Journal of clinical and diagnostic research

A Compendium of Fibonacci Ratio

Priyanka Katyal, Pratima Gupta, Nikhita Gulati, Hemant Jain

The Fibonacci sequence of numbers is known since the ancient past. It is considered as a proportion which can be frequently appreciated in nature. The associated ratio, called as the golden ratio is manifested in the works of art, nature, galaxies, monuments etc. Many famous mathematicians, philosophers, and artists have used this ratio in their work. Humans distinguish this proportion as pleasing, as it enlightens beauty when applied in living or non living entities. The ideal proportion is directly related to golden proportion. It ranges from 1 to 1.618. Moreover, the proportion can be applied in facial aesthetics also. Studies have showed that the beautiful faces have facial measurements close to golden ratio. Thus, the treatment following the standard will help in obtaining optimal facial aesthetics. The review is written with an aim to highlight the historical perspectives, its varied applications in the past and present; and further scope of research in future.

Journey to a Healthy Life

Kaushik Bharati

Management of Central Retinal Vein Occlusion through Ayurvedic Outpatient Medicines

Central Retinal Vein Occlusion (CRVO) is divided into ischaemic and non-ischaemic varieties and are differentially diagnosed based on characteristic symptoms and signs. Treatment modalities include pan-retinal LASER photocoagulation, intra-vitreal anti-Vascular Endothelial Growth Factor (anti-VEGF) injections, and pars plana vitrectomy in advanced cases. A case of a 53-year-old male who presented with a 1-month history of foggy vision and inability to see in the morning hours is presented here. He was provisionally diagnosed with CRVO. Assessment using Ayurvedic diagnostics revealed that he had Timira or blurring of vision. He underwent five courses of outpatient management. He was prescribed Kashaya (decoction), Gutika (tablet), and Lepa (pastes). He was assessed using Visual Acuity (VA), posterior segment examination and Optical Coherence Tomography (OCT) scanning. VA showed improvement at the second consultation and was maintained through the final three consultations. Posterior segment examination and OCT scanning showed gradual improvement over the course of the consultations and ended up as an almost-normal appearance at the fifth consultation. This case illustrates that prompt diagnosis and intervention brought about a maintained visual acuity and almost near-normal results for the retina.

Cryptogenic Organising Pneumonia as Main Presenting Feature of Rheumatoid Arthritis

Sunil Kumar, Amrutha Garikapatti, Amole Andhale, Atma Nayak

Cryptogenic Organising Pneumonia (COP) has been associated with several connective tissue disorders, but very rarely with rheumatoid arthritis. Here, the present authors report a 60-year-old female who presented with breathlessness on exertion, cough, fever, and multiple joint pains mainly of wrist and fingers as the main symptoms. On investigation, the RA factor and anti-CCP Abs were positive. She was diagnosed as COP on the basis of High Resolution Computed Tomography of thorax.

Tuberculosis of Uterine Cervix Presenting with Recurrent Leucorrhoea in Guise of Carcinoma of Cervix

Rajnandini Prasad, Mariam Khan, Fariha Anjum, Surabhi Bhoyar, Neema Acharya

Leucorrhea is a common gynaecologic symptom which affects quality of life of a women when it becomes recurrent. Tuberculosis (TB) as cause of abnormal looking cervix or growth on cervix is not commonly thought. We present a rare case who presented with recurrent leucorrhea having growth on cervix clinically appearing like cervical malignancy but on histopathology it was found to be TB of cervix.

Giant Placental Chorioangioma with Severe Polyhydramnios and Foetal Anaemia- A Case Report

Harpreet Kour Isher, Mandeep Singh

Giant placental chorioangioma is a rare, benign, vascular hamartoma of the placenta of >4-5 cm in size, since size beyond this range is associated with adverse perinatal outcome. This is a case of giant placental chorioangioma with severe polyhydramnios and foetal anemia. Serial ultrasound surveillance was able to detect foetal anemia due to the arteriovenous shunt in the chorioangioma. Severe polyhydramnios was managed with repeated amnioreduction to relieve the mother. A non-reassuring cardiotocography and suspicion of placental abruption following the last amnioreduction led to an emergency caesarean. Perinatal morbidity was increased due to severe foetal anemia, coagulopathy and prematurity which was successfully managed.

Endodontic Management of Unusual Maxillary First Molar with Fusion using Cone-Beam Computed Tomography as a Diagnostic Aid

Manoj Mahadeo Ramugade, Apoorva Patel, Apurva Sagale, Sayed Abrar

Maxillary first molars are distinguished for their numerous anatomical variations including the single root with a single canal, the presence of additional canals or the fusion. Fusion is an uncommon morphological variation that often occurs in deciduous anteriors but in the permanent maxillary first molars, it is rarely observed. Management of such diversions requires magnification, refinement in every step such as in access cavity preparation, cleaning-shaping and modification in the technique of obturation. The reported case enlightens the endodontic management of maxillary first molar exhibiting the fusion with the supernumerary tooth diagnosed using a Cone-Beam Computed Tomography (CBCT).

Migration of Thecoperitoneal Shunt into a Hernial Sac

Yeshwant Lamture, Varsha Gajbhiye

Thecoperitoneal shunts are commonly used to treat several conditions, but their use can result in significant complications like migration of it in hernial sac. Only few cases of scrotal migration of shunt is reported. This case report is about a middle aged gentle man, presented with irreducible right sided inguinal hernia. He was subjected to emergency surgery and found to have omentum and thecoperitoneal shunt as a content. Early surgical removal is recommended for catheters remaining in the abdomen or in scrotum after thecoperitoneal shunt migration. These tubing can cause injury to the testicle, or other abdominal viscera.

Embryonal Rhabdomyosarcoma of Testis

Gunjan Bhatia, Namita Goyal

Embroynal Rhabdomyosarcoma of the testis is a rare and aggressive tumour, mostly seen in children and young adults. It usually originates from the para testicular tissue. Intra testicular rhabdomyosarcoma of testis is a rare entity. The authors present a case of testicular rhabdomyosarcoma in a 28-year-old male patient. The patient presented to the surgical OPD with a painless scrotal mass of two months duration. A clinical diagnosis of testicular mass was made and patient was investigated and treated accordingly. Ultrasound (USG) revealed a right sided testicular mass measuring 16×6 cm. Patient underwent right sided inguinal orchidectomy. On microscopic examination tumour had varying degrees of cellularity, alternating densely packed hypercellular areas of oval to spindle shaped cells showing vesicular nucleus and pleomorphism along with loosely textured myxoid areas in between. IHC for keratin, Alpha-Fetoprotein (AFP), Inhibin and CD 117 were negative while Immunohistochemistry (IHC) for myogenin was positive. On basis of histopathology and IHC a final diagnosis of Embryonal Rhabdomyosarcoma was given. Intra testicular rhabdomyosarcoma of the testis is a rare tumour but should be kept in mind when dealing with a case of scrotal mass. Rarity of this entity makes it a strong learning point for our fellow clinicians and pathologists.

Modified Sacrospinous Colpopexy with Standard Needle and Needle-Holder: Video Presentation

Manidip Pal, Soma Bandyopadhyay, Ranita Roy Chowdhury

Among the different operations for treatment and prevention of vaginal vault prolapse, sacrospinous colpopexy is the most preferred one. Many devices are used to perform this operation. Unfortunately these devices are not easily available in developing countries. This paper shows an improvisation wherein, to make the operation easier using standard needle and needle-holder, under direct visualisation, a stage 3 POP-Q vault prolapse, patient was operated. Needle was held longitudinally at its middle so that the long axis of the needle and needle-holder were in the same line. (Traditionally, needle is held transversely, hence long axis of needle and needle- holder remains perpendicular to each other). Swag end of the needle touched the needle-holder. This positioning created a smaller diameter at needle-holder tip than the diameter created by the traditional holding. Bite on sacrospinous ligament was from above downwards and forwards which coincided the normal curvature of the needle. Inferiorly, needle came out easily and retrieval was also easy. The sutures were then brought out through the apex of the vault which was tied after posterior vaginal mucosa closure, High-up vaginal vault was seen at the end. Holding the needle longitudinally eases the sacrospinous operation in the narrow operative field.

Acute Vaginitis: A Rare Cause of Labial Adhesions

Ankita Mann, Sumita Mehta, Anshul Grover

Labial adhesions occur most often in infants and young girls and are associated with low oestrogen levels. Herein, we report a case of labial adhesion in a 24-year-old young girl, who presented with acute retention of urine. Clinical examination revealed normally developed external genitalia and a thin membrane occluding the introital opening. Her secondary sexual characters were normal; the most probable cause being acute vaginitis, her hormonal profile was not done. Patient was managed with sharp excision of membrane followed by local application of antibiotics. Patient was asymptomatic at three months follow-up with completely healed labia. Hence, all women including unmarried ones who present with urinary complaint need to have a complete gynaecological examination as the two can be related.

Successful Transradial Coronary Angioplasty in a Patient with Dextrocardia

Suindu Keshari Narayan Dash, Krishna Sekhar Patri, Mantravadi Sai Sudhakar

Even though dextrocardia occurs rarely, these people have similar incidence of coronary artery disease like normal population. Because of unfamiliarity with the reverse anatomy transradial coronary angiography and angioplasty is seldom tried in these patients. Here the authors present a case report of successful transradial angiography and angioplasty in a patient with dextrocardia with myocardial infarction.

Recurrent Abortions Presenting with Congenital Absence of Inferior Vena Cava in a Young Female

Surabhi Gupta, Neha Nischal

Inferior Vena Cava (IVC) agenesis is an unusual cause of deep vein thrombosis, particularly in young individuals. We report a case of a 28-year-old Indian female presenting with recurrent abortions, multiple episodes of deep vein thrombosis and clinically positive for lupus anticoagulant. CECT abdomen demonstrates complete/partial agenesis of IVC and delineates the superficial and deep collateral pathways which develop subsequent to IVC agenesis.

Salmonella Typhi Septicaemia with Rhabdomyolysis and Hepatitis

Amit Khelgi, Pratibha Bhat, Vimal Kumar Karnaker, Asha Pai

Typhoid fever is an important health concern across the globe. It is caused by the gram negative bacilli, Salmonella Typhi. The clinical manifestations range from a febrile systemic disease to varied spectrum of serious complications like intestinal perforation, circulatory collapse, meningitis and arthritis. Here, the present authors report one such rare complication; a case of rhabdomyolysis due to Salmonella Typhi. The patient came with chief complaints of fever, loose stools, weakness of limbs and inability to walk. As the case had an unusual presentation of gross motor dysfunction, it was challenging to clinically suspect the condition but laboratory investigations pointed towards the diagnosis of typhoid fever.

Vaginal Rhabdomyoma: A Rare Occurrence

Varsha Shree Rajanna, Kalyani Raju, Gomathi Ethiraj, Hajra Khursheed Mehdi

Rhabdomyomas represent ≤2% of all striated muscle tumours. Among the extracardiac subtypes, genital rhabdomyoma is most uncommon. The vaginal type commonly presents as a polypoidal mass. Benign and malignant mimickers should be differentiated from vaginal type of genital rhabdomyoma for appropriate treatment. Here, the present authors report a case of a 48-year-old nulliparous woman who presented with the history of bleeding per vagina. Clinical examination revealed pedunculated polyp in anterior vaginal wall. Followed by, histopathological examination confirmed diagnosis of vaginal rhabdomyomas.

Anomalous Morphology of Liver and Rare Variation of Ligamentum Teres

Rajani Singh

Hypoplasia, absence or accessory lobes are common variations in liver. Anatomically liver is divided into right and left lobes by falciform ligament, fissure for ligamentum teres and fissure for ligamentum venosum. Ligament of teres is present in the free margin of falciform ligament and winds round the inferior border of liver to reach the fissure for ligamentum teres. During routine dissection of abdomen of a 75-year-old female cadaver fixed in 10% formalin, abnormal disposition of ligamentum teres together with variant morphology of liver on its anterior surface consisting of a curved depression and an elongated gap was observed. Ligamentum teres was attached to superior margin of curved depression 6 cm above the inferior margin of liver. It passed through elongated gap situated 2.5 cm above inferior border of liver. The fissure for ligamentum teres and quadrate lobe was normally present. There was no other abnormality in the liver. The depression and gap found on the anterior surface of liver may give false impression of abnormal cavity to a surgeon during laproscopic liver surgery and also it may lead to misinterpretation of radiographs. Though ligamentum teres is described to be less important yet its variant dispostion is important in various therapeutic and diagnostic procedures.

Unilateral Molluscum Contagiosum Following Eyebrow Grooming

Palak Kedia, Bhushan Madke

Eyebrow threading is a popular technique done to shape the eyebrows. Although the procedure is simple, it may cause some dermatological complications like wart, molluscum contagiosum, folliculitis. Hereby, we report a case of unilateral molluscum contagiosum along the threaded eyebrow. The purpose of this report is to create awareness about this complication of threading so that appropriate preventive measures can be taken.

Grossly Asymmetrical Refractory Vernal Keratoconjunctivitis Treated with Supratarsal Triamcinolone Injection and Bandage Contact Lens: A Case Series of Three Young Male Patients

Pallavi Dhawan, Atul Dhawan

Vernal Keratoconjunctivitis (VKC) is a chronic conjunctival inflammatory condition predisposed to atopic disease. It usually starts before the age of ten years and affects individuals in warm climates. It generally resolves after puberty. The disease is more common among male. Generally, most cases are bilateral (98%), with symmetrical involvement. Routine treatment to start with involves topical corticosteroids, mast cell stabilisers and cyclosporine. In recalcitrant cases supratarsal triamcinolone injection is also given. Hereby, three cases of grossly asymmetrical vernal keratoconjunctivitis has been reported. All cases were young boys with history of recurring severe itching and use of topical steroids along with topical mast cell stabilisers and cyclosporine. All cases in the recent episode of ocular allergy developed corneal involvement and treated with supratarsal triamcinolone and bandage contact lens.

Reducing Complications of IV Cannulation: A Quality Improvement Project

Bhavana Bhushan Lakhkar, Sachin Damake

Introduction: Intravenous (IV) cannula insertion is the most common invasive procedure in Neonatal Intensive Care Unit (NICU). A large number of complications are due to cannula itself, increasing the morbidity and sometimes duration of NICU stay in newborn. Aim: To find the impact of structured training program for nurses and residents on IV cannula related complications. Materials and Methods: The study was done in two phases with a structured training program (of doctors and nurses) after first phase. In first and second phase, the newborns with IV cannula insertion (each cannula separately) were included in the study. Those with no parental consent or having bleeding disorder were excluded. The site was observed for complications, duration of stay and reason for removal, after recording the details of baby. Results: Total of 190 babies with 300 IV lines and 120 babies with 373 IV lines were the subjects in two phases. Significant changes were observed after training program. Number of IV insertions (2.5 to 1.9 per baby) and complications (190, 63% to 125, 33.5%, p-value <0.0001) significantly reduced. Indicated removal (98, 32.6% to 247, 66.4%, p-value <0.00001) and duration of stay (2.5 days to 5 days, p-value <0.00001) improved. Extravasation was the most common complication which also significantly reduced. Conclusion: Training of staff nurses and residents in IV cannula insertion and maintenance should be a part of hospital activities for better outcome.

Comparing the Effects of Olanzapine and Aripiprazole in Rat Animal Model using Heart Rate Variability: An Emerging Parameter of Cardiovascular Safety

Vaishali Bhargava, Chetankumar Acharya

Introduction: Patients taking typical antipsychotic drugs have an increased risk of cardiovascular mortality. More data is required to prove the cardiovascular safety of atypical antipsychotics, which are currently used largely in clinical practice. Heart Rate Variability (HRV) analysis can be used to assess cardiovascular safety and tolerance of antipsychotics in experimental animal models. Aim: To compare the effects of atypical antipsychotics aripiprazole and olanzapine in ketamine induced schizophrenic rats using HRV as a parameter of accessing cardiac autonomic activity. Materials and Methods: Total 36 adult male wistar albino rats were randomly divided into six groups containing six rats in each group. Group I was administered with distilled water intraperitoneally for 28 days. Group II, III, IV, V and VI were administered with ketamine intraperitoneally for seven days and then from 8^th day, distilled water intraperitoneally, low dose olanzapine (5 mg/kg) intraperitoneally, high dose olanzapine (15 mg/kg) intraperitoneally, low dose aripiprazole (5 mg/kg) orally and high dose aripiprazole (15 mg/kg) orally was administered daily for 21 days respectively. Twenty-four hours after the administration of last dose, that is on Day 29, ECG was recorded in all the animal of each group. Time domain and frequency domain parameters of HRV was measured using digital polygraph for five minutes. The statistical analysis was performed using analysis of variance using SPSS software followed by Tukeys’s post-hoc analysis to compare variables among different groups. Results: There was no significant deviation found in all the time as well as frequency domain parameters of HRV as determined by one-way ANOVA (p>0.05) in all the six groups i.e., distilled water treated group (control), ketamine treated group, low and high doses of olanzapine and aripiprazole treated group respectively. This data suggests that the sympathetic and parasympathetic modulation of HRV remains unchanged even during olanzapine and aripiprazole treatment. Conclusion: This study indicates that both olanzapine and aripiprazole can be considered as safe drugs to be used as antipsychotics without causing cardiovascular complications in terms of alteration in HRV.

An Intriguing Case of Chronic Cough in a Child

Gautam Bir Singh, Vishaka Bettadahalli, Sonali Malhotra, Arun Krishna

Opsoclonus-Myoclonus Syndrome (OMS) Due to Dengue Meningoencephalitis

Aniket Patil, Sourya Acharya, Samarth Shukla

Correspondence: Persistent Mullerian Duct Syndrome with Ovarian Endometriosis

Correspondence: ‘Influenza as a Cause of SIADH Related Hyponatremia’

Takahiko Nagamine

Multiple Dental Anomalies in a Patient with Down Syndrome

Profile of Patients with White Lesions of the Oral Mucosa Treated at a Dental School in Southern Brazil

Introduction: Oral diseases are frequent in dentistry. It is important to know the clinical and epidemiological characteristics of a series of cases of white lesions to intercept possible cancerous lesions of the oral cavity, enabling proper diagnosis and correct treatment. Aim: The aim of this study was to go through the profile of a series of patients with white oral lesions treated at the Faculty of Dentistry of the University of Passo Fundo, RS, Brazil, in a 2 years period. Materials and Methods: The records of patients treated between July 2017 and June 2019 were analysed. In a total of 3,000 patients were initially analysed, 1,829 (60.96%) were women and 1,171 (39.04%) were men. The epidemiological data of the individuals (geographic region of origin, age, gender, ethnicity and deleterious habits) were collected, as well as clinical data regarding lesions {clinical or histopatologic diagnosis (depending on the lesion), aetiology, surface keratinization, treatment performed and time of evolution}. Data collected were entered into Microsoft Excel spread sheet and analysed using SPSS version 23.0 software. Chi-square test was used to compare categorical variables at 95% significance level. Results: It was observed that white lesions were more prevalent in males (25-69.4%), who were in the sixth decade of life (17-47.2%), white people (31-86.1%), that inhabited the south-west Rio-Grandense (35-97.2%). As for lesions, actinic chelitis (8-22.2%), with “excessive sun exposure” (8-22.2%) and non scrapable surface (24-66.7%) were the most frequent lesions. No cases of leukoplakia were identified. The most common form of treatment for the lesions was laser therapy (7-19.7%) and the evolution time was up to three months (24-66.7%). The majority of the patients (19-52.8%) were neither smoker nor alcoholic (27-75.0%). Conclusion: Actinic cheilitis was the most prevalent lesion. The cancerous lesions included in the sample (lichen planus, nicotine stomatitis, frictional keratosis and actinic cheilitis) demonstrate a significant presence in the sixth decade of life and men had more deleterious habits when compared to women in the studied region.

Advanced Glycation End Product (AGE)-Mediated Reactive Oxygen Species Production in Cultured Endothelial Cells is Dependent on NADPH Oxidase Activation

Introduction: The interaction of Advanced Glycation End-product (AGE) with Receptor for Advanced Glycation End product (RAGE) on endothelial cells enhances the intracellular Reactive Oxygen Species (ROS) production. Activation of the NADPH Oxidase (NOX) is one of the important mechanisms for ROS generation in the endothelial cells. Aim: To determine the role of AGE in ROS production via NOX activation in endothelial cells. To assess the ameliorating action of drugs, ramipril, and losartan, as well as the antioxidants, resveratrol and N-Acetyl-Cysteine (NAC) on AGE-mediated effects in endothelial cells. Materials and Methods: The present experimental in-vitro study was conducted at Department of Biochemistry, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. The cultured Human Umbilical Vein Endothelial Cells (HUVECs) were treated with advanced glycation end product-bovine serum albumin (AGE-BSA) 200 µg/mL and unmodified BSA in the same concentration for 24 hours. The HUVECs were also co-treated with losartan (5 µM), ramipril (5 µM), resveratrol (5 µM) and NAC (5 µM) with AGE-BSA for 24 hour. ROS generation was assessed by using 2’, 7’-dichlorodihydrofluorescein diacetate (H2DCFDA) method. For the activation of NOX, NOX p47phox subunit mRNA expression was analysed by Real Time Polymerase Chain Reaction (qPCR). Significant difference between the two groups was determined by the Student’s t-test. A value of p<0.05 was considered significant. Results: A significant increase (p<0.01) in ROS production was observed at a concentration of 200 µg/mL of AGE-BSA as compared with control (cells treated with unmodified BSA). NOX expression in cells was found to be significantly increased (p<0.01) 2-fold at mRNA level after 24 hours treatment with AGE-BSA. Losartan, ramipril, resveratrol and NAC significantly scavenged ROS production, and decreased the AGE-mediated increased NOX mRNA expression was observed. Conclusion: The present in-vitro study signifies the role of AGE in enhanced ROS generation by activation of NOX in endothelial cells. Losartan, ramipril, resveratrol, and NAC may attenuate the AGE-mediated endothelial dysfunction by counteracting the NOX-mediated increased ROS production.

Changes in Anthropometry and Biochemical Parameters after Six months of Treatment in Newly Diagnosed Schizophrenic Patients: A Prospective Study

Dimpal Rochlani, Afzal Ahmad, Sanjiv K Bansal, Sanjay Lahariya, Maya Malviya

Introduction: In schizophrenia, chemical pathophysiology is not fully understood. Hereditary, environmental free radical-induced damage is the proposed mechanism associated with it. Drug-related complications in schizophrenia due to altered pro-oxidative and antioxidant homeostasis is the major concern for a psychiatrist. Aim: To evaluate changes in anthropometry and biochemical parameters by antipsychotic drugs and correlation between Serum Uric Acid (SUA) with other parameters before and after third and six months of treatment, in newly diagnosed schizophrenic patients. Materials and Methods: In this prospective, observational study based on ICD-10 criteria, 107 drug-naive schizophrenia patients were screened for weight, height, Body Mass Index (BMI), Waist Circumference (WC) as anthropometric variables, Blood Pressure (BP) and biochemical variables i.e., Fasting Blood Sugar (FBS), Total Cholesterol (TC), Triglyceride (TG), High Density Lipoprotein Cholesterol (HDL-c) and uric acid at the time of diagnosis, then after 3rd and 6th months of treatment. Statistical analysis was performed using paired t-test and Pearson’s correlation coefficient. A p-value <0.05 was considered statistically significant. Results: Significant (p<0.001) increase in SUA levels (5.17±1.3 mg/dL) were found after six months in respect to three months (4.85±1.5 mg/dL) after and before the start of treatment group (4.37±1.6 mg/dL). Increase in BMI, FBS, TC, TG were more after 6th month (26.3±5.2 kg/m2, 105.6±33 mg/dL, 174.5±49.8 mg/dL, 158.1±77.6 mg/dL respectively) compared to 3rd (24.3±4.5 kg/m2, 100.6±31.1 mg/dL, 160.5±38.3 mg/dL, 137.2±54.6 mg/dL respectively) and beginning (22.7±4.1 kg/m2, 95.5±27 mg/dL, 148.9±37.1 mg/dL, 113.2±42.4 mg/dL respectively) of treatment. Significant decrease in level of HDL-c and negative correlation with SUA were recorded after 6th, 3rd month of treatment and at baseline. Conclusion: This prospective data provides the importance of serial monitoring of SUA in newly diagnosed schizophrenic, its level >4 mg/dL could be the ‘Red flag’ sign to trigger antioxidant SUA into pro-oxidant. These outcomes also provide a hypothetical basis for use of antioxidant supplementation as novel therapeutic strategies. Such implications could improve the prognosis and prevent future complication in schizophrenic patients.

Comparative Study to Evaluate the Effectiveness of Vestibular Rehabilitation Therapy versus Dual Task Training on Balance and Gait in Posterior Cerebral Artery (PCA) Stroke

Sana Saleem, Bharti Arora, Priya Chauhan

Introduction: Vestibular Rehabilitation Therapy (VRT) and Dual Task (DT) training are rehabilitation approaches increasingly used in the care of stroke patients to improve balance and gait, although no comparative evidence has been provided for their efficacy. Aim: The study was aimed to compare the effectiveness of vestibular rehabilitation therapy versus dual task training on balance and gait in posterior cerebral artery stroke. Materials and Methods: A total of 30 subjects i.e., subacute Posterior Cerebral Arterystroke individuals were randomly assigned into 2 groups, group A Vestibular Rehabilitation with Conventional Therapy (n=15) and group B DT training (n=15). Each group received treatment for 45 minutes in a day, 3 times in a week for 4 weeks. Both the groups A and B were also given Conventional Physiotherapy treatment comprising of stretching, strengthening and stability exercises, over the period for 5 days for 4 weeks. Participants were assisted with Wisconsin Gait Scale (WGS) to assess the performance of gait and Mini-BEST test to assess the balance. Mean change score were calculated as the difference between post and pre-test scores and an independent t-test was used to test the difference in the changed scores between two groups. Paired t-test was used to analyse within group differences. A level of significance was set at p=0.05. Results: The comparison of post intervention scores of Mini-BESTest between Group A and Group B showed significant difference (t-value=2.577, p-value=0.018). The comparison of post intervention scores of WGS between Group A and Group B showed significant difference (t-value= -2.356, p-value=0.028). So, result showed that Group A (Vestibular Rehabilitation) was more significant as compared to Group B (DT training) in both Mini-BESTest and WGS. Conclusion: The result of this study is encouraging to use VRT as a part of rehabilitation protocol by alleviating their gait disturbances, improving balance and gaining confidence of walking with PCA stroke patients as compared with DT Training.

Comparison of Homocysteine Levels in Various Liver Diseases

Harsharan Kaur, Gesu Singla, Bharti Singla

Introduction: Homocysteine (Hcy) is an intermediate product formed in methionine metabolism. Disturbances in liver function are likely to affect the metabolism of both methionine and Hcy which leads to increased serum Hcy levels. Hyperhomocysteinemia might be a risk factor for cirrhotic patients in addition to its known role for cardiovascular diseases. Hcy metabolism is dependent on B complex vitamins, particularly folate and vitamin B12 are associated. Individuals with low folate status along with mutated methylenetetrahydrofolate reductase have an increased levels of Hcy. The decreased levels of Vitamin B12 and folic acid in the cells, increases the serum levels of Hcy thus causing hyperhomocysteinemia. Aim: To estimate Hcy levels in patients with Chronic Liver Disease (CLD). Materials and Methods: This hospital based cross-sectional comparative study was conducted on a total of 100 individuals which included 50 patients of CLD with sub groups- alcoholic liver disease-fibrosis (30), cirrhosis (10), viral hepatitis patients (10) and 50 age and sex matched healthy individuals. Three mL of blood sample was collected under all aseptic conditions for investigations. The samples was allowed to clot and the serum was separated and analysed for estimation of Hcy levels and was estimated on chemiluminiscence machine based on competitive immunoassay. Statistical analysis was done using SPSS version 16. All the tests were 2 tailed and the p-value <0.05 was considered significant. Results: The study groups included patients with age between 25-65 years, which comprised of 44 males and 6 females. Hcy levels were statistically increased in CLD patients in comparison with controls. Conclusion: While evaluating a patient of CLD, the physician should keep in mind the possibility of increased Hcy levels as one of its risk factors.

Is Only Septoplasty Justified in Deviated Nasal Septum with Chronic Rhinosinusitis?

Rachana Singh, Amit Kumar Rana, Suresh Singh Narula

Introduction: Nasal septal deviation is a common condition and it alters the nasal cavity airflow dynamics which causes hypertrophy of sino-nasal mucosa. It leads to impaired mucociliary clearance, osteo-meatal complex obstruction and sinusitis. Aim: To compare the adequacy of septoplasty and Functional Endoscopic Sinus Surgery (FESS) done concomitantly and septoplasty alone in patients with Chronic Rhinosinusitis. Materials and Methods: Fifty patients of refractory Chronic Rhinosinusitis (CRS) with Deviated Nasal Septum (DNS) were included in the study. They were randomly divided into two groups of 25 each. First group (Group A) underwent septoplasty with FESS while the second group (Group B) underwent septoplasty alone. The results were analysed to find out the efficiency of each procedure when done independently and concomitantly. Results: At 6 months follow-up, in patients who underwent FESS and Septoplasty only 2 patients out of 25 had nasal obstruction giving 92% improvement while 3 out of 19 patients showed persistent nasal discharge showing an improvement of 84.22%. Post nasal drip was still present in 3 out of 14 patients giving an improvement of 78.58% patients. In Group B, 9 out of 25 patients still had nasal obstruction giving only 64% improvement whereas 13 out of 17 had nasal discharge showing 23.53% relief. Post nasal drip was present in 8 out of 13 giving an improvement of only 38.47% patients. Post-operative Contrast Enhanced Computer Tomography (CECT) PNS demonstrated the midline position of the nasal septum in patients of both groups in unilateral or bilateral disease. In Group A, Osteo-Meatal Complex (OMC) Obstruction reduced from 14 to 3 patients in unilateral disease and from 11 to 2 in bilateral disease. Mucosal hypertrophy reduced from 7 to 2 and 6 to 1 patients in unilateral and bilateral disease respectively. Polypoidal-sinonasal mucosa decreased from 4 to 1 in unilateral disease and is not seen in any of the 6 patients in bilateral disease. There was less improvement in Group B for same parameters than Group A. Conclusion: Though both groups reported improvement in symptoms as compared to pre-operative state, it was more in group which underwent FESS with septoplasty rather than septoplasty alone. In deviated nasal septum with features of chronic rhinosinusitis, septoplasty alone is inadequate, therefore FESS must be concomitantly done with septoplasty.

Quality Analysis of Haematological Parameters of Whole Blood, Packed Red Blood Cells and Platelet Concentrate: A Study from a Tertiary Care Hospital of Northern India

Introduction: The ultimate goal of blood transfusion services is to provide whole blood and blood components that are safe, efficacious and potent to the recipients. Building blocks of quality include- quality control, quality assurance and quality audit. Quality control is a process by which product standards are established and met without mistake. Aim: To establish the quality of standards of haematological parameters of whole blood, Packed Red Blood Cells (PRBCs) and platelet concentrate in a blood bank of tertiary care teaching hospital of Northern India with reference to standard guidelines. Materials and Methods: This was a retrospective study in which samples of 3.6% of total whole blood collection (48/1321), 2.3% of PRBCs (50/2155), and 9.3% of platelet concentrate (42/451) was prepared and were tested for haematological parameters of quality control for the period of 1^st January 2017 to 31^st December 2017. Results: The quality analysis of haematological parameters for whole blood, PRBCs and platelet concentrate were done. All the whole blood and PRBCs samples tested had hematocrit above 30% and 65% respectively. Out of 42 platelet concentrate samples 95% had platelet yield of >5.5×10¹⁰/U and WBC and RBC contamination was well within the normal range. Conclusion: Continuous quality improvement is of utmost importance for safe and potent blood transfusion services. Thus, care should be taken to use standard criteria for quality assessment and adherence to standard values should be periodically ensured by objective analysis.

Relationship of the Hospital Ethical Climate with Nurses’ Attitude to Interprofessional Collaboration

Introduction: Hospital ethical climate is a kind of organisational climate consisting of interpersonal relationships between treatment personnel and personnel communication with patients and their families. Collaboration between physician and nurse is a prominent and important aspect of professional ethics and designed to achieve a common goal of patient care. Ethical climate that reflects persons’ perceptions of their organisation and is one of the important and influential factors affecting the attitudes and behaviours of employees in the workplace, can be influenced by the interprofessional collaboration between physicians and nurses. Aim: To investigate the correlation of hospital ethics with nurses’ attitude towards the interprofessional collaboration between physicians and nurses. Materials and Methods: In this descriptive study, 196 nurses working in the intensive care units of selected hospitals of Shahid Beheshti University of Medical Sciences, Tehran, Iran, who were eligible to enter the research, were selected by available method. To collect data, Olson’s ethical climate questionnaire and attitude toward the collaboration of physicians and nurses Jefferson scale were used. Due to the fact that the validity of the questionnaire was verified and confirmed in numerous domestic researches in Iran, it was not re-examined. Cronbach’s alpha coefficient was used to verify their reliability. Results: The average score of the ethical climate of the hospital from the nurses’ viewpoint was 3.26±0.56, which indicates an unfavourable level of understanding of the ethical climate among the nurses. The mean score of nurses’ attitude towards the collaboration of physician and nurse was 51.17±4.98, which is in the positive level. The results of statistical analysis showed that there was no statistically significant relationship between the dimensions of nurses ‘perception of the ethical climate of the hospital and the nurses’ attitude toward the collaboration between the physician and the nurse (r=-0.26, p-value=0.695). Conclusion: Considering that collaboration between physician and nurses is one of the important features in providing care, it is suggested that training be provided to develop the morale of participation and cooperation in educational and clinical settings. Also, considering the importance of nurses’ perception of the ethical climate of the hospital, it is suggested that ethical workshops with the aim of familiarising all employees with the importance of the concept of organisational ethics in hospitals should be held.

Impact of Blood Transfusion on Haematopoietic Stem Cell Transplantation Outcome

Nermeen Adel Nabih, Shaza Abdelwahab Elkorashy, Rasha Magdy

Introduction: Allogeneic Haematopoietic Stem Cell Transplantation (AHSCT) is a potentially curative therapy for many haematological malignancies. Nearly all patients who undergo AHSCT require frequent transfusion of blood products until Red Blood Cells (RBCs) and platelet engraftment occur. However, blood transfusion has seldom been studied as a risk factor for adverse post-transplant outcome. Aim: To investigate the impact of blood transfusion on post-transplant outcome. Materials and Methods: This single-center retrospective study, analysed the data of 50 adult patients with haematological malignancies who had received AHSCT, regarding the incidence of infection‚ acute and chronic Graft Versus Host Disease (GVHD) and overall survival, for one year after AHSCT. The collected data was divided into two groups according to the amount of transfused RBCs and platelet units; the low transfusion group (<10 units, n=30) and high transfusion group (>10 units, n=20). Results: The incidence of infectious episodes and GVHD development were significantly higher among the high transfusion group than that in low transfusion group (p=0.006) and (p=0.02), respectively. In the low transfusion group, the incidence of acute GVHD was 3.3% and of the chronic GVHD was 3.3% while in high transfusion group, the incidence of acute GVHD was 15% and of chronic GVHD was 20%. The overall survival was significantly lower in the high transfusion group 25% than that in the low transfusion group, 46.7% (p=0.02) during the first year post-transplant. Conclusion: Data from the present study indicate that higher transfusion history was associated with increased risk of infection, development of GVHD and worse overall survival in patients who received AHSCT. Thus, new rational for improving transfusion practice based on symptoms driven criteria for such patients is highly warranted.

Evaluation of Sensitivity and Resistance of Linezolid in Pre Extensively Drug Resistance Tuberculosis and Extensively Drug Resistance Tuberculosis at a Tertiary Care Hospital, Jamnagar, Gujarat, India

Introduction: The diseases have a high prevalence in India, accounting for one fourth of the Tuberculosis (TB) cases in the world. The situation becomes more complicated due to the rising of Human Immunodeficiency virus/AIDS pandemic, the emergence of Multidrug- Resistance (MDR) TB, Pre Extensively Drug Resistance (Pre-XDR) TB, and Extensively Drug Resistance (XDR) TB. Therefore, new anti-TB drugs are urgently needed to treat MDR-TB, Pre XDR-TB, and XDR-TB. Linezolid was the first oxazolidinone compound licensed for clinical use. Aim: To evaluate the sensitivity and resistance of linezolid in Pre XDR-TB and XDR-TB patients at a tertiary care hospital, Jamnagar, Gujarat, India. Materials and Methods: This was a prospective study conducted from May 2017 to January 2018. Total sample received were 590 MDR-TB suspected cases. All samples were proceeded for rapid detection of MDR of Mycobacterium tuberculosis by direct Drug Susceptibility Testing (DST) using Bactec MGIT 960 system. Results: Out of the total 590 samples, 468 were culture positive among this: 14 (3%) were linezolid resistance, 9 were Pre XDR-TB with linezolid resistance, 03 were XDR-TB with linezolid resistance and 2 were only linezolid resistance. A total of 454 (97%) were linezolid sensitive, 143 were Pre XDR-TB with linezolid sensitive and 19 were XDR-TB with linezolid sensitive. A total of 14 (3%) were HIV infected of which 2 had Pre XDR-TB and 1 had XDR-TB. All 14 were linezolid sensitive. Conclusion: The present study showed that linezolid was found to be highly sensitive (97%) with low (3%) resistance in MDR-suspected patients. Linezolid is effective in treatment of MDR-TB, Pre XDR-TB and XDR-TB patient, but while receiving linezolid, patients should be closely monitored for signs or symptoms of bone marrow toxicity and peripheral and optic neuropathy.

Workshop as a Teaching Learning Tool for Training Interns in Writing Rational Prescription

Hema Narasimhegowda, Manjunatha Nagaraja

Introduction: Rational drug usage is well recognised as an important part of the National Health Policy. Proper prescription writing is an essential skill for doctors in medical specialities. Several studies have shown deficiencies in students in prescribing. To overcome these difficulties, WHO produced the Guide to Good prescribing based on the concept of Rational use of Medicines. Workshops are known to play an important role in developing more instrumental skills of listening, presenting ideas and learning as a team. Aim: To assess the effectiveness of workshop as a Teaching Learning tool for training Interns in Rational prescribing and study their perceptions regarding the same. Materials and Methods: The study was carried on 6th December 2017 at Mysore Medical College and Research Institute, Mysore, Karnataka, India. A one day workshop (six sessions) was conducted on Rational prescriptions. Thirty Interns were recruited (purposive sampling) who followed the WHO six steps of rational prescribing. Clinical teachers facilitated the discussions. A Pre-test (just before) and Post-test (immediately after) were administered. Paired t-test was used for analysis of scores. Students’ perceptions were graded on Likert’s scale (Mixed method study design). Results: Significant improvement was observed in rational prescription writing after conducting the workshop which is evident by the post-test scores. The t value was -6.22873. Most of the interns (70%) strongly agreed that the case vignettes helped to develop logical thinking. Many of them (72.3%) believed that this knowledge is more effectively imparted in workshop mode of teaching and majority (83.3%) felt that they needed to be exposed to this method of learning. Conclusion: This study confirms that workshop is a good teaching learning method to reinforce rational prescription writing.

Early Outcome of Platelet Rich Plasma and Non-steroidal Anti-inflammatory Agent Alone and in Combination on Primary Knee Osteoarthritis

Introduction: Platelet rich plasma is an emerging treatment modality in managing mild and moderate cases of osteoarthritis. There is no consensus on dose and various combination of this product with other available treatment modalities especially Non-Steroidal Anti-Inflammatory Drugs (NSAID). Aim: To determine and compare the early treatment outcomes of intra-articular injection of Platelet Rich Plasma (PRP) and oral NSAIDs alone and in combination in mild and moderate knee osteoarthritis. Materials and Methods: Forty-five subjects with mild and moderate osteoarthritis who met the study criteria were randomly allocated into three intervention groups: Group A: had intra-articular injections of autologous PRP only; Group B: received oral NSAIDs only, while Group C: had both oral NSAID and intra-articular injection of autologous PRP. Subjects in Group A had 3 sessions of injections at monthly interval while Group B had 75 mg of Diclofenac taken daily at 8 am and 8 pm. Subjects in the Group C had both monthly injections of autologous PRP and oral administration of NSAIDs for three months. Outcome measures were severity of pain assessed using Visual Analogue Scale (VAS) and functional outcome using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Data were analysed using the IBM SPSS Statistics Version 22, Armonk, NY; IBM Corp and Comparison of the means were done using analysis of variance (ANOVA). Results: Better responses in the severity of pain and functional outcome were seen in subjects who had intra-articular administration of autologous platelet rich plasma with or without NSAIDs than in subjects who had only NSAIDs (p<0.05). Conclusion: PRP alone and in combination with NSAID is superior to NSAID only therapy in mild and moderate osteoarthritis.

Knowledge, Beliefs and Psychosocial Predictive Factors of Intention and No Intention to Quit Shisha Smoking among University Students in Sharjah

Coumaravelou Saravanan, Amita Attlee, Nabil Sulaiman

Introduction: Shisha smoking is common in the Arab culture. Shisha smoking is one of the major preventable risks of morbidity and premature mortality rates. Aim: The aim of this study was to assess the knowledge, beliefs and predictive factors of intention and no intention to quit shisha smoking among undergraduate students in Sharjah, United Arab Emirates. Materials and Methods: A total number of 633 university students participated in this cross sectional study. Socio-demographic profiles and shisha smoking status of the students were identified. Fagerstrom Test for Nicotine Dependence assessed their dependency and Knowledge and Beliefs Scale identified their knowledge and beliefs regarding shisha smoking. Transtheoretical Model Questionnaire measured the intention to quit and not having any intention to quit shisha smoking. Brief Wisconsin Inventory of Smoking Dependence Motives determined the reason for no intention of quitting smoke. Results: Students who have intention to quit shisha smoking have more knowledge that shisha leads to heart diseases and hypertension and these students believe that shisha is more addictive than cigarettes and shisha has lot of nicotine than the students who did not have intention to quit shisha smoking. Dangerous to health, addiction and waste of money were significantly correlated and predicted the level of intention to quit smoking. However, mood enhancement, craving, social environment, cue experience, tolerance were the significant predictors for not intent to quit smoking. Conclusion: Professionals who offer treatment to smokers need to focus on enhancing the knowledge and belief about consequences of shisha smoking, and the predictive factors of not intent to quit shisha smoking.

Distribution Characteristics of Benign and Malignant Thyroid Nodules

Introduction: The right thyroid lobe has a little bigger size and a few more number of cells than the left lobe. It is uncertain whether this anatomical variation may reflect the distribution differences of the malignant thyroid nodules. Aim: To investigate the location differences and clinical characteristics of the benign and malignant thyroid nodules. Materials and Methods: A total of 2194 participants with thyroid nodules were enrolled in this study. Colour Doppler was used to observe the parameters, including the number of nodules, nodule size, nodule shape, nodule capsule, internal echo and haemodynamics . The malignant thyroid nodules were diagnosed by thyroid ultrasonography and pathology. Statistical analysis was conducted with SPSS 16.0 software. Results: The right lobes (46.5%) were more frequently encroached by Papillary Thyroid Carcinoma (PTC) than the left lobes and isthmus. The ratio of envelopes invaded by tumours was 45.6% for the right lobe, 40.4% for the left lobe, and 14% for the bilateral lobes. The ratio of lymph node metastases, which were encroached by PTC was approximately 24.2%. Adenoma, cyst and calcification were observed more frequently in the right lobes than in the left lobes. Conclusion: The right lobe suffered from benign and malignant thyroid diseases more frequently than the left lobe. The right envelopes and lymph glands were more frequently encroached by PTC. More attention should be paid to the nodules on the right lobes.

Analysis of Correlation between Google Search Trends and Dengue Outbreaks from India

Nasir Salam, Farah Deeba, Faizan Qadir, Fras Al-Hijli, Yaser Naif Al-Otaibi

Introduction:Dengue has become an endemic problem in India with frequent outbreaks reported from several parts of the country every year. A passive surveillance system is unable to deal with the mounting number of cases every year. In the last couple of years the internet has become a valuable tool to access healthcare related information. Aim: To analyse the correlation between dengue cases reported every year and annual Internet search data for the term “dengue” obtained via Google trends. Materials and Methods: Dengue incidence data was collected from the National Vector Borne Disease Control Programme (NVBDCP) database alongside relative search volumes from Google trends for the term “dengue” and correlation was estimated by calculating Pearson’s correlation coefficient. Results: The data was analysed from the year 2004 up to year 2017. In this period, a total of 693,318 cases of dengue were reported from India. Relative search volume for dengue searches on Google trends was found to be highly correlated with dengue incidence data. Google trends indicate a seasonal pattern showing maximum search volume in the monsoon months, which also coincides with most dengue cases. Internet based searches and Google trends can be used in addition to traditional surveillance methods for predicting disease outbreaks. Conclusion: The analysis shows an overall strong positive correlation between incidence of dengue cases and Google trends indicating the usefulness of internet searches in gathering healthcare related information during the time of outbreaks. Internet based searches could be an additional tool along with classical surveillance methods for accurately predicting disease outbreaks in resource poor settings.

Effect of General and Regional Anaesthesia among Diabetic Patients undergoing Surgery: A Retrospective Study

M Vasantha Kumar, B Ravi

Introduction: Diabetes Mellitus (DM) is a multisystem metabolic disorder. The techniques of anaesthesia, specifically the usage of general and regional anaesthesia can change (or) modify any residual insulin secretion and catabolic hormones secretion. Aim: To compare and determine the perioperative and postoperative changes in the blood glucose, Blood Pressure (BP), Heart Rate (HR) and Visual Analog Scale (VAS) pain score among the diabetic patients under regional and general anaesthesia. Materials and Methods: A retrospective study of 100 diabetic patients who had undergone surgeries under general and regional anaesthesia was performed. The patients were divided into two groups based on the type of anaesthesia used during surgery. Information pertaining to the level of blood glucose, BP and HR of the diabetic patients under general and regional anaesthesia were retrieved and analysed. Statistical analyses was performed to determine the significance of any differences observed between the two groups. Results: The study revealed that the blood glucose level among the diabetic patients under general and regional anaesthesia was found to be higher in post surgery period when compared to the blood glucose level among the patients in pre surgery period under general and regional anaesthesia. The study also reported that the level of Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP) and HR among the diabetic patients during surgery under general and regional anaesthesia decreased when compared to the level of SBP among the patients at pre surgery under both general and regional anaesthesia. The level of the SBP post surgery under regional anaesthesia remained the same as pre surgery level. VAS pain score among the patients in general anaesthesia group was found to increase almost instantly after the completion of surgery while that among the regional anaesthesia group was found to increase only after the 3rd or 4th hour of post-surgery. Conclusion: The study concludes that there was an increased intraoperative blood glucose fluctuation, alterations in the BP and HR level among the diabetic patients upon administration of both general and regional anaesthesia.

Surgical Correction of Isolated Total Anomalous Pulmonary Venous Connection: A Prospective Longitudinal Study

Introduction: Total Anomalous Pulmonary Venous Connection (TAPVC) is an uncommon congenital heart defect. They are classified into cardiac, supracardiac, infracardiac and mixed subtypes. It has a very high mortality without surgical correction. Aim: To assess the results and early outcomes of surgical repair in patients with isolated total anomalous pulmonary venous drainage with biventricular anatomy. Materials and Methods: This was a prospective study on 27 patients with isolated TAPVC, who underwent surgical correction between January 2012 and December 2018 at a tertiary cardiac care centre in Chennai, Tamil Nadu, India. This study involved detailed pre-operative Echocardiography and CT pulmonary angiography. Analysis of surgical repair, post-operative intensive care unit stay and up to 1 year follow-up of patients was done. Parametric variables were expressed as mean±standard deviation. Chi-square test was used to analyse categorical variables and calculate p-value. Results: The mean age of 27 patients was 4.86±10.08 months and mean weight was 4.69±4.13 kg. The subtype of anomalous connection decided the specific technique of surgical correction. The mean cardio-pulmonary bypass time for all TAPVC types was 111.04±39.82 minutes, mean aortic cross clamp time was 61.44±25.95 minutes and mean hospital stay of the patients was 9.11±2.08 days. There was one early post-operative death in supracardiac TAPVC variant (72 hours after surgery). There were three late post-operative deaths in infracardiac TAPVC variant due to post-operative pulmonary venous obstruction. One patient died three months after surgery and the other two died six months after surgery. The cumulative proportion of patients surviving at the end of one year was 0.88 (standard error of 0.07). Conclusion: Good early outcomes after surgical correction for TAPVC can be achieved. The duration of cardio-pulmonary bypass in infracardiac type of TAPVC is significantly higher than supracardiac and cardiac variants. Infracardiac TAPVC and preoperative Pulmonary Venous Obstruction (PVO) are associated with a poorer prognosis. This subset of patients represents the extreme end of TAPVC spectrum where they often require prolonged cardiopulmonary bypass support.

Folate Cycle and Interleukin 6 Genes Polymorphisms in Children with Idiopathic Scoliosis and its Relation with Pathogenesis of Disease: A Case Control Study

Introduction: Spine deformity formed as a result of anomalies in its development and this is one of the common orthopaedic pathologies of childhood. The results of some genetic studies did not show significant relationship between the different polymorphisms studied and the rate of progression of Idiopathic Scoliosis (IS). The study on new genetic markers for IS is an important and urgent task. Aim: To study the molecular genetic analysis of folate cycle genes and Interleukin 6 (IL-6) gene polymorphism in children with progressive type of IS. Materials and Methods: The case-control study was conducted on 110 children with IS between the age of 14 years to 18 years and 110 healthy volunteers without pathology of the spine. The study was carried out by the methods of molecular genetics analysis. Molecular diagnostics were carried out by analysing multiple polymorphic regions in the folate group and IL-6 gene, which are of clinical importance due to their predisposing factors in spine malformations. Genotyping of the gene polymorphism was performed using Polymerase Chain Reaction (PCR) in conventional and real-time method and the PCR products were analysed directly on the CFX96 Touch Real-Time PCR Detection System or by gel electrophoresis. Statistical analysis was performed with software package Statistica 6.0. Results: The polymorphisms of the genes MTHFR, MTR, MTRR, IL-6 and their frequency distribution among patients with IS and control group were investigated. Some differences in the distribution of genotypes compared with the control group were found in the MTHFRA1298C, MTHFRC677T, MTRA2756G, MTRRA66G, and IL-6G (-174)C polymorphisms. The most significant differences were revealed for MTRA2756G polymorphism, and especially when dividing the group of patients with IS by gender. Conclusion: The results suggested that some polymorphisms of the folate group and IL-6 genes are involved in the pathogenesis of IS. This is also indicated by the well-known role that these genes do play in the ontogeny of the spine.

Role of Nanotechnology Structured Water to Achieve Controlled Blood Glucose Level in Type 2 Diabetic Patients: A Randomised Controlled Trial

Introduction: Type 2 Diabetes Mellitus (DM) occurs due to insulin resistance or low insulin secretion or sometimes a combination of both. Nanotechnology structured water is a type of water that is produced using energy field modulators to change the biological, chemical and physical properties of water molecules and improve the bioavailability of this nano-water. Aim: To find out the effect of drinking nanotechnology structured water (Magnalife®) on the blood glucose levels in patients with Type 2 diabetes mellitus. Materials and Methods: This study was a randomised control trial involving Type 2 Diabetic patients (n=387) who were randomly divided into two groups. Group A (n=191) given nanotechnology structured water and Group B (n=196) with ordinary bottled water. Blood glucose level was measured as Glycated Haemoglobin (HbA1c) in the same laboratory for both groups. It was tested at baseline and at the end of the third month after drinking the water, they were given in a daily dose of 20 mL/kg body weight divided over the day. Turkey test and independent t-test were used to compare the results. Results: At the end of the study, only 352 patients were included (35 patients dropped out for different reasons). Interventional group (Group A) showed a significant difference between baseline HbA1c (8.1%±1.38) vs. HbA1c after 3 months (6.6%±0.85), (p<0.001). While there was no significant difference in pre-post HbA1c tests (7.9%±1.36) vs. (7.8%±1.16), (p=0.274) among the control group (Group B). The study revealed elevation in the percentage of patients with (HbA1c <7) in Group A from (25.1%) at baseline to (61.2%) after 3 months of intervention, while in Group B, the percentage of patients with (HbA1c <7) decreased from (27.2%) to (19.5%). Conclusion: The use of nanotechnology structured water Magnalife® in Type 2 diabetic patients is innovative way to achieve better control of blood glucose level.

Cost-Effectiveness Analysis of Screening Chronic Kidney Disease in Iran

Introduction: The prevalence of Chronic Kidney Disease (CKD) in Iran amounts to 15.14%, which is higher than the global average. Given the substantial cost of this disease, health insurance companies need evidence of the cost-effectiveness of screening for the disease in adults at risk so that they can control the prevalence of the disease and the associated incremental medical costs by implementing a nationwide screening. Aim: To explore the cost-effectiveness of screening for CKD among adults as compared with having a non-intervention strategy. Materials and Methods: The study had a cross-sectional design and uses the cost-effectiveness analysis approach to compare the costs and outcomes of screening versus non-screening CKD. The estimated Glomerular Filtration Rate (GFR) was used for primary screening of the population. For this purpose, blood creatinine was measured; subsequently, urine creatinine and volume were analysed. However, some complementary measures and diagnostic tests were employed for positive cases, including the kidney ultrasonography. Costs and outcomes of the two strategies was calculated using a Markov decision model. This model is designed based on the natural course of CKD and GFR as a five-stage model. Costs of services required for patients were calculated based on Iran Health Insurance Organisation database, and outcome data were extracted in terms of the Quality-Adjusted Life-Year (QALY) index. Using TreeAge software, costs and outcomes were simulated for 1000 patients, and sensitivity analysis was used to test the reliability of the model data. Results: For an adult population, the cost-effectiveness ratio for screening versus non-screening was 277,686,954 Rials per QALY, which was the effective cost. The results of one-way sensitivity analysis on the variables of the model shows that the screening strategy can be considered a dominant strategy in different domains. Conclusion: Given the high prevalence of CKD in Iran, early detection of this disease via adult population screening is cost-effective for health insurance companies, and these organisations can control the costs of dialysis and kidney transplantation by reducing the rate of patient transitions from early to the final stages of the disease.

Hypertension and Anthropometric Indicators in Urban Male Youth of Moradabad: JNC 8 2014 vs. ACC/AHA 2017 Guidelines

Arun Kumar, Anuradha R Gawarle, Ashlesh Laxman Patil

Introduction: JNC 8 2014 and the recent ACC/AHA 2017 guidelines used to classify hypertension differ a lot in defining various stages of hypertension and thus will change the prevalence of the disease. However, the relationship between anthropometric parameters and blood pressure considering the two hypertension guidelines in urban Indian population is still unclear. Aim: To compare the anthropometric parameters and prevalence of prehypertension and hypertension between two hypertension guidelines for urban young male adults in Moradabad. Materials and Methods: This cross-sectional study was done in 2018 by using standard protocol blood pressure and anthropometric parameters were measured in 444 subjects residing in urban areas of Moradabad (18-25 years of age). Subjects were classified using JNC 8 and ACC/AHA 2017 into 8 BP categories. ANOVA was used to compare the anthropometric parameters between the BP categories. Results: Waist Circumference (WC), Skinfold Thickness at Biceps (STB) and at Triceps (STT) was significantly higher in JNC Stage 2 as compared to ACC/AHA Stage 2. Additionally, waist hip ratio, waist height ratio, STB and STT were significantly higher in JNC Stage 2 as compared to JNC Prehypertension but not for ACC/AHA classification The prevalence of prehypertension and hypertension (stage 1 and stage 2) was 33.11% and 13.06% according to JNC 8 2014, respectively; while, it is 9.91% and 36.26% according to AHA/ACC 2017 guidelines, respectively. WC & BMI, the strongest predictors of hypertension, were significantly more in hypertensive than normal subjects according to both the classifications. Conclusion: New ACC/AHA 2017 classification increases the prevalence of hypertension and decreases the prevalence of prehypertension in young urban males of Moradabad. JNC 8 2014 classifies prehypertensives with higher peripheral obesity as compared to ACC/AHA 2017. While, ACC/AHA 2017 misses higher hypertension grades that have increased peripheral obesity at the biceps as compared to JNC 8 2014. The two classifications show different anthropometric parameters at various stages. Since obesity management is interrelated with hypertension management, there is a need of obesity-hypertension classification.

Looking Beyond LDL-Cholesterol - A Study on Extended Lipid Profile in Indian Patients with Acute Coronary Syndrome

Introduction: Assessment of dyslipidemia with only Total Cholesterol (TC), Triglyceride (TGL), Low- and High-Density Lipoprotein Cholesterol (LDL-C, HDL-C) levels, Standard Lipid Profile (SLP), leads to under-estimation of dyslipidemia as a risk factor in Acute Coronary Syndrome (ACS). Aim: To assess whether extended lipid profile gives a better risk assessment in ACS patients. Materials and Methods: In this single-centre, prospective, observational study of statin-naïve patients presenting with ACS, SLP and Extended Lipid Profile (ELP), consisting of TC/HDL-C ratio, non-HDL-C, apolipoprotein-B, apolipoprotein-A1 and their ratio, were studied at baseline and after high-intensity statin therapy. For continuous data, descriptive statistics mean±standard deviation and also 25^th-75^th percentile was reported. Number of patients and percentages were reported for categorical data. Pearson correlation coefficient was used to find the relationship between continuous variables. Results: In the present study, 139 patients (mean age 55 years, range 21-88 years, 78% male) presented with ACS: ST-Elevation Myocardial Infarction (STEMI) 79%, non-STEMI 17%, Unstable Angina (UA) 4%. The ELP (barring non-HDL-C) showed more dyslipidemia than SLP. Dyslipidemia declined across the age spectrum from young to old and worsened across the ACS spectrum from UA to STEMI. High-intensity statin therapy reduced LDL-C significantly but not to target levels in most patients. Conclusion: ELP is better able to identify dyslipidemic risk than SLP or LDL-C alone. Dyslipidemia is more prevalent in young and STEMI patients, suggesting a greater role as risk factor in them. Achievement of target LDL-C with statin therapy remains practically elusive in most patients.

Neonatal Cholestasis Syndrome: Aetiological Spectrum and Outcome Analysis- Single Center Study

Introduction: Neonatal Cholestasis syndrome is a common condition among infants that needs to be evaluated in detail to establish aetiology. Although Idiopathic neonatal hepatitis is common, clear outcome for same has not been established. Aim: To assess the clinical profile, aetiological spectrum of infants with Neonatal Cholestasis Syndrome (NCS) followed-up over 10 years. Materials and Methods: It was a retrospective study; data were collected from online records Jan 2008-Dec 2018. Total of 300 infants (210 males) were studied. Clinical outcome was assessed in non-surgical patients with a minimum of 6 month follow-up period. Chi-square test was used for statistical analysis. Results: Intrahepatic NCS was identified in 232 (77%)-majority 164 (54.6%) were idiopathic hepatitis. Remaining 68 (23%) had Extrahepatic NCS and Biliary Atresia (BA) was confirmed in 64 (21.3%). Mean age of presentation was 2.4 months in the intrahepatic group and 3 months in Extrahepatic NCS. All underwent blood tests and ultrasound. Liver biopsy was done in 72 (24%) -35 neonatal hepatitis (2 with cirrhosis), 24 BA, 11 Progressive Familial Intrahepatic Cholestasis, 1 bile duct paucity. All received multivitamin therapy till 1 year of age. Follow-up analysis done in 95 subjects at a mean age of 23.5 months (range 6-90) showed significant improvement in growth (weight centile from 8.9 to 27.7 and height centile from 16.7 to 22.4) and in liver function. Hepatobliary scan had a sensitivity of 90% in diagnosing Biliary Atresia. Conclusion: Idiopathic neonatal hepatitis is the most common aetiology in Neonatal hepatitis. Intrahepatic NCS has good outcome in terms of growth and normalisation of liver function.

Immediate Effect of the Autogenic Drainage over the Active Cycle of Breathing Technique in Airway Clearance in Subjects with Chronic Bronchitis- A Quasi Experimental Study

Jincy Samuel

Introduction: Chronic Bronchitis (CB) is an obstructive pulmonary disease in which there is obstruction in airways due to excessive mucous secretions. Chest physiotherapy is effective in clearing secretions from the lung of the patients with copious secretions. This includes some newer techniques like Autogenic Drainage (AD) and Active Cycle of Breathing Technique (ACBT) which is effective as well as have less deleterious effect when compared to conventional physiotherapy management. Aim: To know the effectiveness of AD over ACBT in airway clearance in CB. Materials and Methods: The study was a quasi experimental study which included 30 subjects in the study. They were equally divided into two groups. One group received AD technique for 30 minutes and other received ACBT for 30 minutes. The outcome measures were compared and evaluated by Visual Analogue Scale (VAS) for breathlessness, Peak Expiratory Flow Rate (PEFR) and expectorated sputum volume to compare effect on dyspnea and airway clearance. VAS for breathlessness, PEFR and expectorated sputum volume was measured before the session and after 30 minutes following the session. Paired t-test, Wilcoxon’s signed rank test and Mann-Whitney U test was done using SPSS software to compare the outcome measures. Results: Paired t-test showed that there is a significant difference in pre and post-PEFR and VAS for breathlessness in both the groups. Wilcoxon’s signed rank test also showed significant difference in pre and post-sputum volume in both groups. However, Mann Whitney test shows that there is no significant difference between the groups for PEFR (p=0.348), VAS for breathlessness (p=0.910) and sputum volume (p=0.123). Conclusion: The study showed that there was no significant difference in effect of AD technique over ACBT on mucus clearance and level of dyspnea. Both the airway clearance techniques can be used effectively in CB based on patient and therapist preference.

Influence of Antiplatelet Therapy on Cardiovascular Disease Prevention among Type 2 Diabetic Patients in Thailand

Introduction: Cardiovascular Disease (CVD) is globally known as a common disease for diabetic patients. Antiplatelet therapy is a key pharmacological method to prevent and treat CVD. However, it has not been conclusive whether antiplatelet could significantly reduce the risk of CVD. An evaluating influence of antiplatelet therapy among Thai diabetics may be administered as a functional management in the future. Aim: To investigate the effect of antiplatelet therapy for CVD prevention in type 2 diabetic patients in Thailand. Materials and Methods: A cross-sectional study was investigated on 24,992 cases of Type 2 Diabetes (T2DM) and T2DM with Hypertension (HT) recorded under the program “An assessment on Quality of Care among Patients Diagnosed with T2DM and Hypertension Visiting Hospitals of the Ministry of Public Health and the Bangkok Metropolitan Administration, Thailand” in the year 2012. Among these cases, 10,799 participants were treated with antiplatelet drug whereas, 14,193 participants had no history of this treatment. Patients whose age over 30 years and attended a hospital for their treatments more than one year were recruited. CVD incidence was investigated in both who were treated with antiplatelet drug during one year preceding the data collection and those who were not treated. However, other factors, such as sex, age, period of having the disease, Body Mass Index (BMI), HbA1c level, cholesterol (total, LDL-C, HDL-C), systolic blood pressure and diastolic blood pressure were also recorded. Descriptive statistics with multiple logistic regression and 95% CI were used for analysis. Results: Total of 24,992 cases of T2DM and T2DM with HT were recruited for analysis. The final model of the multiple logistic regression observed that T2DM who did not obtain antiplatelet therapy had a significantly higher risk of CVD (OR_adj=4.35, 95% CI=3.89 to 4.87, p-value <0.001). Other significant co-variates were found including duration of disease ≥10 yrs (OR_adj=1.30 95% CI 1.16 to1.44 p-value <0.001), serum creatinine >1.2 mg/dL (OR_adj=1.45, 95% CI=1.31 to 1.61, p-value <0.001) and latest systolic blood pressure >120 mmHg (OR_adj=1.38, 95% CI 1.23 to 1.55, p-value <0.001) and had HDL-C <40 mg/dL (OR_adj=1.25, 95% CI=1.12 to 1.40, p-value <0.001). Conclusion: Low-dose antiplatelet therapy was significantly associated with decreasing the incidence of CVD. Whereas the duration of disease, serum creatinine, systolic blood pressure and HDL-C were found to be risk factors of CVD.

Bacteriological Analysis of Water Samples from Different Points in a Tertiary Care Hospital

Yashraj Kirankumar, Giridhara Upadhyaya, Vasundhara Bhatia

Introduction: Water is a critical component of public health, and failure to supply safe water will place a heavy burden on humanity. Drinking water is the major source of microbial pathogens in developing regions. Water contamination can be a major source of infection in a hospital. Aim: To determine the percentage of contamination (if contamination is present) with calculation of prevalence of bacteria and to analyse the bacteriological profile of the organisms present. Materials and Methods: Hi Media test kit was used to collect water samples from 20 different points in the hospital and was subjected to incubation for 24-48 hours. The bottles that showed colour change were further subjected to culture and sensitivity with identification of organism. Results: There was 100% contamination of the water samples and the organisms identified include E.coli, Klebsiella, Enterobacter, Citrobacter, Proteus, NF GNB, Salmonella, Pseudomonas and Acinetobacter. Some of these organisms and isolates were found to be resistant to Cefuroxime, Ampicillin, Amoxicillin- clavulanic acid, Cefoperazone, Imipenem. Conclusion: These results provoked the authors to reconsider the efficacy of the existing water purification systems and analyse where the point of contamination is, take corrective measures and use the apt method of purification systems to improve the quality of life of the patients.

Evaluation of Nano-Crystalline Silver Dressings in Superficial Partial Thickness Burns

Anshul Jain, Jafar Husain, Ajit Singh

Introduction: Silver as an antimicrobial agent has been known for the treatment of burns. Silver nitrate causes discoloration of skin and silver sulphadiazine causes tissue irritation and pseudo-eschar formation. Nano-crystalline silver dressings were a significant break-through in the management of burn wounds. Aim: To assess the efficacy of nano-crystalline silver dressing in management of second degree superficial burns. Materials and Methods: Thirty patients suffering from second degree superficial burns of different aetiologies were treated and wound healing was closely monitored with regular photographic evidence. Results: The mean score of pain using numeric and faces pain rating scale was 7.36 at the time of admission. Eighteen patients didn’t have pain at one week. Mean score of remaining 12 patients was 1.5. When the total score is divided by 30 (18+12), then mean pain was 0.6. The mean number of dressing changes required was 4.73. Burn wounds of four patients epithelialised completely within one week requiring no more dressings, whereas 18 patients took up to two weeks and eight patients required more than two weeks for epithelialisation. However, complete healing was observed in all patients at four weeks and at three months follow-up, the scar was supple with no evidence of raised skin or hypertrophy. Conclusion: The ease of use, powerful antibacterial effect, lower frequency of dressing change, good molding, short time of wound clearing and epithelialisation, and painless dressing change are the advantages of nano-crystalline silver dressing which provide reasons to consider it as highly efficient for application in superficial burns of second degree.

Effect of Music Therapy on Hospital Induced Anxiety and Health Related Quality of Life in Coronary Artery Bypass Graft Patients: A Randomised Controlled Trial

Abeeshna Ashok, Sukumar Shanmugam, Ajith Soman

Introduction: Augmented incidence of anxiety is associated with Coronary Artery Bypass Graft (CABG) compared to other surgeries; it affects the function of vital organ. Preoperative anxiety may persist after surgery and affects health related quality of life. Music therapy is found to have an impact on patient’s anxiety. Aim: To find the effect of music therapy on hospital induced anxiety and Health Related Quality of Life (HRQoL) in patients after CABG. Materials and Methods: Forty participants were recruited for the study, (age group 30-80 years) and randomised into two groups. The intervention group received music therapy along with cardiac rehabilitation and control group received cardiac rehabilitation alone once in a day. The primary outcome measure was Hospital Anxiety and Depression Score (HADS) was measured by a trained physiotherapist on preoperative day and postoperative day 2 and 7. The secondary outcome measures were SF-36 and 6 minute walk distance, measured by a trained physiotherapist on preoperative day and post operative day 7. Results: HADS anxiety score showed significant difference within the intervention as well as control group, with p-value <0.05. The p-value of HADS depression component was <0.05 within each group. The values show that there is the reduction in both anxiety and depression in both groups nevertheless the p-value between the group was >0.05, which showed that there is no significant difference in HADS score between groups. The p-value of 6 MWT between the group was >0.05, but showed significant difference in control group. Physical component of SF-36 outcome did not show significant difference between the groups with p-value >0.05. Mental component of SF-36 did not established significant improvement between the groups. There was significant improvement in Physical component of SF-36 within the intervention group. Conclusion: Both Phase I cardiac rehabilitation and music therapy has positive impact on anxiety, with music therapy being the most advisable.

Multidrug Resistance in an Emerging Group of Enterobacteriaceae: A Retrospective Analysis at a Tertiary Hospital in Haryana, India

Shalini Upadhyay, Sharmila Sengupta, Kaitlin F Mitchell, Nasia Safdar

Introduction: The SPICE group of Enterobacteriaceae (Serratia, Providencia, ‘Indole positive’ Proteus and other common species of Proteus, Citrobacter, and Enterobacter species) have emerged as causes of infection in otherwise healthy patients, and are especially concerning due to their intrinsic resistance to several last-resort antibiotics. Aim:To estimate the trend of incidence and resistance pattern among SPICE group organisms and its association with the increased use of antibiotics. Materials and Methods: This was a single center, retrospective study conducted over a period of five years (January 2011 to December 2015). Clinical specimens from patients were collected and bacterial organisms were identified and tested for antibiotic susceptibility. The level of antibiotic usage was also analysed throughout the study period. Results: Levels of all SPICE group organisms has increased over the course of the study, with several genera exhibiting notable increases when each year of the study period and was compared to the baseline year. Most of the SPICE organisms exhibited decreased sensitivity to each of nine tested antibiotics. Usage of several antibiotics was also found to increase over the study period. Conclusion: This study demonstrates the rising incidence of SPICE group Enterobacteriaceae, which coincided with increased dispensing of antibiotics at our institution. In institutions with limited resources, the monitoring of antibiotic usage is especially important in curtailing the emergence of drug resistant infections.

Moral Distress and Self-efficacy among Nurses Working in Critical Care Unit in Iran- An Analytical Study

Introduction: Moral distress is one of the major issues that can affect the healthcare system adversely and is defined as discomfort in mental peace and it occurs as a result of failure to take appropriate moral actions despite knowing it. Aim: To determine the average frequency and intensity of moral distress and its relationship with self-efficacy in nurses working in Critical care units. Materials and Methods: This study was analytic one, conducted on 300 nurses working in critical care unit selected through simple random sampling method. The data were collected using demographic characteristics questionnaire, Corley’s moral distress scale, and Riggs et al., self-efficacy beliefs questionnaire. The data were analysed using descriptive statistics and Pearson’s correlation coefficient. Results: The results showed a moderate level of moral distress among Critical care unit nurses in both frequency and intensity. Also, the results showed that different wards affect frequency and intensity of moral distress in nurses differently, as ICU nurses experienced higher moral distress than nurses of other Department in this study. A significant relationship was observed between intensity (p=0.03 and r=-0.19) and frequency of moral distress (p=0.03 and r=-0.14) and perceived self-efficacy in nurses. Conclusion: This study showed that there is a significant negative relationship between moral distress and the level of perceived self-efficacy i.e., by an increase in moral distress, the level of perceived self-efficiency in nurses decreases.

Study of Outcomes of Smoking Cessation Interventions in Tuberculosis Patients using Urinary Cotinine Levels

Aseem Yadav, Deeptika Agarwal, Tentu Ajai Kumar, Kislay Kishore, Rachana Warrier

Introduction: In a developing country like India, patients of pulmonary Tuberculosis (TB) form an important subset of individuals requiring smoking cessation counselling and pharmacotherapy. Smoking increases risk of Mycobacterium Tuberculosis (MTB) infection, the risk of progression from infection to disease and the risk of death from TB. Smoking cessation counselling and pharmacological therapy help in improving outcomes of TB treatment, reduce transmission of TB and improve the quality of life of TB patients. Aim: To assess the effectiveness of smoking cessation counselling combined with bupropion in patients of pulmonary tuberculosis using urinary cotinine levels. The study was a prospective interventional study, carried out at Out Patient Department (OPD) and inpatient setting of a tertiary care respiratory centre in an urban setting between the period of July 2016 to June 2019. Materials and Methods: Seventy-six pulmonary TB patients who were active tobacco smokers and fulfilled the inclusion criteria were recruited for the study. Subjects received smoking cessation counselling for one year along with tab bupropion for first three months. Effectiveness of the interventions was assessed by regular follow-up visits at one month, three months, six months and twelve months post-initiation of therapy. Data analysis was done by using SPSS version 17.0 and Microsoft Excel. Chi-square test was used and p-value <0.05 was considered significant. Results: A total of 63 subjects were eligible for statistical analysis. Abstinence rates with bupropion and smoking cessation counselling at 12 months of follow-up were found to be 15.9%. Abstinence rates were found to be higher in patients with low nicotine dependence. Conclusion: The study will provide data on smoking cessation with counselling and bupropion in Indian patients suffering from pulmonary TB.

Comparison of Two Different Glenoid Bone Loss Calculation Methods using Three-Dimensional Computed Tomography

Abhijit D Pawar, Varsha P Rangankar, Priya R Bhole

Introduction: An accurate estimation of the glenoid bone loss is an important factor in management of glenohumeral instability. Three-dimensional Computed Tomography (CT) technique is the most widely used modality. Various methods are used for glenoid bone loss calculations on CT. Aim: To compare the two methods of glenoid bone loss evaluation namely, Griffith’s and Best fit circle method using three-dimensional CT. Materials and Methods: A retrospective study was conducted in which a total of 34 patients with recurrent shoulder dislocations who underwent computed tomography, were included in the study. Scans were reconstructed using multiplanar reconstructions and bone loss was evaluated using the Griffith’s index and Best fit circle method. Quantitative data were calculated as mean±SD. The chi-squared test was used to determine the p-value. Results: The mean for percentage glenoid bone loss using Griffith method was 18.8±6.6 and by best fit circle method was 18.8±5.9. The p-value was 1 and the t value was 0, proving that there is no statistical difference between both these tests. Conclusion: The results of the study showed that best fit circle method is comparable to Griffith’s method for estimation of bone loss (p=1) and can be used alone on the affected glenoid.

Assessment of Knowledge, Attitude, Perceived Barriers towards Research among First Year Undergraduate Medical Students: A Study from Chennai, Tamil Nadu, India

Introduction: Developing research skills and attitude to practice health research is an important area to be focused during undergraduate medical education. Aim: To assess the knowledge, attitude and perceived barriers among first year medical students to practice research skills during under graduate medical course. Materials and Methods: This survey-based cross-sectional study was conducted among 205 (male: 93, female: 112) first year medical undergraduate students of a tertiary care medical school in Chennai, Tamil Nadu, India. The questionnaire consisted of demographic data, four true or false type, three open-ended questions for knowledge, a Likert’s scale of point 1-5 to assess the perceived promoting factors and barriers to taking up research during under graduation and yes or no type questions to assess the practice of research. Analysis of data were done using SPSS version 16.0 and data is expressed in proportions. Results: The survey results showed 72% of the participants had an acceptable level of knowledge on the basic research concepts and 81% of them had a high positive attitude to practice research during different years of undergraduate medical course. The mainly perceived barriers are lack of time (79%), lack of research skills training (87%) and academic overload to acquire professional skills (50%), to take up research during under graduation. Conclusion: The study participants are with moderate awareness towards research skills and very positive to take up research during their under graduation period. The structured research skills training and effective support system will help them to overcome the barriers and motivate them to undertake research and also pursue research as a career.

Characteristics and Pregnancy Rate of IVF-ICSI Patients with Short Antagonist Protocols: A 4-Year Single Center Retrospective Study

Introduction: In-vitro Fertilisation-Intracytoplasmic Sperm Injection (IVF-ICSI) is a modern technology where a sperm is injected into an ovum. IVF-ICSI is a solution to overcome infertility when all other assisted reproductive technique is not successful. The short antagonist protocol is the most commonly performed ovarian stimulation and the preference in many IVF clinics. The pregnancy rate for IVF-ICSI program in each clinic is influenced by variety of factors. Aim: To study the success rates and patients characteristics that would increase the pregnancy rate in the IVF-ICSI patients with short antagonist protocols for ovarian stimulation. Materials and Methods: Medical records of patients who participated in IVF-ICSI program in IVF clinic, from January 2014 to December 2017 were studied. The data were then analysed using Chi-square test. Results: A total of 428 IVF-ICSI patients met the inclusion criteria; 191 (44.6%) had clinical pregnancies. The mean age of the study population was 33.06±4.529 (22-45) years, the mean maternal BMI was 24.49±4.193 (15.8-43.5) kg/m2 , and the mean duration of infertility was 6.03±3.594 (0-20) years. The number of oocytes obtained Ovum Pick Up (OPU) was 6.74±3.726 (1-22) and mean number of Embryo Transfer (ET) was 2.58±0.946 (1-4). The clinical pregnancy rates significantly increased with the maternal age below 35 years (p=0.017), normal BMI (p=0.016), infertility period less than six years (p=0.005), oocytes more than five obtained during OPU (p=0.001), and three embryos transferred during ET (p=0.003). Conclusion: The pregnancy rate of IVF-ICSI patients with a short antagonist protocol and fresh ET was 44.6%. The number of oocytes more than five obtained during OPU and three embryos transferred during ET significantly increase the pregnancy rates, while the characteristics of patients who are more likely to be pregnant stastistically are maternal age less than 35 years, a normal BMI, and infertility period of less than six years.

Correlation of Brachial Cuff Oscillometric Device Based Central Haemodynamic Indices with Syntax Score in Patients with Coronary Artery Disease

Introduction: Early recognition of atherosclerosis is important, considering the epidemic proportion of Cardiovascular Disease (CVD) across the world. Non invasive methods of estimation of central blood pressure and other parameters help in early recognition of atherosclerosis. Aim: To measure the Central Haemodynamic Indices (CHIs) by a non-invasive brachial cuff based oscillometric methodCentral Blood Pressure (CBP), Central Pulse Pressure (CPP), Pulse Pressure Amplification (PPA), Augmentation Index (AIx), Augmentation index @ 75, Reflection coefficient, Pulse Wave Velocity (PWV), Total Peripheral Resistance (TPR). To evaluate the Angiographic severity of patients by Syntax Score (SS) and correlate with the CHIs. Materials and Methods: The present study was a hospital based observational study. A total of 120 patients presenting with symptoms suggestive of Coronary Artery Disease (CAD) with age >18 years and those willing to undergo conventional coronary angiography were included. Patients with cardiogenic shock, Chronic kidney disease (eGFR <30 mL/min), malignancy, hepatic dysfunction, pregnancy, and contraindications to angiography were excluded. All the patients underwent coronary angiography and the SS was calculated. Patients were grouped into low, intermediate and high SS based on the scores. The CHIs obtained were then compared among the groups of low, intermediate and high SS to identify the parameters which correlate with severity of CAD. Pearson correlation coefficient (r) for the correlation of the CHIs with SS and the Receiver Operating Characteristic (ROC) curve analysis with Area Under Curve (AUC) was done for the cut-off values to predict significant CAD. Results: Males were predominant than females with ratio of 4:1. Most patients, 54 (45%) were between 51 and 60 years. Most of the patients were having dyslipidemia 70 (58.33%), followed by hypertension 58 (48.33%). High SS patients were found to be having diabetes (26 vs. 2 vs. 10), dyslipidemia (45 vs. 17 vs. 8), and increased BMI (27.16±2.55 vs. 22.65±2.12 vs. 21.80±1.73, p=0.001) compared with intermediate and low SS patients respectively. There was no significant difference between males and females, when the various CHIs measured by the oscillometric device were compared but were statistically significant when compared among the groups according to SS. The cut-off points for AP, AI, PWV in predicting the patients with CAD (SS >23) according to ROC curves are 9.5 mmHg, 23.7, 9.35 m/sec respectively. Conclusion: CHIs assessed noninvasively have a significant role in the clinical evaluation and an incremental value in the risk stratification of the CAD patients.

Impact of Remedial Teaching for Low Achievers in Pharmacology to Improve their Academic Performance

Reneega Gangadhar, Charmila Veeraswamy, Supriya Selvakumar Suseela

Introduction: Remedial teaching helps in finding specific learning difficulties and provides suitable remedial measures and support to prevent them in future; thus resolving learning difficulties in low achievers. Aim: To identify the reasons for low achievement of the students in pharmacology and also to assess the effectiveness of remedial teaching. Materials and Methods:It was a quasi experimental study (Pre-test Post-test design) conducted in the Department of Pharmacology, SMIMS among fifth semester-low achieving students of the additional batch, for a period of three months. Eleven students whose score were <60% in the fourth semester exam were selected and administered a questionnaire format which contained 20 statements regarding the curricular and noncurricular causes for their low performance. The responses were analysed on a 5 point Likert scale. Pre-test, Remedial teaching (using class assignments) and Post-test were conducted and finally statistical analysis was done using SPSS version 16. Results: Poor performance in low achievers in Pharmacology was found to be mainly due to curricular causes. There was statistically significant difference (p-value <0.05) between Pretest and post-test for assignments. There was also significant difference between fourth sessional and send up marks after remedial teaching. Conclusion: Remedial teaching helps low achievers to score better. Implementing this program right from the beginning will help low achievers to improve their academic performance.

Cytomegalovirus Seroprevalence and Immunity in Indian Perinatal Women: Experience of a Cord Blood Bank

Introduction: Cytomegalovirus (CMV) is a DNA virus and member of herpes virus family, which is known to frequently infect, a growing fetus by vertical transmission. Since the frequency of congenital infection in newborn infants tends to vary with the prevalence of infection in population, the need to determine immunity against CMV, in perinatal women cannot be over emphasised. Aim: To perform a retrospective data analysis over 8 years to find out seroprevalence of CMV in Indian women in perinatal period. Materials and Methods: Large scale retrospective data analysis was carried out over eight years and on 23,029 maternal samples tested in perinatal period with uncomplicated pregnancies, at Regrow Biosciences Private Limited, India. The humoral response to CMV infection was determined by ELISA test for CMV IgG and IgM. Results: Out of 23,029 maternal samples, 21,312 (92.5%) were IgG positive, 1,717 (7.5%) were CMV IgG negative and 23,029 (100%) were CMV IgM negative. Conclusion: CMV infection is significant factor for Bad Obstetric History (BOH) and results in poor fetal outcome. Therefore, extensive serological screening of CMV infection attains utmost importance to know the factual status of this infection amongst women of childbearing age. Overall conclusion is that in Indian women population, zero prevalence of active CMV infection with uncomplicated pregnancy has been observed. However, the prevalence of high IgG antibody titers is substantial (92.5%) which is consistent with findings in other developing countries.

Low-dose Misoprostol for Second Trimester Pregnancy Termination in Women with a Prior Caesarean Delivery

Emine Aydin, Ozgur Ozyuncu

Introduction: Termination of Pregnancy (ToP) is an obstetric procedure that can be performed by surgical or medical techniques during the first or second trimester of pregnancy. Medical ToP is recommended in the second trimester owing to its low rate of maternal morbidity. Low-dose misoprostol is an effective option in such cases. Aim: To compare the safety and efficacy of two different vaginal misoprostol regimens for ToP in the second trimester in women with previous Caesarean Deliveries (CDs), against controls. Materials and Methods: This retrospective study was conducted at a university hospital, between January 2005 to December 2014. The study cohort was divided into two groups: history of CD (Group I, n=85) and control (Group II, n=434). The method used for ToP was chosen with respect to history of CD. Four doses of 50 µg misoprostol and 4 doses of 200 µg misoprostol were applied vaginally each day, until regular uterine contractions were observed, to Groups I and II, respectively. Indication of ToP, gestational age at the ToP (weeks), duration from induction to abortion (hours), total misoprostol dose (µg), foetal weight (gram), post-abortion hospitalisation time (day), and any complications were recorded. The Chi-square or Fisher’s-Exact test was used for qualitative data, and the Student’s t-test or Mann-Whitney U-test was used for quantitative data. The p<0.05 was considered significant. Tests were performed using the SPSS statistical package for Windows, version 17 (SPSS, Chicago, Illinois, USA). Results: The success rate of termination was 91.8% (78/85) in Group I and 99.1% (430/434) in Group II (p<0.001). The median induction to abortion interval was 54.08±42.85 hours for Group I and 47.19±31.39 hours in Group II (p=0.371). One case of uterine rupture was recorded in Group I (p=0.164). The incidence of requiring transfusion for haemorrhages was higher in Group I than in Group II (5.9% vs. 1.6%, respectively, p=0.032). Conclusion: Low-dose vaginal misoprostol appears to be a safe and effective procedure for second trimester ToP in women with a history of CD.

Antibacterial Activity of Homoeopathic Tinctures on Bacterial Strains of Streptococcus mutans and Enterococcus faecalis: An In vitro Study

Viraj Satish Yalgi, Kishor Gajanan Bhat

Introduction: In view of increasing resistance to existing antimicrobial agents herbal drugs are being looked as very important source for discovery of new agents for treating various ailments related to bacterial infections. Hypericum perforatum, Arnica Montana, Echinacea Angustifolia and Calendula Officinalis are well known homoeopathic tinctures which possess a wide range of pharmacological activities. Aim: The present study was carried out to investigate the antibacterial activity of Hypericum perforatum, Arnica Montana, Echinacea angustifolia and Calendula officinalis against two strains of bacteria namely Streptococcus mutans, Enterococcus faecalis. Materials and Methods: The antibacterial susceptibility of the Mother tinctures was determined by disc diffusion method and minimum inhibitory concentration. Two bacterial strains S. mutans (ATCC No 25175) and E. faecalis (ATCC No 35550) were obtained from department of microbiology Maratha Mandal’s Nathajirao G Halgekar Institute of Dental Sciences and Research Centre Belgaum. For disc diffusion testing, blood agar and brain heart infusion agar were used. After inoculum preparation, the agar plates were incubated for 24 hours at 37 degree Celsius. For minimum inhibitory concentration 9 dilutions of each drug were done with brain heart infusion broth. Then serial dilution was repeated upto 10-9 dilutions for each drug and then the above culture containing the strains of microorganisms used were added and the tubes were incubated for 24 hours at 37°C. Results: For agar diffusion among the tinctures largest zone of inhibition for S. mutans was seen with Hypericum perforatum and for E. faecalis largest zone of inhibition was seen with Echinacea angustifolia. Arnica Montana also exhibited good antibacterial activity with both organisms whereas Calendula officinalis demonstrated lower inhibitory activity with E. faecalis and no activity with S.mutans. The Minimum Inhibitory Concentration (MIC) for all the tinctures for S. mutans was 62.5 mg/mL and for E. faecalis the MIC for Hypericum perforatum was 1 mg/mL for Arnica Montana and Echinacea angustifolia 4 mg/mL and for Calendula officinalis 16 mg/mL. Conclusion: So, it was concluded that all the homoeopathic medicines used in the form of tinctures exhibited good antibacterial activity against both strains of bacteria, except for Calendula officinalis for disc diffusion against S.mutans but with Hypericum perforatum the highest activity was observed. The use of homoeopathic tinctures is safe and may provide a good alternative for use as antibacterial agents.

Correlation of Anti Mullerian Hormone with Homeostatic Model Assessment-Insulin Resistance in Polycystic Ovarian Syndrome and Normally Ovulating Women

Introduction: Polycystic Ovarian Syndrome (PCOS) is the most common metabolic syndrome in reproductive age group women with incidence of approximate 3.7% in Northern India. It is characterised by chronic anovulation, polycystic morphology of the ovaries and hyperandrogenism and predisposes women to Gestational Diabetes Mellitus (GDM), Type II Diabetes Mellitus, dyslipidemia, hypertension and coronary vascular disease later in life. Aim: To study correlation of Antimullerian Hormone (AMH) with fasting plasma glucose, serum fasting insulin, triglyceride and Homeostatic Model Assessment-Insulin Resistance (HOMA-IR) in PCOS and normally ovulating women. Materials and Methods: This was a hospital based observational study conducted in the Department of Gynaecology for a period of 1 year in 2018. The study included 40 PCOS and 40 normally ovulating women of similar age. After taking consent, history and examination, ultrasonological evaluation of ovaries was done in order to identify PCOS and normally ovulating women. A fasting sample was tested for serum fasting insulin, fasting plasma glucose, triglyceride and HOMA-IR were calculated. A blood sample was tested for serum AMH, androgens (DHEAS, Testosterone), Luteinising Hormone (LH) and Follicle Stimulating Hormone (FSH) levels on day 2 of menstrual cycle for all the women. Statistical analysis was done by using IBM SPSS version 25.0. Results: BMI, Serum AMH, fasting insulin, fasting plasma glucose, HOMA-IR, triglyceride, androgens (Testosterone and DHEAS) were high in PCOS women as compared to normally ovulating women (p-value <0.001, <0.001, 0.009, <0.001, 0.005, <0.001, <0.001 and 0.011, respectively). There was a significant positive correlation between AMH and Fasting insulin, HOMA-IR and Triglycerides in PCOS group (p-value 0.01, 0.002 and <0.001 respectively) but the correlation between AMH and fasting blood glucose was not statistically significant (0.059). Conclusion: PCOS is associated with spectrum of metabolic abnormality like hyperandrogenism, insulin resistance, hyperlipidemia. The positive correlation of AMH with insulin and HOMA-IR indicates insulin resistance and risk of GDM and Type II diabetes mellitus in PCOS women with raised AMH. The positive correlation of AMH with triglyceride in PCOS women also indicates risk of hyperlipidemia and its complications like risk of cardiovascular diseases.

Benign Glandular Lesions of Urinary Bladder: Diagnostic Dilemma and Clinical Significance

Prasad Mylarappa, Sandeep Puvvada, D Ramesh

Introduction: Different types of glandular lesions are seen in the urinary bladder which pose a significant diagnostic dilemma. Aim: To report modalities of diagnosis, management and follow-up of patients with glandular lesions of the bladder. Materials and Methods: This was a retro-prospective study of 16 consecutive patients of urinary bladder glandular lesions. The data were obtained from hospital records. These patients underwent urine cytology, ultrasonography and contrast-enhanced computed tomography. All patients underwent cystoscopy with biopsy of the lesion or Transurethral Resection of Bladder Tumour (TURBT) and were followed-up for 6-34 months after surgery. Results: There were 11 females (68.7%) and the median age was 34 (17-48) years. The most common symptom was dysuria, frequency, and nocturia. The most common site of tumour was at the trigone (68.8%) followed by lateral wall (25%) and dome (6.3%). The commonest macroscopic appearance was a papillary lesion (68.8%) followed by polypoidal (18.7%) and flat lesions (12.5%). Fourteen patients underwent TURBT (87.5%) and two patients underwent bladder biopsy (12.5%). Two patients (14.3%) with TURBT developed recurrence of tumour after 1.5 and 2 years, while one of the patient with bladder biopsy developed recurrence of the lesion after nine months. The most common histopathological finding was a combination of cystitis cystica with cystitis glandularis (31.3%). Conclusion: Results suggest that a combination of various investigation modalities and a high index of suspicion is required in establishing the diagnosis. The accurate diagnosis could be established after histopathological examination of the resected specimen or bladder biopsy.

3D Printed Organs: The Future of Regenerative Medicine

Rahul Badwaik

Three-dimensional (3D) printing has been recently looked upon as a method to quickly obtain predesigned tissue scaffolds. They have the potential to cater to the increasing demand for organ replacement. An ideal replacement 3D printed tissue should be biocompatible, mechanically durable and should be able to mold easily. The ability to build personalised or patient-oriented implants containing either cells, bioactive drugs or proteins have made the 3D printing technology revolutionary in the clinical field. Researchers have identified a large number of biomaterials which can be used in clinical settings. The 3D printed organs have the potential to bring an era of personalised medicine as 3D printed organs can relieve the burden of organ transplants and donors. Additionally, it will also help reduce healthcare and associated costs because of reduced waiting time for organs, leading to fewer days of hospitalisation and a lower rate of transplant rejections. Increased organ supply can also help decrease the death rate for some chronic diseases. This review aims to provide an overview of the basic principles and techniques used in 3D printing technology. A brief overview of recent advances of 3D bioprinting and clinical applications has also been presented. This review also includes updates on Indian 3D bioprinting industry.

Pneumocystis jirovecii Pneumonia: A Revisit to the Old Malady

Kante Meenakshi, Racherla Rishi Gowtham, Kalawat Usha

Pneumocystis jirovecii Pneumonia (PJP) was previously called as Pneumocystis carinii Pneumonia (PCP), it is one of the most common opportunistic fungal infection in immuno-compromised individuals. Patients may present clinical symptoms such as fever, non-productive cough, chills, weight loss, dyspnoea, shortness of breath and respiratory failures in severe cases. Clinical samples such as Sputum, Induced sputum, Bronchio Alveolar Lavage fluid (BAL), Pleural fluid and Lung tissue are used for identification of Pneumocystis infection. Diagnosis of Pneumocystis jirovecii is done by staining, serology, in-vitro cultivation and molecular methods. Different types of Polymerase Chain Reaction (PCR) assays can be used for different gene targets for detection of Pneumocystis. PCR assays are most sensitive and specific methods which can be useful for detection of P. jirovecii from infected individuals, recurrent PJP patients. Treatment of PJP infection is based on the severity of the illness and diagnosis. Evidence based guidelines should be followed for giving proper treatment. If treatment is not given, the patient will die with PJP infection. Trimethoprim/Sulfamethoxazole (TMP-SMZ) is given as an early treatment prophylaxis in patients with PJP. If side effects are severe with TMP-SMZ, other drugs include Pentamidine, Trimetrexate, Atovaquone, clindamycin and primaquine combined with leucovorin, dapsone and Caspofungin combined with clindamycin can be given as alternative drug regimen to the patients with PJP infection. Wide spread and long term usage of PJP prophylaxis can lead to rising new cases of dihydropteroate synthetase (DHPS) mutant strains. Extensive utilisation of TMP-SMZ and dapsone in Human Immunodeficiency Virus (HIV) and other immuno-compromised individuals can lead to sulfa (sulfonamide or sulfone) drug resistance. Evaluation of drug resistance is complicated in HIV patients and finally further advance research is required for strategies development as well as to stop the further increase of resistant strains. New diagnostic methods and usage of non-invasive respiratory specimens such as oral washes for diagnosis of PJP should be expanded. PCR is the most sensitive method compared to other conventional and serological methods. Using PCR and Sequence analysis can be helpful for estimation of prevalence of disease as well as epidemiological purposes. There is an urgent need to develop newer drugs and vaccines to eradicate the PJP disease burden. This review of literature gives recent information on PJP by highlighting epidemiology, taxonomy, pathophysiology, mortality, present situation, recent diagnostic methods, recommended immuno-prophylaxis and recent advances.

Myofascial Trigger Points in Adhesive Capsulitis: A Systematic Review

Reepa Avichal Ughreja, Mukesh Dhungana, Prakriti Awasthi

Introduction: Adhesive Capsulitis (AC) causes musculoskeletal disorder of shoulder which is a common reason for loss of function and disability in patients. Several interventions have been used for treatment of AC but very few of them have taken into consideration “Myofascial Origin” as a probable cause of pain. Aim: To review the current literature related to prevalence, diagnosis, and treatment of “Myofascial Trigger Points (MTrPs) in AC”. To compare the prevalence of MTrPs in Diabetic and Non-Diabetic patients. Materials and Methods: Google Scholar, Pubmed, Cochrane library, Central register for clinical trial were searched for published randomised controlled trials, systematic or literature reviews, case study, pilot study and book references in English language from inception till December 2018. Out of total 1833 results identified, 7 relevant studies with a total of 190 patients were finally selected for the review. Four studies were analysed for methodological quality using Pedro tool for randomised controlled trial and National Institutes of Health tool for observational study and case reports. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement (PRISMA). Results: Among all the articles, three of them discussed about the prevalence of MTrPs in AC. These studies showed the greater prevalence of MTrPs in subscapularis muscle which may be the cause for pain and restricted shoulder movements. There was no study on diagnosis of MTrPs in AC. The studies (four in number) which showed the efficacy of treatment of MTrPs included techniques like Myofascial release technique+deep stroking (Niel Asher Technique), Ischaemic Compression of MTrPs, Dry Needling, Infiltration of Subscapularis TrPs with Subscapularis nerve block. Conclusion: MTrPs acts as an important contributing factor for causing pain, movement restriction and disability in the patients. Interventional studies have found significant improvement in shoulder pain and function but the exact method and the muscles which received the treatment were not mentioned. This review suggests that, there is need for good quality studies related to the prevalence, diagnosis and treatment of MTrPs in AC subjects with Diabetes Mellitus as well as without Diabetes Mellitus.

Effect of Dynamic Balance Training on Agility in Adolescent Volleyball Players

Harsha Vikas Gadre, Deepti Chaitanya Lele, Medha Deo, Chhavi Mathur

Introduction: Sports training is perching as a new trend and encourages young children to participate in competitive sports. Balance training has been an integral part of conditioning in several sports as it has been a key factor in improving performance of players after sustaining ankle and knee injuries. Aim: To study the effect of active, intensive and dynamic balance training on improving the agility of young volleyball players and comparing effectiveness of the training with gender difference. Materials and Methods: Study design was a one group pre-post-test design. Based on inclusion and exclusion criteria, 30 young healthy volleyball players in the age group of 12 to 16 years from a school volleyball team were selected. There were 14 boys and 16 girls. Anthropometric measurements were taken and Body Mass Index (BMI) was calculated for every participant. All the children underwent structured intensive balance training for 4 weeks (6 days/week). Pre and post training t-test of agility assessment was done. Paired t-test applied to see the difference in the performance pre and post training in agility. Unpaired t-test was applied to compare between the pre and post values of the male and female population. Results: Paired t-test, pre and post values of t-test of agility showed significant difference (p<0.05) and unpaired t-test was applied to compare between the pre and post values of male and female population, whereas when compared between boys and girls it did not show clinically significant difference. As per statistical analysis using paired t-test, balance training has a significant impact in improving agility of the young volleyball players. When compared within the groups using unpaired t-test, there was no statistically significant change seen in performance in both boys and girls, but clinically girls showed improvement in agility. Conclusion: Study shows that balance training is effective in improving agility. Clinically females performed better than males but change in performance was not statistically significant. Hence, it can be concluded that balance training is equally effective in improving agility for both genders. From the pre and post training changes in t-test of agility findings it can be concluded that balance training improves agility. Balance training has an equal effect in improving agility for males and females, it is gender indifferent. Scope of further research is there, using multiple outcome measure or with elder age group and larger sample size.

Correction :2016 Apr: 10(4): TD05-TD07

Shavitri A Mahendiran, A. Jill Leibman, Adam S. Kornmehl, Male Breast Abscess Secondary to Actinomycosis: A Case Report (Published in Journal of Clinical and Diagnostic Research. 2016 Apr: 10(4)). In this article there was a typo error in the surname of the third author. This has been corrected.