulin sensitivity. Hence, low Vitamin D levels are implicated in decreased insulin secretion and increased insulin resistance. In this study, we tried to find out the probable association of Vitamin D3, calcium and magnesium with reference to insulin resistance in type 2 diabetes mellitus (T2DM) cases. It is well documented that measurement of circulating 25-Hydroxycholecalciferol {25 (OH)Vitamin D3} is a marker of total Vitamin D status. Methodology: We measured 25(OH) Vitamin D3 levels in thirty T2DM subjects with thirty age and sex matched healthy controls. We estimated Vitamin D status, calcium and magnesium levels in the light of insulin resistance. Insulin resistance was measured by homeostasis model assessment of insulin resistance (HOMA-IR). Results: Twenty five (OH) Vitamin-D3 level was significantly low among T2DM cases (12.29+2.32ng/ml) in comparison to healthy controls (19.55+0.50ng/ml) (p<0.01). The levels of calcium and magnesium were also significantly low in T2DM cases as compared to healthy controls (p<0.01). There was significant negative correlation between Vitamin D status and insulin levels, and insulin resistance (p<0.01). Implication: A significant negative correlation between Vitamin D status and insulin levels suggest that the supplementation of Vitamin D has the potential to increase insulin sensitivity and lower the risk of developing type 2 diabetes mellitus.

Elevation of HbA1C in Non-diabetic Hypothyroid Individuals: Is Anaemia the Connecting Link? -A Preliminary Study

Alap L. Christy, Poornima Manjrekar, Ruby P. Babu, Rukmini M.S., Anupama Hegde

Aim: Studies have shown elevated HbA1C in non-diabetic hypothyroid patients. Hypothyroid patients often show anaemia as an associated feature which is an another condition showing falsely elevated A1C. Hence this study is aimed to investigate whether elevated A1C in hypothyroidism can be attributed to anaemia. Material and Methods: HbA1C levels of 120 non-diabetic hypothyroid patients (30 microcytic hypochromic anaemia, 30 normocytic normochromic anaemia and 60 non anemic patients) with 120 age, sex, plasma glucose levels and anaemia status matched controls were assessed. Anaemia status was determined by ferritin, Haemoglobin, red cell indices and peripheral smear. Glycemic status was determined by fasting Plasma glucose. Results: HbA1C levels in hypothyroid patients with hypochromic microcytic anaemia and normocytic normochromic anaemia were 6.82 ± 0.71% & 6.32 ± 0.75% against 6.43 ± 0.43% & 5.87 ± 0.46 % of euthyroid anaemia matched controls respectively. While hypothyroid non anemic patients showed A1C levels of 5.91 ± 0.31% against 5.46 ± 0.62% of euthyroid non anemic controls. Hypothyroid Patients with anaemia had a significant odds ratio 3.16 (95% CI 1.426-7.016) for HbA1C > 6.5. Discussion and Conclusion: Non-diabetic hypothyroid individuals with anaemia shows elevate A1C levels in prediabetes range. Hence care should be excercised while using HbA1C as a diagnostic tool for diabetes in such patients.

Increased Levels of Markers of Oxidative Stress and Inflammation in Patients with Rheumatic Mitral Stenosis Predispose to Left Atrial Thrombus Formation

Background: Rheumatic mitral stenosis (MS) causes stagnation of blood flow, leading to thrombus formation in the left atrium (LA), which may lead to systemic thromboembolic complications. We compared alterations in circulating levels of pro-/anti–oxidants and markers of inflammation in patients of severe rheumatic MS with and without LA thrombus and studied their predictive power to detect the presence of LA thrombus in patients with rheumatic MS. Material and Methods: This is a cross-sectional study of 80 patients with rheumatic MS, evaluated for percutaneous mitral commisurotomy. Group 1 comprised of patients with rheumatic MS with LA thrombus (n=35) and Group 2 included patients with rheumatic MS without LA thrombus (n=45). The following oxidative stress markers-malondialdehyde (MDA), protein carbonyls, total oxidant status and total antioxidant status and inflammation markers-high sensitivity C-reactive protein (hs-CRP), total sialic acid (TSA) and protein-bound sialic acid (PBSA) were estimated in all study subjects. Results: Levels of plasma MDA, protein carbonyl and total oxidant status were significantly elevated, whilst the total antioxidant status levels were significantly lowered, in Group 1, as compared with Group 2. hs-CRP, TSA and PBSA levels showed a significant rise in Group 1 patients, as compared with Group 2. Conclusion: Our results suggest that circulating levels of MDA, protein carbonyl and PBSA were independent predictors of occurrence of LA thrombus in patients with rheumatic MS.

Study the Effect of S-Methyl L-Cysteine on Lipid Metabolism in an Experimental Model of Diet Induced Obesity

Senthilkumar G.P., Sithara Thomas, Sivaraman K., Sankar P., Zachariah Bobby

Background: S-methyl L-cysteine (SMC) is a hydrophilic cysteine-containing compound naturally found in Alium plants such as, garlic and onion. Objectives: The present study was aimed to evaluate the hypoglycemic and antihyperlipidemic properties of SMC in high fructose induced diabetic rats. Material and Methods: The present study was designed to evaluate the hypoglycemic and antihyperlipidemic properties of SMC in high fructose induced diabetic rats. Blood samples were collected and the fasting plasma glucose, lipid profile, total antioxidant status (TAS) aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were estimated using standard procedures. Differences between the groups were assessed by using One way Analysis of Variance with (ANOVA) Tukey post hoc test. Results: Oral administration of SMC at a dose of 100 mg/kg bodyweight/day to HFD-treated rats for a period of 60 days showed significant reduction in the animal weight, fasting plasma glucose, total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), VLDL-C and elevation in the level of high-density lipoprotein cholesterol (HDL-C) and TAS compared with fructose fed group. The effects of SMC was compared with metformin; a well-known antihyperglycemic drug. Conclusion: In conclusion, SMC found to be effective in improving the high fructose induced hyperglycemia and dyslipidemia. It may possibly provide a potential adjuvant for the treatment and management of diabetes.

Comparative Study of Feasibility of Day-Care Surgery in Rural and Urban Patients

Abbas Ali Zaidi, Tasneem Zahra

Background: Day-care surgery is a common procedure in most of the hospitals. It has the advantages of early discharge and thus contributes to cost effectiveness. Objectives: The aim of this study was to compare the feasibility of day-care surgery in rural and urban patients. Material and Methods:Around 200 cases undergoing day-care surgeries of various types in urban and rural patient were enrolled randomly in the study. Results: The maximum number of patients in both the groups were between the range of 21-40 years. The most frequent surgery in rural group was dilatation and curettage (25%) and in urban group was herniotomy (20%). In follow up only 1% complication occurred in rural group with 6% patients were lost in follow up and 4% changed the treatment center. In urban patients follow up was uneventful. The urban group people were more educated than the rural group. Conclusion: Day-care surgery is overall a beneficial procedure but understanding of the patient regarding the surgery and importance of follow up according to educational standard and intellectual status are very important criteria.

Clinicopathological Study and Management of Peripheral Soft Tissue Tumours

Abhijit Mohan Gogi, Ranjani Ramanujam

Background: Soft-tissue tumours comprise a large heterogeneous group of mesenchymal neoplasms that is classified according to their normal tissue counterpart. They are ubiquitous in nature and can pose a challenge in terms of diagnosis and therefore, in their management. Biopsy findings bear direct implications on the treatment outcomes. Aims: The current study was conducted to understand various modes of clinical presentation, diagnostic modalities and to correlate them with operative findings, to delineate the different treatment modalities for patients with soft tissue tumours. We also assessed the risk factors and complications associated with soft tissue tumours. Setting and Design: This was a prospective study conducted at a rural teaching hospital in India. Methods: Accurate history was elicited from patients with peripheral soft tissue tumours and a thorough physical examination was done. The patient demographics were noted. The clinical parameters assessed included location and size of swelling, any associated pain, neurovascular symptoms, presence of any deformity and medical risk factors. To diagnose the type of swelling, biopsy was done. All swellings were excised, and based on the diagnosis, additional therapeutic measures were employed. Post-operative complications and hospital stay were recorded. Results: A total of 74 patients were included in the study, with male to female ratio of 1:1 and average age of 37.96 years. All of them presented with a swelling. The lower extremities and trunk were the most common sites, with each comprising about 25%. The size of tumour varied from 2 to 10 cm in diameter. Seventy one were benign and three were malignant. About one third of patients complained of pain. Comorbid illnesses were present in three patients. For benign tumours, simple excision was done, while for the malignant ones, multimodal therapeutic approach was taken. Post-operatively, two patients developed skin ulceration over the tumour, and six had wound infection. Conclusion: Most soft tissue tumours encountered in clinical practice are benign, of which lipoma is the commonest. While simple excision suffices for most benign tumours, a more aggressive treatment approach is required for their malignant counterparts.

Cross Finger Dorsal Adipofascial Flap-is It a Aesthetically Better Variant?

Kumaraswamy Mohan kumar, Smitha Segu

Introduction: The cross finger flap is a useful option for coverage of finger defects. The Adipofascial flap, a variant has been a good option being aesthetically more acceptable. Since hand is generally exposed part, we tried to find out the aesthetic value of the adipofascial cross finger flap. Methods: We operated on 15 patients who had complex defects on the fingers, who needed a flap cover and accepted for the adipofascial variant. We asked for ten independent non-medical literate persons to rate the photos of donor site and recipient site of these patients. We also requested the same ten people to rate the photos of similar, paired defects of the standard flap, which were obtained from the department archive. Results: All the flaps survived. The mean score for adipofascial flap donor finger was 3.859 and it was 3.6 for the donor finger of the standard cross finger flap. The Cornbach’s alpha of the interpretors was more than 0.7 for donor fingers and more than 0.9 for recipient fingers. The ICC was 0.767 foradipofascial donor finger and more than 0.9 for recipient fingers of both flaps. Conclusion: Adipofascial cross finger flap may be an aesthetically better flap.

Evaluation of Placenta in Foetal Demise and Foetal Growth Restriction

Ujwala Ch, Shyamala Guruvare, Sudha S Bhat, Lavanya Rai, Sugandhi Rao

Aim: The study objective was to evaluate the pathological changes of the placenta in foetal death and foetal growth restriction and to find correlation of the findings with clinical causes. Setting and Design: Prospective study at a tertiary care hospital. Material and Methods: Gross and histopathological examinations of the placentae were carried out in pregnancies with foetal demise (IUD) and Foetal Growth Restriction (FGR). Statistical analysis: SPSS, version 11.5. Results: Placentae of twenty seven women with foetal demise and of equal number of women with foetal growth restriction were studied. Placental weight was less than 10th percentile in 61.5% women in IUD group and in 93% women in the FGR group. Gross examination of placentae showed abnormalities in 12 (44%) women of IUD group and in 16 (59%) women of FGR group. Histopathological abnormalities were observed in 74.1% women of the IUD group and in 66.7% women of FGR group. Placental histopathology correlated with clinical risk factors in 60% women of IUD group and in 40% women of FGR group. Among the women with no clinically explainable cause for IUD and FGR, 86% and 57% had placental histopathological abnormalities respectively. Conclusion: The histopathological abnormalities of the placenta can be used to document the clinical causes of foetal demise and growth restriction; it may explain the causes in cases of clinically unexplained foetal demise and foetal growth restriction.

A Study of Efficacy of Ormeloxifene in the Pharmacological Management of Dysfunctional Uterine Bleeding

Ravibabu KomaRam, JayasRee Palla, GanaPathi Swamy Chintada

Objective: This study was carried out to evaluate the efficacy of Ormeloxifene in the pharmacological management of dys functional uterine bleeding. Design and Setting: A prospective study was conducted on women with dysfunctional uterine bleeding, who attended to out – patient department of Obstetrics & Gynaecology in a tertiary care general hospital. Material and Methods: Women with DUB were diagnosed by presence of excessive, prolonged, or frequent intervals of bleeding for eight or more days, unrelated to anatomical lesions or systemic diseases. They were enrolled randomly and after baseline assessment each patient was treated with Ormeloxifene 60 mg orally twice a week for first 12 weeks, followed by once a week for another 12 weeks. The efficacy of the study drug was analyzed by comparing the baseline and post treatment PABC score, haemoglobin level, endometrial thickness, presence of clots in menstrual blood and dysmenorrhoea. The data obtained was analyzed using the paired ttest and Ztest. Results: There was significant decrease in median PABC score from baseline to 25th week of treatment followup and the reduction was found to be statistically significant (p<0.001). There was also significant decrease in the mean endometrial thickness (p<0.001) after treatment with Ormeloxifene when compared to mean baseline value. The difference in mean haemoglobin level is 1.3 gm/dl between baseline and post treatment levels and was found to be statistically significant (p<0.001). There was significant improvement, 84% of patients had relief from dysmenorrhoea (p<0.001). No major adverse events were experienced by patients in this study. conclusion: The results in this study indicate that Ormeloxifene, a nonsteroidal, nonhormonal agent, provides effective and favour able pharmacological management option with least side effects, suitable for the treatment of dysfunctional uterine bleeding

Menstrual Abnormalities in School Going Girls – Are They Related to Dietary and Exercise Pattern?

Rupa Vani K., Veena K.S., Subitha L., Hemanth Kumar V.R., Bupathy A.

Context: Adolescence is the transitional phase of physical and mental development between childhood and adulthood and is characterized by immense hormonal changes.75% of girls experience some problems associated with menstruation. Aim: We tried to find out the prevalence of menstrual abnormalities in school going girls in Pondicherry and their association with dietary and exercise habits. Setting and Design: A cross-sectional questionnaire based study was conducted in adolescent girls who attained menarche in four secondary schools of Pondicherry, India. Material and Methods: All students who attained menarche and willing to participate in the study were invited to answer the questionnaire, which dealt with anthropometric data, socioeconomic data, menstrual history, and diet and exercise pattern. Statistical Analysis: Chi-square test and Fisher’s exact test was used to compare the dietary and exercise patterns among students having menstrual abnormalities and those who do not have menstrual abnormalities. Results: A total of 853 students participated in the study. Dysmenorrhea and premenstrual symptoms were the most frequent problems encountered. Premenstrual symptoms were significantly more common among girls who were overweight, in girls who were eating junk food regularly, in girls who were eating less food (dieting) in order to lose weight and in those who were not doing regular physical activity. Dysmenorrhea was significantly more common in the girls who were dieting to lose weight. Passage of clots was also significantly high in the girls who were dieting. Conclusion: Lifestyle modifications like regular physical activity, decreasing the intake of junk food and promoting healthy eating habits should be emphasised in school health education programs to improve their menstrual health.

Induction of Ovulation with Clomiphene Citrate Versus Clomiphene with Bromocriptine in PCOS Patients with Normal Prolactin: A Comparative Study

Saswati Tripathy, Satyajit Mohapatra, Muthulakshmi M, Anjalakshi Chandrasekhar

Introduction: Polycystic ovarian syndrome (PCOS) is the main cause of anovulatory infertility. Various combination of drugs have been tried to induce ovulation in PCOS patients with varied result. So, this study was planned to compare the effect of bromocriptine combined with Clomiphene Citrate and Clomiphene Citrate alone, in patients of polycystic ovarian syndrome with normal prolactin level. Materials & Methods: On the basis of inclusion and exclusion criteria, seventy four PCOS patients with normal prolactin level (< 20 ng/ml) and BMI between 20-30 were randomly assigned into two groups. One group (n=38) received 50 mg clomiphene citrate (CC) from day3 to day7. The other group (CC+Bcrt) was given 50 mg of clomiphene citrate from day3 to day7 along with 0.8mg of bromocriptine daily for full cycle (n=36). Both the groups were treated for 3 cycles. The outcomes were measured by the hormonal status, follicular size, ovulation rate and pregnancy outcomes. Results: The serum prolactin level was normal in both the groups before treatment. After 3 cycles the prolactin level decreased in (CC+Bcrt) group (p< 0.01). Follicular development (size >15mm) was observed in 30 patients (78.9%) in CC group and 28 patients (82.3%) in CC+Bcrt group. There was no significant change in hormonal status (LH, FSH and Estradiol) of both the groups. The rate of ovulation was 69.4% in CC group and 75.8% in CC+Bcrt group. During the treatment period, nine patients in CC group and seven patients in CC+Bcrt group became pregnant. Conclusion: There is no added benefit of bromocriptine with clomiphene citrate as compared to clomiphene alone in ovulation induction as well as pregnancy outcomes in PCOS patients with normal prolactin.

Introduction of Structured Oral Examination as A Novel Assessment tool to First Year Medical Students in Physiology

Mrunal R. Shenwai, Krishnakant B. Patil

Background: The traditional viva examination which is still predominantly used in most of the medical institutions as one of the assessment methods has some demerits like lack of standardization, objectivity & reliability. The process involves many faculty members from respective departments. Hence there can be variations in the time allotted to each student, number of questions asked, and difficulty level of the questions. These can be resolved by structuring the oral examination to make it a better assessment tool. The present study was conducted to introduce structured oral examination (SOE) as a novel assessment tool to first year M.B.B.S. students in Physiology and evaluating the process by taking feedback from the students and faculty. Material and Methods: All the subjects [first year M.B.B.S. students (n=100)] were initially assessed by traditional viva. Feedback in the form of a questionnaire was collected from the students. Questionnaire included various questions based on Likert scale and numerical value for each response was decided. Topic for the structured oral examination was decided by the faculty members. Students were intimated about the viva process well in advance. A checklist of questions to be asked in the structured viva was prepared and their probable/most correct answers were discussed with the faculty in advance. Feedback was again collected from the students after the viva session. Statistical analysis of the questionnaire was done using ‘paired t–test’. Results: Questionnaire analysis depicted that students were overall satisfied with the structured viva and felt it better than the traditional viva. Statistically significant differences (p=0.0001) were observed in terms of uniformity of questions asked, syllabus coverage, reduction in the anxiety levels etc. between these two assessment methods. Faculty members also expressed that structured oral examinations are better in terms of reducing bias, minimising luck factor and uniformity of questions makes SOE a fair assessment tool. Conclusion: Structured oral examination can be a better assessment tool and with some modifications in blueprinting it will be acceptable to the students as well as faculty.

Hemodynamic Responses with Different Dose of Ketamine and Propofol in Day Care Gynecological Surgeries

Background: Day care gynaecological surgeries mandate use of hemodynamically stable combination of commonly used intravenous agents, propofol & ketamine. Hence we proposed to evaluate the hemodynamic profile of different dose combination of propofol & ketamine as induction agents in ambulatory gynecological surgeries. Material & Methods: Thirty adult patients scheduled for day care gynecological surgeries were randomly divided into five Groups. Group I received inj. propofol 2mg/kg i.v + inj. Normal saline (NS); Group II received ketamine 2mg/kg i.v + inj. NS; Group III was given inj. Propofol 2mg/kg i.v followed by inj. Ketamine 1 mg/kg i.v.; Group IV received inj. Ketamine 2 mg/ kg i.v followed by inj. propofol 1 mg/kg i.v; Group V received combination of inj. Propofol 1 mg/kg i.v and inj. Ketamine 1 mg/ kg i.v. After administration of the drug, non invasive systolic, diastolic and mean arterial pressures, heart rate, respiratory rate, arterial oxygen saturation and ECG were recorded every minute for five minutes. Results: Statistically significant hemodynamic alterations were observed in Group I & II, with Group I having the highest incidence of apnea (23.3%). No significant changes in hemodynamics were seen in Group V. Conclusion: We conclude that the combination of 1mg Propofol and 1mg ketamine produced better hemodynamic stability in comparison to other Groups.

Evaluation of Health Literacy Status Among Patients in a Tertiary Care Hospital in Coastal Karnataka, India

Introduction: People with limited health literacy are more likely to make medication errors, and they have less health knowledge, worse health status, more hospitalizations, and higher healthcare costs than people with adequate literacy. The objective of this study is to assess the health literacy status among patients who are able to read and understand English attending a tertiary care hospital by using Rapid Estimate of Adult Literacy in Medicine [REALM] technique and to compare the health literacy levels to educational status and other baseline characteristics. Material and Methods: A widely used word recognition method [REALM] was used to assess the HL status of 200 patients attending a tertiary care hospital in Southern India. The number of correctly pronounced words was used to assign a grade-equivalent reading level. Scores 0 to 44 indicate reading skills at or below the 6th grade level, scores from 45 to 60 represent skills at the 7th or 8th grade level, and scores above 60 indicate skills at the high-school level or higher. Results: HL status was found below adequate level in more than 50% of the patients. Younger age group showed better HL scores compared to those aged more than 25 years. General education level or the medium of education does not truly reflect HL levels as brought out in the study. Even those with postgraduate qualification had poor HL skills. Conclusion: The study was carried out to find out the HL levels among patients attending a tertiary care hospital. It was assumed that the general education levels may not reflect true HL status. In view of the results of this study it can be concluded that patient’s HL skills should not be taken for granted and adequate attention should be paid in educating and briefing patients whenever patients are required to interpret and understand health care related documents.

Vigabatrin induced Cell loss in the Cerebellar Cortex of Albino Rats

Deepa Singh, Sunder Lal Jethani, Aksh Dubey

Background: Vigabatrin (an antiepileptic drug) is used as the drug of choice in resistant epilepsy and infantile spasms. Ataxia, tremors and abnormal gait have been frequently reported following the use of this drug, indicating an involvement of the cerebellum. Objectives: The present study was designed to study the histopathological effects of Vigabatrin on the cerebellum of albino rats. Material and Methods: Rats were divided into an experimental and a control group. Vigabatrin was administered intra–peritoneally to the experimental group in graded doses for a period of 4 weeks. At the end of the treatment period, rats were sacrificed and brains were dissected out. The cerebellum was separated and fixed. Slides were prepared for histological examination. Results: Decreased cell counts in the cerebellar cortex secondary to toxic injury were found. Severity increased with increasing doses. Interpretation and conclusion: Vigabatrin may be neurotoxic and should be used with caution, assessing cerebellar function at regular intervals.

A Prospective Study of Prognostic Factors for Recurrence in Early Oral Tongue Cancer

Prashant Sharma, S.V. Shah, Charu Taneja, Ashok M. Patel, Mahesh D. Patel

Background: Tongue cancer is one of the common cancers in head and neck region. Cervical node metastasis is the strongest poor prognostic factor. Other prognostic factors were also said to be of significance. Our aim was to find out the significant prognostic factors of tumor aggressiveness in Indian perspective. Material and Methods: Sixty cases of early cancer of oral tongue with clinically non palpable neck nodes were managed by upfront surgery. Surgeries performed for the primary tumor were ‘wide excision’ or ‘hemiglossectomy’ along with neck dissection. Patients were then given post-operative radiotherapy according to standard guidelines. They were analyzed using a detailed proforma. Three patients were lost to follow-up rest all patients were followed. Results: Recurrence was seen in 11 out of 60 patients (18.3%), in an average follow-up period of about 28 months. Among those who recurred, one patient had both nodal and local recurrence, 2 patients had nodal only (regional) recurrence and rest 8 patients had local recurrence. The prognostic factors that significantly affected the recurrence were endo-phytic disease, depth of invasion, lymphatic invasion, muscle invasion, healthy margin and adjuvant radiotherapy. Conclusion: The risk factors for recurrence in early lesions of oral tongue are - Cervical nodal metastasis, Lymphatic permeation, Depth of disease - 6 mm or more, poorly differentiated tumor, Endophytic (infiltrative) disease, Young age at presentation and Muscle invasion. In early tongue lesions, that are node negative, selective node dissection (SND) including level 1, 2, 3 and 4, is a viable option for neck to decrease the morbidity of MND.

Management of Unstable Thoraco-Lumbar Fractures with Pedicular Screw Instrumentation: A Series of 30 cases

Atmananda Hegde, Rajan Babu, Abhishek Shetty

Introduction: Trauma to spine is one of the grave injuries. They cause infinite morbidity and disability to the patient. Lately consensus is evolving across the world for stabilization of unstable spines with fusion and instrumentation even though most authors agree that neurological recovery is independent of treatment modality. Objectives of this study are to evaluate effectiveness of spinal stabilization with pedicular instrumentation in the management of thoraco-lumbar fractures to restore structural stability, early ambulation and improving neurological status of the patient. Material and Methods: During the period from October 2009 to September 2010, 33 cases of thoraco-lumbar spine fractures were treated operatively with posterior decompression and pedicular screw instrumentation. Of these, 3 cases were lost to follow up. Hence the results of 30 cases were evaluated. All patients were treated by posterior decompression and pedicular screw instrumentation. Neurological and radiological parameters were assessed during serial follow-ups. Observation and Results: The mean duration of follow-up was 11 months. Of the 30 patients 24 showed neurological improvement by at least 1 grade and average grade of improvement was 1.5 grades. Mean pre-operative sagittal angle (SA) was 19.9 degrees and sagittal index (SI) was 0.54. Mean post-operative SA was 9.3 degrees and SI was 0.72. Mean SA and SI during the final follow-up were 10.9 degrees and 0.69 respectively. Discussion and Conclusion: Neurological recovery and maintenance of radiological correction in our study were comparable to other studies. The results in our short series of 30 cases have been encouraging. But there is need for more cases and longer follow-ups to come to categorical conclusion.

Comparison Effect of Oral Propranolol and Oxytocin Versus Oxytocin Only on Induction of Labour in Nulliparous Women (A Double Blind Randomized Trial)

Ashraf Direkvand-Moghadam, Molouk Jaafarpour, Ali Khani

Background and Aim: Today, research on new methods for preventing caesarean sections owing to labour induction, have been requested in obstetric practice, because of the increased morbidity related to caesarean section. Therefore, the aim of this study was to compare the effect of Oral Propranolol and Oxytocin versus Oxytocin only on induction of labour in nulliparous women. Material and Methods: A double blind randomized controlled trial was performed at the Ilam Mostafa Hospital, Ilam, Iran, from March 2010 to March 2011 on 146 nulliparous pregnant women who had gestational age of 40–42 weeks of pregnancy and a Bishop score of =5. Participants were divided in two groups (with 73 participants in each group). In the first group (placebo plus Oxytocin group = 73), Oxytocin was used for the induction of labour. In the second group (Propranolol plus Oxytocin group = 73 cases), before the use of Oxytocin, 20 mg Propranolol was administrated orally and then the Oxytocin was initiated. Twenty mg Propranolol was repeated after 8 hours if good contraction was not obtained. Results: The mean duration for obtaining good contractions was significantly shorter in the Propranolol group than in the placebo group, on both the first and second day of induction (p<.05). The mean duration of latent phase was shorter in the first in Propranolol group (p<.05). In Propranolol plus Oxytocine group, frequency of cesarean deliveries significantly decreased than in the placebo plus Oxytocin group (21% versus 39.7%). No significant differences in neonate outcome, such as Apgar scores of minutes 1 and 5 and need of admissions to NICU, were found between the groups (p>.05). Discussion and Conclusion: Our study showed that oral Propranolol was effective for labour induction and that it could decrease the frequency of caesarean deliveries without producing any adverse effects on mothers or neonates.

Effect of Vitamin E on Uroepithelial Cells and Changes of Urinary Sediments in Oncology Hospital Nursing Personnel

Introduction: Vitamin E is an important natural antioxidant, and its most common and biologically active form is a-tocopherol. The antiproliferative effects of alpha-tocopherol have been previously demonstrated. In this study we investigated the effects of vitamin E on urinary epithelial cells and urinary sediments of nursing from oncology hospital. Material and Methods: Sixty-two female nursing personnel from oncology hospital participated in the study. They received orally 200mg of vitamin E per day for two weeks. Also prior to vitamin E and after vitamin E administration, the uroepithelial cells counts and other components of urinary sediments were carried out. Results: There were significant differences in the epithelial cells count and treatment with vitamin E causing significantly more number of epithelial cells and urinary sediments to be excreted in the urine. Discussion: Vitamin E significantly plays an important role on the excretion of uroepithelial cells and urinary sediments. Conclusion: In conclusion we propose that use of vitamin E at nontoxic levels would significantly enhance its antioxidative properties, especially among individuals subjected to prophylaxis of occupational hazards

A Mini Accessory Liver Lobe in the Fissure for Ligamentum Teres and Its Clinical Significance: A Case Report

The liver can present a number of congenital anomalies. More common among them are the irregularities of the shape and the number of lobules. The less common variations include the presence of accessory lobes or accessory livers. The accessory lobes may be attached to the liver through a mesentery or a bridge of the hepatic tissue and they are usually asymptomatic. An accessory liver lobe is a very rare occurrence and when it exists, it becomes clinically important because of its rarity. We are reporting here the presence of a very small accessory liver lobe and have discussed its clinical relevance. We observed a mini liver lobe which was situated in the posterior part of the fissure for ligamentum teres. It was triangular in shape and about one inch in width. It was attached to the left anatomical lobe of the liver through a vascular pedicle which contained the branches of hepatic artery and portal vein and hepatic duct. Histological sectioning revealed the normal liver architecture in the accessory lobe. The knowledge of this accessory lobe could be of use to surgeons and radiologists.

Nonrotation of Intestine: A Case Report

Ashwini Chamanahalli Appaji, Roopa Kulkarni, Jayanthi S. Kadaba

Nonrotation of intestine is a congenital abnormality of the midgut which is due to error in the process of rotation. Errors in the 2nd and 3rd stage of rotation can lead to series of abnormalities in the form of malrotation and reversed rotation. As a consequence, the relative position of other organs likes caecum, intestine, meckel’s diverticulum changes. This can lead to missing diagnosis of common clinical conditions such as appendicitis. The incidence of nonrotation is 1:500. The congenital abnormality appears to be rare as this could be an incidental abnormality. The symptoms of nonrotation of intestine could be biliary vomiting, recurrent abdominal pain. This could be due to midgut volvulus and intestinal obstruction which happens as a consequence of nonrotation of the intestine. The investigations used for detection and confirmation are CT Imaging. Other associations of nonrotation of the intestine are peritoneal bands. Here we report a case of nonrotation of intestines. In the cadaver of age around 70 years, the small intestinal loops was situated in the right side of the abdominal cavity and large intestine looped on the left side of the abdominal cavity. This was also associated with aberrant position of the caecum and appendix. There were associated peritoneal bands extending from the ascending colon to the left side the abdominal wall. The bands had been removed to visualize the large intestinal loops.

Infective Endocarditis by Aggregatibacter paraphrophilus: Case Report and Literature Review

Smita Sood

Aggregatibacter paraphrophilus (former name, Haemophilus paraphrophilus) is a normal inhabitant of the naso- and oropharynx and has been rarely reported as a cause of human infections. A case of infective endocarditis by this organism is being reported and literature of endocarditis cases caused by Aggregatibacter paraphrophilus is being reviewed.

Diabetic Foot Ulcer Due to Scedosporium Apiospermum

Vijaya D., Nagaratnamma T., Sathish JV.

We report a case of diabetic foot ulcer caused by Scedosporium apiospermum in a seventy year old male patient with uncontrolled diabetes. Scedosporium apiospermum, the asexual phase of Pseudallescheria boydii a fungus isolated from a variety of natural substrates throughout the world including soil, polluted water, sewage and manure of poultry and cattle. P.boydii is now recognized as a medically important opportunistic fungus. This case has been reported for its rarity.

Salpingitis Isthmica Nodosa: A Case Report

Parasappa Joteppa Yaranal, Vijayakumar Hegde

Salpingitis isthmica nodosa places the patient at risk for recurrent ectopic pregnancy or infertility. Hence, we report a case of salpingitis isthmica nodosa which was salpingectomized for pain abdomen in a 46- year old woman.

Hepatic and Adrenal Hemangioendothelioma-A Case Report

Sulata M. Kamath, H.K. Nagaraj, Vijaya V. Mysorekar

Haemangioendothelioma (HE) liver is a mesenchymal vascular tumour, intermediate between a haemangioma and an angiosarcoma. It has a variable clinical course, is a low grade malignancy and is associated with long-term survival. It has a characteristic histologic appearance. Immunohistochemical studies have shown that the neoplastic cells in HE are of endothelial derivation. These are essential to distinguish HE from metastatic carcinoma and primary epithelial liver tumour. We report a case of a 36-year-old male with HE of the liver with adrenal involvement, probably metastatic, with tuberculosis as an incidental finding. To our knowledge this is the first such case reported in literature. The confirmation of diagnosis was done by immunohistochemical study.

Neuroendocrine Carcinoma of Breast: A Rare Case Vignette

Nandeesh M., Anitha T.K., Shravan Rajpurohit, Santosh R.

Neuroendocrine tumour of breast is an extremely rare condition. It may present as focal neuroendocrine differentiation with other histological subtypes of breast cancer or primary neuroendocrine tumour of breast or a metastatic foci in breast. There are no radiologic or clinical signs specific to this subtype. With rarity of its occurrence and absence of randomised trials regarding neuroendocrine tumour of breast, very little is known about the behaviour, prognosis and proper management of this condition. Only the available case reports suggests the necessary strategies for optimal management of this minimally explored medical condition.

A Case of Acute on Chronic Uterine Inversion with Fibroid Polyp

Mamatha Shivanagappa, Ambarisha Bhandiwad, M. Mahesh

Chronic nonpuerperal inversion of the uterus is uncommon and is usually associated with a fundal submucous myoma extrusion. We report herewith the case of a young lady with hitherto asymptomatic long standing mass per vagina presenting acutely with vaginal bleeding and shock. The mass was a uterine myoma. She underwent hysterectomy in view of extensive necrosis.

Adenoid Cystic Carcinoma of Cervix: Treatment Strategy

Adenoid Cystic Carcinoma (ACC) of cervix behaves aggressively and it has a propensity for local infiltration, invasion in lymphatic vessels as well as perineural spaces, with subsequent haematogenous spread. In advanced disease (Stage III and IV), outcome is invariably poor. Moreover, these cases have a high tendency to recur locally and also to metastasize to distant sites. There are no standard treatment protocols because of rarity of disease. The guidelines for its management are established similarly as for staged squamous cell carcinoma of cervix. Therefore, recommended treatment in advanced disease is aggressive multimodality treatment, which includes chemotherapy and radiotherapy. We are presenting a case of adenoid cystic carcinoma of cervix in 55 years old patient, staged as III B. The patient was treated with concomitant radiotherapy and chemotherapy. The patient responded well to treatment and is disease free, three years after treatment.

Radiation Induced Sarcoma of Oral Cavity-A Rare Case Report and a Short Review

Sivaraman Ganesan, Elizabeth Mathew Iype, Aravind S. Kapali, Renu S.

Radiation - Induced Sarcomas(RIS) are rare clinical entity. They arise from the previously irradiated areas with a prolonged latency period. In this case report we present a rare case of radiation induced sarcoma with a brief review of literature. We report radiation-induced sarcoma in a 67 year old male, involving the left Retromolar Trigone region following treatment of squamous cell carcinoma of tongue with wide excision, neck dissection and post-operative radiation. Diagnosis of radiation induced sarcoma was confirmed by history, latency period and biopsy.

Metastatic Cardiac Tumor from Bronchogenic Carcinoma via Pulmonary Vein: A Case Report

Metastatic tumors of the heart are more common than the primary cardiac tumors. Bronchogenic carcinoma is one of the common primaries for cardiac metastases. Cardiac metastasis from bronchogenic carcinoma via pulmonary vein is rare occurrence. We present a case of central bronchogenic carcinoma with left atrial tumor thrombus via right superior pulmonary vein.

Bilateral Acute Epidural Hematoma with Good Outcome

Epidural haematomas are one of the most common complicated closed-head injuries, but they, rarely show any bilateral localization. We are reporting here a case of a man found unconscious with Glasgow Coma Scale score; 8/15. Computed tomography of skull revealed bilateral epidural hematoma. Two emergency craniotomies were performed simultaneously, with satisfactory radiological control and neurological outcome. We discussed the aspects of a etiology and treatment about this unusual condition.

Pheochoromocytoma an Adrenaline Addict - A Case Report

Safiya I. Shaikh, Sarala B.M., Bheemas B. Atlapure

Pheochromocytomas are rare catecholamine secreting neuroendocrine tumours arising from chromaffin cells of the sympathetic nervous system in the adrenal medulla or extra-adrenal paraganglia. A 20-years-old female presented with paroxysms of abdominal pain, palpitation, sweating and headache since last 2 years. Pheochromocytoma was confirmed by 24 hour urinary catecholamine level and CT of abdomen. After three weeks of preparation, tumour was excised. The following discussion outlines current approaches to preoperative, intraoperative and postoperative anaesthetic management of patients suffering from pheochromocytoma.

Huge Bilateral Paramesonephric Cysts in a 25 year old Nulliparous woman

Haritha Sagili, Manikandan Krishnan, Papa Dasari

Paraovarian cysts are uncommon adnexal masses which are usually asymptomatic. We describe a case of bilateral huge paramesonephric cysts in a nulliparous woman. A 25-year-old lady presented with abdominal distension for one year duration. Examination and imaging revealed large abdominopelvic cystic masses with no solid areas or septations. Intraoperatively there were huge bilateral paraovarian cysts which were excised. Histopathology revealed low cuboidal to ciliated columnar epithelium with no evidence of ovarian parenchyma suggestive of paramesonephric cyst. Paraovarian cyst should be included in the differential diagnosis of a cystic mass visualised on ultrasound.

Acinetobacter baumannii: A Brief Account of Mechanisms of Multidrug Resistance and Current and Future Therapeutic Management

Harmanjit Singh, Pugazhenthan Thangaraj, Amitava Chakrabarti

Acinetobacter baumannii, a non-motile, glucose non fermentative, oxidase negative, encapsulated, gram-negative coccobacillus, has recently gained importance because of its increasing resistance to the available antibiotics. Three main mechanisms of resistance in A. baumannii are: enzymes inactivating antibiotics, reduced entry into the target site of bacteria and alteration of the target or cellular functions due to mutations. Multi-drug resistant A. Baumannii, including carbapenam resistant A. Baumannii, are posing a potential threat to mankind by causing lethal infections, especially in ICU set up and in patients who are on ventilators, for which our conventional antibiotics were not shown to be effective. Many reports have indicated carbapenam resistance among A. Baumannii and only colistin and tigecyclyne have shown some promise in combating this lethal microorganism.

Distant Perijoint Calcifications: Sequel of Non Traumatic Brain Injury-A Review and Case Report

Sushil G. Kachewar, Devidas S. Kulkarni

Soft tissue calcifications and ossifications at distant sites have been reported as a sequel to head injuries or spinal cord injuries. They are usually noticed many months after injury, when once such bedridden patients try to be ambulatory, it rarely goes. Thus, they are an uncommon, disturbing and avoidable complication in patients who have injuries to central nervous system. Therefore, this article emphasizes on pathology, treatment options and finally, the preventive aspects.

The Adoption of New Endodontic Technology by Indian Dental Practitioners: A Questionnaire Survey

Ruchi Gupta, Rochna Rai

Aim: To ascertain the adoption of new endodontic technology in general dental practice in India in 2011. Methodology: A postal questionnaire survey comprising 26 questions was sent to 700 general dental practitioners. The questions covered professional activity, root canal preparation and instrumentation, choice of irrigants and intracanal medicaments, choice of obturation techniques and other aspects of endodontics. The data were analyzed using descriptive statistics and the Chi-square (?2) test at 0.05 level of significance. Results: The overall response rate was 88%. The results showed that rubber dams were used by 27% of dental practitioners in India. The most widely used irrigant was sodium hypochlorite, which was used by 33% of the respondents. Thirty nine percent of the practitioners were still incorporating only hand files during the cleaning and shaping phase of treatment. The technique of choice was both step back and crown down (35%). Calcium hydroxide was found to be the most frequently used (62%) intracanal medicament. Lateral condensation with guttapercha (61%) was the most common method used for obturation. Majority used zinc oxide eugenol as a sealer (55%). The post obturation restoration was done mostly by composite material (46%). Most of the respondents placed crowns after root canal treatment. Digital radiography was reported as being used by 17% of the respondents. There was no difference between males and females with respect to the incorporation of new technologies in dentistry. They had been incorporated significantly more by respondents who held postgraduate qualifications and had professional activities of <5 years. Conclusion: The results indicated that new endodontic technology and materials are slowly being incorporated in clinical practice of endodontics in India. This survey shows the importance of continuing dental education for practitioners to update their knowledge.

Immunohistochemical Expression of PCNA in Epithelial Linings of Selected Odontogenic Lesions

Guiding Intellect for Occlusal Errors

Mansi Patel, Ponnanna A.A., Gaurav Tripathi

Purpose: The purpose of the study is to quantify occlusal errors seen, during the processing of complete denture. Material and Methods: Maxillary and mandibular complete dentures were fabricated for 30 subjects. Anterior and posterior markings were made on articulator and the distance was measured from these points before and after processing of complete dentures. Occlusal errors following processing of complete dentures was determined by subjecting the values obtained to statistical analysis using paired t-test. Results: The results indicated the existence of discrepant amount of occlusal errors following processing of complete denture and statistical test applied was paired t-test, p-values obtained are, p=0.00 anterior reference markings and p=0.006 for posterior reference markings (p = 0.001 highly significant). Conclusion: The processing errors are inevitable. Hence for patient comfort, laboratory remounting is an important procedure that needs to be followed as a regular step after processing of each and every denture.

An Indigenously Designed Apparatus for Measuring Orthodontic Force

Aim: An indigenous apparatus is designed to measure the orthodontic force delivered from elastomeric chains and compare this force with values obtained from the Instron universal testing machine. Material and Methods: An indigenously designed apparatus is developed to evaluate forces delivered by various orthodontic auxiliaries. The apparatus consists of a flat steel platform, movable arm, and a mounted screw gauge arm. Orthodontic brackets can be attached to these arms. An electric circuit is connected, to the movable arm, which will estimate the forces exerted between brackets with elastomeric chain. The circuit is connected to the signal conditioner which will display the reading. Elastomeric chain with four links is attached to the arms. The movable arm is adjusted to create orthodontic forces and calibrated on the digital displayer. Twenty Elastomeric chains are used and forces are calibrated with the indigenously designed apparatus. The values of the force is compared with the forces calibrated with Instron universal testing machine to compare the efficacy of the indigenous apparatus. Results: The force values obtained from activation of elastomeric chain segments, in the Instron universal testing machine and the indigenous apparatus were in the range of 100 to 150 grams, initially at 1mm activation then, took a steep rise to 300 to 350 grams at 5mm activation and then, had a gradual increase for the remaining 5mm activation, reaching 400 to 450 grams. Conclusion: The Indigenous apparatus can be considered efficient in measuring tensile force generated by orthodontic auxiliaries.

Donor Site Evaluation: Anterior Iliac Crest Following Secondary Alveolar Bone Grafting

Nandagopal Vura, Rajiv Reddy K., Sudhir R., Rajasekhar G., Varun Raja Kaluvala

Introduction: The use of autogenous bone graft for Secondary alveolar bone grafting is well established in the treatment of cleft lip and palate patients. Aims and Objectives: To evaluate post-operative morbidity of anterior iliac crest graft after secondary alveolar bone grafting in cleft patients. Material and Methods: Forty patients during the period from July 2008 to March 2013, who underwent secondary alveolar bone grafting by harvesting graft from anterior iliac crest in Mamata Dental Hospital, Khammam, Andhra Pradesh, India are included in the present study. Unilateral and bilateral cleft patients who had undergone secondary alveolar bone grafting (SABG) with anterior iliac crest as their donor site have been selected and post- operative complications from the surgery were evaluated with the help of a questionnaire which included pain, gait disturbances, numbness and scar problems (infection, irritation). Results: Patients who were operated gave maximum score for pain as 8 on visual analogue scale. No pain was observed in any of the cases after 8 days, gait disturbances were seen in all patients (limping) for 2-6 days, there was no post-operative numbness with all the patients returning to their routine in 6- 15 days and 90% of the patients gave a satisfied response towards scar. Conclusion: From the results in our study the morbidity after harvesting bone from iliac crest was found to be moderate to low, which had minimal complications and were well tolerated and greater acceptance from the patient.

Traumatic Dental Injuries and Its Relation to Overweight among Indian School Children Living in an Urban Area

Singamaneni Vijaykumar, Madiraju Guna Shekhar, Rajendran Vijayakumar

Aim: The aim of the present study was to determine the prevalence of traumatic dental injuries to permanent incisors and explore the association between dental trauma and overweight in a sample of school children residing in an urban area. Our hypothesis was that there was a significant association between overweight and the presence of dental trauma among urban children. Material and Methods: This cross–sectional survey included 858 school children aged 10-12 years, of both sexes, randomly selected from 12 schools in urban Bangalore, India. The dental examination for traumatic injuries included only maxillary and mandibular permanent incisors. Anthropometric data were collected and Body Mass Index (BMI) was calculated (weight in kg/(height in meters)2. Results: The prevalence of Traumatic Dental Injuries (TDI) was 15.04% and boys experi enced more traumatic injuries than girls, but the difference was not statistically significant (p>0.05). OW boys sustained more TDI than OW girls and the association between dental trauma and OW was statistically significant (p<0.05; OR=3.85; 95% CI=2.62-5.24). Conclusion: Overweight could be considered a significant risk factor for the occurrence of TDI to permanent incisors in Indian school children residing in urban areas.

Estimation of Salivary Amylase in Diabetes Patients and Saliva as a Diagnostic Tool in Early Diabetes Patients

L. Malathi, K.M.K. Masthan, N. Balachander, N. Aravindha Babu, E. Rajesh

Aim: The aim of this study was to estimate the salivary amylase levels in non-insulin dependent diabetes mellitus patients and to correlate these findings with those in normal individuals, in order to provide salivary amylase level as a bio-chemical indicator for diagnosing and monitoring the glucose levels. Material and Methods: The study samples consisted of 60 individuals. Both males and females participated in the study. Thirty non-insulin dependent diabetes mellitus patients of age group of 30 to 60 years and healthy individuals of same number and age group were included in this study. The data obtained in this study were statistically analyzed by using Student’s t–test. Results: In estimation of salivary amylase levels, the comparison of mean and standard deviation showed the highest mean score (2739.48 +1525.20) among the diabetic patients and lowest mean score (1740.38 + 638.51) among the non-diabetic patients. The P-value obtained was less than 0.01. Hence, a highly significant difference in the mean scores regarding salivary amylase (u/l) was found among the two groups. Conclusion: The mean scores of age, fasting blood sugar, post prandial blood sugar, HbA1c and salivary amylase levels were greater in diabetic patients than in non-diabetic patients.

Mandibular Second Molar with a Single Root and a Single Canal: Case Series

Anna Roy, Natanasabapathy Velmurugan, Nandhini Suresh

The variability of root canal system morphology of multirooted teeth represents a continuous challenge to endodontic diagnosis and therapeutics. This report extends the range of known possible anatomical variations to include teeth with lesser number of root and root canals. Variations of root canal systems need not always be in the form of extra canals. Clinicians should be aware that there is a possibility of existence of fewer number of roots and root canals than the normal root canal anatomy. Thus the aim of this article is to present three cases of endodontically managed mandibular second molars with a single root and root cana.

Aggresive Desmoplastic Fibromatosis - A Clinicians Dilemma Case Report and Review of Literature

Fibromatoses are a heterogeneous group of distinct entities which differ in biological behaviour, but arehistologically very similar. This group of fibrous tumor or tumor like lesions, present considerable difficulties in pathologic diagnosis. Aggressive fibromatosis (AF) of the oral or para-oral structures is a very uncommon finding and its intra-osseous component is even relatively unusual. Such lesions with their origin from within the bone are termed desmoplastic fibromatosis (DF). These lesions must be distinguished from other fibroblastic tumors of the head and neck such as benign fibrous histiocytoma (BFH), fibrosarcoma, nerve sheath tumors and tumors of muscular origin. The major challenge in dealing with lesions of fibromatosis is to avoid an overdiagnosis of fibrosarcoma or an underdiagnosis of reactive fibrosis.Problems of differential diagnosis concern a wide range of diseases and immunohistochemical analysis may be helpful in diagnosis. With respect to the patient’s post-operative well-being and if periodic follow-ups are guaranteed, the tumor should be carefully resected with only narrow safety margins. A rare case of aggressive desmoplastic fibromatosis in a 12–year–old girl is presented in this article with emphasis on the need and challenges for diagnosing such lesions as they have to be differentiated from other soft tissue tumors which display borderline pathological features regarding benign or malignant behaviour. Synonyms listed for the same include extra-abdominal desmoids, extra-abdominal fibromatosis, desmoids tumor, aggressive fibromatosis, juvenile desmoids-type fibromatosis, infantile fibromatosis.

A Technique Elucidating the Retrieval of an Adhered Cover Screw in a Dental Implant – A Case Report

J. Bhuvaneswarri, S.C. Chandrasekaran

Dental implants have become one of the most popular and rapidly growing techniques for replacing missing teeth. While their predictability, functionality, and durability make them an attractive option for patients and clinicians alike, complications can arise at any stage from patient assessment to maintenance of therapy. Failure of dental implants not only occurs due to biological factors, like unsuccessful osseointegration or peri-implantitis but may also occur due to technical complications like, failures of implant-supported restorations relating those from the implant components, and those relating to the prosthesis. Technical problems related to implant components include abutment screw fractures and cover screw fractures. In this case report we have elucidated an adhered cover screw in an implant.

A Natural Meliorate: Revolutionary Tissue Engineering in Endodontics

I.B. Geeta1, Girish Galagali, Kulkarni Sangeeta, Suran Pushpa, Faizal Noushin

Platelet-Rich Fibrin (PRF) was first described by Choukroun et al., (2001). It has been referred to as a second-generation platelet concentrate, which has been shown to have several advantages over traditionally prepared platelet-rich plasma. PRF has a physiologic architecture that is very favourable to the healing process, obtained due to the slow polymerization process. The development of platelet concentrate as bioactive surgical additives that are applied locally to promote wound healing stems from the use of fibrin adhesive. Developments in the field of tissue engineering have made the generation of artificial substitutes in several areas of medicine. Various clinical applications in endodontics include Periapical surgeries, Revascularisationprocedures, Regenerative pulpotomy, Perforation repair. This article aims to discuss the various applications of PRF in the field of Endodontics with few case reports.

Stabilishing Springs for Fixed Lingual Retainer

M.K. Karthikeyan, Ramachandraprabhakar, R. Saravanan, N. Rajvikram, Kuppuchamy

Most treated malocclusion needs fixed lingual retention. To stabilise fixed lingual retainer in the exact location needs proper stabilisation. Proper stabilization requires a holding spring. This Stabilising Spring should be easy to fabricate and help the clinician to stabilise the retainer quickly and save the chair side time. More over it should not irritate the mucosa and should be easy to insert and remove.

Microsurgical Aesthetic Treatment of Gingival Fenestration by a Coronally Repositioned Partial Thickness Graft:

Punit Vaibhav Patel, Naresh Kumar, Farhan Durrani

Gingival fenestration is a rare pathological entity, scarcely described in the literature. The present paper has reported a case of a 22-year-old male patient with a “Gingival fenestration” in the lower left central incisor. The lesion was successfully treated using a coronally positioned partial thickness graft under 4 X magnification, with excellent aesthetic results.

Palatal Swelling in a Patient Suffering from Filariasis’

Karen Boaz, Krupa Kaushik Mehta, Srikant Natarajan, Mohan Baliga, Nandita KP

Sclerosing mucoepidermoid carcinoma (SMEC) is a distinct but an uncommon salivary gland neoplasm with only 19 cases reported in English literature till date. Densely collagenous sclerotic stroma, resemblance to other benign lesions and rarity of this tumour often makes the diagnosis of SMEC challenging. Here we report a case of SMEC in a 73–year old female patient suffering from filariasis. Clinical, radiological, fine needle aspiration biopsy, gross and histopathological features are discussed with detailed review of literature and probable pathogenesis.

Serum Carbohydrate Deficient Transferrin as a Sensitive Marker in Diagnosing Alcohol Abuse: A Case Control Study

Teena Thomas, Jayadevan Sreedharan

Adverse Reactions to 6% Hydroxyethyl Starch in the Operating Room

Shaswat Kumar Pattnaik, Kalyan Chakravarthy Peddinti, Kartika Balaji Samala

Correction:The Diagnostic Utility of Intraoperative Cytology in the Management of Ovarian Tumours

Ananthalakshmi Vijayakumar, The Diagnostic Utility of Intra-operative Cytology in the Management of Ovarian Tumours (Published in Journal of Cilinical and Diagnostic Research. 2013 June: 7(6).1047-1050. In this article Corrections were done in legends of some images to acknowledge the source of that image [Table/Fig-2,3,4,5,6] and Reference (17) was added.