Journal of clinical and diagnostic research

Assessment of Lung Function by Spirometry and Diffusion Study and Effect of Glycemic Control on Pulmonary Function in Type 2 Diabetes Mellitus Patients of the Eastern India

Introduction: There are so many complications involving eyes, kidneys, lungs and nerves associated with diabetes. But, pulmonary complications are poorly characterized among eastern Indian diabetic populations. Aims and Objectives: To assess pulmonary function in patients with type 2 diabetes mellitus. To find out correlation of the pulmonary functions test variables with Glycemic control. Materials and Methods: Total of 60 type 2 diabetes patient of age between 35-55 y and same number of age and sex matched apparently healthy control individual were included in the present study. All subjects were evaluated for PFT by flow sensitive spirometer (RMS HELIOS-401), the spirometric parameters were measured as a percentage of predicted and DLCO (by single breath technique). HBA1c of all cases were measured and they were grouped according to HBA1c level (Group-a =>7%, Group-b =6%-7%, Group-c =<6%). Results: Significant differences in the spirometric parameters (FVC, FEV1/FVC) and diffusion capacity (DLCO% and DL/VA%) existed between cases and controls. There was a significant decrease in FVC, DLCO and DL/VA and significant increase in FEV1/FVC in that groups having HBA1c level >7% than the other groups. FEV1, FVC, DLCO, and DL/VA were negatively correlated with HbA1c where as FEV1/FVC has positive association with HbA1c. Conclusion: Significant deterioration of lung function and diffusing capacity was observed in type 2 diabetes patients with poor glycemic control.

Comparison of the Volar and Medial Approach in Peripheral Block of Ulnar Nerve at the Wrist – A Cadaveric Study

Ivan James Prithishkumar, Praisy Joy, Cephas Satyanandan

Context: Two standard approaches are described to block the ulnar nerve at wrist. These include a) the traditional Volar approach where the needle is inserted lateral to tendon of flexor carpi ulnaris (FCU) b) Medial approach where the needle is inserted posterior to the tendon of FCU. Caution must be exercised to avoid puncture of the ulnar artery and/or intraneural injection of the ulnar nerve in both the approaches. Aim: This study compares the volar and medial approach to the peripheral block of ulnar nerve at the wrist. The objective was two fold: a) to analyze the position of the ulnar nerve and the ulnar artery in relation to the Flexor Carpi Ulnaris tendon b) to assess the risk of injury to ulnar artery in both the volar and medial approach. Settings and Designs: Twelve cadaveric upper limbs were used and both approaches compared by an observational study. Materials and Methods: Two 18 G needles were inserted up to a depth of 7 mm using the standard volar and medial approach. The pattern of arrangement and positions of the ulnar artery and nerve in relation to FCU tendon were observed. The distance between the tip of needle and its proximity to the ulnar artery, and risk of injury were determined. Statistical analysis was done using SPSS for Windows, Version 16.0. Chicago, SPSS Inc. Results: Three patterns of arrangement and position of the ulnar nerve and artery were observed. Puncture of ulnar artery was seen in 50% of cases in the volar approach as compared to no injury at all in the medial approach. The ulnar artery is highly liable to injury during the volar approach in type I and II and safe only in type III arrangement of ulnar artery. The medial approach showed no injury to the ulnar artery or nerve at a penetration depth of 7mm. Conclusion: The medial approach is safer compared to volar approach for peripheral block of ulnar nerve at wrist.

Study of Variations in the Branching Pattern of Lower Subscapular Nerve

Santosh Manohar Bhosale, Pavan Prahlad Havaldar

Background: Variations in the origin of lower subscapular nerve of the posterior cord of brachial plexus are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of origin show population differences. Data from the South Indian population is scarce. Objective: To describe the variations in the origin of the lower subscapular nerve of the posterior cord of brachial plexus in the South Indian population. Materials and Methods: Forty brachial plexuses from 20 formalin fixed cadavers were explored by gross dissection. Origin and order of branching of lower subscapular nerve was recorded. Representative photographs were then taken using a digital camera (Sony Cyber shot R, W200, 7.2 Megapixels). Results: Lower subscapular nerves had origin from axillary nerve in 57.5% of specimens, in 37.5% specimens, it was originating from the posterior cord and in 5% of specimens it arose from common trunk. Conclusion: Lower subscapular nerves in studied population display a wide range of variations. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid in advertent injury.

Prevalence and Mophometry of Os Peroneum amongst Central Indians

Pragati S. Mittal, Sharda S. Joshi, Rupapa Chhaparwal, Subhash D. Joshi

Introduction: Os Peroneum is round or oval shaped sesamoid within the substance of the Peroneus longus tendon as it plays on the Cuboid bone. Materials and Methods: Thirty six embalmed cadavers were dissected bilaterally. Lateral part of foot and sole was dissected to expose Peroneus longus tendon and Os Peroneum. Measurements of Os Peroneum and articular surfaces of cuboid (calcaneum) were taken by the Digital Vernier Caliper. Histological and Radiological Examinations of Os Peroneum were also done. Observation: A flattened oval enlargement i.e. Os Peroneum was found in all the tendons examined. The deep surface of Os Peroneum (i.e. articular surface) was concave, smooth and shiny; sometimes divided into two parts. There was a well defined convex articular facet on the Cuboid at the proximal end of the peroneal sulcus, which sometimes extended proximally on to the Calcaneum forming a synovial joint. Results: Average length of Os Peroneum was found to be 13.35 mm (Right - 13.35 mm, Left - 13.35 mm). Average breadth of Os Peroneum was 8.96 mm (Right - 8.87 mm, Left - 9.05 mm). Average thickness of Os Peroneum was 4.11 mm (Right - 4.13 mm, Left - 4.10 mm). Incidence of double articular facets on cuboid and Calcaneum was more on the right side (25.80%) than the left (16.20%). Conclusion: Findings suggest that Os Peroneum is present at the site of angulations of Peroneus Longus tendon with attendant change in direction and the exposure to various stresses and strains leading to its thickening and formation of Os Peroneum.

Study of Effect of Age and Gender Related Differences on Common Paper and Pencil Neurocognitive Tests in Adolescents

In this article typo errors were noticed. A correction has been done in the Title and [Table/Fig-1a,b],[Table/Fig-8],[Table/Fig-9a,b] and [Table/Fig-10a,Table/Fig-10b]. Current PDF is updated pdf Last Updated Date: 1 April 2015 Background: Neurocognitive tests are routinely used to assess cognitive domains in the adolescents for assessing cognitive deficits and for therapeutic interventions. Now they are being used to assess their mental abilities in athletics too. Aim: To study the effect of age and gender differences on routinely used common paper and pencil neuro-cognitive tests in adolescents and present the trends of normative data of Indian adolescent population. Settings and Design: Present study was conducted as a joint collaboration between Department of Physiology and Jawahar Navodaya school, Puducherry, India. Materials and Methods: Four hundred and thirty nine adolescents in the age group of 12 to 17 y (M = 250, F= 189) were selected in the present study after meeting the inclusion and exclusion criteria. Subjects were administered commonly used paper and pencil neuropsychological tests in the following order: Two Target Letter Cancellation test, Trail Making test A and B, Ruff Figural Fluency test (RFFT). Statistical Analysis: We divided the students based on their age into six groups - from age 12–17. Neurocognitive parameters were compared between these age groups using one-way-ANOVA with Bonferroni post-hoc test. Only the p-values for one, two and three year difference were considered. The same analysis was repeated for each gender separately. We compared males and females from the entire sample using unpaired t test. We then repeated the same test to compare males and females in each age group separately. Pearsons correlation was done to find correlation between the neurocognitive test parameters using the entire sample size. Then the correlation was done again after adjusting for age. All the statistical analysis was done using Statistical package for social sciences (SPSS) version 19. Results: Year wise normative data has been presented for all the age groups from 12 y onwards to 17 y. The results showed a consistent improvement in performance on the tested neuro-psychological tests with increasing age in adolescents. Overall gender comparison showed significantly better RFFT performance in males than females, with a non-significant difference in other tested parameters. However, no such difference was observed when the comparison was made within each age group. Conclusion: Improvement in the tests as a function of age may represent ongoing neuro-maturational process. Overall gender comparison from 12 to 17 y demonstrates that males performed better on nonverbal fluency task and strategic analysis suggesting difference in cognitive growth patterns but changes are so slow and gradual that no significant difference was observed at each intra-age group gender comparison. Baseline testing should be at least repeated once in two years.

Normal Pregnancy- A State of Insulin Resistance

Amit D. Sonagra, Shivaleela M. Biradar, Dattatreya K., Jayaprakash Murthy D.S.

Background: Purpose of insulin resistance (IR) adapted by mother is to deliver enough quantity of nutrients to the growing fetus. Many maternal hormones and factors play role in causation of IR during pregnancy. Aim: The study aims at evaluating IR at different trimesters of pregnancy. Materials and Methods: Pregnant women at 1st, 2nd and 3rd trimester were grouped into groups I, II and III respectively (n=20 in each group). Healthy non-pregnant women were taken as controls (n=30). Fasting plasma glucose (FPG) and fasting serum insulin (FSI) were measured and IR indices such as fasting glucose to insulin ratio (FGIR), quantitative insulin sensitivity check index (QUICKI), log FSI and log HOMA1-IR were calculated. The student’s t-test and one way Analysis of variance (ANOVA) were used for data analysis. Results: The mean FSI, log FSI and log HOMA 1-IR were significantly higher in 2nd and 3rd trimesters while QUICKI was significantly lower in 2nd and 3rd trimesters of pregnancy when compared with controls. Also, mean FGIR was found to be significantly lower in 3rd trimester when compared with controls. Conclusion: As pregnancy advances, IR increases. Increased IR is associated with poor maternal and fetal outcome. Screening of all pregnancy for IR and early intervention may help to reduce the associated complications.

Zinc Status in Type 2 Diabetic Patients: Relation to the Progression of Diabetic Nephropathy

Dhia J. Al-Timimi, Dhia M. Sulieman, Kajeen R. Hussen

Background and Objectives: Zinc deficiency often occurs in patients with diabetes. Therefore, the relationship between zinc status and progression of nephropathy in diabetes has been explored. Materials and Methods: Total 300 diabetic patients and 100 non-diabetic healthy subjects (age matched) were selected followed by informed consent and divided into five groups as I: non-diabetic normotensive control; II: diabetic normotensive; III: diabetic hypertensive; IV: diabetic normotensive with microalbuminuria; V: diabetic hypertensive with microalbuminuria. The blood samples of all subjects were collected and analyzed for serum zinc, serum creatinine, and estimated-glomerular filtration rate (e-GFR). Urine zinc, creatinine and microalbuminuria concentrations were determined. Results: The serum zinc levels were low (p<0.01) in diabetic patients as compared to non-diabetic control subjects. The lower levels (p<0.001) of serum zinc were observed in Group IV and V as compared to group I-III. Significantly low levels of e-GFR (p<0.05) and high levels of microalbuminuria (p<0.001) were observed in diabetic patients with low serum zinc level as compared to normal serum zinc level. Serum zinc level in diabetic patients was inversely correlated with serum creatinine(r=-0.331, p<0.001), microalbuminuria (r=-0.587, p<0.001) and positively with e-GFR (r=0.194, p<0.01). Conclusion: It is evident from this study that advancing diabetic nephropathy represented by decreasing GFR and increasing microalbuminuria is associated with lower serum zinc levels. It thus indicates the need for determining serum zinc levels and the effectiveness of zinc supplementation in diabetic patients, particularly during the assessment of kidney damage.

Study of Serum Sodium and Potassium in Acute Myocardial Infarction

Vinod Wali, Singi Yatiraj

Objectives: Acute myocardial infarction (AMI) is one of the leading causes of morbidity and mortality across the world. Serum electrolytes changes in AMI have not been studied extensively and there is paucity of information in the literature in this regard. Scanty information is available in the literature about prognostic value of serum electrolytes in ischaemic heart disease. Hence this study was undertaken to study any changes in the serum electrolytes with special reference to serum sodium and potassium in cases of AMI and study the correlation of serum sodium and potassium in the severity and outcome of AMI. Materials and Methods: Hundred people were included in study divided equally in study and control groups. Study group comprised confirmed diagnosis of recent onset of AMI. The blood samples of both the groups were analysed for Serum electrolytes (Na+, K+) by flame-photometry (Bio-Lab Diagnostic kit). Results: There was statistically significant decrease in sodium and potassium levels in across all age groups & in both sexes of study group compared to control group. Significant high level of sodium was observed in AMI patients who are smokers and AMI patients with Diabetes whereas the level was low in AMI patients with hypertension. Potassium levels were low in AMI patients with Diabetes whereas the change was insignificant in association with smoking and hypertension. Conclusion: Decrease in sodium level was due to hypoxia and ischaemia, which increase the permeability of sarcolemma to sodium whereas decrease in potassium level was influenced by the catecholamine levels which are elevated in early acute myocardial infarction.

Diagnostic Utility of Heat Stable Alkaline Phosphatase in Hypertensive Disorders of Pregnancy

Background: Hypertensive disorders in pregnancy (HDP) complicate 3-10% of all pregnancies. Though there are several biochemical parameters which aid in predicting hypertension of pregnancy, human placental alkaline phosphatase (PLAP), synthesized in placenta during pregnancy by placental syncytiotrophoblast, assumes diagnostic relevance. The purpose of this study was to compare the total alkaline phosphatase (ALP) and heat stable placental alkaline phosphatase (PLAP) levels in the serum of normotensive and hypertensive disorders of pregnancy and to evaluate the clinical utility of ALP and PLAP as a reliable, sensitive, specific and economical biochemical marker of HDP. Materials and Methods: This was a case control study, carried out on pregnant women with hypertension, of south Indian population. Study included pregnant women, 60 patients with hypertension and 60 controls. Biochemical assays were carried out by the IFCC approved procedures based on spectrophotometric method and using fully automated random access chemistry analyser. Data was compared by using student t-test. ROC was drawn to find out optimum cut off for ALP, PLAP and PLAP/ALP ratio in HDP. Pearson’s correlation was performed to ascertain the association among markers. Results: Serum total ALP, PLAP and PLAP/ALP ratio levels were significantly higher in hypertensive pregnant women when compared to controls (p<0.05). There was significant correlation among ALP, PLAP and DBP. ROC analysis of ALP (169.5), PLAP (69) and PLAP/ALP (0.44) ratios showed optimum cut-offs in diagnosis of hypertension in pregnancy. Conclusion: Serum heat stable ALP isoenzyme and PLAP/ALP ratio could be useful adjuvant markers in diagnosis of HDP in association with other relevant and economically viable biochemical tests.

The Serum Levels of Malondialdehyde, Vitamin E and Erythrocyte Catalase Activity in Psoriasis Patients

Vijaykumar M. Pujari, Shankargouda Ireddy, Inderraj Itagi, Siddesh Kumar H.

Background: Psoriasis is a common skin disease which is characterized by increased epidermal proliferation and dermal inflammation affecting 0.1-3% of general population. Most of the psoriasis patients are young or middle aged adults, although no age exempted. The oxidative stress develops due to imbalance in oxidants and antioxidants, which was proposed to have role in psoriasis. Aims and Objectives: The presented research work was planned to evaluate oxidative stress by measuring serum malondialdehyde (MDA) as oxidant and serum vitamin E, erythrocyte catalase (CAT) activity as antioxidants in psoriasis patients. Materials and Methods: Total 90 clinically diagnosed psoriasis patients of age group of 20 to 60 years and without any drug therapy for preceding two months and 90 matched healthy controls were included in the presented study. The severity of psoriasis was determined by PASI score. The fasting blood sample collected and accessed for serum MDA, serum vitamin E and erythrocyte catalase activity. Results: The study results were compiled and statistical analysis was done using students t-test. Our results showed significantly increased levels of serum MDA (p<0.001) and significantly decreased serum vitamin E (p<0.001) as well as erythrocyte catalase activity (p<0.001) in psoriasis patients as compared to controls. Conclusion: The presented study concluded the oxidative stress in psoriasis, indicated by increased serum MDA and decreased Vitamin E, erythrocyte catalase activity. Our study also supports the possibility of involvement of oxidative stress in pathogenesis of psoriasis.

Detection of Salmonella in Blood by PCR using iroB gene

Background: Salmonella, a genus of more than 2500 serological variants (serovars), includes many organisms that can cause human disease. Enteric fever remains an important public health problem in developing countries. Non typhoidal salmonella generally produce a self limited gastroenteritis in healthy individuals whereas in extremes of age and immunocompromised cause severe fatal disease. The protean manifestations make this disease a true diagnostic challenge. Aim: The present study was carried out to optimize PCR for detecting the Salmonella genus using iroB gene and evaluate its use in the rapid diagnosis of typhoid and non typhoidal salmonellosis. Materials and Methods: The study was carried out between August 2009 and July 2011 on blood samples from patients attending JIPMER hospital, Pondicherry, India with clinical suspicion of enteric fever and salmonellosis. Whole blood was used DNA extraction and conventional PCR done with iroB and fliC primers. Blood culture and Widal test were performed for all the patients. Statistical Analysis: Performed using Fischer’s exact test with Graphpad Instat 3. Results: PCR results were compared with blood culture. Sensitivity and specificity of PCR with fliC gene are 95.6% and 93.3% respectively. Sensitivity and specificity of PCR with iroB gene are 96.6% and 93.3% respectively. Conclusion: With iroB gene, additional cases of Salmonella Paratyphi A and non typhoidal Salmonella were detected when compared to fliC gene.

A Comparison of Microscopy and Enzyme Linked Immunosorbent Assay for Diagnosis of Giardia Lamblia in Human Faecal Specimens

Noor Jahan, Razia Khatoon, Siraj Ahmad

Background: Giardia lamblia, a flagellate protozoa, is a common causative agent of parasitic diarrhoeal diseases of humans. Laboratory diagnosis mainly consists of direct microscopic examination of stool specimen for trophozoite and cysts of Giardia. However, due to intermittent faecal excretion of parasite, the case may be miss diagnosed and the patient may continue excreting the parasite and infecting others. Therefore, other mode of diagnosis should be looked for, which overcome the above drawbacks of microscopy used alone for diagnosis. Objectives: The present study was done to evaluate the efficacy of RIDASCREEN Giardia (ELISA) test in comparison to direct microscopy in the diagnosis of Giardia lamblia in stool specimens from patients with diarrhea and other gastrointestinal symptoms. Materials and Methods: A total of 1680 patients were included in the study and three faecal specimens were taken from each patient which was divided into two parts. One part was used for direct wet mount examination and second part was used to put ELISA by using RIDASCREEN Giardia test. Results: Out of 1680 stool samples, 380 specimens (22.6%) were found to be positive for Giardia lamblia. Maximum cases were detected by RIDASCREEN Giardia (ELISA) test with sensitivity of 100% and specificity of 91.5%. Maximum cases of giardiasis were detected in children less than 10 y of age (12.8%). Conclusion: RIDASCREEN Giardia test is a rapid and effective method with high sensitivity and specificity and detects Giardia antigens in stool specimens even when the count of parasite is low, thus reducing the chances of missing even the asymptomatic cases.

Comparison of ELISA and Microscopy for detection of Cryptosporidium in stool

Seema Mittal, Madhu Sharma, Uma Chaudhary, Aparna Yadav

Background: Cryptosporidiosis, a diarrheal disease caused by the protozoan parasite Cryptosporidium spp. has become recognized as one of the most common causes of water borne diseases in humans. Aims and Objectives: To compare the sensitivity of ELISA and Microscopy for detection of Cryptosporidium in stool samples. Materials and Methods: The study was conducted in the Department of Microbiology of PT. B.D. Sharma PGIMS Rohtak, between January 2011 to june 2011 on 50 stool samples, which were processed for detection of cryptosporidial antigen by ELISA and detection of cysts by microscopy (Modified Ziehl and Nelsen staining). Study and Design: This was a prospective study conducted in the Department of Microbiology in PT. BD Sharma, PGIMS, Rohtak, India. Result: Out of total, 50 stool samples eighteen (36%) samples were found positive for Cryptosporidium cysts by microscopy in comparison to 3(6%) stool samples which were found positive for cryptosporidial antigen by ELISA. Samples found positive with ELISA were also positive with microscopy. Sensitivity, specificity, positive predictive value and negative predictive value for ELISA was 16.7%, 100%, 100% and 68% respectively. Conclusion: The study concludes that stool microscopic Modified acid fast staining is more sensitive method than ELISA for detection of Cryptosporidium in stool samples but the specificity of ELISA was more than microscopy.

Evaluation of Efficacy and Tolerability of Cefotaxime and Sulbactam Versus Cefepime and Tazobactam in Patients of Urinary Tract Infection-A Prospective Comparative Study

Objective: Urinary tract infection (UTI) is the third most common infection experienced by humans after respiratory and gastro-intestinal infections. Cephalosporins are now widely been used in UTI, but emerging resistance is a problem to that. Our study aims at evaluating efficacy and safety of third generation cephalosporin combined with beta lactamase inhibitors compared with fourth generation cephalosporin. Materials and Methods: The present, open, randomised, parallel group comparative study includes 60 patients of urinary tract infection. Group A patient were put on treatment regimen of cefotaxime and sulbactam (0.5-2 gms IV/IM BD) and Group B patients were prescribed cefepime and tazobactam (0.5-1 gm IV/IM BD) depending upon urine culture and sensitivity pattern of causative agent and condition of the patient. Bacteriological cure rate, clinical cure rate will be assessed for efficacy and adverse drug reaction (ADR) recorded for evaluating safety. Results: The study showed a male predominance with 37 males (61.6%) and 23 (38.4%) females out of the total 60 patients with a maximum number within the age group of 50-70., and the most common organism isolated was E coli (73.3%), in rest of the patients Klebsiella (13.33%), Proteus (6.66%), and Staphylococcus (6.66%) were isolated. The overall bacteriological cure rate, in the present study, with cefotaxime/sulbactam and cefepime/tazobactam was 86.5%±6.5 and 93.3%±6.7 respectively. The clinical cure rate post five days of therapay, in goup A1 was 79.03%±2.82 and the same in group B1 was 87% ± 2.11. The clinical cure rate post ten days of therapy in group A2 98.57±0.03 and the same in group B2was 100%. Overall success rate as evaluated by our data in the present study in group A i.e those treated with cefotaxime/sulbactam was 89.28±9.1% and in group B i.e. those treated with cefepime/ tazobactam and 94.49±5.06%. Conclusion: From the present study, those drugs in both generations of cephalosporins combined with beta lactamase inhibitors cefotaxime/sulbactam and cefepime/tazobactam were equally effective and well tolerated in the treatment of UTI. However the cost effectiveness and safety parameters are the important deciding factors for prescribing the same.

Potential Drug - Drug Interactions among Medications Prescribed to Hypertensive Patients

Nitin Kothari, Barna Ganguly

Context: Drug-drug interactions(DDIs) are significant but avoidable causes of iatrogenic morbidity and hospital admission. Aim: To detect potential drug-drug interactions among medications received by hypertensive patients. Materials and Methods: Patients of both sex and all adult age groups, who were attending medicine out -patient department (OPD) of a tertiary care teaching rural hospital since last six months and were being prescribed antihypertensive drug/s for essential hypertension, were selected for the study. Hypertensive patient with co-morbities diabetes mellitus, ischemic heart diseases, congestive heart failure, and chronic renal diseases were also included in the study. Potential drug drug interactions were checked with medscape drug interaction software. Results: With the help of medscape drug interaction software, 71.50% prescriptions were identified having atleast one drug-drug interaction. Total 918 DDIs were found in between 58 drug pairs. 55.23% DDIs were pharmacodynamic, 4.79% pharmacokinetic type of DDIs. 32.24% DDIs were found affecting serum potassium level. 95.42% DDIs were found significant type of DDIs. Drug drug interaction between atenolol & amlodipine was the most common DDI (136) followed by metoprolol and amlodine (88) in this study. Atenolol and amlodipine ( 25.92%) was the most common drugs to cause DDIs in our study. Conclusion: We detected a significant number of drug drug interaction in hypertensive patients. These interactions were between antihypertensive agents or between hypertensive and drug for co-morbid condition.

Maxillary Posterior Teeth Removal Without Palatal Injection –Truth or Myth: A Dilemma for Oral Surgeons

Background: Pain control is one of the most important factors for successful treatment. Each new measure to control pain has been looked as miraculous act at the initial stages. The improvements in agents and techniques for local anaesthesia are probably the most important advances in dental science to have occurred in the past years. Aim: To evaluate 4% articaine hydrochloride against 2% lignocaine hydrochloride anaesthesia in providing adequate palatal anaesthesia in maxillary posterior regions, without the need for a palatal block. Settings and Design: Healthy patients above 15 y of age and requiring bilateral extraction of their maxillary posterior teeth were included in this crossover study. The exclusion criteria included medical history of cardiovascular and kidney diseases, gastrointestinal bleeding or ulceration, allergic reactions to local anaesthetic, pregnancy or current lactation. Materials and Methods: Eighty patients, requiring bilateral extraction of their teeth due to various reasons were enrolled for this study. Each patient received both lignocaine and articaine anaesthetic in equivalent dose at two different appointments. Maxillary infiltration technique was used for extraction of maxillary posterior teeth at both the appointments. A 170-mm Heft Parker visual analogue scale was used to assess the pain on the palatal mucosa after buccal infiltration of either anaesthetic agent. Blood pressure, Pulse rate and electrocardiographic monitoring were done during the procedure. Adverse effects during the study period were also monitored. Statistical Analysis: Data was analysed by Z-test and student’s t-test. Results: Pain scores on probing palatal mucosa after buccal infiltration of the anaesthetic were more for lignocaine as compare to articaine and it was statistically significant (p <.001). However, for hemodynamic parameters and electrocardiographic monitoring, there was no statistically significant difference in blood pressure, pulse rate and electrocardiograph before and after the completion of extraction (p > 0.05). Conclusion: Four percent articaine offers better clinical performance than 2% Lignocaine, particularly in terms of providing adequate palatal anaesthesia with only buccal infiltration.

Alpha- Foetoprotein in the Diagnosis of Prelabour Rupture of Membranes

Chhavi Rana Singh, Rajeshwari Gurumoorthy Bhat

Content: Prelabour rupture of membranes (PROM) complicates overall 10% of gestations which include 7% at term and 3 % preterm gestations. Making an early and accurate diagnosis of PROM is important, to allow gestational age specific obstetric interventions and to optimize perinatal outcome. Objective: To study the efficacy of alpha-foeto protein in cervicovaginal secretions, to diagnose prelabour rupture of membranes. Setting: A tertiary care centre. Materials and Methods: We performed a prospective study on 130 patients who were at = 24 weeks of gestation, who had complaint of leaking per vagina, between September 2011 and August 2013. Alpha-foetoprotein test was perfomed on cervicovaginal secretions which were collected during per- speculum examinations. A diagnosis of prelabour rupture of membranes was made, based on combined clinical diagnosis which was made during hospital stay of the patients prospectively. The efficacy of Alpha-foetoprotein was studied. Stastical Analysis: Chi-square test, Kappa analysis. Results: The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of Alpha-foetoprotein were 88.9%, 98.5%, 98.3%, 90.1% and 93.8% respectively. Degree of agreement of Alpha-foetoprotein with combined clinical diagnosis was 0.875. Conclusion: Assessment of alpha-foetoprotein levels in cervi - covaginal secretions can be used as a reliable test to diagnose prelabour rupture of membranes when faced with a diagnostic dilemma.

Extensor Pollicis Longus Injury in Addition to De Quervain’s with Text Messaging on Mobile Phones

Charu Eapen, Bhaskaranand Kumar, Anil K Bhat, Anand Venugopal

Objective: To do a clinical and ultrasonic evaluation of subjects with thumb pain with text messaging. Background: Thumbs are commonly used for text messaging, which are not as well designed for fine manipulative or dexterous work. Repetitive use as in text messaging can lead to the injury to the tendons of the thumb. Materials and Methods: Ninety eight students with symptoms of Repetitive Strain Type of injuries of the thumb were selected from a survey and evaluated both clinically and by ultrasound analysis of the musculotendinous unit of the thumb to note changes due to excessive use of the mobile phone. Age and sex matched controls were also subjected to ultrasound evaluation. Results: Clinical examination showed positive Finkelstein test in 40% of the cases, significant reduction in the lateral and tip pinch strengths in the cases. Ultrasound detected changes in the first and the third compartments in 19% of the cases. Conclusion: Isolated cases of pain in the thumb have been reported but this study noted changes both clinically and by ultrasound in the tendons of the thumb. These changes should be taken as warning signs of possible subclinical changes taking place in the soft tissues of the thumb in these subjects due to repetitive use of mobile phones and thus, making them prone for developing painful Musculoskeletal Disorders. Application: Repetitive use of mobile phones for text messaging can lead to the damage of Extensor pollicis longus of the thumb in addition to the tendons of the first compartment of the wrist.

A Comparitive Evaluation of Sealing Ability, pH and Rheological Properties of Zinc Oxide Eugenol Sealer Combined with Different Antibiotics: An In Vitro Study

Aim: The objective of this study was to evaluate and compare the sealing ability, pH & viscosity of Zinc oxide eugenol sealer mixed with different antibiotics (Amoxicillin, Ciprofloxacin, Clindamycin and Doxycycline). Materials and Methods: Ninety single rooted anterior teeth were randomly divided into four experimental groups of 15 teeth each and 3 control groups of 10 each. Sealer-antibiotic combination was used as a sealer in experimental group. Teeth were sectioned longitudinally to assess linear dye penetration. pH and viscosity of the experimental groups were evaluated with Elico pH Meter and Brook Field Viscometer respectively. Results: (Amoxicillin+ ZOE) Group II and (Clindamycin + ZOE) Group IV have shown minimum linear dye leakage of 1.07mm & 1.22 mm respectively & (Ciprofloxacin + ZOE) Group III and (Doxycycline + ZOE) Group V 2.69 mm & 2.59 mm respectively. There was decrease in the viscosity of the experimental group. pH was found to be 8.55 for Group II sealer which was greater than control group. Conclusion: Amoxicillin and sealer combination can improve the success rate of endodontic therapy by enhancing the antimicrobial activity, alkaline environment and reducing apical microleakage.

Epidemiological Features of violence-related Injuries in Jamaica

Background: Violence-related injuries are common in Caribbean countries such as Jamaica and are a major cause of mortality and morbidity. The study examined the epidemiology of violence-related injuries and ascertained the extent to which the utilization of violence-related injury reports and surveillances inform health policy and programme planning implementation in Jamaica. Materials and Methods: Primary data was gathered by the Ministry of Health through its Public Hospital Monthly Statistical Reporting System (HMSR) and the Jamaica Injury Surveillance System (JISS). These data files were collected over a four and five year period respectively. The sample size comprised 187,610 cases (117,615 from HMSR) and (69,995 from JISS) which were seen and treated at the public hospitals in Jamaica because of violence-related injuries. This study employed a descriptive analysis of visits and cases (episodes) relating to violence-relating injuries. Simple random sampling method was used in this study and the data was analysed using both Microsoft Excel and the Statistical Package for Social Scientists 18.0. Results: The highest number of violence-related injuries was in 2007 and assault (stab wounds, gunshot and blunt injury) was the most frequent violence-related injury with human bites, and burns being the least. The highest number of violence-related injuries in males and females was in the age group 20-29 y. More males experienced violence-related injuries compared with females with male to female ratio of 1.35:1 to 1.45:1 in the years considered. Conclusion: The findings of this study are consonant with local and international studies and confirm that assault was the most frequent violence-related injury. Males compared with their female counterparts are a stronger demographic risk factor where violence-related injuries are concerned. Violence-related injuries have spurred the charge for effective interventions, policy initiatives, and strategic and programme planning by the Ministry of Health, through multi-sectoral and multi-agency approaches in Jamaica.

Predicting Lumbar Central Canal Stenosis – A Magnetic Resonance Imaging Study

Divya Premchandran, Vasudha V Saralaya, Ajith Mahale

Background: Low back pain is a common complaint among adults, worldwide. Lumbar canal stenosis is frequently diagnosed as a cause for low back pain. In this study we evaluate morphometric measures using MRI sections to predict the occurrence of lumbar central canal stenosis. Settings and Design: One hundred and fifty four lumbar spinal MRI sagital and axial section images, 77 males and females each were evaluated from the Department of Radiology, Kasturba Medical College, Mangalore, Manipal University. The study design was a prospective study. Materials and Methods: Various measurements were taken and two constant ratios were calculated. The Canal Body Ratio and the Ratio between the area of the dural sac and the vertebral body was evaluated. Statistical analysis: Unpaired t-test analysis was conducted using SPSS software. Results: A canal body ratio less than 0.6 from L1 to L3 levels and less than 0.5 at L4 and L5 levels were found. The ratio between area of dural sac and vertebral body was found to be a constant at 0.2 at all levels. It was found that maximum central canal stenosis occurred at the L5 lumbar vertebral level in 15.6% males and 13% females. This was followed by stenosis at the L4 and L3 lumbar vertebral levels with 5.1% males having stenosis at both levels and 3.9% and 5.1% females in L4 and L3 lumbar levels respectively. Conclusion: These morphometrical findings of the lumbar vertebrae could be of use in evaluating the possible cases of lumbar canal stenosis.

Domestic Violence and its Effect on Oral Health Behaviour and Oral Health Status

Introduction: Violence against women is one of the major public health and human rights problem in the world today. Hence, the present study was conducted with the aim to assess the effect of domestic violence on oral health behavior and oral health status of females attending community outreach programmes in and around Modinagar. Materials and Methods: A cross-sectional study was conducted through the community outreach programmes organized in Modinagar. A structured questionnaire was used to illicit information regarding socio demographic characteristics, oral health behavior and domestic violence. The dental health examination was done to record dental health status, intraoral and extraoral soft tissue injury, tooth fracture and tooth avulsion due to the injury. Results: Out of the total 304 women, 204(67.1%) reported positive domestic violence. Psychological violence was found to be severe whereas sexual violence was found to be mild in most of the cases. Significant difference was found between oral hygiene aids used , frequency of tooth brushing, periodontal status, missing teeth, intraoral soft tissue injuries and fractures between both the groups (p<0.05). Conclusion: The present study confirmed that domestic violence had significant influence on oral health behavior and oral health status of women. Thus, the dental professionals also should make an attempt to help victims gain access to support and referral services and to provide adequate treatment to them so as to make a positive difference in their lives.

Modifications in Canal Anatomy of Curved Canals of Mandibular First Molars by two Glide Path Instruments using CBCT

Anil Dhingra, Nayasha Manchanda

Background: The creation of glide path reduces the risk of instrument breakage. Glide path is created before using NiTi rotary instrumentation. Aim: This study compared the changes in the root canal anatomy after creation of glide path using Path Files (PF) and V Glide Path 2 (VGP2) using Cone Beam Computed Tomography (CBCT). Materials and Methods: Hundred extracted mandibular first molars with curved mesial roots, curvature angles ranging within 20-30 degrees were assigned into two groups (n = 50 each). Glide path was prepared using PF (Group I) and VGP2 (Group II). CBCT images were obtained before and after instrumentation. The technical outcomes were compared at 0, 1, 2, 3, 5 and 7mm intervals. The data was analyzed using t-test and Chi-square test. Result: There was a statistical difference between the root canal curvatures and working time between the two groups (p < 0.05). Canals transported towards the distal side in Group II but there was a slight mesial transportation in Group I at 0mm. Group I exhibited a better centric ability except at 1mm interval (p > 0.05). The changes in the volume were statistically significant only at 2mm interval (p < 0.05). The difference in the cross sectional area was not statistically significant at any interval (p > 0.05). Conclusion: Within the limits of this study the rotary Nickel Titanium Path Files appeared to be suitable instruments for safe and easy creation of glide path.

Prevalence of Heptavalent Vaccine-related Pneumococcal Serotypes in Nasopharyngeal carrier in children under five years old in Shahrekord, Iran by Multiplex-PCR during 2010- 2011

Background: Heptavalent pneumococcal vaccine which included pneumococcal serotypes 4, 6B, 9V,14, 18C, 19F and 23F has been regularly used and is effective on preventing invasive pneumococcal infection. This study aimed to determine vaccine-related serotype distribution in nasopharyngeal carrier and healthy children under five years old. Materials and Methods: In this cross-sectional study from September 2010 to September 2011, 363 nasopharyngeal specimens were collected from healthy children in day care centers. In positive cultures of streptococcus pneumoniae (S. pneumonia) distribution, serotypes were detected by Multiplex polymerase chain reaction (PCR). Electrophoresis of PCR products was used for detection of serotypes of S. pneumoniae. Results: The carrier rate of S. pneumoniae was 29.5% with 95% confidence interval as 24.8- 34.5%. Electrophoresis of PCR products for detection of serotypes of S. pneumonia revealed 430, 220, 753, 189, 573, 304, and 384 bp (s) for 4, 6B, 9V, 14, 18C, 19F, and 23F serotypes of S. pneumoniae, respectively. The frequency of 23F, 6B, 19F, and 18C serotypes were 43%, 34%, 18%, and 5% respectively, but other serotypes (4, 9V and 14) were not detected. Conclusion: Based on the 30% carrier rate and high prevalence of most of heptavalent pneumococcal conjugate vaccine serotypes in our study, this vaccine should be used for prevention of invasive infection in Iranian children.

Mix-infection of S. Typhi and ParaTyphi A in Typhoid Fever and Chronic Typhoid Carriers: A Nested PCR Based Study in North India

Introduction: Enteric fever is a systemic disease caused by Salmonella organism such as serotypes Typhi and ParaTyphi A, B, C. Salmonella ParaTyphi A contributes more than 50% of all the enteric fever cases and it has recently been projected as an emerging pathogen. Materials and Methods: The present study was aimed to detect Salmonella Typhi and ParaTyphi A in urine, blood and stool specimens collected from cases of enteric fever (110), chronic typhoid carriers (46) and healthy controls (75) to explore the possibility of mixed infection by nested PCR. A new nested PCR primer was designed targeting putative fimbrial protein (stkG) gene which is one of the fimbrial gene families to Salmonella ParaTyphi A and for S. Typhi already reported primers targeting flagellin (fliC) gene. Results: Large volume of urine specimens (15 ml) was found to be the best for detection of Salmonella serotypes. The urine sample was found to have mixed-infection by both the serotypes in 40.9% of the cases but lower in blood (27.3%) and stool (13.6%). Conclusion: The present study concludes that occurrence of mixed infection may be quite frequent in typhoid and chronic typhoid carriers’ individuals, although the reported recent rise in ParaTyphi A incidence may not be real.

Comparative Efficacy of Oil Pulling and Chlorhexidine on Oral Malodor : A Randomized Controlled Trial

Poonam Sood, Aruna Devi M, Ridhi Narang, Swathi V, Diljot Kaur Makkar

Background: Oral malodor affects a large section of population. Traditional Indian folk remedy, oil pulling not only reduces it but can also bring down the cost of treatment. Aims: To compare the efficacy of oil pulling and chlorhexidine in reducing oral malodor and microbes. Materials and Methods: Three week randomized controlled trial was conducted among 60 students of three hostels of Maharani College of science and arts and commerce and Smt V.H.D.College of Home Science. The hostels were randomized into two intervention groups namely chlorhexidine group, sesame oil and one control (placebo) group. Twenty girls were selected from each hostel based on inclusion and exclusion criteria. Informed consent was obtained. The parameters recorded at the baseline (day 0) and post intervention on day 22 were plaque index (PI), gingival index (GI), objective (ORG1) and subjective (ORG2) organoleptic scores and anaerobic bacterial colony (ABC) count. Intra and inter group comparisons were made using Kruskal Wallis test, Wilcoxan sign rank test, ANOVA and student t-test. Results: There was significant reduction (p<0.05) in the mean scores of all the parameters within sesame oil and chlorhexidine group. Among the groups significant difference was observed in objective and subjective organoleptic scores. Post hoc test showed significant difference (p<0.000) in mean organoleptic scores of sesame oil and placebo and chlorhexidine and placebo group. No significant difference (p<0.05) was observed between sesame oil and chlorhexidine group. Conclusion: Oil pulling with sesame oil is equally efficacious as chlorhexidine in reducing oral malodor and microbes causing it. It should be promoted as a preventive home care therapy.

Impact of Fetal Presentation on Pregnancy Outcome in Preterm Premature Rupture of Membranes

Smitha Joy, Sobha Nair, Radhamany K

Aim of the Study: To determine the impact of fetal presentation on pregnancy outcome in preterm premature rupture of membranes (PPROM) Study Design: Retrospective. Materials and Methods: Fifty eight PPROM patients (gestational age of 24-34 wk, complicated by PPROM and latency more than 24 h) between January 2008 to December 2012 were categorized into cephalic and non cephalic and pregnancy outcome were analyzed with standard statistical methods including the Chi-square test, t- test and Mann Whitney test. Results: The non cephalic (20.7%, 12/58) and cephalic group (79.3%, 46/58) among the 58 patients with PPROM were demographically homogenous. PPROM was significantly earlier in non cephalic group although latency was not much different in both groups. Maternal complications (abruption, chorioamnionitis and post operative wound infection) as a composite were more in non cephalic group. Neonatal death was also significantly more in non cephalic than cephalic. Conclusion: Non cephalic presentation at diagnosis of PPROM is likely to have an unfavorable effect on the maternal and fetal outcome

The Effect of Scaling and Root Planing on Glycaemic Control, Periodontal Status and Gingival Crevicular Fluid TNF-a Levels in an Indian Population-To Reveal the Ambivalent Link

Context: Periodontal disease and diabetes mellitus(DM) share a two - way relationship. It can be hypothesized that successful management of periodontal infection in diabetes will lead not only to reduction of local signs and symptoms of the disease, but also to better control of glucose metabolism. Aims: To monitor the effect of Scaling and Root planing (SRP) on glycaemic control in patients with type 2 diabetes mellitus by estimating the HbA1c and GCF TNF- a levels. Settings and Design: This Interventional clinicobiochemical study was carried out over a period of 6 months from December 2010-May 2011 in Bengaluru, Karnataka. Materials and Methods: 15 well-controlled, 15 moderately controlled and 15 poorly controlled diabetic subjects were enrolled in this study. All participants were subjected to non- surgical periodontal (SRP) therapy. GCF sampling and clinical periodontal parameters assessment were done at baseline and 3 months post-therapy. TNF- a levels in GCF were analyzed by enzyme-linked immunosorbent assay (ELISA) at baseline and 3 months post therapy. The improvement in glycaemic control was assessed using HbA1c levels at 3 months reevaluation. Statistical analysis used: The data obtained were statistically analysed using Kruskal-Wallis test, Mann-Whitney test and Wilcoxon Signed Rank test. Results: Following periodontal treatment, all patients demon- strated a significant improvement in periodontal status. A reduction in TNF- a level and the HbA1c values were also observed. Conclusion: The result indicates that SRP is effective in improving metabolic control in Type 2 Diabetes Mellitus patients possibly through the reduction of TNF- a which in turn might improve the insulin resistance.

Detection Of Rankl Positive Cells in Gingival Tissue in Healthy & Chronic Periodontal Disease Patients -A Comparative Study

J. Bhuvaneswarri, Bagavad Gita, S. C.Chandrasekaran

Aim & Objective: The receptor activator of NF-kappa B ligand (RANKL) and its decoy receptor, osteoprotegerin (OPG), are the important proteins implicated in osteoclastogenesis. This study aimed to identify & quantify RANKL positive cells in gingival tissues in healthy & diseased patients & the study looks for immunohistochemical evidence of the expression of the protein in gingival tissue samples. Materials and Methods: Patients were randomly selected. Thirty subject each for (test & control). Age range of 25-55y, either sex was selected. Tissue samples were collected from Control – Healthy Gingiva & Test-Chronic Periodontitis Patients. Tissue sections were prepared. An Immunohistochemical analysis was done & cell counting was done for RANKL positive cells. Results: Immunohistochemical staining showed that RANKL-positive cells were significantly distributed in the inflammatory epithelium & connective tissue zone of diseased & non-diseased gingiva. RANKL, positive cells was increased significantly in patients with chronic periodontitis (p < 0.05). Conclusion: These findings imply that in this comparative study of gingival tissue for, RANKL positive cells, these cells were present in both healthy & chronic periodontitis samples, but number of positive cells present is significantly increased in chronic periodontitis.

Comparision of Immunohistochemical Expression of CD10 in Odontogenic Cysts

Background: Expression of CD10 has been documented in various tumors like nasopharyngeal carcinoma, gastric carcinoma, squamous cell carcinoma, odontogenic tumors. Aim: To evaluate and compare CD10 expression in odontogenic cysts like radicular cyst, dentigerous cyst and odontogenic keratocyst (OKC). Materials and Methods: Total 60 cases were included in the study, comprising 20 cases each of radicular, dentigerous and odontogenic keratocyst. Each case was evaluated and compared for immunohistochemical expression of CD10. Results obtained were statistically analysed using ANOVA test followed by post hoc test Tukey-Kramer Multiple Comparisons Test for continuous variable and Chi-square test for discrete variable. Results: More number of cases showing sub-epithelial stromal CD10 expression were found in OKC among the cysts. Conclusion: CD10 expression was more in OKC compared to radicular and dentigerous cysts.

Value of Bone Marrow Imprint Smears in Early Diagnosis Of Bone Marrow Pathologies

Vijai Tilak, Subhajit Das, Soobashchan Bundhun

Background: Examination of bone marrow plays a pivotal role in the practice of haematology. It can be evaluated by three ways–bone marrow aspiration (BMA), bone marrow touch imprints (BMI) and bone marrow biopsy (BMBx). Aim and Objective: To study the efficacy and reliability of BMI smears in comparison to BMA smears, in making a diagnosis of diseases involving bone marrow. Setting and Designs: This study was carried out in the Department of Pathology, Institute of Medical Sciences, Varanasi over a period of 26 months. Materials and Methods: A total number of 182 cases, with their BMA, BMI and BMBx samples (from each and every case), were evaluated and their findings even compared. Statistical Analysis: All the observations were evaluated using simple and basic statistical tool, i.e. percentage. Results: The cellularity or cell density on BMI correlated with the cellularity of BMBx in 78.6% cases, which was higher than the value observed with BMA smears (71.4%). The spreading quality was better and cytological details were better appreciated in BMI as compared to BMA. Also, the presence of lymphoglandular bodies and particles on BMI were additive diagnostic clues. All of those findings were reflected in the higher diagnostic accuracy of BMI than BMA. Conclusion: BMI should be a standard practice and be considered as an early and reliable diagnostic tool for evaluating bone marrow pathologies.

Evaluating Student’s Perceptions of the Learning Environment in an Indian Dental School

Dolar Doshi, B. Srikanth Reddy, P. Karunakar, Kopparesh Deshpande

Objective: To evaluate student’s perception of the learning environment in a private dental institute in India based on DREEM inventory. Materials & Methods: This cross-sectional study included students in all four years of the undergraduate dental course of Panineeya Institute of Dental Sciences and Hospital, Hyderabad, India. Self-administered Dundee Ready Education environment Measure (DREEM) inventory consisting of 50-items on a five-point Likert scale was utilized to assess the students’ perceptions regarding learning environment in this academic dental school. Comparison for the total and domain DREEM score means was carried out via independent t-test for dichotomous variables (gender) and ANOVA for more than two variables (year of study). Significant difference was noted for p < 0.05. Results: The response rate for this study was 86.8%. Mean age of the study participants was 19.61 + 1.50 y. The overall DREEM score for this population was 125.24 + 21.10 reflecting a more of positive than negative education environment in this institution. When individual domain scores were accounted, except for the domain SAS, females had a higher mean scores for all domains which was however statistically significant only for the domains SPL (p = 0.03) and SPT (p = 0.01). Likewise, significant differences were also noted for SPL and SPT based on the year of study, wherein for both the domains, third year students had significantly higher mean scores and least was recorded for fourth year students. Correlation of the various domains demonstrated significant positive correlation among the domains. Conclusion: Overall this sample of dental students rated the learning environment in this dental institute as positive.

Clinical Evaluation of Autologous Platelet Rich Fibrin in Horizontal Alveolar Bony Defects

Rosamma Joseph V, George Sam, Nagrale Vijay Amol

Background: Horizontal bone loss is the most common periodontal problem confronting the clinician but has received little attention. Platelet rich fibrin (PRF) is a second generation platelet concentrate. The platelets, leucocytes, growth factors and cytokines contained within PRF make it a healing biomaterial with tremendous potential for bone and soft tissue regeneration. Aim: This interventional clinical trial evaluates the clinical effectiveness of Autologous Platelet Rich Fibrin (PRF) in the management of horizontal bony defects. Settings and Design: Department of Periodontics. Design was Non Randomized Clinical Trial with split mouth design. Materials and Methods: A total of 45 sites with horizontal bone loss in 15 patients were studied, 15 sites were treated with PRF gel (experimental group I) and 15 sites were treated with PRF gel and PRF membrane (experimental group II). Control group (15 sites) were treated with open flap debridement. Statistical Analysis: All the parameters were assessed at baseline and after nine months which included Pocket Depth (PD), Clinical Attachment level (CAL), Gingival Recession (REC) and Relative Crest Height (RCH). The mean changes at baseline and after 9 months within each group were compared using Wilcoxon Signed Ranks Test. The mean changes for each parameter between groups were compared using Kruskal Wallis Test. Results: Re-evaluation at nine months revealed that all groups showed a significant reduction in probing depth (1.1±0.38 mm in control, 1.73±0.53 mm in group I, 1.7±0.45 mm in group II)(p<0.05) and clinical attachment gain (0.86±0.58 mm in control, 1.56±0.62 mm in group I, 1.7±0.52 in group II)(p<0.05) as compared to baseline. Intergroup comparisons of reduction in probing depth and clinical attachment gain showed significant differences in the experimental groups as compared to control (p<0.05), but there was no significant difference between the experimental groups (p>0.05). There was no significant difference in gingival recession and radiographic bone levels at 9 months post surgery (p>0.05) in all the three groups Conclusions: Within the limitations of this study, it can be concluded that, clinically the use of PRF in both gel and membrane form is more effective than open flap debridement alone in the management of horizontal periodontal defects at nine months post surgery.

Morphometry, Asymmetry and Variations of the Sylvian Fissure and Sulci Bordering and Within the Pars Triangularis and Pars Operculum: An Autopsy Study

Olufemi Emmanuel Idowu, Sunday Soyemi, Kazeem Atobatele

Objective: Speech and Language, one of the most lateralized of all cerebral functions is located within the pars opercularis (PO) and pars triangularis (PT). There is also inter-hemispheric variability of the sulcal contours bordering these areas. The study was undertaken to note the morphometry, asymmetry and variations of the Sylvian fissure (SF), and the sulci bordering and within the PO and PT. Materials and Methods: An adult autopsy cadaveric study was carried. The measurements made amongst others, included fronto-occipital cerebral length, cerebral width, Sylvian fissure length, and anterior Sylvian point (ASP) to inferior Rolandic point distance. The PT and PO were also studied. Results: Sixty-two adult cadaveric hemispheres were studied. The SF length on the right (mean=84.3mm, median=88mm) was significantly shorter than that on the left (mean=89.4mm, median=92.0mm) (p=0.037). The anterior ascending and anterior horizontal rami of the SF arose from the ASP and either divides at this point (43 hemispheres, 69.4%) or have a common short stem before separating distally giving a Y-shape configuration. The triangularis sulcus was noted in 49 hemispheres (79%) while the diagonal sulcus was noted in 26 hemispheres (41.9%). Conclusion: The left SF was significantly longer than the right and both were positively correlated. The presence of the triangularis sulcus was not dependent on the side (p=0.348) or gender (0.622) unlike the diagonal sulcus was side dependent (p= 0.000).

Waist Circumference, Waist-to-Height Ratio and Body Mass Index of Thai Children: Secular Changes and Updated Reference Standards

Sanguansak Rerksupp aphol, Lakkana Rerks uppaphol

Background: The prevalence of obesity in pediatric age group has been increasing globally. Body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR) are commonly used to define obesity. The cut-off references for these parameters vary between racial and ethnic groups. We aimed to measure the secular changes and update the reference standards for these three parameters for Thai children in this study. Materials and Methods: We completed a cross-sectional survey of 3,885 school children 6.0-12.99 y of age in Ongkharak district of central Thailand during May to June 2013. Weight, height and WC were recorded by trained staff using sensitive and calibrated instruments. BMI and WHtR were calculated by standard formulae. The summary estimates were described by gender and whole year age groups. Age and gender specific smoothened percentile curves were created by using least mean squares method. The data was compared with that from a 2008 cohort from the same area. Results: Age and gender specific percentile data and curves of WC, WHtR and BMI have been provided for Thai children. BMI and WC increased but WHtR changed relatively little with age in both genders. In comparison to 2008, WC and WHtR have increased consistently across all age groups and both genders. The 75th percentile for WHtR corresponded closely to 0.50 in both genders which has been the suggested cut-off. Conclusion: Since 2008, there have been significant increase in WC and WHtR across all age groups and in both genders in Thai children. These indicate increasing prevalence of central obesity and upcoming cardio-metabolic health problems. This needs to be tackled urgently by creating awareness and promotion of healthy diets and physical activities in school children. WC and WHtR should be routinely measured in paediatric examination for early diagnosis of central obesity.

XRCC-1 Gene Polymorphism (Arg399Gln) and Susceptibility to Development of Lung Cancer in Cohort of North Indian Population: A Pilot Study

Background: Smoking has been considered to be the major cause of lung cancer. However, only a fraction of cigarette smokers develop this disease. This suggests the importance of genetic constitution in predicting the individual’s susceptibility towards lung cancer. This genetic susceptibility may result from inherited polymorphisms in genes controlling carcinogen metabolism and repair of damaged deoxyribonucleic acid (DNA). These repair systems are fundamental to the maintenance of genomic integrity. X-ray repair cross complimenting group I (XRCC1), a major DNA repair gene in the base excision repair (BER) pathway. It is involved in repair by interacting with components of DNA at the site of damage. Inconsistent results have been reported regarding the associations between the Arg399Gln polymorphism of XRCC1. This study demonstrates the importance of recognition of this relationship of lung carcinoma and genetic constitution of the person which will help guide clinicians on the optimal screening of this disease. Aim: To assess the role of XRCC1 gene polymorphism (Arg399Gln) directly on the variation in susceptibility to development of lung cancer in North Indian subjects. Materials and Methods: One hundred males with diagnosed cases of lung cancer were recruited from Delhi State Cancer Institute (DSCI). Hundred healthy volunteers were taken as controls. DNA isolation was done and Polymerase chain reaction–Restriction Fragment Length Polymorphism (PCR–RFLP) procedure undertaken to amplify the region containing Arg/Gln substitution at codon 399 (in exon 10). Results: XRCC1 gene polymorphism is associated with increased risk of lung cancer when the Arg/Arg genotype was used as the reference group. The Arg/Gln and Gln/Gln was associated with statistically increased risk for cancer. Conclusion: Arg399Gln polymorphism in XRCC1 gene polymorphism is associated with lung cancer in North Indian subjects and screening for this polymorphism will help in targeting predisposed individuals and its prevention.

Molecular Docking Study for Inhibitors of Aggregatibacter Actinomycetamcomitans Toxins in Treatment of Aggressive Perioodontitis

Makesh Raj.L.S., Jude. J., Kannan.I., Sai Krishna.P., Shankar.K.A.

Introduction: Periodontitis is a chronic inflammatory disease of the periodontal tissues causing periodontal attachment loss and destruction of the alveolar bone which leads to mobility and loss of teeth. Aggregatibacter actinomycetemcomitans (Aa) is a gram negative, capnophilic, coccobacillus that plays an important role in aggressive Periodontitis. Aa produces a variety of virulence factors that facilitate the colonization, invasion and destruction of the periodontal tissues. Leukotoxin and cytolethal distending toxin (Cdt) are most important virulence factors of Aa. Materials and Methods: The three dimensional structure of leukotoxin was derived by Easy modeller software and Cdt was retrieved from RCSB database. The possible binding sites of toxins were searched using binding site prediction tool Q site finder. A total of 1000 ligands of flavanol derivatives were generated with the help of software ACD chemsketch. Rapid virtual screenings of these compounds were performed in the docking tool iGEMDOCK v2.0. Based on the binding energy, six ligands were selected for the further study. The selected six ligands were then analysed for drug relevant properties based on “Lipinski’s rule of five” and other drug like properties. The accurate docking of six ligands was performed using docking tool iGEMDOCK v2.0. Results: From the present study, it has been found that carboxyl {(2R,3R)-3,7 dihydroxy 4-oxo-2(3,4,5-trihydroxyphenyl)-3,4-dihydro2H-chromen-5-yl} oxonium, which is a novel compound can effectively act as an inhibitor for both the toxins. Conclusion: The leucotoxin and cytolethal distending toxin of Aa is found to be the major virulence factors involved in the causation of aggressive periodontitis. Hence the inhibitors of these toxins can be an effective drug in treatment of aggressive periodontitis

Evaluation of Tibial Condyle Fractures Treated with Ilizarov Fixation, A Prospective Study

Background: Tibial plateau fractures are associated with significant soft tissue injuries which increases the risks of complications and must be considered when managing tibial plateau fractures. Various modalities of treatment are available for treatment of these fractures but Ilizarov fixation has a special advantage over others. Review of literature shows many studies of Ilizarov fixation in the treatment of tibial plateau fractures with variable results. Aim of our study was to evaluate tibial condyle fractures treated by Ilizarov fixation. Materials and Methods: Study included 43 patients with Schatzker type II and above tibial plateau fractures treated by ilizarov fixation. Standard trauma evaluation, a meticulous musculoskeletal and neurologic examination was carried out. All patients underwent Ilizarov fixation by same team of surgeons. Clinicoradilogical assessment of the patients carried out at regular intervals. Results: Our study included 43 cases of tibial plateau of various types except type I. Mean time for radiological union was 24.51 wk (range 15 to 32 wk). Mean fixator period was 26.6 wk( 16-34 wk). The functional results were measured by Lyshom’s and Hohl and Luck score. The mean Lyshom’s score was at the end of one year was 82.16. At end of one year by Hohl and Luck grading 11 patients had fair, 23 had good and 9 had excellent results. Conclusion: High energy tibial plateau fractures can be definitively treated with Ilizarov external fixation. Treatment with this method gives good union rates and less risk of infection. Closed reduction, minimal soft tissue damage and early mobilization are the key to low complications.

Effect of Different Doses of Dexmedetomidine as Adjuvant in Bupivacaine -Induced Subarachnoid Block for Traumatized Lower Limb Orthopaedic Surgery: A Prospective, Double-Blinded and Randomized Controlled Study

Dexmedetomidine, Hyperbaric bupivacaine, Spinal anaesthesia (intrathecal, subarachnoid)

Comparative Study Using Intramedullary K-wire Fixation Over Titanium Elastic Nail in Paediatric Shaft Femur Fractures

Sanjiv kumar, Tushar Anand, Sudhir Singh

Background: Fracture shaft femur is common paediatric trauma leading to significant morbidity. Conservative treatments available are associated with prolonged periods of immobilization. Use of flexible intramedullary implant allows early rehabilitation in diaphyseal fractures of femur in children. Aim: The aim of the present study is to compare fixation of diaphyseal femur fracture by titanium elastic nail and intramedullary K-wires in children. Setting and Design: Prospective randomized study in a tertiary care hospital. Material and Methods: Fifty-two children between 6 years and 14 years of age with femoral shaft fracture were assigned either in Group I or Group II based on computer generated random numbers. In Group I closed percutaneous intramedullary K- wire fixation and in Group II closed percutaneous intramedullary titanium elastic nail was used to fix the fractures. Partial weight bearing was allowed after 6 weeks of surgery and full weight bearing at clinico-radiological union. Results: Average time of radiological union was 6 to 10 weeks in both groups. In both the groups two cases had entry site irritation which resolved with early implant removal. One case in both the groups had unacceptable mal-alignment. Both the groups had few cases of limb-length discrepancy, which was in acceptable limit, except two cases of TENS. There was no statistically significant difference between the results of both the groups. But, using K-wires significantly reduced the cost of treatment. Conclusion: Most of such fractures in our society are neglected because of high cost of treatment. Providing a cheaper alternative in form of K-wires may be beneficial for the patients from low socio-economic status.

Prevalence of Gingivitis among Children of Urban and Rural Areas of Bhopal District, India

Vijayta Sharva, Venugopal Reddy, Ajay Bhambal, Rohit Agrawal

Background: Gingivitis is inflammation of the soft tissue without apical migration of the junctional epithelium. Redness, oedema and bleeding on probing characterize this condition. Untreated cases may lead to a more complex and destructive entity known as chronic periodontitis. Periodontitis are the main cause of tooth loss. Poor oral health has thus the potential of hampering the quality of life. So the aim of this study was to find the prevalence of gingivitis, among school-going children of urban and rural areas of Bhopal district, India. Materials and Methods: The present descriptive, cross-sectional study was conducted among 12 & 15 y old middle and high school government rural and urban school children of Bhopal district. It was conducted of a period of two months. 1100 Children were examined by using WHO (modified) oral health assessment form, Loe and Silness index was used for recording gingival status. For statistical analysis SPSS version 20 was used. The chi-square test was applied for categorical data. p<0.05 was considered statistically significant. Results: Prevalence of gingivitis was 59% found. 584 (53.09 %) children had mild gingivitis,61(5.5%) children had moderate gingivitis. Conclusion: This indicates the need for community health activities and awareness program.

A Comparative Study on Diagnostic Accuracy of Colour Coded Digital Images, Direct Digital Images and Conventional Radiographs for Periapical Lesions – An In Vitro Study

Objectives: The identification and radiographic interpretation of periapical bone lesions is important for accurate diagnosis and treatment. The present study was undertaken to study the feasibility and diagnostic accuracy of colour coded digital radiographs in terms of presence and size of lesion and to compare the diagnostic accuracy of colour coded digital images with direct digital images and conventional radiographs for assessing periapical lesions. Materials and Methods: Sixty human dry cadaver hemimandibles were obtained and periapical lesions were created in first and second premolar teeth at the junction of cancellous and cortical bone using a micromotor handpiece and carbide burs of sizes 2, 4 and 6. After each successive use of round burs, a conventional, RVG and colour coded image was taken for each specimen. All the images were evaluated by three observers. The diagnostic accuracy for each bur and image mode was calculated statistically. Results: Our results showed good interobserver (kappa > 0.61) agreement for the different radiographic techniques and for the different bur sizes. Conventional Radiography outperformed Digital Radiography in diagnosing periapical lesions made with Size two bur. Both were equally diagnostic for lesions made with larger bur sizes. Colour coding method was least accurate among all the techniques. Conclusion: Conventional radiography traditionally forms the backbone in the diagnosis, treatment planning and follow-up of periapical lesions. Direct digital imaging is an efficient technique, in diagnostic sense. Colour coding of digital radiography was feasible but less accurate however, this imaging technique, like any other, needs to be studied continuously with the emphasis on safety of patients and diagnostic quality of images.

Comparison Between Virulence Factors of Candida albicans and Non-Albicans Species of Candida Isolated from Genitourinary Tract

Udayalaxmi, Shani Jacob, Diney D’Souza

Background: Candida spp. is frequently isolated from cases of vulvovaginal candidiasis and catheter associated UTI. C.albicans is the most frequently isolated species but non-albicans species of candida are gaining clinical significance. Objectives: To compare the virulence factors like biofilm production, phospholipase and hemolytic activity in C.albicans with that of non albicans species of candida isolated from urogenital tract. Materials and Methods: Vaginal swabs and urine samples received in Microbiology laboratory during one year period were processed by standard methods. The candida isolates were speciated and biofilm production, phospholipase and hemolytic activity were studied in them. Statistical analysis was performed using SPSS version 11.5. Results: Out of the 3001 urine samples processed 41 (1.3%) were positive for candida, out of 293 high vaginal swabs 41(14%) were positive for candida. C.albicans was the most prevalent isolate followed by C.tropicalis, C.glabrata and C.krusei. Out of 40 C.albicans strains, 22 (55%) produced biofilm, 39 (97.5%) produced hemolysin and 21 (52.5%) produced phospholipase. Out of 42 strains of non albicans species of candida, 19 (45%) produced biofilm, 41(97.6%) hemolysin and 5 (12%) produced phospholipase. Conclusion: Phospholipase production was better in C.albicans in comparison toother species of candida. There was no statistically relevant difference between hemolysin and biofilm production by C.albicans and non albicans strains of candida.

Quantification of Plasma Fibrinogen Degradation Products in Areca Nut Chewers with and without Oral Submucous Fibrosis

Sonia Gupta, Manjunath SM, Manveen Kaur Jawanda, Achla Bharti

Introduction: Fibrinogen degradation products (FDPs) are the products that are released from fibrin/fibrinogen. Recently, it has been observed that these FDPs have been identified in the plasma of OSMF patients. Areca nut being the major aetiological agent for OSMF may play a role in the increased plasma levels of FDPs in OSMF. Aim: The aim of this study was to quantify the plasma FDPs levels in the individuals with the habit of areca nut chewing with and without OSMF. Materials and Methods: Total of 95 subjects were included,35 subjects with the habit of areca nut chewing with OSMF, 30 with the habit of areca nut chewing without OSMF, 30 without any habit of areca nut chewing without OSMF (control group). Five ml of venous blood was withdrawn from all the subjects and plasma FDP levels were estimated. Results: Plasma FDPs were detected in all the subjects of OSMF but could not be detected in other two groups. As the clinical grades of OSMF increased, levels of plasma FDPs also increased. Conclusion: When plasma FDP increases, fibrin deposition also increases. This strengthens the finding that these FDPs may be an early indicator of the OSMF.

Energy Status And Metabolism in Intracranial Space Occupying Lesions: A Prospective 31p Spectroscopic Study

Ravindra Bhimrao Kamble, Jayakumar Peruvumba N, Ravishankar Shivashankar

Aim: Intracranial space occupying lesions can be infective or tumour. There are various advanced Magnetic resonance imaging techniques like perfusion, diffusion and proton spectroscopy which can differentiate between them. However, 31 Phosphorus spectroscopy studies the energy status and the metabolism pattern of various tissues and can be used potentially to differentiate between them depending on their Metabolism pattern. Thus, we aimed to study energy status of various intracranial lesions and try to differentiate between them including grades of gliomas. Materials and Methods: 31PMRS was done in 1.5T MRI in 43 patients prior to surgery or through/via stereo-tactic biopsy, of which 25 were men and 18 women with mean age 41.34 y ranging from 7-71 y. Single voxel phosphorus spectroscopy was done from the solid portion of the lesions and data was analysed and post processed. Results: Study includes Lymphoma (n=6), Grade 1 and 2 glioma (n=5), grade 3 glioma (n=9), grade 4 glioma(n=6), metastases (n=5), tuberculoma (n=7) and pyogenic abscesses (n=5). The integral values of PME, Pi, PDE, ?-ATP, a-ATP, ß-ATP with reference to the position of PCr were calculated along with various ratios. Integral values of Pi and PDE were significantly increased in metastases but decreased in gliomas grade 1-2 compared to other pathologic conditions. Mean integral values of LEP (low energy phosphates) and total phosphates were significantly decreased in gliomas grades 1 and 2 and increased in metastases when compared with other pathologic conditions. PCr /Pi was increased in glioma grades 1, 2 and 3 but decreased in metastases; the significance was observed only in gliomas grade 3 and metastases. Metabolic ratios of PDE/ßATP and Pi/ßATP were decreased in glioma grades 1 and 2 and increased in metastases with statistical significance. Conclusion: 31PMRS may help in differentiating primary from secondary lesions and assess grades of gliomas.

A Double-Blind, RCT Testing Beneficial Modulation of BDNF in Middle-Aged, Life Style-Stressed Subjects: A Clue to Brain Protection?

Introduction: The aim of this prospective study was to see whether LD-1227, a quality-controlled marine nutraceuticals shown to protect experimental stress-induced hyppocampal degeneration, could beneficially modulate BDNF, as measured in the serum, in otherwise healthy but work-stressed individuals. Methodology: Forty-eight men and women between the ages of 38 and 62 reporting high-demanding work activity but with an overall positive attitude towards their personal life were recruited. Subjects were divided in two group (24 patients each) and blindly supplemented for 2 month with: a) LD-1227 400mg or b) placebo. A third group of healthy non-stressed subjects was used as well. Blood samples were taken before and after the supplementation period. Unstimulated saliva was collected and tested for amylase while serum levels were used to measure BDNF. State Trait Anxiety Inventory (STAI), Pittsburgh Sleep Quality Index (PSQI) and psychological well-being assessment (PSWB) were measured too. Patients with Val66Met functional polymorphism of BDNF excluded those given their reported association with an impaired release of BDNF. Results: Results showed that, as compared to healthy, non-stressed individuals, stressed ones has a trend decrease of BDNF and this was significantly increased by LD 12-1227 supplementation and the same inverse phenomenon occurred to salivary amylase (p<0.05). No change was noted in the PSQI score but, either STAI or PSWB tests scored better in LD-1227 supplemented subjects. Conclusion: the present data suggest that LD-1227 is beneficially affecting neuromodulation and related symptoms during common stressful life conditions and may have the potential as tools in a neuroprotective clinical strategy.

An in Vitro Evaluation of Antimicrobial Efficacy of 2% Chlorhexidine Gel, Propolis and Calcium Hydroxide Against Enterococcus faecalis in Human Root Dentin

Sonam Bhandari, Ashwini T S, Chetan R Patil

Aim: To evaluate in vitro the antimicrobial efficacy of 2% Chlorhexidine gel, Propolis and Calcium hydroxide against Enterococcus faecalis in human root dentin. Methodology: One hundred and twenty human extracted anterior teeth were decoronated below CEJ and the apical part of root was removed to obtain 6mm of middle of the root. GG no 3 was used to standardize the internal diameter of root canal. Dentin blocks were infected with E faecalis for 21 d. They were assigned into four groups (n = 30).Group 1, Saline (negative control); Group 2, Propolis; Group 3, 2% CHX; Group 4, Calcium hydroxide, At the end of 1, 3, and 5 days an assessment of microbial cells was carried out at a depth of 400 µm and colony counts were calculated.The data were analysed statistically with one-way analysis of variance followed by Scheffe multiple comparison test (p < 0.05). Results: The number of colony-forming units was significantly lower in all experimental groups compared to the control group – Saline. 2% Chlorhexidinegluconate produced better antimicrobial efficacy (100%) on day 1, 3 and 5. Propolis (66.37%) had greater antimicrobial activity than Calcium hydroxide (50.89%) on day 1 but there was no significant difference in their antimicrobial activities on day 3 and day 5. Conclusion: 2% Chlorhexidine gel showed the maximum antimicrobial activity against E faecalis and Calcium hydroxide the least. Propolis can be used as an effective alternative intracanal medicament.

Recurrent Aphthous Ulcers Among Tobacco Users- Hospital Based Study

Shamaz Mohamed, Chandrashekar Janakiram

Current evidence shows ambiguous relationship between tobacco use and the occurrence of aphthous. Objectives: We studied the relationship between the occurrence of recurrent aphthous ulcers and various forms of tobacco usage. Materials and Methods: A hospital based case control study was carried out in a dental teaching hospital in Cochin India. One hundred and two outpatient subjects (Males 56.9%) were identified having aphthous ulceration using Natha’s diagnostic criteria and were classified as cases. One hundred and eight subjects (Males, 70.4%) with no aphthous ulceration were selected randomly as controls. Exposure ascertainment of tobacco usage was done by structured interview. Results: The adjusted odd ratio was found to be 0.41 (95% CI 0.19-0.87) for tobacco usage and occurrence of aphthous ulceration compared to non tobacco users. The odds ratio of 0.41 for tobacco usage infers that subjects using tobacco were 59% less likely to have aphthous ulcerations compared to nontobacco users. Conclusion: The tobacco consumers have less frequency of aphthous ulceration compared non users.

Comparison of Various Methods Used to Detect Biofilm Production of Candida Species

Rahul P. Dhale, M. V. Ghorpade, C. A. Dharmadhikari

Purpose: The biofilm of organisms can be considered as a virulence factor because of the resistance towards antimicrobial agents. Formation of Candida biofilms are observed in blood, mucosal surface and most medical devices i.e. nonliving objects in patient’s body. The study was undertaken to conclude the most sensitive and specific test for detection of biofilm formation. Materials and Methods: Quantitative measurement of biofilm formation was assessed by three methods- 1) XTT reductionassay, 2) Percentage Transmission (%T) and 3) Crystal Violet assay in microtitre plate for 425 Candida isolates. Results: Out of 425 Candida strains, XTT reduction assay gave 72 Biofilm positive strains accounting for 16.94 %. The percentage transmission (% T) method gave 56 strains Biofilm positive (13.17 %) and Crystal violet assay gave 50 positive strains (11.76 %). Compared to Percentage Transmission (% T) and Crystal violet method, XTT reduction assay gave maximum percentage of Biofilm positivity. Conclusion: In comparison of 3 methods used for detection of biofilm formation, XTT reduction assay was the most sensitive and specific method.

A Randomised Trial Comparing Efficacy, Onset and Duration of Action of Pethidine and Tramadol in Abolition of Shivering in the Intra Operative Period

Mahesh T, Lavanya Kaparti

Introduction: Regional anaesthesia (spinal anaesthesia) is widely used as a safe anaesthetic technique for both elective and emergency operations. Shivering is known to be a frequent complication, reported in 40 to 70% of patients undergoing surgery under regional anaesthesia. Various methods are available for the control of shivering during anaesthesia. Here we have compared Tramadol, a synthetic opioid with Pethidine, the gold standard drug for the treatment of shivering, in the quest for more safe and efficacious drug. Materials and Methods: Forty patients of ASA 1 and 2 status posted for elective surgical procedures under neuraxial block were selected. Group P (n=20) received Pethidine 0.5mg/kg IV and group T (n=20) received tramadol 1.0 mg/kg IV. Results: Both the drugs were found to be effective in reducing shivering. Nineteen patients in the Group T had control of shivering at end of 5 minutes but there were no patients who had control of shivering Group P (p < 0.0001) which is statistically significant. Conclusion: Tramadol reduced the occurrence of postanesthetic shivering more significantly than pethidine.

Evaluation of Bowel Wall Thickening by Computed Tomography to Differentiate Benign from Malignant Lesions

Purpose: Computed tomography(CT) is an excellent non-invasive modality to evaluate bowel wall thickening.The aim of our study was to evaluate CT appearance of bowel wall thickening due to various benign and malignant conditions taking into consideration pattern of attenuation, bowel wall thickness, extent of lesion, symmetry of lesion and other associated CT findings. Materials and Methods: The prospective study was carried out on 50 patients who underwent computed tomographic evaluation of abdomen for suspicion of bowel pathology based on ultrasonography, barium studies and/or clinical grounds. The studies were conducted on Siemens ART and GE High speed CT scanners. The examination was performed as is done routinely for an abdominal scan with imaging done from diaphragm to pubic symphysis in supine position with the right lateral decubitus scans in selected cases for better characterization of gastric antral and duodenal lesions. Oral, rectal and intravenous (IV) contrast agents were administered. The diagnosis was confirmed by cytology or histopathology of any biopsy or surgical specimen. However, in cases where surgery was not done, diagnosis was confirmed by clinical response to medical treatment. Results: Based on the various CT characteristics of abnormal bowel wall thickening, sensitivity and specificity of classifying a lesion as benign or malignant were calculated. Majority of the malignant bowel lesions were showing the following characteristics i.e. heterogeneous pattern of enhancement, marked bowel wall thickening, asymmetry of the lesion and focal/segmental bowel involvement. Overall, CT showed a sensitivity of 97% and specificity of 93% in differentiating between benign and malignant etiology of abnormal bowel wall thickening. Conclusion: Due to its high sensitivity and specificity, CT is an ideal imaging modality for differentiating between benign and malignant etiology of abnormal bowel wall thickening. Radiologists should be aware of the usefulness of specific CT criteria of bowel wall thickening to better differentiate benign lesions from malignant or potentially malignant lesions that warrant further diagnostic evaluation.

Clinico-Pathological Study of Space Occupying Lesions of Nasal Cavity, Paranasal Sinuses and Nasopharynx

Dinesh Garg, Kusum Mathur

Background: A variety of non-neoplastic and neoplastic lesions of nasal cavity, paranasal sinuses and nasopharynx are commonly encountered in clinical practice. The aim of this study was to study clinical and histopathological profile of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx in a tertiary care hospital of Rajasthan over the period of January 2013 to January 2014. Materials and Methods: This was a prospective study of 147 cases (male 100, female 47; age group ranging from less than 1 y to 76 y) of space occupying lesions of nasal cavity, paranasal sinuses and nasopharynx over the period of 12 months (from January 2013 to January 2014). All tissues after fixation in 10% buffered formalin, processed and then stained with Hematoxylin & Eosin to study various histopathological patterns. Results: These 147 cases were broadly categorized in two categories, one category as nasal and paranasal sinus masses and the other as nasopharyngeal masses with 91 and 56 cases, respectively. These lesions were common in second and third decades of life with male predominance. Among nasal and paranasal sinus masses, there were 67 (73.6%) non-neoplastic and 24 (26.4%) neoplastic lesions. Inflammatory polyps (89.5%) were the most common among the non-neoplastic masses; Inverted papilloma (45.46%) the most common among the benign neoplastic and squamous cell carcinoma (46.15%) was the commonest out of all malignant masses. Out of 56 nasopharyngeal masses, there were 53 (94.6%) non neoplastic and 3 (5.4%) neoplastic lesions. Majority of these i.e. 52 cases were of adenotonsillar hypertrophy. Conclusion: We concluded that complete clinical, radiological and histopathological correlation helps us to categorize these sinonasal lesions into various non-neoplastic and neoplastic types. But final histopathological examination provides a confirmatory diagnosis, although Immunohistochemistry is the final diagnostic method in few cases.

Carcinoid Tumors of the Appendix – Last Decade Experience

Introduction:Carcinoid of the appendix is a rare clinical entity in childhood and usually has a good clinical outcome. The impact of the operative preparations appendix ranges between 0.1-0.9%. The aim of our study is to report the experiences of our department in the management of appendiceal carcinoid tumors in children. Materials and Methods: Data of all patients aged 15 y or less who underwent appendectomy at the 2nd Department of Pediatric Surgery of Aristotle University of Thessaloniki between January 2004 and February 2014 were evaluated for the existence of appendiceal carcinoid tumors in pathological specimens. The collected data included: gender, patient’s age, clinical indications and surgical intervention, tumor localization in the appendix and the diameter of lesion, histological type of the tumor and postoperative care (follow up) of patients. Results: Four cases (3 girls, 1 boy) with carcinoid treated at our department during a 10 y period. Median patient age was 10.75 y (9- 12 y). In all cases the diagnosis was after appendectomy on ground of acute appendicitis. A single incident brought findings of gangrenous appendicitis. In three cases the tumor’s diameter was smaller than 1cm, while the incident with the gangrenous appendicitis was larger than 1cm in diameter. In four cases the tumor was localized at the apex of the appendix without extending to the surrounding tissues. In all patients with carcinoid tumor followed a further testing based on specific monitoring protocol. In no case was residual or metastatic disease identified and no further treatment was required. No relapse was observed during follow-up. Conclusion: Our study confirms the good prognosis of appendiceal carcinoid.

Assessment of Photodynamic Therapy (PDT) in Disinfection of Deeper Dentinal Tubules in a Root Canal System: An In Vitro Study

Context: Periodontal disease and diabetes mellitus(DM) share a two - way relationship. It can be hypothesized that successful management of periodontal infection in diabetes will lead not only to reduction of local signs and symptoms of the disease, but also to better control of glucose metabolism. Aims: To monitor the effect of Scaling and Root planing (SRP) on glycaemic control in patients with type 2 diabetes mellitus by estimating the HbA1c and GCF TNF-alevels. Settings and Design: This Interventional clinicobiochemical study was carried out over a period of 6 months from December 2010-May 2011 in Bengaluru, Karnataka, India. Materials and Methods: Fifteen well-controlled, 15 moderately controlled and 15 poorly controlled diabetic subjects were enrolled in this study. All participants were subjected to non-surgical periodontal (SRP) therapy. GCF sampling and clinical periodontal parameters assessment were done at baseline and 3 months post-therapy. TNF-a levels in GCF were analyzed by enzyme-linked immunosorbent assay (ELISA) at baseline and 3 months post therapy. The improvement in glycaemic control was assessed using HbA1c levels at 3 months reevaluation. Statistical analysis: The data obtained were statistically analysed using Kruskal-Wallis test, Mann-Whitney test and Wilcoxon Signed Rank test. Results: Following periodontal treatment, all patients demon- strated a significant improvement in periodontal status. A reduction in TNF-a level and the HbA1c values were also observed. Conclusion: The result indicates that SRP is effective in improving metabolic control in Type 2 Diabetes Mellitus patients possibly through the reduction of TNF-a which in turn might improve the insulin resistance.

A Study of Utilization of Antimicrobial Agents in Patients on Ventilator in Intensive Care Unit (ICU) at Tertiary Care Teaching Hospital, India

Prakash R Shelat, Anuradha M Gandhi, Prakruti P Patel

Objective: To study the use of antimicrobial agents in patients on ventilator in ICU. Materials and Methods: Study was conducted at tertiary care teaching hospital Ahmedabad, India. Total 300 patients admitted in ICU and prescribed antimicrobial agents were included in the study. The data were recorded in preformed Case Record Form (CRF) and were analysed by Z and x2 Test. Result: Patients were divided into group A (patients on ventilator support) and group B (patients without ventilator support). In all the patients antimicrobial agents were prescribed empirically and more than two antimicrobial agents were prescribed in both groups. It was observed that above 60% antimicrobial agents were prescribed according to WHO, National and State Essential Medicine List (EML). Restricted antimicrobial agents (according to antimicrobial policy of tertiary care teaching hospital) were prescribed significantly (p<0.05) higher in group A as compared to group B. Resistance to antimicrobial agents by Pseudomonas aeruginosa and Kleibsella shown significantly (p<0.05) higher in group A as compared to group B. Change of antimicrobial therapy after Culture Sensitivity Test (CST) was significantly (p<0.05) higher in group A as compared to group B Conclusion: Number of antimicrobial agents, antimicrobial resistance and change of antimicrobial therapy after CST were higher in patients on ventilator support.

Dental Camp Experience in Lifeline Express (LLE) Train among Rural Population of Central India

Introduction: The lifeline express is the world’s first hospital train. To date, over 800,000 patients living in the remote rural interiors of India where medical facilities are scarce, have been treated. Objective: To evaluate the application and feasibility of providing screening, diagnosis, preventive dental treatment for rural population through mobile dental unit in lifeline express train from last three years in Madhya Pradesh, India. Materials and Methods: The study was retrospective and the data was extracted from six dental camps which have been conducted by Life line Express/ Impact India foundation in between 2011 to 2013 in rural and remote area of Madhya Pradesh. Results:Conclusion: The study shows a mobile dental hospital like LLE can provide an excellent opportunity for rural populations regarding oral health care.

Effective Factors on Patients’ Satisfaction with Emergency Care Services using Factor Analysis: A Cross Sectional Study

Introduction: Due to certain physical and psychological conditions of patients in emergency wards, pay attention to the effective factors on Patients’ satisfaction is an essential issue in modern medicine. The aim of the present study was to investigate the effective factors on Patients’ satisfaction with emergency medical services. Materials and Methods: A cross-sectional survey was carried out from November to December 2010. The study sample consisted of 100 patients hospitalized in the emergency wards of Imam and Mustafa Hospitals in Ilam- Iran. Subjects were selected through simple random sampling method. Data gathered using questioner. The questioner validity was obtained using the content validity. Reliability of questionnaire was checked using Cronbach a coefficient. To find the most important factors affecting patient satisfaction, factorial analysis technique was used. Result: Exploratory factor analysis showed that the Patients’ satisfaction is composed of six factors, including: satisfaction of physicians, nursing staff, the presence of students, the method of reception and discharge, deciding to cure and knowing the position of the therapist. Base on the results of the factorial analysis, the most important aspect of satisfaction was the satisfaction of physicians. The results revealed significant relationships between the occurrence time and the satisfaction of physician (r = 0.23, p=0.027), the number of visits and the satisfaction of physician (r =0.27, p=0.01), the time of visits and the satisfaction of physician (p= 0.016), also between occurrence time and the number of visit (r = 0.36, p=0.001). Conclusion: Physicians and nurses actions and decision making are the major affecting factors satisfaction in emergency patients. Thus improving the quality of these factors will improve the quality of emergency services for patients.

Vascular Endothelial Growth Factor Levels in Gingival Crevicular Fluid Before and after Periodontal Therapy

Padma R., Annaji Sreedhara, Indeevar P., Indranil Sarkar, Chetan S Kumar

Introduction: Of the various cytokines and growth factors regulating angiogenesis, the most potent agent acting on vascular endothelium is vascular endothelial growth factor(VEGF). The present study aims to access VEGF concentration in periodontal diseases and the effect of periodontal therapy on its concentration in gingival crevicular fluid (GCF). Materials and Methods: Ninety five subjects (47 females and 48 males) 25- 47 y of age were divided into healthy (group-1), gingivitis (group-2), and periodontitis (group-3). GCF samples were collected using micro-capillary pipettes & were transferred immediately to plastic vials and stored at -70 °C until the time of the assay. The concentration of VEGF was determined using commercially available ELISA kit. Results: The mean VEGF concentration was highest in periodontitis patients (Group 3) (88.08±8.04pg/ml), with lowest in healthy patients (Group 1). VEGF levels reduced significantly after therapy in Groups 2 and 3. Conclusion: VEGF levels in GCF had a significant correlation with both periodontal disease progression and healing after therapy.

Association of Root Caries with Oral Habits in Older Individuals Attending a Rural Health Centre of a Dental Hospital in India

Jayanna Vinayaka Bharateesh, Ganganna Kokila

Background: Many risk factors can compromise an older adult’s systemic health. Among the oral ailments in the elderly, root caries is a significant one which causes tooth loss in them. Hence, there is a need to have a baseline data for understanding problem of root caries in elderly population and factors which affect its prevalence. Aims: a)To asses the prevalence of root caries in older individuals in a rural health centre in India. b) To asses the relationship of oral habits with root caries. Materials and Methods: The study included 210 elderly dentate and consenting individuals (123-females, 87-males) aged 55 to 75 y and above. Demographic and health behaviour data were collected through personal interviews. The subjects were examined for root caries. Statistical analyses of the data were done using chi-square and multiple logistic regression analysis. Results: Out of all, 94.76% of elderly patients examined had gingival recession in one or more teeth. The prevalence of root caries was 41.9%. The prevalence of root caries was significantly associated with age, perceived dryness of mouth, smoking, smoking and tobacco chewing and tobacco chewing only (p<0.05). There was significantly higher root caries in the age group of 75 years and above (OR-3.67). Conclusion: It was evident from our study that root caries prevalence was high in elderly population. Age, root surfaces with recession, deleterious oral habits such as smoking, tobacco chewing, and dryness of mouth had a definite effect on the prevalence of root caries.

Colorectal Cancer: A Study of Risk Factors in a Tertiary Care Hospital of North Bengal

Aim: Age, sex, living place (urban or rural), smoking, alcohol consumption, dietary pattern, obesity are considered as risk factors for Colorectal cancer. Our study was done to evaluate the association between these risk factors and colorectal cancer in the population of North Bengal. Materials and Methods: The present study was done over a period of one year as a hospital-based analytical observational type of study with cross-sectional type of study design. All the patients undergoing colorectal endoscopic biopsy at the Department of Surgery, NBMC&H during the study period for various clinical indications comprised the study population. History and clinical examination were done of the patients whose colorectal biopsy were taken and filled-up in a pre-designed pre-tested proforma. Significance was tested at 95% confidence interval. Results: There is an increased risk of colorectal carcinoma (CRC) with increasing age in our study population. Odd’s ratio for last 2 age groups are statistically significant with 2.83 for 41-50 years age group (95% CI is0.3-24), 13.6 for 51-60 years age group (95% CI is 2.1-85.9), 42.5 for more than 60 y age group patients (95% CI is 3.1-571). There is increased risk of colorectal carcinoma in males with an Odd’s ratio of 1.6 (95% CI is 0.5-5.5), but it is not statistically significant. There was an increased urban incidence of colorectal carcinoma compared to rural population with an Odd’s ratio of 1.8 (with a 95% CI of 0.6-5.9). In our study smoking also proved to be a risk factor and it is significant with an Odd’s ratio of 5.4 with a 95% CI of 1.6-8.7. Odd’s ratio for cases of alcohol consumption was 3.5 with a 95% CI of 1-11.6. Carcinoma cases were more common among patients with history of non-vegetarian dietary intake with Odds ratio of 1.5 (with a 95% CI of 0.3-8.7), but it was not statistically significant. Obesity has got a significant association with CRC in our study with an Odd’s ratio of 7.2 (with 95% CI of 1.3-40.2). Conclusion: More than 50 years of age, smoking, obesity were significant risk factors in our study. Other risk factors were though not significant, but much more common in colorectal cancer patients compared to non-malignant population

Positive Association of Sperm Dysfunction in the Pathogenesis of Recurrent Pregnancy Loss

Kavitha P, Suttur S. Malini

Background: Recurrent pregnancy loss (RPL) is one of the most frustrating and difficult areas in reproductive medicine, because the aetiology is often unknown and there are few evidence-based diagnostic and treatment strategies. RPL diagnosis is mainly focused on the female partner. The male factor contributing in evaluation of RPL has been less investigated, it is restricted to karyotype and basic semen analysis, assessment of functionality of sperm is largely ignored. Aim and Objective: To investigate the role of sperm factors in RPL through regular semen analysis preceded with sperm function tests. Materials and Methods: We performed a case control study of 95 males whose partner has experienced two or more pregnancy loss as case and 37 volunteers who had fathered child/children without the history of RPL as control group. Basic semen analysis and sperm function test (Nuclear chromatin decondensation {NCD}, Hypo osmotic swelling {HOS} and Acrosome intactness test {AIT} was performed. The results were analysed by performing Independent-sample t-test using SPSS (version 14.0). Results: One individual had anatomical abnormality which was confirmed through trans-rectal ultrasound scanning and RPL group showed statistically significant (p<0.05) value for NCD, HOS and AIT and 36.8% of RPL individuals had reduced score for sperm count and motility. Less than 4% normal morphology was recorded in 16.8% individuals of RPL group. Conclusion: Our study revealed that the positive association of sperm dysfunction in RPL cases, hence male may be considered for a routine part of the evaluation along with his partner in the near future in order to achieve desirable outcome

Comparative Evaluation of Microleakage of Lingual Retainer Wires Bonded with Three Different Lingual Retainer Composites: An In Vitro Study

Smita Nimbalkar-Patil, Anna Vaz, Pravinkumar G. Patil

Objective: To evaluate microleakage when two types of retainer wires were bonded with two light cured and a self cured lingual retainer composites. Materials and Methods: Total 120 freshly extracted human mandibular incisor teeth were collected and separated into six subgroups of 20 teeth each. Two different wires, a 0.036 inch hard round stainless steel (HRSS) wire sandblasted at the ends and 0.0175 inch multistranded wire bonded onto the lingual surfaces of the incisors with three different types of composite resins of 3M company; Concise Orthodontic (self-cure), Transbond XT (light-cure) and Transbond LR (light-cure). Specimens were further sealed with a nail varnish, stained with 0.5% basic fuchsine for 24 hours, sectioned and examined under a stereomicroscope, and scored for microleakage for the enamel-composite and wire-composite interfaces. Statistical analysis was performed by Kruskal-Wallis and Mann-Whitney U-tests. Results: For HRSS wire, at the enamel-composite interface, the microleakage was least with Transbond LR followed by Concise Orthodontic and greatest for Transbond XT (p<0.05). At the wire composite interface too, the microleakage was in order of Transbond LRConclusion: Transbond LR in combination with 0.0175 inch multistranded wire showed least microleakage amongst the groups studied.

To Evaluate the Role of Bone Marrow Aspiration and Bone Marrow Biopsy in Pancytopenia

Melina Desalphine, Permeet Kaur Bagga, Parmod Kumar Gupta, Amarjit Singh Kataria

Background: Pancytopenia is not a disease entity but a triad of findings that may result from various disease processes, primarily or secondarily involving the bone marrow. Bone marrow aspiration and biopsy evaluation along with good clinical correlation is of utmost importance to evaluate the causes of pancytopenia and planning further investigations. Aims: The present study was a prospective clinicohaematological study undertaken to analyse the various causes of pancytopenia by evaluating bone marrow aspiration and biopsy and correlating with clinical findings, complete blood counts and peripheral blood picture. Materials and Methods: Fifty patients of pancytopenia were included in the study in which relevant history and physical examination findings were recorded. Bone marrow aspiration and biopsy were performed simultaneously in all cases. Perl’s stain was done in all cases and special stains like MPO, PAS and reticulin were also done wherever necessary. Results and Conclusion: The maximum cases of pancytopenia were in the age group of 10 to 30 y with male preponderance. Aplastic anaemia was found to be the most common aetiology of pancytopenia followed by normoblastic erythroid hyperplasia, megaloblastic anaemia, acute leukemias, myelofibrosis, lymphoid neoplasia and iron deficiency anaemia. It was concluded from the study that although the advantages of bone marrow aspiration and biopsy differ, both are complimentary to each other and should be performed simultaneously for a complete bone marrow work up and evaluation. It is only through the correlation of clinical, hematological and bone marrow examination findings that proper evaluation and management of patients of pancytopenia can be made.

A Comparative Study of RIPASA Score and ALVARADO Score in the Diagnosis of Acute Appendicitis

Background: Acute appendicitis is one of the most common surgical emergencies. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendicectomy rates. A number of scoring systems have been used for aiding in early diagnosis of acute appendicitis and its prompt management of which Alvarado score is the most popular. The accuracy of Alvarado score in the diagnosis of acute appendicitis is disappointingly low in Asian population and RIPASA scoring has been designed for the diagnosis of acute appendicitis in the Asian population. So we prospectively applied and compared Alvarado and RIPASA score in the diagnosis of acute appendicitis in Indian population. Materials and Methods: We compared prospectively RIPASA and Alvarado scoring system by applying them to 206 patients. Both scores were calculated for patients who presented with right iliac fossa pain during the study period. Depending on clinical judgment appendicectomy was done. Post operative histopathology report was correlated with the scores. A score of 7.5 is the optimal cut off threshold for RIPASA and 7 for Alvarado scoring system. Sensitivity, specificity, positive predictive value (PPV) and negative predictive (NPV) for RIPASA & Alvarado system was done. Results: The sensitivity and specificity of RIPASA score were 96.2% and 90.5% respectively. The sensitivity and specificity of Alvarado score were 58.9% and 85.7% respectively. RIPASA score correctly classified 96 percent of all patients confirmed with histological acute appendicitis to the high probability group (RIPASA score greater than 7.5) compared with 58.9% with Alvarado score (Alvarado score greater than 7.0; p-value less than 0.001). Conclusion: RIPASA scoring system is more convenient, accurate, and specific scoring system for Indian population than Alvarado scoring system.

An in Vitro Evaluation of Remineralization Potential of Novamin® on Artificial Enamel Sub-Surface Lesions Around Orthodontic Brackets Using Energy Dispersive X-Ray Analysis (Edx )

Pritam Mohanty, Sridevi Padmanabhan, Arun B Chitharanjan

Objective: To evaluate and compare the Ca/P ratio of enamel samples around the orthodontic brackets for time periods of 0, 2 and 10 days in two groups (control group and study group). Materials and Methods: Forty extracted teeth were randomly divided into control group and study group. All samples were demineralized and incubated in artificial saliva at 37°C for a period of 10 days after demineralization. During this phase the enamel samples in the study group were treated with remineralizing paste (NuproNusolution containing Novamin®- Dentsply) for 10 days. At the end of the incubation period, Ca/P ratios were analyzed for both the groupsby EDX analysis. Data obtained was subjected to statistical analysis using student t-test for paired samples and Student t- test for individual samples(p = 0.05). Results: It was found that the mean Ca/P ratio was significantly lower for the control group as compared to the study group (p-value < 0.05) after 10 d of incubation. Conclusion: Novamin ® containing remineralization toothpaste showed significant remineralizing potential in inhibition of artificial enamel sub- surface lesion around bracket after 10 days of remineralization phase. EDX element analysis was found to be an efficient method to quantify the changes in mineral content of a sample during in vitro caries studies.

Antimicrobial Activity and Stability of Electron Beam Irradiated Dental Irrigants

A. Veena Shetty, A Geethashri, K.J. Palaksha, K. R. Sridhar, Ganesh Sanjeev

Background: The electron beam (e-beam) radiation is considered as an effective means of sterilization of healthcare products as well as to induce the structural changes in the pharmaceutical agents/drug molecules. In addition to structural changes of pharmaceutical it also induces the formation of low molecular weight compounds with altered microbiological, physicochemical and toxicological properties. Among the several known medicaments, sodium hypochlorite (NaOCl) and chlorhexidine digluconate (CHX) are used as irrigants in dentistry to kill the pathogenic microorganisms like Enterococcus faecalis, Staphylococcus aureus, Streptococcus mutans and Candida albicans inhabiting the oral cavity. Objectives: The aim of this study was to evaluate the antimicrobial activity and stability of e-beam irradiated dental irrigants, NaOCl and CHX. Materials and Methods: Two dental irrigants NaOCl (1.25% and 2.5%) and CHX (1% and 2%) were exposed to various doses of e-beam radiation. The antimicrobial activities of e-beam irradiated irrigants were compared with the non-irradiated (control) irrigants against E. faecalis, S. aureus, S. mutans and C. albicans by disc diffusion method. Following the storage, physico-chemical properties of the irrigants were recorded and the cytotoxic effect was evaluated on human gingival fibroblast cells. Result: The irrigants, 1.25% NaOCl and 1% CHX showed significantly increased antimicrobial activity against both E. faecalis, (16+0.0) and S. aureus (25+0.0) after irradiation with 1 kGy e-beam. Whereas, 2.5% NaOCl and 2% CHX showed slightly increased antimicrobial activity only against S. aureus (28+0.0). The significant difference was noticed in the antimicrobial activity and cytotoxicity of irradiated and non-irradiated irrigants following the storage for 180 d at 40C. Conclusion: The e-beam irradiation increased the antimicrobial activity of irrigants without altering the biocompatibility.

Correlation of Qualitative and Quantitative MRI Parameters with Neurological Status: A Prospective Study on Patients with Spinal Trauma

Ranjana Gupta, Puneet Mittal, Parambir Sandhu, Kavita Saggar, Kamini Gupta

Introduction: Spinal trauma is relatively more common in young active individuals. Although its mortality is low, it is an important cause of long term disability. Magnetic resonance imaging (MRI) can accurately depict presence and extent of spinal cord injury (SCI) in these patients. This study was aimed to look for various qualitative and quantitative MRI findings which are predictive of initial neurological deficit in patients with spinal trauma and final outcome on follow up. Materials and Methods: The present study was conducted on 50 patients with suspected acute cervical or dorsal spinal trauma presenting for MRI study. American Spinal Injury Association (ASIA) motor score was used for assessing neurological status at the time of presentation, at the time of discharge/2weeks and at 3-6 months follow up. Various MRI qualitative and quantitative parameters were evaluated for correlation with severity of spinal injury. Results: Normal baseline MRI (pattern 0) was seen in 12 subjects and was associated with incomplete SCI in 4 subjects (ASIA grade D) followed by complete recovery in all patients on follow-up examination. Pattern I (haemorrhage) was associated with complete spinal cord injury. Pattern II (oedema) was associated with incomplete SCI and good functional recovery on follow up.Pattern III (contusion) was associated with intermediate severity of injury. Compression and transection patterns were associated with complete neurological deficit at presentation and increased mortality at subsequent follow-up. All the three quantitative parameters i.e. lesion length,maximum (bony) canal compromise (MCC), maximum spinal cord compression (MSCC) were significantly increased in patients with complete SCI as compared to those with incomplete SCI. The best predictors for baseline ASIA score were MCC, cord oedema and cord haemorrhage. For the final ASIA score, the best predictors were baseline ASIA score and cord haemorrhage. Conclusion: MRI is excellent imaging modality for detecting and assessing severity of spinal trauma. In our study, presence of cord haemorrhage, MCC and cord oedema were best predictors of baseline neurological status at presentation, whereas baseline ASIA score and cord haemorrhage were best predictors of final neurological outcome.

Hepatitis B & C Among Farmers – A Seroprevalence Study

Background: Hepatitis B & C are the two major causes of chronic liver disease, having the similar parenteral route of transmission, thereby responsible for significant morbidity and mortality. Objective: Agriculture being the backbone of this part of country, the present study was undertaken to assess the seroprevalence of these diseases among the farmers which form the major occupation class in the Malwa belt of Punjab, India. Materials and Methods: Screening camp was organized at Kisan Mela at the regional station of Punjab Agriculture University at Faridkot, Punjab. Blood samples were collected, and tested for HBsAg and anti-HCV. Results: Total of 1219 subjects, 63% being in the age group of 30-50 years, were screened of which the seroprevalence of HCV & HBV was 5% and 0.32% respectively, and 72% of HCV positive cases were between 30-50 years of age. Conclusion: The study stresses on the need of safe injection practices especially in villages and control on addiction, a more effective vaccination program for HBV, strict check on commercial blood banks, and community education regarding tattooing and sexual behaviour.

Immunolocalization of CD34 Positive Progenitor Cells in Diabetic and Non Diabetic Periodontitis Patients – A Comparative Study

Background: Little research has been documented to determine the CD34 positive cells in healthy periodontium, chronic periodontitis and in chronic periodontitis with diabetes mellitus individuals. Aim: The aim of the present study was to evaluate and compare the CD34 positive progenitor cells of the gingiva in patients with healthy periodontium, chronic periodontitis and chronic periodontitis with Diabetes Mellitus. Materials and Methods: A total number of 75 patients were divided into 3 groups which included Group I (healthy periodontium), Group II (chronic periodontitis) and Group III (chronic periodontitis with diabetes mellitus). Periodontal examination included Plaque index, Gingival index, Gingival bleeding index, Probing pocket depth and Clinical attachment levels. Gingival biopsies were collected from each participant and they were fixed in formalin embedded in paraffin which was later subjected to immunohistochemical procedure with anti-CD34 (a stemness marker). T-Test and Regression analysis (R-square) was used to analyse the data. Results: The mean number of CD34 positive cells were higher in group III (5.71+/-1.97) compared to Group chronic periodontitis group I (4.98+/- 2.08) and II (4.48+/- 1.24). Conclusion: Although CD34 is a non specific stemness marker, results suggest that there is a significant difference in the number of CD34 positive progenitor cells between Group II and Group III but no significant difference was observed between Group I, II and Group I, III.

Characteristics of Medial Depression of the Mandibular Ramus in Patients with Orthodontic Treatment Needs: A Panoramic Radiography Study

Sudhakar S., Naveen Kumar B., Prabhat M.P.V., Nalini J.

Background: Medial sigmoid depression or medial depression of the mandibular ramus (MDMR) is a known variant of the normal radiographic anatomy. The clinical importance of MDMR has been recognized, however, its prevalence and association with patients with orthodontic needs have been poorly documented. Aims and Objectives: To estimate the prevalence and characteristics of MDMR on panoramic radiographs of patients with different Angle’s molar relation. Materials and Methods: Three hundred panoramic radiographs of 100 each belonging to patients with Angle’s class I, II and III molar relationship was recruited from an orthodontic clinic. The radiographs were evaluated for presence of MDMR along with its characteristics such as site and shape. The data was entered in the proforma and subjected for statistical analysis. Results: The overall prevalence of MDMR in the present study was 23.2%. MDMR was found to be more prevalent in Class II – 28 (9.3%) followed by class III-23 (7.6%) and Class I- 19 (6.3%). There was equal distribution of MDMR with respect to site and the semilunar shape was the most common 36 (34%). All these findings were statistically non-significant. Conclusion: Although MDMR is considered as a normal radiographic finding, the present study confirms the disparity in the prevalence of MDMR in patients with dentoskeletal deformities. Thus our findings suggest the importance of recognizing this entity prior to orthognathic surgery so as to avoid untoward sequelas.

Lipid Profile and Metabolic Syndrome Status in Patients with Oral Lichen Planus, Oral Lichenoid Reaction and Healthy Individuals Attending a Dental College in Northern India - A Descriptive Study

Bhuvana Krishnamoorthy, Suma GN, Mamatha N S, Sowbhagya M B, Komali Garlapati

Background: Chronic inflammation causes disturbances in the lipid metabolism. When this dyslipidemia becomes prolonged it increases the risk of cardiovascular disease. Recent literature reveals similar dyslipidemia in patients with lichen planus. However, the results were not compared with lichenoid reactions. Objective: The aim of this study was to profile the lipid levels and metabolic syndrome status in patients with oral lichen planus (OLP), oral lichenoid reactions (OLR) and healthy individuals in order to evaluate their respective cardiovascular risk. Materials and Methods:This case-control descriptive study included 32 adults from the OPD visiting the Department of Oral Medicine, 18 with either oral lichen planus or oral lichenoid reactions and 14 age and sex matched healthy controls. Ethical clearance and informed consent were obtained. Their lipid levels, body mass index and metabolic syndrome status were evaluated. Statistical analyses were performed with the SPSS version 16.0 software.P = 0.05 was considered significant. Results: The key findings of this study were a) increased levels of S.cholesterol and LDL-C in OLP and OLR patients when compared to normal healthy individuals b) significantly higher S.triglyceride and VLDL in OLP when compared to OLR and c) lower HDL-C levels in OLP when compared to OLR. 2(18%) patients with OLP and 3(50%) with OLR were found to have high BMI suggestive of obesity whereas none of the normal individuals were obese. Conclusion:There may be an association between chronic inflammation and dyslipidemia that increases the risk for cardiovascular disease. OLP and OLR patients have increased serum cholesterol and LDL-C when compared to normal adults. Further research on lipid levels in OLR are required to establish the findings of this study.

Imaging of Temporomandibular Joint: Approach by Direct Volume Rendering

Background: The purpose of this study was to conduct a morphological analysis of the temporomandibular joint, a highly specialized synovial joint that permits movement and function of the mandible. Materials and Methods: We have studied the temporom-andibular joint anatomy, directly on the living, from 3D images obtained by medical imaging Computed Tomography and Nuclear Magnetic Resonance acquisition, and subsequent re-engineering techniques 3D Surface Rendering and Volume Rendering. Data were analysed with the goal of being able to isolate, identify and distinguish the anatomical structures of the joint, and get the largest possible number of information utilizing software for post-processing work. Results: It was possible to reproduce anatomy of the skeletal structures, as well as through acquisitions of Magnetic Resonance Imaging; it was also possible to visualize the vascular, muscular, ligamentous and tendinous components of the articular complex, and also the capsule and the fibrous cartilaginous disc. We managed the Surface Rendering and Volume Rendering, not only to obtain three-dimensional images for colour and for resolution comparable to the usual anatomical preparations, but also a considerable number of anatomical, minuter details, zooming, rotating and cutting the same images with linking, graduating the colour, transparency and opacity from time to time. Conclusion: These results are encouraging to stimulate further studies in other anatomical districts.

Dual Release Paracetamol in Osteoarthritis of Knee: A Randomized Controlled Clinical Trial

Background: Paracetamol is recommended as first line agent for pain management in osteoarthritis (OA) by various guidelines. The main problem associated with management of osteoarthritis is long term patient compliance to paracetamol due to its frequent dosing. Objective: To evaluate the efficacy and safety of Paracetamol 650 mg dual release tablet twice daily (PCM 650 dual release) compared to paracetamol 500mg immediate release tablet thrice daily (PCM 500 IR) in the treatment of Knee OA. Materials and Methods: In this randomized, open label, parallel, active controlled clinical study, 250 patients of OA knee meeting inclusion criteria were randomized to receive either PCM 650 dual release two times daily or PCM 500 IR three times daily for 6 weeks. Patients were assessed at baseline, 2, 4 and 6 weeks. Primary efficacy measures were severity of pain (Visual Analogue Scale) and Knee injury and osteoarthritis outcome score (KOOS) subscale for pain at week 2, 4 and 6. Other KOOS subscales (symptoms other than pain, function in daily living, function in sport and recreation, quality of life) and patient’s and physicians global assessment of therapy were included as secondary endpoints. Results: Both treatment groups showed improvement in primary endpoints at each evaluation visit. Patients receiving PCM 650 dual release showed significant improvement of pain in both primary endpoints at each study visit compared to patients receiving PCM 500 IR ( p <0.001). PCM 650 dual release was significantly superior to PCM 500 IR for improvement in all KOOS subscales at each study visit ( p <0.01). Less number of patients required additional rescue analgesics in PCM 650 dual release group (16% patients vs 26%, PCM 500 IR; p > 0.05). Adverse effects were significantly less in PCM 650 dual release group (6% vs. 14% in PCM 500 IR; p <0.05). Patient’s and physician’s global assessment of therapy favoured PCM 650 dual release than PCM 500 IR ( p <0.001). Conclusion: Patients with symptomatic OA of the knee showed a greater improvement in pain and functional capacity with PCM 650 dual release than PCM 500 IR with better tolerability.

A Comparative Evaluation of Gutta Percha Removal and Extrusion of Apical Debris by Rotary and Hand Files

Chandrasekar, A.V.Rajesh Ebenezar, Mohan kumar, A.Sivakumar

Aim: The aim of this study was to evaluate the efficacy of Protaper retreatment files in comparison with RaCe, K3 and H-files for removal of gutta-percha and apically extruded debris using volumetric analysis. Materials and Methods: Forty extracted single rooted maxillary incisor teeth with straight canals and mature apices were selected for the study. After access cavity preparation, apical patency was confirmed with a size 10 K-file extending 1mm beyond the point at which it was first visible at the apical end. Working lengths were determined with the use of size 15 K-file. The canals were prepared in a step-back technique and the master apical file was size 30 for all teeth. 3% sodium hypochlorite was used as an irrigant after each instrumentation. Before final rinse, size 20 K-file was passed 1mm beyond the apex to remove any dentinal shaving plugs and maintain the apical patency. Then the canals were dried with paper points. The root canal was filled using standard gutta-percha points and zinc oxide eugenol sealer under lateral condensation technique. The teeth were then randomly divided into four groups of ten teeth each based on the instrument used for gutta percha removal. All the rotary instruments used in this study were rotated at 300rpm. The instruments used were: Group 1 – RaCe Files, Group 2 – ProTaper retreatment Files, Group 3 – K3 Files and Group 4 – H Files. The volume of the obturating material was calculated before and after removal using volumetric analysis with spiral CT. The removal efficacy with each instrument was calculated and statistically analysed. Results: The results of the study show that the ProTaper retreatment files (Group 2) (97.4%) showed the highest efficiency in the removal of obturating material, which was followed by RaCe (95.74%), K3 (92.86%) and H files (90.14%) with the efficiency in the decreasing order. Similarly the mean apical extrusion in H files (0.000 ± 0.002) was significantly lower than all the rotary instruments. However, the difference among the rotary files were not statistically significant (p>0.05). Conclusion: ProTaper retreatment files show significant difference over other groups in removal of obturating material and can be the system of choice in endodontic retreatment procedures.

Expression of Inducible Nitric Oxide Synthase in Keratocystic Odontogenic Tumour and Variants of Ameloblastoma – A Comparative Study

Diana.H, Maya.R, Sekar.B, Murali.S, Ramesh . K

Introduction: The odontogenic keratocyst (OKC) is a histopathologiocally and behaviourally unique and specific entity. It is the most aggressive and recurrent of all the cysts and shows characteristics resembling both cyst and a tumour. The unique nature of OKC and the recent shift of OKC as a tumour made us evaluate yet another factor, Inducible nitric oxide synthase an (iNos) enzyme which has been implicated in the tumourigenesis of various neoplasms. Aims and Objectives: The objective of the study was to analyse and compare the immunohistochemical expression of iNOS in odontogenic keratocysts (OKC’s) in variants of ameloblastoma affecting the oral cavity, to determine the neoplastic potential of OKC and to reinforce the classification of OKC as keratocystic odontogenic tumour. Materials and Methods: Thirty two specimens, eight specimens each in OKC, follicular ameloblastoma, plexiform ameloblastoma and unicystic ameloblastoma, taken from the Oral Pathology Department were randomly selected for this study and were evaluated for epithelial expression of iNOS by immunohistochemistry. Results: Epithelial immunoreactivity to iNOS was strongly positive in 93.5% of follicular ameloblastomas, 68.7% of plexiform ameloblastomas, 66.9% of odontogenic keratocysts and 66.2% of unicystic ameloblastomas. Conclusion: iNOS may be an important marker involved in the biological behaviour of OKC. Furthermore the presence of increased expression of iNOS in Follicular ameloblastomas followed by Plexiform ameloblastomas, OKCs and Unicystic ameloblastomas is yet another evidence to support that OKC could be considered as a neoplasm.

Efficacy of Rebamipide and Levamisole in the Treatment of Patients with Recurrent Aphthous Ulcer - A Comparative Study

Context (Background): Recurrent aphthous stomatitis is an inflammatory condition of unknown aetiology characterized by painful recurrent, single or multiple ulcerations of the oral mucosa. Aims: To compare the efficacy of rebamipide, a gastro-protective agent and levamisole, an immunomodulating agent in the treatment of recurrent aphthous stomatitis. Materials and Methods: Hundred patients diagnosed with recurrent aphthous stomatitis were enrolled in the study. Fifty patients were assigned randomly to each of the two treatment groups. After the clinical diagnosis and ulcer measurement, a subjective evaluation of symptoms was done for each subject. Both the drugs were given orally at specified intervals. Ulcer measurements and subjective evaluations were made at day one. Statistical Analysis: Analysis was done using various test like Mann Whitney and t-test. Results and Conclusion: The overall results showed mean number of episodes whose values were not statistically significant (p=0.43), neither were the mean number of ulcers (p=0.75), or values for mean size of ulcers (p=0.91). However, the overall results suggested that efficacy of rebamipide is almost same as that of the efficacy of previously proved drug levamisole. The current study with a three months follow up, including patients with high scores of pain, aphthae count, ulcer size and frequency of occurrence showed better results in both the study groups. However, rebamipide is suggested to be well tolerated and may therefore be useful in the treatment and prevention of frequently recurrent aphthous ulcers not restricted to Behcet’s disease.

Comparative Study of Fracture Resistance of Porcelain in Metal Ceramic Restorations by Using Different Metal Coping Designs- An In Vitro Study

Nilesh Bulbule, B. K. Motwani

Aim: The aim of this study was to compare effect of different metal coping designs on fracture resistance of porcelain in metal ceramic restorations Materials and Methods: Fracture resistance of porcelain was assessed in porcelain fused to metal crowns with three different coping designs i.e. metal coping extension on labial surface upto gingivoaxial line angle, metal coping extension 1mm short of the gingivoaxial line angle and metal coping with 0.4mm wide labial metal collar. For crowns without labial metal collar margin; shoulder porcelain was used to build the labial cervical margin of the crowns. Results: Results were assessed with statistical analysis using the student unpaired‘t’ test. Visual examination of the fractured specimens of group A, B and C showed remarkably similar failure modes with nearly all specimens failing through a shear fracture of porcelain from load point to facial margin of the crown. Conclusion: Within the scope of this study, it was observed that the mean facture strength of the samples with shoulder porcelain labial margins having metal coping design extending upto gingivoaxial line angle of the finish line was highest as compared to samples with shoulder porcelain labial margins having metal coping design 1mm short of gingivoaxial line angle & samples having porcelain fused to metal coping design with 0.4mm wide metal collar.

Effects of Green Tea on Streptococcus Mutans Counts- A Randomised Control Trail

Context: Mouth rinses have been in use from time immemorial as a supplement for routine oral hygiene. There are many number of mouth rinses currently available in the market in which many of them possess certain drawback, which has necessitated the search for alternate mouth rinses. Aim: The aim of the present study was to assess the effect of rinsing with green tea in comparison with chlorhexidine and plain water on Streptococcus mutans count. Setting and Design: A short term, single blinded, cross over randomised control clinical trial. Materials and Methods: Study includes a total of 30 subjects aged 20 to 25 years divided into three groups that is green tea group, chlorhexidine group, and plain water group. A baseline plaque samples were collected and under supervision of examiner all the subjects rinsed with 10 ml of respective solutions for one minute. Plaque samples were collected at five minutes after rinsing. All the 30 subjects were exposed to all the three rinses with a wash out period of seven days between the interventions. All the samples were sent to microbial analysis. Results: Wilcoxon matched pair test and Mann-Whitney U test showed that both chlorhexidine and green tea significantly reduced Streptococcus mutans colony counts compared to plain water. Conclusion: The results of present study indicate that green tea mouth rinse proved to be equally effective compared to chlorhexidine which is considered as gold standard. This may also be a valuable public health intervention as it is economical and has multiple health benefits.

Evaluation of Chromogenic Media in Detection of Vancomycin Resistant Enterococci

Vijaya D., Vijaya S., Santhya S.T., Yashaswini M.K., Megha S.

Introduction: Vancomycin resistant Enterococci have become important nosocomial pathogens. So it is necessary to monitor continuously such infections in the hospitals. Materials and Methods: A total of 100 Enterococci isolated from 4489 various clinical samples were speciated and antibiogram was done according to standard laboratory methods. The efficacy of CHROMagarTM VRE (France) and Hicrome VRE (Himedia) in detecting VRE was evaluated using E- test (Himedia). Results: Hicrome VRE and CHROMagarTM VRE showed sensitivity of 100% and specificity of 99% as compared to E-test. Conclusion: In the present study VRE was not isolated. Prudent use of vancomycin and continuous surveillance for VRE will prevent the emergence of vancomycin resistant Enterococci in the locality in future. Identification of VRE by chromogenic media is rapid, easy to perform, cost effective compared to technically demanding, time consuming and costly conventional method.

Relationship of Perceived Stress and Dental Caries among Pre University Students in Bangalore City

Meena Jain, Amitoch Singh, Ankur Sharma

Introduction: Stress can increase the susceptibility to dental caries by four possible mechanisms. Studies show that adolescents tend to more likely develop negative body image, disturbed eating behaviours and high levels of stress. Students report stress, taking and studying for exams being the greatest source of academic stress due to competition and the large amount of content in less time. Aims and Objectives: The objectives were to analyze the caries experience in relation to perceived stress during preuniversity examination period, to estimate the prevalence of dental caries and to calculate SiC (significant caries index) among preuniversity students in Marathahalli, Bangalore city, India. Materials and Methods: This cross-sectional, correlational study involved 210 students (Response rate = 65.37%). The questionnaire consisted of demographic details and Perceived Stress Scale (PSS). Dental caries status was evaluated using the WHO (1997) caries diagnostic criteria for decayed, missing, and filled teeth (DMFT: Dynamical mean field theory). Results: Prevalence of dental caries was 50.48%. Mean DMFT was 1.74 and Sic index was 4.56. The correlation between PSS and caries experience was found to be weak (r=0.389) (p<0.001). Conclusion: Academic stress appears to affect oral health, shown by higher caries experience in high perceived stress score individuals.

A Comparative Study of Clear Corneal Phacoemulsification with Rigid IOL Versus SICS the Preferred Surgical Technique in Low Socio-economic group Patients of Rural Areas

Jaya Devendra, Smita Agarwal, Pankaj Kumar Singh

Context: Low socio-economic group patients from rural areas often opt for free cataract surgeries offered by charitable organisations. SICS continues to be a time tested technique for cataract removal in such patients. In recent times, camp patients are sometimes treated by clear corneal phacoemulsification with implantation of a rigid IOL, which being more cost effective is often provided for camp patients. This study was undertaken to find out which surgical technique yielded better outcomes and was more suited for high volume camp surgery. Aim: To find the better surgical option- phacoemulsification with rigid IOL or SICS, in poor patients from rural areas. Settings and Design: A prospective randomised controlled trial of cataract patients operated by two different techniques. Materials and Methods: One hundred and twelve eyes were selected and were randomly allocated into two groups of 56 eyes each. At completion of the study, data was analysed for 52 eyes operated by clear corneal phacoemulsification and implantation of a rigid IOL, and 56 eyes operated by SICS. Statistical Analysis Used: Unpaired t-test was used to calculate the p- value. Results: The results were evaluated on the following criteria The mean post-operative astigmatism at the end of four weeks - was significantly higher in phacoemulsification group as compared to SICS group. The BCVA (best corrected visual acuity) at the end of four weeks - was comparable in both groups. Subjective complaints and/ or complications: In phaco group two patients required sutures and seven had striate keratitis, while none in SICS group. Complaint of irritation was similar in both groups. Surgical time- Was less for SICS group as compared to phaco group. Conclusion: SICS by virtue of being a faster surgery with more secure wound and significantly less astigmatism is a better option in camp patients from rural areas as compared to phacoemulsification with rigid IOL.

Bacterial Efficacy of Ca(oH)2 Against E.faecalis compared with three Dental Lasers on Root Canal Dentin- An invitro study

Narasimha Reddy Kanumuru, Rama Subbaiah

Aim: The aim of this study was to evaluate bactericidal effect of Ca(OH)2 compared with 810 nm diode, 980 nm diode, and Nd:YAG lasers on root canal dentin against E.faecalis. Materials and Methods: Sixty five freshly extracted human mandibular single rooted teeth were selected for the study. The apical third of these roots was gradually enlarged until reaching the ISO 40- K file. The samples were divided into 4 groups, each containing 15 teeth and 5 teeth for control group. Group-1: 810 nm Diode; Group-2: 980 nm Diode; Group-3: Nd:YAG; Group-4: Ca(OH)2. 50µL of the E.faecalis ATCC 29212 strand was incubated in 1 mL of Brain Heart Infusion Broth (BHI) culture medium in37oC incubator for 4h. The concentration of the inoculation was then adjusted for a degree of turbidity which was adjusted to 0.5 McFarland scale. Later from the incubated broth, 10µL of E.faecalis culture was inoculated into the main canal and were sealed. Results: The incubated plates were checked for growth and the colony was counted using colony counter and the results are interpreted. There was statistically significant difference (p<0.05) amongst the Ca(OH)2 group regarding the laser groups. Conclusion: The teeth irradiated with the Nd:YAG laser had significantly higher bacterial reduction than all the other groups and the respective control groups.

Comparison of the Source of Introduction to Cariogenic Food Substance and Caries Prevalence in Children

R. Somasundaram, B.N. Rangeeth, Joyson Moses, S. Sivakumar

Introduction: Dental caries being a multi-factorial disease depends on lot of factors. Since awareness and exposure seems to have increased, in the present scenario it is difficult to assume that one particular source would increase the occurrence of dental caries. Children are exposed to different media sources and spend most of their free time watching them. They are attracted by messages of advertisers’ and susceptible to stylish advertisements of foods often harmful to oral and general health. Aim: To compare the effects of three different sources of introduction to cariogenic food substance among school children and their role in caries prevalence. Materials and Methods: A total of 300 school children were selected for the study and a questionnaire was prepared keeping in mind the various sources introducing cariogenic foods to children namely television advertisement, magazines/news paper, posters/banners. Following which oral examination will be done to determine the number of carious lesions in the subjects. The data will be acquired, computed and statistically analysed to compare the correlation between these sources and caries prevalence. Results: Children who watched television advertisements and asked for food items and soft drinks were found to have more caries and DMFT/dmft index. Conclusion: A total ban on advertisements would not be practically possible. A more realistic approach would be to limit the number of advertisements that feature potentially cariogenic and unhealthy food products, and also ensure that they ideally carry statutory warnings.

Gender Determination Using Diagonal Measurements of Maxillary Molar and Canine Teeth in Davangere Population

Ahmed B.R. Mujib, Ratna Kumari V. N. Tarigoppula, Pavan G Kulkarni, Anil BS

Background: Mesiodistal and buccolingual measurements of the teeth have been the traditional means of determining gender which sometimes are difficult to measure. Aims and Objectives: To assess the degree of sexual dimorphism in upper permanent canines and first molars using diagonal diameters and to evaluate the applicability of diagonal measurements in sex determination. Materials and Methods: Mesiobuccal-distolingual (MBDL) and distobuccal-mesiolingual (DBML) measurements of the crown and cervix of maxillary canine and maxillary molar were taken using digital vernier callipers in 100 upper dental casts obtained from 50 males and 50 females of the age group of 17-25 y. Results: With step wise discriminant function analysis, results were statistically significant with males showing higher diagonal measurement values. The classification accuracy for males was 69% and in females was 73% with overall accuracy of 71%. Results showed that canines exhibited highest accuracy with cervical measurements being more dimorphic. MBDL measurements were found to be more reliable. Most dimorphic measurements included right molar cervical MBDL, left molar cervical MBDL followed by right and left molar crown MBDL. Conclusion: In cases of tooth rotations, crowding, certain fillings and attritions where traditional mesio-distal and bucco-lingual measurements are not applicable, diagonal measurements could be of help in predicting gender.

Evaluation of Pre-Malignant and Malignant Lesions in Cervico Vaginal (Pap ) Smears by Nuclear Morphometry

Divya Rani M.N, Aparna Narasimha, Harendra Kumar ML, Sheela SR

Background: Cervical cancer is the second most common cancer occurring among women worldwide, with almost half a million new cases each year. Normal cells gradually transform to form cancer cells through several stages. So, the changes occurring during the transformational stages need to be assessed. Aim: Our aim was to study various nuclear parameters useful in evaluating pre-malignant and malignant cervico-vaginal pap smears. Materials and Methods: Bethesda System was used to categorize cervical pap smears into premalignant and malignant lesions. Nuclear parameters were calculated using J 1.44C morphometric software. Several nuclear size parameters were analysed. Results: The nuclear area, perimeter, diameter were found to be statistically significant (p<0.05) parameters in differentiating premalignant from malignant cervical smears. Conclusion: Nuclear morphometry was thus a useful objective tool in differentiating premalignant from malignant cervical smears.

Collision Tumours of Ovary: A Very Rare Case Series

Ajay Kr. Singh, Monika Singh

Collision tumours are composed of two histologically distinct neoplasms in the same organ without intermixture of cell types. Here the author present a case series of 4 cases of collision tumours of ovary with brief review of literature. Two cases have a combination of mucinous cystadenoma and teratoma whereas third case is a combination of serous papillary cystadenoma with teratoma and the fourth case has a combination of serous papillary cystadenocarcinoma and teratoma. The cases were diagnosed post-operatively. It is important to correctly diagnose the component of tumour for further management and favourable prognosis.

Fibre Reinforced Composite: Post and Core Material in a Pediatric Patient - An Alternative to Usual

Sonu Acharya, Shobha Tandon

Fractured teeth are always a challenge to the dentist. The root canal therapy today can retain even very badly broken teeth. One of the most accepted techniques involve restoration of extensively carious or badly fractured teeth by the fabrication of a post and core while utilizing the root canal space for anchorage. So far, the only materials that are available to the dentist for this procedure have been a variety of metallic alloys. These materials are hard and need to be cast precisely so that they can fit the canals. Today materials are available which usually eliminates all the intermediate steps which are done in laboratories and the total control is rendered in the hands of the dentist, to fabricate on the chair, a resilient, aesthetic and bonded post and core. One such material is discussed here in a pediatric permanent anterior tooth.

Neonatal Septicaemia Caused by Vancomycin Resistant Enterococcus Faecium-A Case Report

Shantala GB, Nagarathnamma T, Pooja DR, Harsha TR, Karthik R

Neonatal bacterial sepsis is one of the major causes of morbidity and mortality in neonates. 10% cases of neonatal bacteraemia and septicaemia are caused by Enterococci. The increasing incidence of Vancomycin resistant enterococci (VRE) is of particular concern because of limited treatment options and increased mortality. We report here a case of neonatal sepsis in a premature baby caused by vancomycin resistant Enterococcus faecium Van A phenotype from a tertiary care Hospital in South India. A preterm baby boy with low birth weight was admitted to the NICU with Respiratory distress and meconium aspiration. On 5th day the baby succumbed to death and a final diagnosis of respiratory distress and meconium aspiration with sepsis was made. Blood cultures sent yielded vancomycin resistant Enterococcus faecium (minimum inhibitory concentration = 256 µg/ml). It was confirmed as Enterococcus feacium Van A phenotype by Automated Vitek system.

Secondary Vaginal Atresia Treated with Vaginoplasty Using Amnion Graft: A Case Report

Setu Rathod, Sunil Kumar Samal

We report a case of 26-year-old primipara with last child birth 1.5 year back who presented with amenorrhoea, cyclical lower abdominal pain and dyspareunia for past six months. Examination revealed vaginal atresia secondary to previous traumatic/mismanaged vaginal delivery with haematocolpos. She was managed by vaginoplasty with amnion graft and regular dilation with soft vaginal mould for six weeks and was advised for regular intercourse after that. On follow up our patient was doing well with restoration of normal coital function.

An Unusual Association of Inflammatory Pseudotumor of the Liver and Dorsal Pancreatic Agenesis Presenting as Reversible Portal Hypertension: A Case Report

Ankur Jain, Naresh Gupta, Praveen Bharti

Inflammatory pseudotumor of liver although a rare entity is an important differential diagnosis of hepatic space occupying lesions as well as an important cause of portal hypertension, commonly mimicking malignant tumors on imaging and histology. We report a case of a 25-year-old postpartum female who presented to our emergency with seizures and altered sensorium and was found to be having uncontrolled hyperglycemia and metabolic encephalopathy. She had a 2 month history of low grade fever and pain in right hypochondrium. Examination revealed an enlarged, tender, left lobe of the liver, splenomegaly and ascites. CT scan of the abdomen revealed an ill-defined mass lesion in left lobe of the liver with dilated intrahepatic biliary radicles along with dorsal pancreatic agenesis and evidence of portal hypertension in the form of ascites and splenomegaly. Histopathology confirmed the presence of inflammatory pseudotumor in left lobe of the liver. Conservative management of the patient resulted in reduction of the tumor size and regression of splenomegaly and ascites in 1 month. Present case highlights inflammatory pseudotumor of liver as a rare entity, it’s resemblance to malignant conditions, pancreatic agenesis as a previously unreported association as well as a potentially reversible cause of portal hypertension by conservative treatment only.

Extra-Oral Approach for Removal of Ectopic Impacted Lower Third Molar: A Case Report

Extra oral approach for removal of the lower third molar is uncommon. This case report illustrates an example of removal of lower third molar by extra-oral approach preserving the inferior dental nerve.

Postmenopausal Huge Ovarian Leiomyoma: A Rare Presentation

Sasikala R., Rupavani K., Rekha R., Erli Amel Ivan

Ovarian leiomyoma is one of the rare solid tumours of ovary, accounting for 0.5-1% of the benign tumours of the ovary. We report one such case which presented in a postmenopausal woman. The differential diagnosis includes ovarian fibroma, thecoma, cellular fibroma and sclerosing stromal tumour. Masson’s trichrome staining helps to distinguish fibrous and smooth muscle components of the lesion and confirms the diagnosis of ovarian leiomyoma. Hence, ovarian leiomyoma should be considered in the differential diagnosis of ovarian spindle cell tumours.

A Fatal Case of Fungal Empyema Due to Candida Krusei and Candida Tropicalis: A Rare Occurrence with an Atypical Presentation

Infections of the pleural cavity remain an important cause of morbidity and mortality despite advancement in diagnostic modalities and therapy. Community acquired empyema thoracis due to Candida species are rarely reported in paediatric literature. We hereby report an interesting case of empyema due to co-infection of Candida krusei with Candida tropicalis. A 11-year-old female child presented with respiratory distress. Chest X-ray showed massive pleural effusion, thoracocentesis showed it as purulent exudate and she was empirically treated with antibiotics. C. tropicalis and C. krusei were isolated from the pus sample proving to be fungal empyema. Inspite of antifungal agents and mechanical ventilation, her general condition rapidly deteriorated and she succumbed.

Infantile Onset Alexander Disease with Normal Head Circumference: A Genetically Proven Case Report

Alexander disease (AD) is an autosomal dominant leukodystrophy which predominantly affects infants and children. The infantile form comprises the most common form of AD. It presents before two years of age and characterized by macrocephaly, psychomotor regression, spasticity, pyramidal sign, ataxia and seizures. The diagnosis is based on magnetic resonance imaging (MRI) findings and confirmed by Glial fibrillary acidic protein (GFAP) gene molecular testing. We report an Indian case with normal head circumference

Neonatal Brain Abscess due to Extended-Spectrum Beta-Lactamase Producing Klebsiella pneumoniae

Klebsiella pneumoniae (K. pneumoniae) causing brain abscess in newborn infants is rare. Presented herein, is a 27-day-old male neonate who developed two frontal lobe abscesses in association with K. pneumoniae sepsis and meningitis. Antibiotic susceptibility testing utilizing the double-disk synergy method (Cefotaxime and Amoxycillin-Clavulanate) confirmed the extended spectrum beta-lactamase (ESBL) production by the isolate. He was treated simultaneously with antibiotics (Meropenem and Amikacin) and abscess aspiration through the anterior fontanelle, with less than satisfactory outcome. ESBL producing K. pneumoniae brain abscess in neonates is extremely rare in the English literature. Emperical carbapenems and aminoglycoside coverage in neonates with K. pneumoniae sepsis and brain abscess, especially in areas with high rate of ESBL producing bacteria may be warranted

Persistent Monotypic Plasma Cells with Absence of Neoplastic B Cell Component in a Treated Case of Waldenström Macroglobulinemia: A Sign of Residual Disease?

Smeeta Gajendra, Ritesh Sachdev, Bhawna Jha, Shalini Goel, Tushar Sahni

Waldenström macroglobulinemia (WM) is a rare indolent variant of non- Hodgkin’s lymphoma characterised by lymphoplasmacytic infiltration of bone marrow (BM) associated with a serum IgM paraprotein. The WHO classification states that the neoplastic cells of WM usually are positive for monotypic surface immunoglobulin light chain, IgM, CD19, and CD20 and are negative for CD5, CD10, and CD23. Serum monoclonal protein detection by serum protein electrophoresis and bone marrow aspirate and biopsy are required for WM diagnosis, monitoring and response assessment. Pathologist must dissuade themselves from making a hasty decision on calling a complete response in WM when neoplastic B cell component is absent. Evaluation of clonality of any residual plasma cells must be done in all cases of WM to evaluate the presence and extent of residual or persistent disease. Role of additional therapy targeted at these residual plasma cells in WM can be evaluated as tools for achieving complete remission. Herein, we present a case of WM with residual monotypic plasmacytosis in BM, without B lymphocytes after therapy.

Orbito-Rhino-Antro Access Osteotomy For Anterior Skull Base Lesions

Sumanth K Sreeramaneni, Vivekanand.S.kattimani

Even with advent of endoscopic assisted surgeries the access osteotomy plays an important role for accessing the pathological lesions of anterior skull base since beginning of the era of surgery. This report introduces the orbito–rhino–antral access osteotomy for the removal of juvenile nasio angio fiboma extending in to the cranial base. This osteotomy provides good access to the lesion with lesser morbidity and without hampering the occlusion as in lefort osteotomies. It is safe, easy and faster to perform. Osteotomised segment is easy to replace and gives ease for the surgeon to access without any hindrance. The osteotomised segment act as free graft and there are no complications postoperatively even after 48 mnth of follow-up.

Anterior Abdominal Wall Haemangioma with Inguinal Extension

Priti P Shah, Siddharth P. Dubhashi, Kaushal Choudhary

Haemangioma are common benign vascular tumour but Intramuscular haemangiomas are rare tumours comprising less than 1% of all. The most frequent sites are extremities, head and neck whereas abdominal wall is a quiet rare location. Ultrasonography is an appropriate initial diagnostic modality and MRI is the investigation of choice. A rare case presented to us as Intramuscular haemangioma of anterior abdominal wall with inguinal extension. Ultrasonography with Doppler study and MRI was suggestive of same finding. Intraoperatively patient had huge haemangioma involving external oblique, internal oblique and transverse abdominus muscle. Wide local excision with meshplasty was done as part of muscle had to be removed. Histology confirmed the diagnosis of Intramuscular Haemangioma.

A Novel Esthetic Approach using Connective Tissue Graft for Soft Tissue Defect Following Surgical Excision of Gingival Fibrolipoma

The aim of the present case report is to evaluate the adjunctive use of a connective tissue graft to overcome soft tissue defects following excision of a gingival fibrolipoma in the aesthetic region. Connective tissue graft has been well documented for treating defects of esthetic concern. However, the literature does not contain many reports on the esthetic clinical outcome following the use of connective tissue graft secondary to excision of soft tissue tumours. A 28-year-old male patient reported with a complaint of a recurrent growth in relation to his lower front tooth region. The lesion which was provisionally diagnosed as fibroma was treated with a complete surgical excision, following which a modified coronally advanced flap and connective tissue graft was adopted to overcome the soft tissue defect. The excised growth was diagnosed histologically as fibrolipoma. One year follow up showed no recurrence of the lesion and good esthetics.The adjunctive use of the connective tissue graft and modified coronally advanced flap predictably yields optimal soft tissue fill and excellent esthetics. Hence, routine use of this procedure may be recommended for surgical excision of soft tissue growths in esthetically sensitive areas.

Sarcoidosis Presenting as Isolated Gingival Enlargement: A Rare Case Entity

Pragya Tripathi, Jaihans Aggarwal, Deepak Chopra, Sukhchain Bagga, Kanika Sethi

Sarcoidosis is a non-caseating granulomatous disease . It is a multiorgan inflammatory disorder of unknown etiology. Conditions affecting skin or other organs frequently involve oral cavity and rarely manifest as gingival disease. Here we are reporting a rare case in which gingival hyperplasia was the initial symptom which finally led to the diagnosis of sarcoidosis. Oral mucous membrane needs to be examined carefully as it may constitute in presenting first sign of systemic sarcoidosis.

Acute Suppurative Thyroiditis Accompanied by Thyrotoxicosis after Fine-Needle Aspiration: Treatment with Catheter Drainage

Murat Yildar, Gulen Demirpolat, Mehtap Aydin

Fine needle aspiration (FNA) biopsy is commonly used in the diagnosis of thyroid diseases. Serious complications are rare and this procedure is generally safe. Acute supurative thyroiditis (AST) after FNA has been seldomly reported. We report a case of a 57-year-old women with diabetes mellitus who developed AST with thyrotoxicosis after FNA. She was successfully treated by sonographically guided percutaneous drainage and antithyroid agent.

Phaeohyphomycotic cyst in the Foot by Exophiala

A 52-year-old male, presented to us with a swelling over plantar aspect of right foot following trauma. Clinically it was a cystic swelling diagnosed as an abscess; ultrasound showed thick walled multilocular collection with thick echogenic debris, following which complete excision of the swelling was done. A part of the swelling was sent for histopathological examination and cut section showed thick purulent material. Other part sent for culture sensitivity grew, Exophiala, which belongs to Dematiaceous group of fungi. Surgical excision with antifungal treatment is the management in general for fungal cyst, whereas in our case complete excision was done without antifungal treatment.

Bronchoscopic Removal of Aspergilloma from a Cavitary Lesion of the Lung

We report a 62-year-old diabetic male who had recurrent episodes of haemoptysis, diagnosed to have Aspergilloma in the right upper lobe cavitary lesion of the lung. Bronchoscopic biopsy revealed a fungal ball (Aspergillus niger) in the right upper lobe. Since the patient did not respond to medical treatment, unfit for any surgical interventions, mechanical removal of the fungal ball was done with both rigid and flexible bronchoscopes. Patient improved symptomatically after the removal of the fungal ball; haemoptysis subsided. The patient is still under follow up without any further episodes of hemoptysis. This case report highlights a new alternative treatment option in patients with open cavitary Aspergilloma.

Primary Renal Large Cell Neuroendocrine Carcinoma in a Young Man

Cornerstone Wann, Nirmal Thampi John, Ramani Manoj Kumar

Neuroendocrine tumours are usually located in the gastrointestinal or respiratory tract. A 23-year-old man was evaluated for loss of weight and a palpable left loin mass. CECT showed a large heterogeneously enhancing mass with calcification arising from the left kidney. He underwent an open radical nephrectomy. Histopathological examination revealed a large cell neuroendocrine carcinoma (LCNEC). LCNEC of the kidney is extremely rare and portends poor prognosis. It is usually a histopathological surprise and requires immunohistochemistry for confirmation

Remedy for Repeated Implant Retained Denture Fracture-A Challenging Case Report

The most common site of fracture in a maxillary or a mandibular complete denture is along an anteroposterior line that coincides with the labial notch in in the denture which used to provide the frenum relief. Osseointegrated implants have been a boon to the patients who are completelly edentulous and are not satisfied with the conventional removable complete denture approach.Implant supported dentures have proven to provide superior retention and support for removable complete dentures. Nevertheless, fracture of the denture bases is a common complication of implant-supported mandibular overlay dentures,ecspecially when the artificial denture is opposing natural dentition. This article describes and illustrates a method of reinforcing implant-supported mandibular overdentures to overcome this problem.

Extramedullary Plasmacytoma of Gingiva and Soft Tissue in Neck

Plasmacytoma is a malignant disease that present either in bone marrow (medullary plasmacytoma), within the bone (solitary plasmacytoma of bone), or outside of bone, as the extramedullary plasmacytoma. Extramedullary plasmacytoma accounts for 3% of all plasma cell tumours and approximately 90% of extramedullary plasmacytomas affect the head and neck region commonly affecting the nasal cavity, paranasal sinuses, tonsillar fossa and oral cavity. Multiple extramedullary plasmacytoma is defined when there is more than one extramedullary tumour of clonal plasma cells and such presentations are extremely rare. We report such a rare case of multiple extramedullary plasmacytoma involving gingiva and neck. Here is a case report of a 65-year-old female patient presenting with extramedullary plasmacytoma of the gingiva and soft tissue in neck.

Imaging Diagnosis of Urethral Leiomyoma, usual Tumour at an Unusual Location

Ritu Verma, Shibani Mehra, U.C.Garga, Nishchint Jain, Krishna Bhardwaj

Leiomyomas are benign tumours of smooth muscle origin and are the most common uterine masses in females of reproductive age group. Extrauterine leiomyomas are also encountered occassionally and most commonly they involve the genitourinary tract. Leiomyomas arising from urethral smooth muscle are exceptionally unusual which can pose a diagnostic dilemma. Patients usually present with urinary complaints and an intraluminal soft tissue mass bulging from urethral meatus. We are presenting the imaging findings of leiomyoma of distal urethra presenting as a perineal mass with histopathological correlation.

Biologic Restoration: A Treatment Option for Reconstruction of Anterior Teeth

Several procedures are advised to manage fractured anterior tooth structure using acrylic resin, composite restoration, ceramic or metal crown with ceramic facing. Biologic restoration is a procedure to restore fractured tooth structure with natural tooth material. In this in vitro case we have made an attempt for aesthetic rehabilitation of maxillary central incisor with similar biologic crown taken form extracted maxillary central incisor. It was observed that biologic restoration is an aesthetic, economical, fast and functional procedure which can be used as an alternative method to restore fractured primary or permanent anteriors.

Fibromatosis Colli - A Rare Cytological Diagnosis In Infantile Neck Swellings

Sabina Khan, Sujata Jetley, Zeeba Jairajpuri, Musharraf Husain

Fibromatosis colli or sternocleidomastoid tumour is a rare cause of benign neck mass in infants. It is a self limiting fibroblastic lesion usually presenting with torticollis and a history of birth trauma.It is one of the few causes in which Fine Needle Aspiration Cytology (FNAC) is indicated in a neonate to confirm the diagnosis and to differentiate it from other congenital, inflammatory and neoplastic causes. FNAC provides a rapid, cost-effective, reliable, non invasive method of diagnosis resulting in conservative management of these lesions. We present two interesting cases of neck swelling in infants where FNAC performed as the first diagnostic procedure was instrumental in establishing the diagnosis of fibromatosis colli thus avoiding unnecessary surgical intervention.

Diffuse Hypopigmentation Followed by Hyperpigmentation in an African American Woman with Hemangiopericytoma Treated with Dasatinib

Karim Boudadi, Rashmi Chugh

Dasatinib is a second-generation multi-target tyrosine kinase inhibitor (TKI) that has activity against many imatinib-resistant BCR-ABL mutant forms, Src, and c-Kit tyrosine kinases. While skin hypopigmentation is a well recognized adverse effect of first generation TKIs; it has rarely been reported with dasatinib. We report a unique case of diffuse cutaneous hypopigmentation induced by dasatinib followed by hyperpigmentation occurring in the same patient. A 52-year-old African American female with a history of metastatic hemangiopericytoma was initiated on dasatinib as part of a clinical trial. After 2 months of treatment, she developed generalized skin hypopigmentation. Within 1 month of discontinuing the drug, the patient’s skin pigmentation returned to normal. However, she then developed diffuse skin hyperpig - mentation over the next couple of months. The hyperpigmentation was self-limited, and eventually resolved after several months.

Waldenstroms Macroglobulinemia Patient Presenting with Rare ‘lytic’ Lesions and Hypercalcemia: A Diagnostic Dilemma

Waldenstroms macroglobulinemia (WM) is an uncommon B-cell lymphoproliferative neoplasm characterized by lymphoplasmacytic cells infiltrating the Bone Marrow, along with demonstration of an IgM monoclonal gammopathy in the serum. Lytic lesions are considered one of the basis for differentiating a patient of Multiple Myeloma (MM) and WM . However, very few cases have been reported with a patient presenting with lytic lesions in a WM patient, thereby, complicating the disease. By finding the extent of these lytic lesions and bone involvement, Not only can we signify the presence or absence of bone lesions, but we can also direct the more efficient use of skeletal X-rays for documentation of the extent, location, and response of bone abnormalities to interventional chemotherapy and radiation therapy. Our case was mimicking the classic case of MM. Using the International Criteria for diagnosis for WM, diagnosis for MM was excluded and diagnosis for WM was made. After two weeks of therapy, the patient showed marked clinical improvement.

Rehabilitation of Edentulous Atrophic Anterior Mandible – The Role of Vertical Alveolar Distraction Osteogenesis

The rehabilitation of patients with edentulous alveolar ridge is always a challenge, more so in case of a long standing atrophic mandible. Mandible, the largest movable bone in the maxillofacial skeleton is associated with many soft tissue attachments which imparts dislodging forces to prosthesis. In addition to this, the rate of resorption of the mandibular ridge is four times that of the maxilla. These factors make the environment of the mandibular arch less favorable to complete denture stability and retention. An ideal solution would be to augment the atrophic alveolar ridge with native bone of the individual which shall eliminate the possible complications, associated with conventional ridge augmentation procedures. With advent of modern technology, and increased biological understanding, the principles of distraction osteogenesis are increasingly being applied to the craniofacial skeleton and have been found to be a viable option in augmenting the native alveolar bone in the mandible. Here the application of an indigenous stainless steel vertical alveolar distraction device to augment atrophic anterior mandibular ridge is assessed in six patients.

Mixed Malignant Germ Cell Tumour of Third Ventricle with Hydrocephalus: A Rare Case with Recurrence

Manjari Kishore, Vidya Monappa, Lakshmi Rao, Ranjini Kudva

Malignant Germ Cell Tumours (GCTs) are rare, accounting for 3% of intracranial tumours and just like their extracranial counterparts represent a wide array of disease. Combination of Germinoma with Teratoma is very rare. Here in, we describe a case of Mixed Malignant Germ cell tumor of third ventricle with recurrence with emphasis on histopathological and radiological findings.

Extra- Adrenal Silent Retroperitoneal Paraganglioma: Report of a Rare Case

Hemalatha. A. L, Avadhani Geeta K, Anoosha. K, Ashok. K.P, M. Rajani Deepa

Extra- adrenal retroperitoneal paragangliomas are extremely rare neuroendocrine neoplasms with an incidence of 2-8 per million. They arise from embryonic neural crest cells and are composed mainly of chromaffin cells located in the para- aortic sympathetic chain. They synthesize, store and secrete catecholamines because of which they may present with headache, sweating, palpitation and symptoms of hypertension. On the other hand, they may remain silent and non- functional and present with vague symptoms like pain abdomen due to episodic release of catecholamines. Histologically and immunohistochemically, non- functional and the functional tumours are no different from each other. Primary methods of pre-operative diagnosis include imaging techniques which also help in surgical planning and pre-operative preparation. Non- functional tumours of ten escape pre-operative detection and create per- operative complications. We present a case of non- functional extra- adrenal retroperitoneal paraganglioma occurring in a 66-year-old female patient presenting with pain and mass per abdomen. On ultrasonongraphy, a retroperitoneal mass of probable mesenchymal origin was suspected. The patient was posted for surgical resection of the mass. Per-operatively, the patient developed hypertensive crisis and massive bleeding. Post-operatively she developed renal failure and succumbed to it after three days. This report highlights the importance of pre- operative diagnosis which is vital in the management of extra- adrenal retroperitoneal paraganglioma

Senior– Loken Syndrome – A Ciliopathy

Hemachandar R

Senior – Loken syndrome is a rare combination of juvenile nephronophthisis and tapeto – retinal degeneration. The author describes two patients who presented with varying degrees of retinal dystrophy and renal insufficiency in their second decade of life. Both the patients presented with severe renal failure requiring hemodialysis. The first patient had early onset progressive retinal degeneration leading to childhood blindness whereas the second patient had asymptomatic retinitis pigmentosa. These cases are presented to highlight the spectrum of eye manifestations of Senior – Loken syndrome. This report also stresses the need for fundus evaluation in patients with chronic kidney disease presenting in second decade of life even if asymptomatic.

Chylolymphatic Cyst of Mesentery of Terminal Ileum: A Case Report in 8 Year-old Boy

Rajendra K Ghritlaharey, Santosh More

Mesenteric cysts are rare benign intra peritoneal tumor and more than half of the mesenteric cysts involve the mesentery of the terminal ileum. We present 8 year-old boy, who presented with features of acute intestinal obstruction. Ultrasonography (USG) of the abdomen revealed a cystic mass in the peritoneal cavity with dilated loops of bowel. Exploration of the abdomen revealed a solitary cyst of the mesentery of the terminal ileum measured 10 x 8 cm. There was twisting of the part of the ileum (volvulus) due to the cyst. It also involved the wall and lumen of the adjacent ileum and there were dilated bowel loops proximal to the cyst. Complete cyst excision and resection of the part of the ileum involved with the cyst was done en bloc. An ileostomy was created due to gross disparity in the lumen of the ileum, which was closed two and half month later. Histopathology of the excised cyst was consistent with the chylolymphatic cyst (mesenteric cyst).

Kabuki Make–up Syndrome – A Case Report with Electromyographic study

Atul Sattur, Pallavi K Deshmukh, Lijoy Abrahim, Venkatesh G Naikmasur

Kabuki make-up syndrome (KMS), also called Niikawa-Kuroki syndrome reported in 1981, is a rare congenital disorder of unknown aetiology. It is know to occur in many other ethnic groups, though initially described in Japan. We report a 24-year-old girl of Asian origin diagnosed with Kabuki syndrome based on characteristic clinical features. It is characterized by distinctive facial features (eversion of the lower lateral eyelid, arched eyebrows with the lateral one-third dispersed or sparse, depressed nasal tip, and prominent ears), skeletal anomalies, Dermatoglyphic abnormalities, short stature. As per our knowledge there is no literature which gives information about the importance of electromyographic study in the diagnosis and treatment of the KMS. Hence, this report emphasizes on the role of the same.

Unusual Infra–Clavicular Venous Circle – A Case Report

Currently, numerous invasive procedures are preferred in cephalic vein (CV) and axillary vein (AV) than other veins in the neck. Anatomical variations of these veins in the axilla and delto-pectoral region may result in failure and postoperative complications of the procedures. A thorough knowledge of possible variations of AV and CV may immensely contribute to the success of any such procedures where the veins are involved. We report the variations of the CV, tributaries of AV and median cubital vein. We observed a venous circle formed by the tributaries of AV in the infra-clavicular region, deep to the pectoral muscles. Cephalic vein joined proximal end of venous circle just before ending into AV. Further, duplication of the median cubital vein was observed.

Lamellar Icthyosis – A case Report

Pranitha V, Thimma Reddy B.V, Daneswari V, Sudhanwa N Deshmukh

Autosomal recessive congenital ichthyosis is a heterogenous group of disorders that are present at birth with generalized involvement of skin and lack of other organ systems. Clinical presentation, pattern of inheritance, and laboratory evaluation may establish a precise diagnosis, which can assist in prognosis and genetic counseling. There is a little knowledge about the oral manifestations of these disorders.This case report presents management and complete oral rehabilitation of a rare case of lamellar ichthyosis.

Occipital Condyle Syndrome in a Young Male: A Rare Presentation of Cranio-Vertebral Tuberculosis

Chaudhry Neera, Patidar Yogesh, Puri Vinod, Khwaja Geeta A

Occipital condyle syndrome (OCS) is a rare syndrome characterized by severe, unilateral, occipital headache and ipsilateral 12th nerve palsy.Tumors are a common cause of OCS. Inflammatory lesions causing OCS is however rare. We describe a young male with OCS as the only manifestation of cranio-vertebral tuberculosis.

Intellectual Disability and Multiple Co Morbid Psychiatric Disorders in a Child: A Case Report

Priyanka Gautam, M.S.Bhatia, Anubhav Rathi

Comorbid psychiatric Disorders are seen commonly in people with intellectual disability and in fact they are at greater risk for developing other health disorders. Most prevalent chronic health conditions in children with intellectual disability are epilepsy, cerebral palsy,anxiety disorders, sleep disorders and autism spectrum disorders. Co morbidities multiply the problem of people with intellectual impairment to a great extent and hence an accurate psychological assessment of multiple diagnoses is useful in detecting the specific underlying processes differentiating the co morbid syndrome and in planning an appropriate management and rehabilitation program. This case report is presented to emphasize the fact that though, it is common for intellectually disabled children to have other co-morbid psychiatric disorders, it is important to have accurate, suitable assessment and recording of every co-morbid disorder as it has its own implication in course and outcome of the disability in the child. A comprehensive management approach involving people from various spheres would be required to improve the quality of life and for reduction of burden of care giver.We describe a child of intellectual disability with multiple co morbidities.

Primary MPNST in Childhood- A Rare Case Report

Sandip Kudesia, Aparna Bhardwaj, Brijesh Thakur, Sanjeev Kishore, Neelima Bahal

Malignant peripheral nerve sheath tumour usually occurs between 20-50 years of age, comprising about 5-10% of soft tissue sarcomas. Only 1.7% of them have been reported to occur in children < 5 months of age according to the literature. Here, we are describing 18 mnth old male child presented with a swelling in the lower back. MRI showed a sacrcoccygeal swelling extending to and communicating with CSF at lower sacral level. Birth history of the child was normal with normal apgar score. The histological diagnosis was malignant peripheral nerve sheath tumour. IHC showed focal positivity of GFAP and S100. Primary spinal MPNST in children are rarer. A careful neurological examination is warranted in children. Early diagnosis and referral to multidisciplinary team are important in ensuring the best diagnosis and optimal therapy in this young age.

Idiopathic Orofacial Granulomatosis – A Diagnostic and Treatment Challenge

R.Vishwanath Rangdhol, N. Madhulika, A. Dany, S. Jeelani, G. S. Asokan

Orofacial granulomatosis is an uncommon disease, usually presenting as recurrent or persistent swelling of the soft tissues, predominantly lips - termed as Cheilitis Granulomatosa. Though various aetiological factors like foreign body reactions, infections, Crohn’s disease and Sarcoidosis have been implicated in the disease process. Delayed Hypersensitivity reaction with a predominant Th1-mediated immune response provide further evidence to the etiopathogenesis in Orofacial granulomatosis. The term Idiopathic Orofacial Granulomatosis is used in cases with unknown aetiology. This case report describes Idiopathic Orofacial granulomatosis in a 25-year-old male patient with persistent upper lip swelling and gingival enlargement. Management with intralesional triamcinolone acetonide 40mg, twice a week for three weeks, resulted in significant remission without recurrence after a eight month follow up.

Isolated Common Iliac Artery Aneurysm: A Rare Entity

Vikas Deep Goyal, Sanjay Sood, Bharti Gupta

Isolated aneurysms in iliac artery are not common. A 65-year-old male patient presented with complaints of pain abdomen, abdominal distension and history of hypertension, Clinical examination revealed pulsatile mass in the right iliac fossa extending upto paraumbilical region with palpable pulsations in all the limbs. Computed tomographic (CT) angiogram was done and it revealed large aneurysm of right common iliac artery. CT chest and abdomen did not reveal aneurysm in thoracic and abdominal aorta. As the size of aneurysm was large and there was risk of rupture, surgical intervention in the form of aneurysmorrhaphy was done. Open surgery was done as the anatomy was not favourable for endovascular intervention. Aneurysmorrhapy was done using 6mm ringed Poly Tetra Fluoro Ethylene graft. Patient recovered well and was discharged after 10 days.

Malignant Colojejunal Fistula First Discovered on CT: A Case Report

Benign coloenteric fistula is an uncommon condition. It may occur secondary to diverticular disease, peptic ulcer, inflammatory bowel disease and so on. Malignant coloenteric fistula is a rare occurrence. Here we present a rare case of malignant colojejunal fistula secondary to locally invading colonic malignancy.

Herpes Gestationis after Ovodonation: Is Placenta the only Target of the Immune Reaction?

Isabella Piva, Giuseppe Lo Monte, Angela Graziano, Roberto Marci

Herpes Gestationis (HG) is an autoimmune disorder that rarely complicates pregnancy. Its pathogenesis has not been clarified yet, as it derives from a complex interplay between immunologic, genetic, and hormonal factors. We present a case of HG occurring in a surrogate mother whose pregnancy was achieved via egg donation and in vitro fertilisation (IVF). The disease appeared at 26 weeks and 6 days of gestation and subsequently worsened despite the administration of oral and topic corticosteroids. A healthy baby was delivered at 35 weeks and 2 days of gestation by elective cesarean section and the clinical manifestations resolved in the postpartum period.

Mesenteric Fibromatosis (Desmoid Tumour) - A Rare Case Report

Mesenteric Fibromatosis (MF) is a proliferative fibroblastic lesion of small intestinal mesentery. It constitutes 8% of all desmoid tumours, which represent 0.03% of all neoplasm. It is histologically benign but may invade locally and recur after excision. It occurs sporadically or in association with Familial adenomatous polyposis (FAP) mutation as a component of Gardner’s syndrome. The presenting features of MF are asymptomatic abdominal mass, abdominal discomfort or pain, bowel or ureteral obstruction, intestinal perforation, fistula, functional impairment of ileoanal anastomosis following colectomy in FAP cases. A 29-year-old male presented with a swelling on the right side of the umbilicus for six months and dull aching pain for two months. Fine needle aspiration cytology, ultrasonography, contrast enhanced computerized tomography findings were inconclusive. After Exploratory laparotomy, a mass approx 6x5x4 cm in ileal mesentery was identified and excised along with 20cm of ileum. End to end anastomosis was done and specimen was sent for histopathology which confirmed the diagnosis of MF. Considering the rarity of this tumour and difficulties in diagnostic and therapeutic ambit, we believe it is justified to describe this case which came to our observation.

A Rare Case of Adult Acquired Tracheo-Oesophageal Fistula with Sub-Glottic Stenosis for Corrective Surgery- An Anesthetic Challenge

Smita Joshi, Anitha Kulkarni, Roopa S Holkunde

Acquired trachea-esophageal fistula (TEF) is a rare condition in adults and causative factors include malignancy, trauma and various iatrogenic causes. The important causative factor of TEF in our case was percutaneous tracheostomy. The normal protective laryngeal reflexes are lost in TEF due to the patent tract from the airway to the upper gastrointestinal tract. The TEF poses a challenge for the surgeon and the anaesthesiologist, as the fistula lies in close proximity to oesophagus, trachea, upper mediastinal contents and large blood vessel. Here we present a rare case of anesthetic management of a 26 year old male patient with complaints of regurgitation of part of swallowed food particles through an in-situ tracheostomy tube since two years.

Unfolding the Hidden Facts of Paediatric Maxillofacial Trauma

Chirag S. Macwan, Anshula N. Deshpande

Hard tissue injuries are uncommon in the paediatric patient; the paediatric population sustains 1 to 14.7% of all facial fractures. The management of the paediatric patient with maxillofacial injury should take into consideration, the differences in anatomy and physiology between children and adults, the presence of concomitant injury, the particular stage in growth and development and the specific injuries and anatomic sites that the injuries affect. Minimally displaced fractures in paediatric patients can be managed conservatively, while displaced fractures may require open approaches and rigid fixation. Hence, the present article presents an overview of the available published literature on maxillofacial trauma in paediatric patient.

SWOT Analysis of Dental Health Workforce in India: A Dental alarm

Mythri Halappa, Naveen B H, Santhosh Kumar, Sreenivasa H

Context: India faces an acute shortage of health personnel. Together with inequalities in distribution of health workers, dental health workers also become a part contributing to it impeding the progress towards achievement of the Millennium Development Goals. Aim: To assess dental health-workforce distribution, identify inequalities in dental health-workers provision and report the impact of this mal distribution in India. Materials and Methods: Situational analysis done by using the primary data from the records of Dental Council of India. Results: In India, 0.088% of dental health worker per 1000 population exists. Inequalities in the distribution of dentists exist in India. Certain states are experiencing an acute shortage of dental health personnel whereas certain cities are over fledged with dentists like Karnataka, Maharastra, Tamilnadu being states with high concentration & Jharkhand, Rajasthan, Uttaranchal being the least. Conclusion:

Ivacaftor: A Novel Mutation Modulating Drug

Harit Kapoor, Astha Koolwal, Ankur Singh
Cystic fibrosis (CF) is multisystemic disorder presenting in newborn period to adulthood, predominantly affecting respiratory system. It is caused by mutation in CF transmembrane conductance regulator gene. ?F508 is the most common mutation seen worldwide. Supportive management with bronchodilators, anti-inflammatory, mucolytics, antibiotics are the corner stone of therapy. Mutation specific drug, Ivacaftor, was recently approved USFDA in January 2012 for patients carrying G551D mutation. It is approved in patients who are six years and older in 150 mg twice daily dosing schedule with fat containing meals. It improves the lung function and other aspects of disease including weight gain. The side effects like upper respiratory infection, headache, rash, diarrhoea, stomach ache and dizziness are mild and self-limiting. This is excellent example of promise of personalised medicine – targeted drug that treat patients with specific genetic makeup.

Relation Between Psoriasis and Geographic Tongue
The aim this article is to investigate the link between geographic tongue and psoriasis skin disease. Our review paper of the literature will handle strict study about the relation between geographic tongue and psoriasis. Our search has identified only limited studies available in English written literature starting from 2006-2013 using pubMed – indexed for MEDLINE. The result of this review suggests that geographic tongue may be an oral manifestation of psoriasis.There is no clear evidence in literature about association with gender and aetiology except one study which shows that benign migratory glossitis is more prevalent in young, nonsmoker and atopic or allergic individuals. Treatment for oral lesions is not standardized. A geographic tongue is significantly more frequent in psoriatic patients but only a limited data is available to date to strongly validate the association between these two entities.We recommend the general practitioner to have a good understanding about the clinical presentation, pathogenesis, diagnosis and treatment of this lesion. Psoriatic patients should be encouraged to undergo routine dental checkups.

Mannitol an Adjuvant in Local Anaesthetic Solution: Recent Concept & Changing Trends (Review)

Anand Kumar, Ruchika Khanna, Ram K Srivastava, Iqbal Ali, Puneet Wadhwawani
Various adjuncts have been utilized with lignocaine to decrement tourniquet pain and prolong postoperative analgesia and its efficacy during dental extraction and various other restorative procedures in dentistry. An obligatory part of the dental process is to sanction a patient to feel comfortable and pain-free during operational and remedial dental procedures. The most popular local anaesthetic injection for lower teeth is the inferior alveolar nerve (IAN) block. Instead of this the percentage of ineffectiveness is higher is inferior alveolar nerve block as compared to other local anaesthetic nerve block. The goal of cumulating different drugs is to engender the best therapeutic effects with the fewest or no unpropitious effects. There are fewer researches and evidence present which recommend and promote the application and effectiveness of mannitol other than in the administration in decreasing raised intracranial pressure. It is paramount to know how the drug interacts with each other to minimize the unexpected or perilous effects.

Effect of Atorvastatin on Memory in Albino Mice

Rinku Rani Biswas, Das M.C, Srinivasa Rao A.S.R, Sldv Ramana Murty Kadali
Objective: The aim and objective of the present study was to evaluate the effect of atorvastatin on learning and memory in albino mice. Materials and Methods: Thirty Swiss albino mice were divided into 5groups (n=6). In group2, group4 and group5 hyperlipidemia was induced by high fat diet (HFD) orally for 28days. Atrorvastatin was given to group3, group4 and group5 orally for 14 d. Learning and memory was evaluated with Hebb Williams’s maze, Elevated plus maze, Y maze and Step through latency. Continuous data were analyzed by one way ANOVA followed by Scheffe multiple range test, discrete data were analyzed by Kruskal - Wallis test. The level of significance was 5% (p = 0.05). Result and Conclusion: HFD treatment had shown significant increase in body weight, significant impairment in learning and memory (p < 0.05). Only atorvastatin treated group had shown better learning and memory in comparison to HFD group. Atorvastatin 10mg/kg and 20 mg/kg had reversed the HFD induced impairment of learning and memory but there was no significant difference between the doses (p > 0.05)

Hepatoprotective Role of Caesalpenia bonduc: A Histopathological and Biochemical Study

Suhani Sumalatha, K Shridhar R Pai, Nitesh Kumar, Kumar MR Bhat
Background: Hepatotoxicity is one of the inevitable side effects of long term use of medicines in many different disorders, chronic use of alcohol and in certain infectious disorders. Even though there are few effective drugs to treat such hepatotoxicity, mortality due to hepatotoxicity is increasing day by day. Therefore, in search of alternative and more effective medicine we found that Caesalpenia bonduc (CB), a shrub grows in hotter places of south Asia has been effectively used to treat such hepatotoxicity in folk medicine. Aim: Aim of the study is to scientifically evaluate the hepatoprotective nature of aqueous extract of CB using Carbon tetrachloride(CCl4) induced hepatotoxic rat model. Materials and Methods and Result: Elevated levels of blood ALT, AST and ALT enzymes were found in CCl4 induced hepatotoxic rat models. Treating these animals with CB either prior or after the induction of hepatotoxicity, shows significant decrease in the levels of ALP, AST, and ALT in their blood in comparison with the untreated hepatotoxic group. Additionally, histologically, hepatotoxic rats show necrotic changes & vacuolation in their hepatocytes, altered hepatic architecture and congested hepatic sinusoids. However, such histopathological adverse changes were minimized when these animals treated with CB. Conclusion: Results of the present study indicate that CB acts as both preventive and curative hepatoprotector.

A case of Chronic Bilateral Axillary Hidradenitis

Anji Reddy Kallam

Emerging Ethical Perspective in Physician-Patient Relationship
Traditional health systems, with patients as passive recipients of care, have proven unsuccessful in stemming the most irresistible and exponential growth of the epidemic we now face. There is considerable healing power in a good Physician-patient relationship. In the field of healthcare, patient empowerment has been acknowledged as an alternative to compliance in order to guide the provider–patient relationship. It will help patients’ confusion, fear and doubt slowly transform into clarity, relief and assurance. With the positive role of physicians, patients will definitely be relieved of hopelessness, have higher satisfaction, better adherence and improved health. There is no doubt that this small gesture by physicians will be a precious gift to humanity.

Congenital Porencephaly in a New Born Child
A 2-day-old male child presented with history of enlarged head and seizures since birth, born by caesarean section. Head circumference was 56 cm (dilated) with widely open anterior and posterior fontanelle. Routine investigations were within normal limits. CT head revealed a large non-enhancing fluid attenuating cystic lesion in posterior parietal and occipital region with communicating to dilated bilateral lateral ventricles and subarachnoid space.

Simultaneous Primary Hydatid Cysts of Liver and Spleen with Spontaneous Intraperitoneal Rupture of Liver Cyst

An Unusual Complication of Esophageal Stenting for Corrosive Acid Injury

Importance of Denture Marking for Human Identification in Forensic Odontology

Rashmi G S Phulari, Rajendrasinh Rathore, Prachi Jariwala

Lethal Short Limb Dwarfism: Thanatophoric Dysplasia- Type I

Charusheela Sujit Korday, Ravindra Kumar Sharma, Sonali Paradhi, Sushma Malik

Images in Medicine: Giant Cell Tumour of the Talus in a 7-Year-old Boy

Isolation, Identification and Antimicrobial Susceptibility of Anaerobic Bacteria: A Study Re-emphasizing Its Role

Ritu Garg, Neelam Kaistha, Varsha Gupta, Jagdish Chander

Accidental Injection of Formalin: Case Report of Severe Negligence in Dental Office

Fixed Drug Eruption due to Fluconazole: Not so uncommon Now-a-days

Ranjita Santra, Sushobhan Pramanik, Patralekha RayChaudhuri

Prevalence of Carbapenemases and Metallo- ß-lactamases in Clinical Isolates of Enterobacter Cloacae

RETRACTED Article
Pugazhenthan Thangaraju, Harmanjit Singh, Amitava Chakrabarti, Short Communication: Drug Information Unit as an Effective Tool for Promoting Rational Drug Use (Published in Journal of Cilinical and Diagnostic Research. 2013 September: 7(9):). 2105-2106 This article has been retracted by the Editorial due to problems with Data discovered on post publication reanalysis of paper following a complaint. Details of the issues related to the data methodology and results, found on re-evaluation can be obtained from the Journal (editors@jcdr.net) . Date of Retraction: 18.11.14