Journal of clinical and diagnostic research

Altered Lung Function Test in Asymptomatic Women Using Biomass Fuel for Cooking

Jeneth Berlin Raj.T

Background: One third of the world’s population use biomass fuel like wood, dung or charcoal for cooking. The smoke from these organic materials increases the incidence of respiratory illness including chronic obstructive pulmonary disease and lung cancer. Aim: To evaluate forced expiratory lung volumes in asymptomatic women previously exposed to biomass fuel smoke. Materials and Methods: The study was done in 74 healthy asymptomatic women divided into two age matched groups of 37 each. Pulmonary function tests (PFT) were assessed by computerised spirometry and statistical comparisons done on women using biomass fuel (study group) and women using other sources of fuel (LPG/ electric stove) for cooking (control group). Results: The PFT results showed significant reduction in forced expiratory lung volumes like Forced Vital Capacity (FVC), Forced Expiratory Volume in 1st sec (FEV1), Forced Expiratory Flow between 25-75% (FEF 25-75%) and Forced Expiratory Volume percentage (FEV1%) in biomass fuel users as compared to those not exposed to biomass fuel smoke. Conclusion: The results of this study suggest that biomass fuel smoke may produce definite impairment in lung function, especially with regard to the smaller airways.

Clinicopathological Profile of Benign Soft Tissue Tumours: A Study in a Tertiary Care Hospital in Western India

Bharti G Ramnani, Ashutosh Kumar, Shruti Chandak, Amar Ranjan, Mehul Kumar Patel

Introduction: The incidence of soft tissue tumours, especially the frequency of benign tumours relative to malignant ones, is nearly impossible to determine accurately. Benign soft tissue tumours outnumber malignant tumours by a wide margin. Objectives: The main purpose of this study was to look into the clinicopathological profile of benign soft tissue tumour in terms of hospital incidence of age, sex, site distribution and comparison of histological types of benign soft tissue tumours with other similar studies. Materials and Methods: The operated specimens or biopsy material of benign soft tissue tumours received from January, 2010 to July, 2010 in the Department of Histopathology of our hospital, were studied in detail. Age and sex incidence, site of lesion, clinical features, gross and microscopic appearance were carefully studied. Results: In our study, most common benign soft tissue tumour was lipoma (50.8%) followed by hemangioma (17.5%) which in turn was followed by neurofibroma, angiofibroma & schwannoma. Most common age group for benign soft tissue tumour were 31-40y (27.5%) followed by 21-30y (22.5%). Overall a male predominance was seen with 60.83% in males. The most common site of occurrence of benign soft tissue tumour overall was found to be trunk (25%), followed by upper extremities (21.7%), lower extremities (17.5%) and nose and nasopharynx (10.8%) in that order. Conclusion: With our study, we were able to reassess the clinical profile of soft tissue tumours and their different types with respect to age, sex, site distribution.

Urinary Tract Infection: Aetiology and Antimicrobial Resistance Pattern in Infants From A Tertiary Care Hospital in North India

Nirmaljit Kaur, Shweta Sharma, Shalini Malhotra, Preeti Madan, Charoo Hans

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood. Present study was undertaken to determine the occurrence of the uropathogens and their antimicrobial susceptibility pattern in infants (< 1yr) suspected with UTI. Materials and Methods: This study was conducted in the Microbiology Department on urine samples received from infants for a period of two years from September 2011 to August 2013. Results: Culture positivity rate was found to be 15.7%. There was an overall male preponderance in cases of UTI (70.1%). Most common bacterial isolate was E.coli (45.4%) followed by Klebsiella (16.7%) and Enterococcus spp (13.2%). Isolation of candida was 21.1%, maximum from ICU (63.1%). Maximum gram negative isolates (50%) showed high resistance to gentamicin, amikacin, cefotaxime and norfloxacin while most of the isolates (5%) were found susceptible to nitrofurantoin and piperacillin-tazobactam. 45.1% of gram negative bacilli were ESBL producer. We recommend continuous monitoring of changes in bacterial pathogens causing UTI and antibiotic sensitivity in each area for effective treatment of UTI. Conclusion: Since antimicrobial resistance is a major problem, such study will help in formulating a strict antibiotics prescription policy in our country.

Foetal Autopsy-Categories and Causes of Death

Uroos Fatima, Rana Sherwani, Tamkin Khan, Sufian Zaheer

Introduction: Intrauterine death(IUD)/ Stillbirth forms a major part of perinatal mortality which thereby is a good indicator of pregnancy wastage as well as quality of healthcare available. The key objectives of autopsy examination are to know the cause(s) of death, elucidation of pathogenic mechanism and quality control of clinical management. The aim of this study was to identify the prevalent causes of IUD, thereby taking appropriate measures to prevent them and decrease the perinatal mortality rate. Materials and Methods: The study included 14 cases of IUD received for autopsy in the Department of Pathology over a period of five years. Autopsies were performed as per standard protocol and included full anthropometric profile, external examination, gross and microscopic evaluation of different organs and placenta. Results: Total number of 14 fetal autopsies were performed over a period of 5 years. The causes were broadly classified as fetal, maternal and placental. Placental causes were seen in majority of cases (48.57%) followed by fetal (35.72%) and then maternal (21.42). Most prevalent cause of death was congenital anomalies (28.6%) followed by placental insufficiency (21.4%) and chorioamnionitis (14.2%). Conclusion: Determination of causes of fetal death would prove beneficial to the clinicians and parents for better management and care in future pregnancies as well as in genetic counseling.

Squash Cytology in Neurosurgical Practice: A Useful Method in Resource-Limited Setting with Lack of Frozen Section Facility

Manish Agrawal, Shiv kumar Chandrakar, Dharampal Lokwani, Manju Raj Purohit

Background: Intra-operative cytology is an important diagnostic tool. It has shown to play an important role especially in the diagnosis of central nervous system tumours. The study was done to assess the feasibility of squash cytology as standalone diagnostic test in setting where frozen section facility is not available. Materials and Methods: Total 48 patients with various intracranial lesions were initially enrolled in the study. Patients were investigated by various radio-imaging techniques and routine blood investigations. Forty-one patients were operated at Netaji Subhash Chandra Bose medical college, Jabalpur. Intra-operative squash cytology diagnosis was performed and was correlated with histology diagnosis as gold standard. Results: Out of 41 patients, inflammatory lesions were diagnosed in nine patients while benign lesions [most common neurilemmoma and meningioma] were observed in 21 and malignant lesions [astrocytoma was most common] were diagnosed in 11 patients. Diagnostic accuracy of intra-operative squash cytology irrespective of lesion & site was 95%. We were able to inform about the diagnosis to neurosurgeon in 15 minutes in all cases and within 12 minutes in >85% cases. Conclusion: Squash smear cytology is reliable and rapid standalone diagnostic method and it can assist for intra-operative decision-making diagnosis of intracranial lesions in resource-limited settings where frozen section facility is not available.

Fine Needle Aspiration Cytology of Male Breast Lesions – A Retrospective Study Over a Six Year Period

Background: Fine needle aspiration cytology (FNAC) has a well-established role in the management of palpable breast lumps. However breast masses in males are rarely aspirated and hence there is limited cytopathologic experience. The aim of our study was to determine the efficacy of FNAC in the diagnosis of male breast lesions and also we attempted to describe the cytomorphological features of some of these lesions. Materials and Methods: Data on male breast FNAC done between 2008 to 2013 were retrieved from the records of the cytopathology laboratory. FNAC diagnosis were categorized as benign, malignant, suspicious for malignancy and inadequate or unsatisfactory. Cytohistologic correlation was done with data from histopathology records. Sensitivity, specificity and diagnostic accuracy were calculated using standard statistical methods. Results: Forty out of 1098 patients undergoing breast FNAC were males. Histopathology was available in 8 (20%) out of 40 cases. There were no false positive or false negative diagnoses. FNAC had a sensitivity, specificity and diagnostic accuracy of 100% for male breast lesions. Conclusion: FNAC is a very accurate tool for the diagnosis of male breast lesions. It is highly sensitive and specific with good cytohistologic correlation. To reduce the high rate of surgical biopsies of benign male breast masses, we conclude that FNAC should be performed as a standard procedure in the clinical evaluation of male breast lesions.

A Study of Anatomical Variations of Osteomeatal Complex in Chronic Rhinosinusitis Patients-Ct Findings

Anita Aramani, R.N.Karadi, Saurabh Kumar

Background: Chronic rhino sinusitis (CRS) is the most common disease for which consultation of otorhinolaryngologist is sought. The approach to patients with chronic rhino sinusitis is endoscopic surgery which aims at removing the obstruction of the main drainage pathway. The osteomeatal complex based essentially on the concept that such obstruction perpetuates the sinus disease. This in turn requires the surgeons to have detailed knowledge of the anatomy of the lateral nasal wall, paranasal sinuses and surrounding vital structures and of the large number of anatomical variants in the region. Aim: To study anatomical variations of osteomeatal complex in chronic sinusitis patients. Materials and Methods: Descriptive Cross-sectional study design in which 54 consecutive cases of chronic rhino sinusitis patients attending the ENT outpatient department, who had chronic sinusitis for more than three months duration not responding to the medical line of treatment and who were willing to undergo Functional Endoscopic Sinus Surgery satisfying the inclusion criteria were studied. The results were expressed in percentage and proportions. Results: In our study it was observed that 53.7% of the chronic sinusitis cases had two or more anatomical variations and 33.3% of the cases had single anatomical variation. Deviated nasal septum was found to be the most common amongst the anatomical variations in chronic sinusitis cases in the present study which was followed by unilateral concha bullosa and paradoxically bent middle turbinate. Agger nasi cell and Haller cell were seen in one case each. Conclusion: Prevalence of multiple anatomical variations was more in our study in comparison to single anatomical variation. Deviated nasal septum was the most common anatomical variation encountered in our study followed by concha bullosa.

Acute Angle Closure Glaucoma with Capilllary Leak Syndrome Following Snake Bite

Chidanand Kulkarni, Twinkle Ann George, Asha Av, Risha Ravindran

Introduction: Acute angle closure glaucoma is rarely seen as complication of snake bite.We report three cases of bilateral acute angle closure glaucoma with capillary leak syndrome and acute renal failure secondary to hematotoxic snake bites. We are also briefly discussing the association of capillary leak syndrome and angle closure glaucoma in hematotoxic snake bite. This is the first time an association between angle closure and capillary leak syndrome following snake bite is reported. Study type: Descriptive case series. Materials and Methods: Records of all patients admitted to ICU with snake bite were reviewed to identify cases developing acute angle closure glaucoma. These cases with acute angle closure glaucoma are analysed in detail for systemic condition. Diagnosis, management and outcome of cases are described. Results: Of the 119 snake bites admitted, 47 patients had confirmed hematotoxic snake bite. Fifteen of these patients underwent hemodialysis for acute renal failure. Seven of them were diagnosed to have capillary leak syndrome and all of them complained of decreased vision. Three of the 7 cases had acute angle closure glaucoma on the second day of bite. One of the patients expired and other two recovered fully, both of them had normal IOP and good vision at one month follow-up. Conclusion: Acute angle closure glaucoma seems to be associated with systemic capillary leak syndrome in hematotoxic snake bite. High suspicion, early recognition, timely and appropriate treatment can prevent visual loss in this rare complication.

A Comparative Study of Lateral Sphincterotomy and 2% Diltiazem Gel Local Application in the Treatment of Chronic Fissure in Ano

Giridhar C. M, Preethitha Babu, K. Seshagiri Rao

Introduction: Anal fissures are commonly encountered in routine clinical practice. Anal fissure has traditionally been treated surgically. Developments in the pharmacological understanding of the internal anal sphincter have resulted in more conservative approaches towards treatment. In this study we compare symptomatic relief, healing and side effects of topical 2% Diltiazem gel and lateral internal sphincterotomy in the treatment of chronic fissure in ano. Materials and Methods: In this prospective trial, 60 surgical out patients and/or admitted patients with chronic fissure in ano were randomly divided into Group 1 (Diltiazem gel) and Group 2 (internal sphincterotomy) with 30 patients in each Group. Patients were followed up at weekly intervals for six consecutive weeks and biweekly for subsequent 3 months. Results: Fissure was completely healed in 88.46% of patients in Group 1 and in 100% in Group 2. The mean duration required for healing of fissure was 5.04 weeks in Group 1 and 3.6 weeks in Group 2. 78.26% patients were free from pain in Group 1 whereas 85.18% patients were free from pain in Group 2. No patient had any side effects in either group. Conclusion: Topical Diltiazem should be considered as first line treatment in chronic fissure in ano. Internal sphincterotomy should be reserved for patients with relapse and therapeutic failure to prior pharmacological treatment.

Combination of Liechtenstein Repair with Herniorrhaphy in Open Inguinal Hernia Repair- A Prospective Observational Single Center Study

Mahesh Pukar, Dhairya Lakhani

Context: This study is about documentation of a technique which includes a combination of both hernioplasty and Herniorrhaphy, and its outcome in terms of recurrence rate and postoperative complications. It also compares the outcome of this method with routinely used techniques reported in the literature. Materials and Methods: LR with Herniorrhaphy was performed in the patients admitted with inguinal hernia under concerned surgeon. Their follow-up was assessed after 12 months. Incidences of recurrence rate and other postoperative complications like painful scar, atrophy of testis, urinary retention, hematoma, sinus and infection were noted and compared with other techniques of repair from published data. Statistical Analysis: was carried out by calculating the mean, standard deviation (SD), percentage and incidence rates. Results: LR with Herniorrhaphy performed in 475 patients showed recurrence rate of <<0.01% (n=1) and very low incidences of other postoperative complications like painful scar (0.01%, n=5), sinus (0%, n=0), atrophy of testis (0%, n=0), retention of urine (0.01%, n=6), hematoma (<<0.01%, n=1) and infection (0%, n=0); as compared to published data with different techniques. Conclusion: LR with Herniorrhaphy can be used for open inguinal hernia repair as the gold standard procedure as it has got low recurrence rate and other postoperative complications as compared to other techniques. However, the result of this study is based on the data from a single center, thus we recommend multicentric trials to test the efficacy of this technique.

Prevalence of Depression in People Living with HIV/AIDS Undergoing ART and Factors Associated with it

M.S. Bhatia, Sahil Munjal

Background: HIV/AIDS is one of the most devastating illnesses that humans have ever faced. Depression in HIV/AIDS patients is very common but the factors affecting it are not well studied. Aims and Objectives: HIV/AIDS though such a big public health problem worldwide, not enough data is available regarding association of HIV and Depression. Therefore this study was undertaken to evaluate the association between HIV/AIDS and depression in an Indian setting. Material and Methods: The study was conducted in Guru Teg Bahadur Hospital and University College of Medical Sciences, Delhi. One hundred sixty patients were interviewed using a questionnaire containing factors that affect depression. CES-D (Center for Epidemiologic Studies – Depression) scale was used to measure depression. The data collected was analyzed using SPSS software. Results: The prevalence of depression in patients with HIV under ART was 58.75%. The prevalence of depression increased with the severity of symptoms. The unemployed, uneducated, unmarried, belonging to joint families, having no or low family income, migrants, having indifferent or poor relationship with spouse, poor social support and had visited commercial sex workers had a greater prevalence of depression. Conclusion: The rate of depression in patients with HIV/AIDS is very high. Detecting depression early and treating it goes a long way in improving the compliance to treatment as well as quality of life.

An Imaging Panorama of Salivary Gland Lesions as seen on High Resolution Ultrasound

Siddappa Gurubalappa Gandage, Sushil Ghanshyam Kachewar

Introduction: Lesions of salivary gland are quite common. Clinical examination alone is not able to differentiate between them and pinpoint the exact cause. It would definitely benefit the patient as well as the doctor if they could get an idea of the exact type of lesion affecting the salivary gland. Hence, this retrospective study was undertaken to demonstrate how high resolution ultrasound imaging (HRUSG) can be useful in evaluation of salivary gland lesions. Materials and Methods: In this retrospective study, imaging findings in patients who underwent HRUSG of salivary glands in the past five years were compiled. Analysis of the imaging findings and clinico-pathological correlation was then performed in this descriptive study. Results: Out of the 87 patients referred for HRUSG of salivary glands in the last five years, characteristic findings were found in 53 patients. HRUSG diagnosis of Acute Inflammation was made in 19 cases, Chronic Inflammation in 13 cases and Primary Neoplastic Lesions in 11 cases, Metastatic deposits in 3 cases and Salivary Calculus in 7 cases. No obvious abnormality was seen in rest of the 34 patients. HRUSG was found to be 93.33 % sensitive and 98.07% specific for diagnosing neoplastic lesions in salivary glands. Conclusion: Patients with salivary gland pathologies may present either with clinically assessable symptoms or just with cosmetic deformities due to bulge in the salivary gland. Clinical examination alone cannot pinpoint the etiology. Sonography can satisfactorily enable visualization of the abnormality noninvasively. It not only confirms the presence or absence of pathology but also enables image guided tissue retrieval for final pathological diagnosis.

Laparoscopy: As a First Line Diagnostic Tool for Infertility Evaluation

Geetika Jain, Ritu Khatuja, Atul Juneja, Sumita Mehta

Introduction: The role of diagnostic and therapeutic hystero-laparoscopy in women with infertility is well established. It is helpful not only in the identification of the cause but also in the management of the same at that time. Materials and Methods: In this study, the aim was to analyse the results of 203 women on whom laparoscopy for the evaluation of infertility was done. This study was carried out at a tertiary level hospital from 2005 to 2012. The study group included 121 women with primary infertility and 82 women with secondary infertility. Women with incomplete medical records and isolated male factor infertility were excluded from the study. Results: It was observed that tubal disease was the responsible factor in 62.8% women with primary infertility and 54.8% women with secondary infertility followed by pelvic adhesions in 33% and 31.5%, ovarian factor in 14% and 8.5%, pelvic endometriosis in 9.9% and 6.1% women respectively. Thus tubal factor infertility is still a major cause of infertility in developing countries and its management at an early stage is important to prevent an irreversible damage. At the same time, it also directs which couples would be benefited from assisted reproductive technologies (ART).

The Effect of Epidural Analgesia on Labour, Mode of Delivery and Neonatal Outcome in Nullipara of India, 2011-2014

Dipti Agrawal, BelaMak hija, Manjeet Arora, Arpana Haritwal, PaPavan Gurha

Aims: This study aimed to evaluate the effect of ropivacaine epidural analgesia on duration and outcome of labour in nulliparous parturients of India with parturient not receiving any analgesia. Settings and design:One hundred and forty nulliparous parturient in established labour at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group (n=60), whereas those not enthusiastic to labour analgesia were allocated in the control group (n=60). Materials and Methods: Epidural analgesia was provided by a bolus injection of 10 ml of ropivacaine 0.2% and 50µg fentanyl and maintained by using a continuous infusion of ropivacaine 0.1% with fentanyl 2µl/ml at a 10ml/hour rate. The outcomes were duration of labour, incidence of cesarean sections and instrumental vaginal delivery and neonatal outcome. Statistical Analysis used:Statistical analysis was conducted using unpaired student t-test and chi-square test as required. All tests of significance were performed using two-tailed probability tests. Differences were considered significant when p-value was <0.05. Results: The two groups were comparable in terms of socio- demographic data. The mean duration of first stage of labour was shorter in epidural group (4.83 ± 1.59 h) compared with control group (5.48 ± 1.56 h) while the duration of second stage of labour was prolong in epidural group (33.13 ± 12.78 min) as compared to control (27.53 ± 11.73 min). Instrumental vaginal or caesarean delivery rate did not increase in the epidural group. The APGAR scores at 5 min were statistically similar in both groups. Conclusions: Epidural analgesia by ropivacaine in Indian nulliparous resulted in shorter duration of first stage and prolongs duration of second stage of labour compared with parturients without analgesia; however, instrumental vaginal or caesarean delivery rate does not increase in the epidural group.

Study of Helminthiasis in Pregnancy and its Correlation with Haemoglobin Level

Shrinivas.K., Radhika, Sreelatha.R., Kavitha.K.

Objectives: To study types of worm infestation in pregnancy and to correlate helminthiasis with haemoglobin level in antenatal women presenting in 2nd and 3rd trimester. Materials and Methods: This prospective cross sectional hospital based study conducted at Vanivilas hospital attached to Bangalore medical college, over a period of sixmonths. Study included 500 pregnant women attending antenatal opd in 2nd and 3rd trimester, selected by systematic random sampling method. Parasitic examination and haemoglobin estimation done respectively with Stool and blood samples collected from study group. Presence of parasites was correlated with haemoglobin percentage. Results: Helminthiasis was found in 62 women (12.4%). All infected women had single type helminth infection. Ascariasis was more commonly found than hookworm (10% Vs 2.4%). Anaemia of various degrees was found in 88.7% of women with helminthiasis as compared to 56.4% women without worm infestation (p-value <0.05). Conclusion: Helminthiasis is a significant burden in pregnancy and it is associated with anaemia. Hence, the policy of universal administration of anthelminthic drug in pregnancy after first trimester, as recommended by WHO should be practically enforced besides health education.

Chromosomal Aberrations and Polymorphic Evaluation in Males with Primary Infertility from Indian Population

Ushang V. Kate, Yamini S. Pokale, Ajinkya M. Jadhav, Suresh D. Gangane

Background and objectives: The chromosomal abnormalities are one of the important causes of male infertility. In view of the genetic risks for the next generation, the importance of careful evaluation of karyotype is essential. The objective of this study was to determine the frequency of chromosomal abnormalities in infertile men with primary infertility from Indian population. Materials and Methods: The 78 infertile men with primary infertility, out of which 26 men were azoospermic, 19 men were oligospermic, 4 men were asthenospermic and 29 men were oligoasthenospermic were studied. Karyoptying was performed on peripheral blood lymphocytes by using the Giemsa trypsin banding (GTG) banding technique. Additional data was collected from published studies in Indian population leading to a total of 1814 cases. Results: Chromosome analysis of 78 infertile males showed major chromosome abnormalities in 10.2%, with 6.4% in autosomal chromosome abnormalities and 3.8% in sex chromosome abnormalities. The incidence of major chromosome abnormalities in oligospermic males were 21% and azoospermic males were 15.4 %. Chromosomal polymorphic variants were identified to be 16.7%. Combining the data from other published studies identified 153/ 1814 (8.4%) infertile men of chromosomal abnormalities; with 10.8% in azoospermia, 7.3% in oligospermia and 7.3% in oligoasthenoteratospermic from India. Interpretation and Conclusion: The overall high prevalence of chromosomal abnormalities in infertile males suggests that the conventional chromosomal analysis is an important investigative tool for male infertility, especially prior to use of any assisted reproductive techniques.

Efficacy of Dental Floss and Chlorhexidine Mouth Rinse as an Adjunct to Toothbrushing in Removing Plaque and Gingival Inflammation – A Three Way Cross Over Trial

Background: Maintaining good oral hygiene is important to combat periodontal diseases. The use of tooth brush alone does not serve the purpose of removing plaque which demands the use of some adjuncts such as proximal cleaning aids. Aim: The study was conducted to compare the efficacy of Dental Floss and 0.12% Chlorhexidine Gluconate Mouthrinse as an adjunct to toothbrushing on plaque accumulation and gingival inflammation. Settings and Design: Department of Public Health Dentistry, Kothiwal Dental College and Research Centre, Moradabad, India. This was a randomized, double blind, three-way cross over clinical trial. Materials and Methods: Forty five dental students in the age group of 19-25yr. were enrolled into the study. Subjects were randomly assigned into three groups (n=15) i.e. Group A– Toothbrushing with Dental floss (TB+DF), Group B– Toothbrushing with 0.12% Chlorhexidine Gluconate Mouthrinse (TB+CHX-MR) and Group C– Toothbrushing alone (TB Alone) in a three-way crossover manner. After 21d of trial period, plaque index (PI) and gingival index (GI) were assessed for each group, oral prophylaxis followed by a washout period for 14d. Statistical Analysis used: Mean, standard deviations and p-values were obtained. ANOVA test was used to compare the intergroup difference and Post hoc test to compare between the two groups. Results: The inter-group comparison for GI and PI at all interventions showed statistically significant difference (p<0.001). While comparing between group A and group C at second and third follow up, no significant difference were observed though group A showed reduction in mean values for both the clinical parameters whereas while comparing between group A and group B, statistically significant difference was observed, which is in line when compared with group B and group C. The Group B showed more reduction in plaque and gingival scores which was found to be statistically significant (p<0.001). Conclusion: CHX-MR when used as an adjunct to toothbrushing is more effective in the reduction of plaque and gingival scores than a toothbrush alone or in combination with DF.

Chair Side Application of NovaMin for the Treatment of Dentinal Hypersensitivity- A Novel Technique

Shivaprasad BM, Padmavati P, Nehal N Sanghani

Objective: To evaluate the efficacy of calcium sodium phosphosilicate bioactive glass (NovaMin) as a chair side desensitizing agent. Materials and Methods: The study was conducted on 60 subjects divided into 3 groups of 20 each as follows. Group I (NovaMin application without scaling and root planing), Group II (NovaMin application after scaling and root planing) and Group III (control group). Sensitivity was assessed using air blast and cold water stimulus at baseline, immediately after application, after half an hour and after 8d using Visual Analog Scale (VAS) Results: Mean VAS (air blast stimulus) for group I was 5.9 at baseline, 3.4 immediately after application, 3.05 after half an hour, and 3.0 after 8 days. In group II VAS score were 6.2, 3.35, 2.9, 2.75 and group III 6.6, 7.0, 7.0, 7.0 respectively. For cold water stimulus in group I VAS score were 5.6, 3.35, 3.15, 3.1, group II VAS score 5.7, 3.35, 3.1, 2.85 and group III 5.8, 6.1, 6.05, 6.05 respectively. VAS scores in between group I and group III and group II and group III were statistically significant (<0.001) immediately after application, after half an hour and after 8days (ANOVA) Conclusion: Chair side application of calcium phosphosilicate bioactive glass can be a therapeutic adjunct to provide immediate relief for the patient with dentinal hypersensitivity.

Oral Health Knowledge, Attitude and Practices of Children and Adolescents of Orphanages in Jodhpur City Rajasthan, India

Objectives: This study had twin objectives of assessing the oral health knowledge, attitude and practices and to assess the dental caries status and treatment needs among the orphan children of orphanages of Jodhpur city, Rajasthan, India. Materials and Methods: This cross- sectional study was carried out on 100 children to assess the oral health knowledge, attitude and practices of children and adolescents of orphanages in Jodhpur city, Rajasthan, India. The data was collected on a pre-tested questionnaire which included 20 closed ended multiple-choice questions on perceived oral health status, knowledge of oral health and attitude, oral health practices, dietary habits and behaviour towards dental treatment. On completion of the questionnaire, each child underwent an oral examination and Dentition status and treatment needs index (WHO Oral Health Surveys- 1997) was recorded for each subject. Results: Almost 93% of the children felt the necessity of maintaining oral hygiene. There were 69% of the children who believed that it was necessary to brush teeth after every meal, 51% children believed that regular tooth-brushing prevents all tooth problems and 93% children knew that tobacco is carcinogenic in nature. Also, it was found that 77% of the children believed that regular dental visits help in maintaining oral hygiene. Conclusion: Many of them had acquired knowledge on oral health. More than half of the study subjects were aware of the importance of keeping good oral hygiene, regular dental visits and harmful effects of tobacco.

Promoter Hypermethylation Profile of Tumour Suppressor Genes in Oral Leukoplakia and Oral Squamous Cell Carcinoma

G. S. Asokan, S. Jeelani, N.Gnanas undaram

An In-vitro Evaluation of the pH Change Through Root Dentin Using Different Calcium Hydroxide Preparations as an Intracanal Medicament

Suneeth Shetty, M.K.Manjunath, Sunil Tejaswi

Context: The aim of the study was to evaluate the pH variation in the surrounding medium after the use of two different vehicles of Calcium hydroxide – Saline (aqueous), Propylene glycol (viscous) and Calcium hydroxide containing guttapercha points over a period of 7 days as an intracanal medicament. Materials and Methods: Sixty single rooted premolars were decoronated at the cementoenamel junction and cleaned and shaped uptil size 40 master apical file. External defects were made on the mesial surface in the coronal third of the roots and divided randomly into 4 groups. One control and three experimental. In the control - group I the root canals were left empty. In the experimental groups - group II was filled with Ca(OH)2 + saline, group III was filled with Ca(OH)2 + propylene glycol and group IV the root canals were filled with Calcium hydroxide points. The coronal accesses were sealed with 3mm of Cavit G and all the surfaces of the root except the defect were covered with 3 coats at Nail varnish. The samples were then placed in air tight vials containing 2ml of distilled water. The vials were kept in an incubator and the pH of the surrounding medium was measured using a digital pH meter after 1,3,5 and 7 days respectively. Results: A statistically significant difference (p<0.05) existed between the experimental groups over the observation period. At day 1, a high pH was recorded by the calcium hydroxide points and saline groups and a lower pH by the propylene group. At day’s 3 and 5, the maximum pH was recorded by the propylene glycol group and minimum by the calcium hydroxide points and saline groups. At day 7, the pH of all the groups had dropped, with propylene glycol recording the maximum pH followed by saline and lastly calcium hydroxide points. Conclusion: Within the limitations of this study, a viscous vehicle is better among other vehicles, calcium hydroxide paste of propylene glycol provided the highest 7 days release of hydroxyl ions.

Immunohistochemical expression of Type IV Collagen and Autocrine Motility Factor Receptor in Odontogenic Tumours

Harshaminder Kaur Grewal, Sneha Sethi

Background: Autocrine motility factor receptor (AMFR) is a tumour motility stimulating protein secreted by tumour cells. The protein encoded by this gene is a glycosylated transmembrane protein and a receptor for autocrine motility factor. It has been known to play a role in progression of neoplastic lesions. Basement membranes are specialized extracellular matrices that serve as structural barriers as well as substrates for cellular interactions. The network of type IV collagen is thought to define the scaffold integrating other components such as laminins and perlecan into highly organized supramolecular architecture. The aim of this study was to determine and evaluate the immunohistochemical expression of Type IV Collagen and Autocrine motility factor receptor in odontogenic lesions. Materials and Methods: Immunohistochemical expression of Type IV Collagen and Autocrine motility factor receptor was evaluated in 31 odontogenic lesions, including unicystic ameloblastoma, multicystic ameloblastoma, keratocystic odontogenic tumour and ameloblastic carcinoma. Normal follicular tissue formed the control. Results: Maximum expression for Type IV Collagen was seen in multicystic ameloblastoma and minimum expression in keratocystic odontogenic tumour. The maximum expression of AMFR was seen in ameloblastic carcinoma and minimum expression in multicystic ameloblastoma. Conclusion: The results of this study suggested an association of loss of expression of type IV Collagen with progression of lesion. AMFR expression was found to be associated with the aggressive potential of tumours.

Assessment of Corticotomy Facilitated Tooth Movement and Changes in Alveolar Bone Thickness - A Ct Scan Study

Introduction: Corticotomy is an effective method of accelerating the orthodontic treatment. The aim of this study was to compare the treatment time for the extraction space closure, between corticotomy assisted and conventional orthodontic tooth movement and to check the alveolar bone thickness before and after corticotomy procedure in the corticotomy group. Settings and Design: Cross-sectional clinical study. Materials and Methods: Twenty patients (age>15 y) requiring orthodontic treatment with upper anterior retraction in the extraction space of 1st premolar were selected and were randomised into control and corticotomy group each group consisted of 10 subjects. Pre retraction, corticotomy was performed in the maxillary anterior segment. The pre and post retraction CT scans were recorded and the thickness of the alveolar plates were measured at crestal level (S1), mid root level (S2) and apical level (S3) PreTreatment (T1). The same measurements were repeated after incisor retraction was completed PostTreatment (T2). Statistical Analysis: Student’s t-test, Pearson correlation coefficient. Results: There was a significant difference in retraction time (days) between control and corticotomy groups (p<0.001). Also, there were significant difference in total alveolar bone thickness at the crest region for all the four incisor teeth (p<0.05). A significant difference was observed in total alveolar bone thickness at the S2 and S3 level for 11, 21 and 11, 12 and 22 (p<0.05) respectively. Conclusion: Alveolar corticotomies not only accelerates the orthodontic treatment but, also provides the advantage of increased alveolar width to support the teeth and overlying structures.

Correlation of Presence of Candida and Epithelial Dysplasia in Oral Mucosal Lesions

Background: Candida and epithelial dysplasia have long been associated with oro-mucosal lesions. Aim and Objective: The present study was designed to evaluate the correlation between presence of Candida organisms and epithelial dysplasia in various oral mucosal lesions associated with areca nut and tobacco use. Materials and Methods: A total of 50 individuals were selected, between age range of 19-70 y. Three separate cytosmears were prepared for each participant. All the slides were stained with PAS stain and the best slide was viewed for candidal organisms. Statistical Tests: The data was analysed using the SPSS version16. Chi square test was performed. Results: Out of these, samples of 26 participants displayed presence of Candida. It was further observed that all the samples that were positive for presence of Candida displayed the organism in hyphal form. Out of 50 biopsy specimens stained for presence of Candida using PAS stain, samples of only 2 participants demonstrated presence of Candida in hyphal form, whereas the biopsy specimens stained for demonstrating dysplastic changes using H&E stain displayed various levels of cellular atypia in samples of 16 participants. Out of these 12 were mild, 3 were moderate & 1 displayed severe dysplastic changes. Conclusion: The study revealed a statistically non significant correlation between the presence of candida and epithelial dysplasia in oral mucosal lesions.

Possible Role of Curcumin as an Efflux Pump Inhibitor in Multi Drug Resistant Clinical Isolates of Pseudomonas aeruginosa

Nidhi Negi, Pradyot Prakash, Mohan Lal Gupta, Tribhuban Mohan Mohapatra

Introduction: Multidrug resistant non-fermenters are continuously increasing in hospital and ICU settings. One of the mechanisms of developing drug resistance is possession of efflux pump through which bacteria extrude antimicrobial agents and other toxic substances. If these efflux channels are blocked or inhibited, increased drug concentration can be achieved in a bacterial cell with optimal drug dose. Present study was aimed to investigate role of curcumin as efflux pump inhibitor (EPI) and to compare its activity with a known EPI like phe-arg-beta-naphthylamide (PA ß N). Materials and Methods: A total of 170 clinical isolates of Pseudomonas aeruginosa were taken, antimicrobial susceptibility was performed by disc diffusion test and minimum inhibitory concentration (MIC) against selected drugs before and after adding known synthetic EPI, PA ß N (20mg/L). Out of these, 30 multidrug resistant strains were taken and MIC was performed with curcumin (50mg/L) with and without selected drugs. Results: Significant reduction in MIC was observed after adding curcumin (50mg/L) with selected antimicrobial agents in 9/30 (30%) of multi drug resistant (MDR) isolates of Pseudomonas aeruginosa , while no change in MIC was observed when curcumin (50mg/L) was used alone, indicating its efflux pump inhibitor activity. Conclusion: This study suggests role of efflux pump in development of drug resistance which can be overcome by use of an efflux pump inhibitor, with more emphasis on compound like curcumin which will have less or no adverse effects if used in vivo.

The Effect of Antenatal L-Arginine and Antioxidant Supplementation on Oxidative Stress Marker Levels in Newborns

Shweta Dr, Khanna Anuradha

Introduction:The present study was conducted in the Department of Obstetrics, Paediatrics & Biophysics IMS, BHU, Varanasi with an aim to study the role of L-arginine and oral antioxidants as a part of therapy in patients diagnosed with IUGR (Intra uterine growth restriction ) and cord serum NO and oxidative stress markers GSH and SOD in newborns following delivery of such patients. Materials and Methods: The study included 40 pregnant patient between 30-32 weeks of gestation diagnosed with IUGR who were divided into 3 groups: Group I (treated with L-arginine N=10), Group II (treated with antioxidants N=10), Group III (without nutritional supplementation N=10) and Group IV (healthy control pregnant patients of same gestational age range N=10) were taken. Cord serum NO & oxidative stress markers (GSH & SOD) were measured following delivery of patients from those four groups. Results: The cord serum NO levels (µmol/lt) showed a significant increase & SOD (U/ml) & GSH (U/lt) values were increased in newborns to mothers diagnosed with IUGR after treatment with L-arginine. Similar results were obtained for treatment with antioxidants. Conclusion: The reduced NO & reduced cord serum circulating levels of oxidative stress markers (GSH & SOD) activity may play an important role in the occurrence of IUGR.

Effect of Curcumin Against Oxidation of Biomolecules by Hydroxyl Radicals

Background: Among various reactive oxygen species, hydroxyl radicals have the strongest chemical activity, which can damage a wide range of essential biomolecules such as lipids, proteins, and DNA. Objective: The objective of this study was to investigate the beneficial effects of curcumin on prevention of oxidative damage of biomolecules by hydroxyl radicals generated in in vitro by a Fenton like reaction. Materials and Methods: We have incubated the serum, plasma and whole blood with H2O2/Cu2+/ Ascorbic acid system for 4 hours at 37 0C and observed the oxidation of biomolecules like albumin, lipids, proteins and DNA. Results: Curcumin at the concentrations of 50,100 and 200 µmoles, prevented the formation of ischemia modified albumin, MDA, protein carbonyls, oxidized DNA and increased the total antioxidant levels and GSH significantly. Conclusion: These observations suggest the hydroxyl radical scavenging potentials of curcumin and protective actions to prevent the oxidation of biomolecules by hydroxyl radicals.

Clinico-Biochemical Correlation to Histological Findings in Alcoholic Liver Disease: A Single Centre Study from Eastern India

Background: Alcoholism is a health problem not only in developed countries but also in developing countries. Cirrhosis due to alcohol is a common cause of death among individuals abusing alcohol. A better knowledge of the spectrum of alcoholic liver diseases, its clinical, biochemical and histopathological features could result in early detection and prevention of alcoholic liver diseases before it’s catastrophic and life threatening effects. Materials and Methods: A total of 200 patients with alcoholic liver diseases were studied with respect to alcohol consumption, clinical features, biochemical and histopathological changes. The clinical features, biochemical parameters, and histopathology of liver including Ishak’s modified histological activity index (HAI) were correlated with the amount and duration of alcohol consumed. Result: Majority of the patients were in the age group of 40- 49 years and all the cases were males. Majority consumed alcohol of about 75-90 grams per day for a duration of 10– 12 years. Anorexia and jaundice were the most common symptom and clinical finding respectively. Hyperbilirubinemia and hypoalbuminemia were the most common abnormalities observed in liver function tests. Advanced HAI stages with features of cirrhosis were most frequent histo-pathological finding noted in this study. Clinico-biochemical profile was significantly correlated with degree of alcohol ingestion as well as with liver histopathology. Conclusion: The wide prevalence of alcoholic liver disease including cirrhosis among Indian males was noted with significantly lower quantity and duration of alcohol ingestion. The severity of liver damage is directly proportional to the quantity and duration of alcohol consumed. Clinical features and biochemical changes may forecast the liver histopathology among the patients of alcoholic liver disease.

Nutritional Status of Children Aged 3-6 Years in a Rural Area of Tamilnadu

Background: A child’s entire life is determined in large measures by the food given to him during his first five years. Since childhood is the most vulnerable phase in the life of human being, nutritional inadequacies will result in the hampering of the development of the body. Future of the country is determined by the growing generation of the country. Objectives: a) To assess the nutritional status of children aged 3-6 y in a rural area of TamilNadu. b) To identify the factors associated with the nutritional status of the above study population. Settings and design: Kuthambakkam village in Tamilnadu, Cross sectional study. Materials and Methods: Total number of children aged 3-6 y is 172 in Kuthambakkam village. The entire children aged 3-6 y was included in the study. Mothers of the children were interviewed using an interview schedule to collect information regarding the sociodemographic profile, feeding practices, and immunization status. Socio-economic status was assessed using modified BG Prasad’s classification. Weight of the children was measured using a portable weighing machine. Nutritional status among 3-6 y old children was assessed by computing weight for age (standard used - National Centre For Health Statistics (NCHS) standards for weight for age) and grading of nutritional status of the children was done using the Indian Academy of Paediatrics (IAP) classification. Grade I to Grade IV nutritional grade is taken as undernourished. Statistical Analytical: Prevalence will be expressed in percentage and Chi-square test will be used to find association with factors. Results: The prevalence of under-nutrition ( < 80 percentage of standard weight for age) was 66.5%. The prevalence of grade 1 malnourishment was 46.2%.The prevalence of under nourishment increased with increasing age and the difference was found to be statistically significant (p< 0.05).Prevalence of under nourishment was higher among male children (76.9%) than female children (56.3%) and was statistically significant. As the socioeconomic status increased the prevalence of undernourishment decreased and the difference was found to be statistically significant(p<0.05). Duration of exclusive breast feeding had influence on the nutritional status. Conclusion: Community based preventive measures should be taken to allievate malnutrition. Health education to the mothers on dietary practices like feeding their children with locally available low cost but healthy food should be given. Nutritional rehabilitation centres should be established. Improving the socioeconomic standards is mandatory.

Anticancer Drug Induced Palmar Plantar Erythrodysesthesia

Background: Palmar plantar erythrodysesthesia (PPE) is a dose limiting toxicity of anticancer agents. In some cases it may mandate for discontinuation of anticancer agents. Evaluation of data of PPE among reported adverse drug reactions (ADRs) from the Department of Medical Oncology could quantify the burden. Aim: To evaluate and analyse the PPE among reported ADRs from medical Oncology. Materials and Methods: The data of all cases of reported PPE were collected during January 2012 to September 2013 and were analysed with WHO causality assessment scale. The severity was clinically graded. The follow-up data regarding outcome of ADRs were also noted. Results: During the study period of 21 months a total of 1418 ADRs have been reported from 1076 patients. Among them PPE was reported from 31 cases (2.9%). Majority (32.2%) of these patients were on chemotherapy for breast cancer. Patient’s age ranged from 17 to 68 y and the median age was 50 y. There were 18 female (58%) and 13 male patients (42%). Capecitabine was the leading drug involved in PPE, reported with 20 cases (64.5%), and followed by docetaxel with 5 cases (16.1%). Majority (67.7%) of the reactions was categorized as certain and 64.5% was grade II severity clinically. Conclusion: Our findings show that PPE accounts for 2.9% of total reported ADRs from Medical Oncology during 21 months. Majority of the reactions were classified as certain. Capecitabine is commonly implicated drug.

Study of Proper use of Inhalational Devices by Bronchial Asthma or Copd Patients Attending a Tertiary Care Hospital

Objective: To examine the frequency of proper use of inhalation devices and influence of age and training on it. Materials and Methods: One hundred and five subjects of bronchial asthma and Chronic Obstructive Pulmonary Disease (COPD); aged between 18 to 75 y (mean ± SD; 46 ± 28.55) were studied. Subjects were enrolled over a period of three months. Data like weight, height and concomitant medications were recorded. It was an observational and questionnaire based study. Parameters were chosen to demonstrate the inhalational technique, errors committed in different steps of use & nature of medical, paramedical, nursing personals and others imparting training for use of inhaler device and time devoted for it. Results: Of total 105 patients, 31 were using dry powdered inhalers (DPI), 50 on metered dose inhalers (MDI), and 24 on MDI with spacer devices. Among study population 83.81% were trained by healthcare professionals (doctors, nurse, pharmacists, paramedical or representatives of Pharmaceutical companies) and 16.19% are trained by general people. Among the MDI users (n=50) only 6%, 16.12% among the DPI users, 20.8%, among MDI with spacer users could use inhalers correctly. At 95% confidence limit there was significance of errors committed between DPI and MDI users (difference of SE is 2.56) and between spacer and MDI users (difference of SE 2.92). There was no difference found in regard of frequency of errors committed in taking different devices according to patient’s socioeconomic, educational background and trainer. Conclusion: It was concluded that use of MDI with spacer most convenient method. Doctors often did not have sufficient time to train patients regarding proper technique of inhaler use. With ever increasing and widespread use of inhalers patients’ education is becoming more important. Proper training will surely make these drugs more effective and cost benefit ratio more favourable.

Evaluation Profile of Thyroid Nodule by FNAC in the Rural Population of Khanpur Kalan, Sonepat, Haryana

Background: Thyroid disease is most common endocrine disorder and is different from other endocrine diseases because of its vis - ible swelling and ease of diagnosis. If left untreated, thyroid disease makes a person more prone for heart disease, infertility and osteo - porosis. In India, significant burden of thyroid diseases exist with an estimation of around 42 million cases. The thyroid status and autoimmune status of adult Indian population in the post iodiniza - tion phase is largely unknown. Aim: The main objective of this study was to generate valuable epi - demiological data regarding the prevalence of thyroid disorders in rural population of Khanpur Kalan, Sonepat in the post-iodinisation era in India. To assess whether thyroid autoimmunity or goitrogens along with environmental factors play role in the development of thyroid.This paper is being presented in view that no such study has been carried out in the rural population of this region in Haryana. Materials and Methods: The present study was conducted in Department of Pathology, Bhagat Phool Singh Medical College for Women, Khanpur Kalan, Sonepat between August 2011 to July 2013. It included retrospective analysis of cytomorphology of fine needle aspiration cytology material of 206 patients presenting with thyroid nodule in the Department of Pathology. Results: The commonest age group affected was 31-40 yrs. The female patients (93.4%) outnumbered the male patients (6.6%). The cytomorphological analysis of 206 patients revealed 190 cases (92.2%) of neoplastic lesions, 10 cases (4.8%) were neoplastic and 6 cases (2.9%) had indeterminate cytomorphology. Maximum number (65.5%) of patients was suffering with goiter followed by lymphocytic thyroiditis (26.2%). Amongst the malignant cases three cases were of papillary carcinoma and one case of medullary car - cinoma. Two out of the six cases of follicular neoplasm proved to be follicular adenoma on histopathology. Four patients with high T3 levels were under treatment with neomercazole. They showed change in cytomorphology from hyperplasia to colloid goiter. Only one case of acute suppurative thyroiditis was reported which shows rarity of its type. Conclusion: The increased prevalence of goiter in this post io - dinisation era can be attributed to goitrogens, autoimmune thyroid disease and micronutrient deficiency of iron and selenium. Higher prevalence of autoimmune thyroiditis in females is linked with both genetic and environmental factors such as infection, stress.

Deroofing of Auricular Pseudocyst: Our Experience

Vinay.S.bhat, Shilpa, Nitha, Ravi K S

Aim: To ascertain a definitive treatment modality for a frequently recurring condition, pseudocyst of pinna in the form of deroofing and compression. Materials and Methods: Thirty patients were diagnosed with pseudocyst of pinna from July 2011 to March 2013. All 30 patients underwent surgical deroofing of the pseudocyst along with compression by buttoning. The patients were followed up for a period of six months. Results: No recurrence was seen in 29 patients in the follow up period of six months (96.7%). One patient had recurrence 15 d following the procedure. The recurrence in the case could be attributed to the usage of improper buttons for compression. Conclusion: Despite numerous treatment options for pseudocyst of pinna, there remains high recurrence rate in patients. Additionally, some treatments carry the risk of cartilage damage or visible distortion of the auricle. Surgical deroofing followed by compression using buttons can be considered as first line treatment of this entity as it is associated with very less rate of recurrence and gives a cosmetically acceptable result.

Comparison of Serum Lipid Profile in HIV Positive Patients on ART with ART Naïve Patients

Indumati V, Vijay.V, M.S.Shekhanawar, Rajeshwari, Amareshwaras.M, Shantala.D

Introduction: The widespread use of effective highly active antiretroviral therapy (HAART) in HIV patients has coincided with increasing reports of complications like HIV-associated lipodystrophy syndrome and the metabolic alterations, affecting the lipid and glucose metabolism. Evidences in support of lipodystrophy and dyslipidaemia associated with First- line HAART in our area is scarce. The aim of the present study was 1) to study and compare Lipid profile in HIV positive patients on ART with that of freshly diagnosed HIV positive patients who were yet to be started on ART. 2) To assess lipodystrophy syndrome in patients on ART. Materials and Methods: Hundred newly diagnosed HIV positive patients who were yet to be started on ART were taken as controls (ART-Naïve).Hundred randomly selected HIV+ patients who were already on First-line ART regimen (Stavudine/Zudovudine + Lamivudine + Nevirapine) for more than 12 months were taken as cases (ART). This study was conducted for a period of 12 months at the VIMS ART centre, Bellary. Results: There was a significant increase (p<0.001) in serum Total Cholesterol, LDL-C, TG, VLDL, Non-HDL -C & TC/HDL-C ratio in ART patients compared to ART-naïve patients. Of the 100 ART patients 23 had lipodystrophy syndrome (buffalo hump, abnormal fat deposition around neck & back, buccal fat resorption, increase in abdominal fat). Conclusion: To conclude, it is evident from our study that there is increase in lipid profile (except HDL) in ART patients compared to ART Naïve group and twenty three ART patients showed lipodystrophy syndrome. Hence it appears reasonable to measure fasting lipid levels before and 3-6 months after antiretroviral therapy is initiated or when ART regimen is changed.

Evaluation of Usefulness of Serum Insulin as Sensitive Predictor of Cardiovascular Dysfunction in Obese Individuals with Normal Lipid Profile

Background: Prevalence of obesity and its subsequent cardiometabolic complications is on exponential rise. Hyperinsulinemia develops in obese individuals long before other metabolic derangements of obesity take place and may be a common pathophysiological factor tying together various components of cardiometabolic dysfunction. Aim: Present study was aimed at evaluating the role of insulin as a sensitive and independent cardiovascular risk marker in apparently healthy overweight and obese individuals with normal lipid profile. Settings and design: This was an opd based case Control study including 100 overweight and obese individuals with normal lipid profile & 100 age and sex matched normal weight healthy controls. Materials and Methods: Participants were evaluated based on detailed history, clinical examination and laboratory investigations. Blood samples were collected after overnight fast. Serum insulin was estimated by chemiluminescence method, glucose and lipid profile (CHOLESTEROL, HDL, TG, LDL) by chemical assays on a fully automated analyser system. Statistical analysis: Results were analyzed by unpaired t-test, p-value was determined & Correlation coefficient was calculated amongst various parameters. Results: Significant difference was noted in mean values of BMI (29.69±1.28 VS 23.47±1.09), waist / hip ratio (0.91±0.07 VS 0.79±0.05) and serum insulin (10.54±2.5 VS 5.94±1.53) (p<0.01) in cases as compared to controls respectively. Glucose levels were high in cases (89.58±8.0 mg/dl) as compared to controls (88.8±7.56 mg/dl) but the difference was statistically insignificant (p=0.11). Hyperinsulinemia was observed in 41 cases & 4 controls. Serum insulin highly correlated with Waist/ hip ratio (R=0.53) than BMI (R=0.26). Conclusion: Study suggests Insulin; a simple, sensitive & independent cardiovascular risk predictor in obesity even with normal lipid profile with a potential to reveal hidden burden of metabolic dysfunction and offers a hope that, cardiovascular event can be well prevented with appropriate interventions.

Rheumatologic Manifestations in Iranian Patients with Autoimmune Thyroid Diseases

Background: Autoimmune thyroid diseases (ATDs) are the most common endocrine diseases which result in rheumatologic manifestations. Some studies have shown association between rheumatologic disorders and ATDs. Thus, the aim of this study was to assess the frequency of rheumatologic manifestations in patients with ATDs. Materials and Methods: In this cross-sectional descriptive study during 2010 to 2011, 65 patients with ATDs referred to the Rheumatology clinic of 5 Azar Hospital in Gorgan (North of Iran) were studied via systematic random sampling and patients with positive antithyroid peroxides (anti-TPO) were included in the study. These patients were examined by a rheumatologist for diagnosis of rheumatologic manifestations and tested for serum levels of TSH, Free T3 and T4, Anti-Nuclear Antibodies (ANAs) and Rheumatoid Factor (RF). SPSS software (version 16) and descriptive statistics were used for data analysis. Results: Nine males (14.8%) and 56 females (86.2%) with mean age of 38.81±1.44 years were studied. Overall, Rheumatologic manifestations were seen in 86.2 % (n=56). In this study, the most frequent rheumatologic manifestations were Carpal Tunnel Syndrome (36.1%) and Osteoarthritis (23%). Reynaud’s phenomenon (RP) (10.7%), Discopathy (8.9%), Fibromyalgia (5.3%), Myopathy (3.6%), Rheumatoid arthritis (3.6%) and trigger finger (3.6%) were other manifestations, respectively. Conclusion: In this region, there is a high frequency of rheumatologic manifestations in patients with ATDs. Thus, initial evaluation and regular checkings are recommended.

Triple Test in Carcinoma Breast

Suman Kharkwal, Sameer, Arindam Mukherjee

Introduction: The commonest clinical presentation in majority of breast pathology is a lump. A definite diagnosis of breast lump is very important for the surgeon to decide on the final course of treatment and also saves the patient from unnecessary physical, emotional and psychological trauma if there is a definite preoperative diagnosis of benign lesion. The present study was done to evaluate the effectiveness and relevance of “TRIPLE TEST”in diagnosis of carcinoma breast in rural labour class population. Materials and Methods: The present study was a prospective study conducted on patients over 35 years of age having palpable breast lumps presenting in the out patient department of general surgery, ESI Hospital Basaidarapur New Delhi, india. The duration of study was from May 2007 to June 2009 and a total of 100 cases were studied. Each patient was subjected to a detailed history, clinical breast examination ,diagnostic mammography and FNAC. In this study, the results of each modality was divided in three groups: benign, suspicious and malignant. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of each test was calculated individually and as combined. Result: Out of 100 patients enrolled in this study, 60 cases were benign and 40 cases were of malignant breast disease. The age of patients with carcinoma breast in the series varied from 35 years to 70 years. The highest incidence of malignancy noted was 30% in 41-50 years age group (4th decade) followed by 27.5% in 51-60 years age group (5th decade). The sensitivity of clinical examination was found to be 75%, specificity was 83.3%, positive predictive value (PPV) of 75% and diagnostic accuracy of 80%. The sensitivity, specificity, positive predictive value and diagnostic accuracy of mammography was calculated and was found to be 94.9% , 90% , 86% and 92% respectively. The sensitivity, specificity, positive predictive value and diagnostic accuracy of FNAC was 94.7%, 98.3%, 97.3% and 96.6% respectively. Out of 100 cases triple test was concordant (all three test either benign or malignant) in 80 cases, all the benign cases detected by triple test were benign on final biopsy i.e. 100% specificity and 100% negative predictive value. Conclusion: TTS is an accurate and least invasive diagnostic test based on which definitive treatment can be initiated.

Hemi Replacement Arthroplasty for Unstable Inter-Trochanteric Fractures of Femur

Sudhir Singh, Chetan Shrivastava, Sanjiv Kumar

Introduction: Unstable inter-trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut-out of the lag screw, are the common problems of attempts to fix these fractures. Present study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty in unstable inter-trochanteric fractures in elderly patients. Materials and Methods: This prospective study included 25 cases with unstable inter-trochanteric fracture of femur between 60 -75 y of age in whom primary Cemented Bipolar hemi - arthroplasty was performed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS), Lower Extremity Functional Scale (LEFS), Visual analogue scale (VAS) for evaluation of outcome. Results: The mean HHS score was 78.86 + 8.13 by the end of one year. Similarly mean LEFS score was 34.36 + 7.01 by the end of one year, whereas the mean pain score on VAS Scale by the year end was 1.04 + 1.02. Discussion : The changes in HHS, LEFS and VAS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. We compared our results with those reported by other authors and our study gave quite comparable results. We also used lower extremity function status score (LEFS) for assessment of functional ability. The purpose of its use was that while Harris Hip Score (HHS) provides information on a multitude of factors, LEFS is more patient oriented and provides the correct information about the level of activities a patient can resume post-operatively and can be offered as a self assessment tool. No significant complication except for grade I pressure sores in four patients were seen in postoperative period but they all resolved with proper nursing care by six week follow up. No patient required revision surgery. Conclusion: The authors believe that primary cemented bipolar hemiarthroplasty for unstable inter-trochanteric fractures of femur in elderly does provide early ambulation, good functional outcome, pain free joint with minimal complications without the need for revision surgery.

Smear Conversion, Treatment Outcomes and the Time of Default in Registered Tuberculosis Patients on RNTCP DOTS in Puducherry, South India

Kavita Vasudevan, Niranjana Jayakumar, Dhivyalakshmi Gnanasekaran

Background: Revised National Tuberculosis Control Programme (RNTCP) in India has achieved improved cure rates. Objectives: This study describes the achievements under RNTCP in terms of conversion rates, treatment outcomes and pattern of time of default in patients on directly observed short-course treatment for Tuberculosis in Puducherry, Southern India. Settings: Retrospective cohort study; Tuberculosis Unit in District Tuberculosis Centre, Puducherry, India. Materials and Methods: Cohort analysis of patients of registered at the Tuberculosis Unit during 1st and 2nd quarter of the year 2011. Details about sputum conversion, treatment outcome and time of default were obtained from the tuberculosis register. Statistical Analysis: Kaplan-Meier plots & log rank tests. Results: RNTCP targets with respect to success rate (85.7%), death rate (2.7%) and failure rate (2.1%) in new cases have been achieved but the sputum conversion rate (88%) and default rate (5.9%) targets have not been achieved. The overall default rate for all registered TB patients was 7.4%; significantly higher in category II. In retreatment cases registered as treatment after default, the default rate was high (9%). The cumulative default rate; though similar in the initial two months of treatment; was consistently higher in category II as compared to that in category I. Nearly 40% of all defaulters interrupted treatment between the second and fourth month after treatment initiation. Conclusion: Defaulting from treatment is more common among the retreatment cases and usually occurs during the transition phase from intensive phase to continuation phase.

Prevalence of Elevated Serum Homocysteine and Serum Lipoprotein ‘a’ in Women

Background: Recent studies indicate that the risk of coronary artery disease (CAD) in women is no less than that in men and menopausal women are equally vulnerable as men. Studies of recent risk factors like hyperhomocysteinemia and elevation in lipoprotein (a) reveal controversial role of the same. This study hence is an attempt to study the prevalence of these factors in women and their correlation with lipid profile. Materials and Methods: Two hundred women were enrolled in the study- 100 premenopausal women (21-45y) and 100 menopausal (50-55y). All the subjects were screened for homocysteine by ELISA and lipoprotein (a) and lipid profile by automation. Results: Prevalence of hyperhomocysteinemia was 52% and 62% in premenopausal and menopausal women respectively. A significant positive correlation was seen for total cholesterol and triacylglycerol with serum Homocysteine in premenopausal women while pronounced positive correlation for serum cholesterol with serum Homocysteine in menopausal women. The prevalence of elevated lipoprotein (a) was 42% and 45% in premenopausal and menopausal women respectively. There was no correlation between lipoprotein (a) and lipid profile in both groups. Conclusion: The findings of the study conclude that premeno - pausal and menopausal women constitute a subpopulation where recent risk factors like hyperhomocysteinemia and el - evated lipoprotein(a) could be assessed along with lipid profile as screening tests to identify the risk of CAD. This would help in proper counselling of the concerned women and minimize the risk

Influence of Rotating Shift Work on Visual Reaction Time and Visual Evoked Potential

Hemamalini R.V, Krishnamurthy N, Saravanan A

Background: The present day life style is changing the circadian rhythm of the body especially in rotating night shift workers. The impact of this prolongs their reaction time. Night shift also interferes with the circadian variation of pupil size which may affect the visual evoked potential. Aim: To compare the visual reaction time, visual evoked potential (VEP) in rotating night shift workers & day workers and also to correlate the changes in visual reaction time with visual evoked potential. Materials & Methods: Forty healthy male security guards & staff (25 – 35 y) who did rotating night shifts at least for six months & 40 d workers (25 – 35 y) who did not do night shift in last two years were involved in the study. Visual reaction time and the latency & amplitude of VEP were recorded. Result: Kolmogorov- Smirnov test for normalcy showed the latencies & amplitude of VEP to be normally distributed. Student’s unpaired t test showed significant difference (p<0.05) in the visual time and in the latencies of VEP between night shift & day workers. There was no significant difference in the amplitude of VEP. conclusion: Night shift workers who are prone to circadian rhythm alteration will have prolonged visual reaction time & visual evoked potential abnormalities. Implementation of Bright Light Therapy would be beneficial to the night shift worker.

Prevalence of Malocclusion and its Psycho-Social Impact among 12 To 15-Year-old School Children in Lucknow City

Background: Facial aesthetics affects how people are perceived by society and how they perceive themselves. Anterior malocclusion can have an impact on the overall facial appearance. Aim: The aim of the study was to assess the prevalence of malocclusion and its psycho-social impact among 12 to 15 yrs old school children in Lucknow city. Materials and Methods: The study consisted of collection of information for psychosocial assessment using a questionnaire and clinical examination of malocclusion. Data regarding psychosocial impact of dental aesthetics was collected using a Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) given by Klages et al., (2006). Results: 15.57% children belonged to the definite malocclusion category and 5.41% to the handicapped malocclusion category. The mean Dental self confidence score differed significantly among both male (p = 0.001) and female children (p = 0.001) across the age groups. The mean Social impact score did not differ significantly among both male (p = 0.31) and female children (p = 0.12) across the age groups. Conclusion: The results of the present study imply that dental aesthetics had a significant impact on the psychosocial aspects of human life irrespective of the gender.

Comparison of Lip Print Patterns in Two Indian Subpopulations and Its Correlation in ABO Blood Groups

Background: The study of lip-print pattern (cheiloscopy) is a scientific method for personal identification and plays a major role in forensic and criminal investigations. Objective: To compare the lip print patterns in Kerala and Maharashtra population and correlate between ABO blood groups. Materials and Methods: Two hundred subjects, 100 from Maharashtra and 100 from Kerala were considered for the study. Lip prints were recorded, analyzed according to Tsuchihashi classification. The lip print patterns were compared in the two populations, correlated in ABO blood groups. The data obtained was statistically analyzed with SPSS software using chi-square test. Results: In our study, predominant lip print pattern observed in Kerala population was type IV (53%) and Maharashtra population was type II (42%). The difference between the two population was statistically significant (p<0.001). Subjects with A+ and O- blood groups had type II lip print predominance. Subjects with B+, AB+ and O+ blood groups had type IV predominance. The lip print patterns do not show any correlation in ABO blood groups. Conclusion: Lip prints are unique to each individual and are different even in two persons. Lip print patterns were different in the two sub populations studied, and they showed no correlation in ABO blood groups.

Post Burn Contracture Neck: Clinical Profile and Management

Nikunj Bhavesh Mody, Sanket S. Bankar, Avinash Patil

Background: Morbidity related to hypertrophic scars and contractures which are well known sequel after burns remains high and in fact has increased as more severely burned patients are surviving. This study was undertaken in order to assess the varied clinical presentation, precipitating factors, preventive measures, treatment modalities of neck contractures and evaluate the results after surgical procedures. Materials and Methods: This hospital based study was conducted on patients admitted in our institution with proven cases of Post burn neck contracture from 1st August 2009 to 31st July 2011. Twenty two patients of post burn neck contracture who underwent operative treatment were included. Observation: 10 of 22 cases were in the middle age group i.e. between 21-30 years. There were 5 males and 17 females. Accidental flame burn was the commonest aetiology. Fourteen patients were treated within 1 year of burns for functional disability. Excisional release was performed in 13 and incisional release in 9 of our patients. Resurfacing with STSG (split thickness skin graft) was carried out in 19 cases and a local or regional flap with or without a graft in 3 patients. Hypertrophy and recontracture were the commonest late complications and occurred in 3 cases. Good to fair results were obtained in 19 patients. Conclusion: Local flaps have many advantages and are to be used whenever possible. It is preferable to place the grafts if used in the area surrounding the neck (donor site of flap) or at least in the non-visible area of the neck (submental area). When a combination of flap & graft is used, it’s preferable to place the flap in a horizontal intersecting fashion in between the two patches of the graft. A follow up program for reasonable period is highly desired.

Cavernous Hemangioma of Tongue: Management of Two Cases

Pranitha V, Niharika Puppala, Sudhanwa N Deshmukh, Jagadesh B, Anuradha S

Hemangiomas are benign tumours of infancy and childhood, most commonly located in the head and neck region and occur more frequently in the lips, tongue and palate. The treatment depends upon lesion location, size and evolution stage and the patient’s age. This paper describes the management of cavernous hemangioma in a 2 -year -old child and 14 -year -old child using different approaches.

Hemodynamic Responses to Etomidate Versus Ketamine-Thiopental Sodium Combination for Anesthetic Induction in Coronary Artery Bypass Graft Surgery Patients with Low Ejection Fraction: A Double-Blind, Randomized, Clinical Trial

Background: During induction of anesthesia and intubation, hemodynamic changes are very important; especially in patients with coronary artery disease (CAD) and left ventricular dysfunction. A little information is available on the hemodynamic effects of a combination of ketamine-thiopental for induction of anesthesia in patients undergoing coronary artery bypass graft (CABG) surgery, with impaired ventricular function. Aim: The aim of this study was to compare the hemodynamic responses to etomidate versus ketamine-thiopental sodium combination for anesthetic induction in CABG surgery patients with low ejection fraction (EF<45%). Materials and Methods: In a double blind randomized clinical trial, a total of 100 patients, scheduled for elective CABG surgery were randomly assigned into two groups. These patients received either etomidate or ketamine-thiopental sodium combination at induction of anesthesia. Hemodynamics variable were measured and recorded at baseline, immediately before and after laryngoscopy and intubation, one, two and three minutes after intubation. Also, muscle twitching incidence among patients in two groups was evaluated. Results: No significant differences between the two groups regarding the changes of hemodynamic variables including systolic and diastolic arterial blood pressure, mean arterial pressure and heart rate, were notice (p>0.05). Muscle twitching was not observed in the two groups. Conclusion: Hemodynamic stability after administration of ketamine-thiopental sodium combination for induction of anesthesia in patients undergoing CABG surgery, with impaired ventricular function, supports the clinical impression that this combination is safe in CABG surgery patients with low EF.

Cold Pressor Response in High Landers Versus Low Landers

Background: Native high landers face two main environmental challenges i.e. hypobaric hypoxia and low ambient temperatures. Both factors contribute to increased sympathetic stimulation and increased blood pressure. Despite these challenges, subjects living at high altitude have lower systolic and diastolic pressures as compared to subjects living in plains. Present study investigated cold pressor test (CPT) which is a potential predictor of future hypertension in high landers and low landers Materials and Methods: Vascular reactivity in terms of changes in systolic and diastolic blood pressure and heart rate in response to cold pressor test has been compared in high lander (n=45) and low lander (n=46) population. Results: Systolic and diastolic blood pressure changes and heart rate changes with cold pressor test are lower in high landers as compared to low landers. Females in both the groups in general exhibited greater cold pressor response than males. Conclusion: Hypo-reactive cold pressor test is due to higher parasympathetic tone and lower sympathetic tone. Decreased cold pressor response in high landers reflects another adaptive modulation of sympatho-vagal activity that enables them to stay in hypobaric atmosphere and lower temperatures without undue autonomic stress.

Origin of Ameloblastoma From Basal Cells of the Oral Epithelium- Establishing the Relation Using Neuroectodermal Markers

Background and Objectives: Basal cell layer of the oral epithelium has been rightfully regarded as a potential source of odontogenic tumours and cysts, but, without substantial evidence. Also, whether the basal cell layer retains within it, some properties of ectomesenchyme, which was imbibed during the early embryogenesis and hence its neuroectodermal relation, is not known. Here, an attempt is made to establish the hidden neuroectodermal potential of the oral epithelium, especially the basal layer, by observing the expression of known neuroectodermal markers, NSE (Neuron Specific Enolase), Synaptophysin and CD99. The expression of the same markers has also been studied in Ameloblastoma, connecting it with oral epithelium, in turn establishing basal cell layer as a potential source of Ameloblastoma. Materials and Methods: Sections of formalin fixed, paraffin embedded tissue samples of 20 cases of Ameloblastoma and 10 cases of Normal Retromolar mucosa, were stained immunohistochemically with NSE, Synaptophysin, CD99 and also with CK-19 and evaluated for positive expression. Results: Positive reaction was obtained in all the cases of Ameloblastoma and NRM (Normal Retromolar mucosa) with NSE, all the cases of Ameloblastoma and eight cases of NRM with Synaptophysin and in six cases of Ameloblastoma and NRM with CD99. The staining was diffuse and more marked in case of NSE than Synaptophysin and CD99. CK19 staining done to assure that the tissue antigenicity was maintained was positive in all the samples. Interpretation and Conclusion: A strong relationship between the neuroectoderm, Ameloblastoma and the basal layer of the oral epithelium is established by the study. It favours the hypothesis that the basal cell layer of oral mucosa may be the sought out culprit in most cases of the Ameloblastomas, especially those occurring in the non-tooth bearing area. This would call for the need to incorporate additional therapy in the form of mucosal striping along with the conventional treatment

Should We Apply Suction During Fine Needle Cytology of Thyroid Lesions? A Prospective Study of 200 Cases

Introduction: Fine needle aspiration cytology (FNAC) is a well-established first line diagnostic tool in evaluating palpable thyroid lesions. However, the technique depends on suction and thus is at times painful, sometimes traumatic and yield haemorrhagic material for cytological study. In more recent times, a modified technique called fine needle sampling without aspiration (FNS) has come into vogue which obviates the use of suction and therefore is more patient friendly. Aims/Objectives: To investigate whether fine needle sampling without aspiration (FNS) gives quantitatively and qualitatively superior cytologic material as compared to the conventional technique of fine needle aspiration (FNAC) in thyroid lesions. Materials and Methods: It is a prospective study of 200 cases carried out in the Department of Pathology during two years period. Both techniques were executed on the same thyroid swelling / nodule in the same clinical session beginning with FNS followed by FNAC. The observation recorded by two pathologists were based on the scoring system proposed by Mair et al., Statistical analysis was done by Student’s paired t-test using SPSS 13 software. Observation/Results: A total of 200 cases were studied. The non-aspiration technique yielded less diagnostically adequate but more diagnostically superior smears when compared with aspiration technique. The average score per case was 5.31 by aspiration technique and 6.35 by non-aspiration technique. Conclusion: Both the techniques have their own merits and demerits and neither is absolutely superior to the other. A combination of both the technique gives better result.

Study of Proper use of Inhalational Devices by Bronchial Asthma or COPD Patients Attending a Tertiary Care Hospital

Nandini J. Desai, B. D. Gupta, Pratik Narendrabhai Patel, Vani Santosh Joshi

Introduction: Obtaining images of slides viewed by a microscope can be invaluable for both diagnosis and teaching.They can be transferred among technologically-advanced hospitals for further consultation and evaluation. But a standard microscopic photography camera unit (MPCU)(MIPS-Microscopic Image projection System) is costly and not available in resource poor settings. The aim of our endeavour was to find a comparable and cheaper alternative method for photomicrography. Materials and Methods: We used a NIKON Coolpix S6150 camera (box type digital camera) with Olympus CH20i microscope and a fluorescent microscope for the purpose of this study. Results: We got comparable results for capturing images of light microscopy, but the results were not as satisfactory for fluorescent microscopy. Conclusion: A box type digital camera is a comparable, less expensive and convenient alternative to microscopic photography camera unit.

Awareness and attitudes regarding prenatal sex determination, Pre-Conception and Pre-Natal Diagnostic Techniques Act (PCPNDTA) among pregnant Women in South India

Objectives: The present study was conducted to assess the awareness and attitude regarding prenatal sex determination and Pre-conception and Pre-natal Diagnostic techniques Act among pregnant women. Materials and Methods: A cross sectional study was carried at tertiary care teaching hospitals of Kasturba Medical College in Mangalore, India among 132 pregnant women. Data was collected using a pre-tested semi-structured questionnaire and was analysed using Statistical Package for Social Sciences(SPSS) version 11.5 and results were expressed in percentages. Results: The study included 132 participants and the mean age of study subjects was around 27 y. Majority of the study subjects (91.7%) knew that prenatal sex determination was possible. Three fourth (74.4%) of the participants prenatal sex determination was a punishable offence. One of the participants was ready to terminate pregnancy if sex of the fetus was revealed to be female before second trimester. Majority of participants (67.4%) were willing to educate people about PCPNDT act and motivate them against sex determination and sex selective abortions. Conclusion: Our study showed that higher proportion of participants knew about the prenatal sex determination and it was a punishable offence, still majority of them preferred to know the sex of unborn child which shows the need to implement the act effectively

A Comparative Evaluation of the Dimensional Stability of Three Different Elastomeric Impression Materials after Autoclaving – An Invitro Study

Kiran Kumar Thota, Sujana Jasthi, Rajyalakshmi Ravuri, Suchita Tella

Aim of the Study: The purpose of the study was to determine the effect of autoclaving on the dimensional stability of three different elastomeric impression materials at three different time intervals. Materials and Methods: Standardized stainless steel master die as per ADA specification number 19 was fabricated. The impression materials used for the study were condensation silicone (GP1), addition silicone (GP2) and polyether (GP3). A total of 45 samples of the stainless steel die were made (n = 45), that is 15 samples for each group. Impression materials were mixed according to the manufacturer’s instructions and were loaded into the mold to make an impression of the die. Impressions were identified with the help of numerical coding system and measurements were made using stereomicroscope (MAGNUS MSZ-Bi) of 0.65x magnification with the help of image analysis software (IMACE PRO-INSIGHT VERSION.The results were subjected to statistical analysis using one way analysis of variance and student t-test for comparison between the groups. Results: Within the limitations of the study statistically significant dimensional changes were observed for all the three impression materials at three different time intervals but this change was not clinically significant. Conclusion: It is well-known fact that all impressions should be disinfected to avoid possible transmission of infectious diseases either by direct contact or cross contamination. Immersion and spray disinfection as well as various disinfection solutions have been tested and proven to be effective for this purpose. But for elastomeric impression materials these methods have proven to be ineffective as they do not prevent cross contamination among the dental team. So autoclaving was one of the most effective sterilization procedure for condensation silicone and addition silicone. Since polyether is hydrophilic it is better to disinfect the impressions as recommended by the manufacturer or by immersion or spray atomization.

Utility of Extra-Oral Aiming Device in Imaging Periapical Regions of Posterior Teeth

Sudhakar. S, Ramaswamy P, Smitha B, Uday. G

Background: Intraoral film placement and the film holding equipments are not acceptable by many due to varied reasons. Objective: To evaluate the utility of extra-oral aiming device developed by Chia-hui chen for imaging the periapical regions of posterior teeth employing the technique suggested by saberi et al. Materials and Methods: The study subjects included 20 patients in the age group of 10-35 y. The subjects were further subdivided according to the area to be imaged into four groups, with 5 in each. Imaging was done using the device developed by chia-hui chen, with the method employed by newmann and saberi et al. The radiographs were then interpreted for complete coverage of the anatomical structure. The findings were recorded and subjected to Analysis of variance (ANOVA) statistical analysis. Results: The visibility of imaging area was more in mandible (95%) than maxilla (86.5%). The overall accuracy was 90.75%. These findings were statistically non-significant (F- 2.152 & P-0.134). Among the reason for reduced accuracy, overlapping of the opposite arch (4%) was more common and the horizontal overlapping (0.5%) was least common. Conclusion: This technique is not meant to replace conventional intraoral radiography. It is a useful supplementary aid to our clinical practice.

Estimation of Levels of Salivary Mucin, Amylase and Total Protein in Gingivitis and Chronic Periodontitis Patients

Swati Kejriwal, Rahul Bhandary, Biju Thomas, Suchetha Kumari

Background: Periodontal diseases are a group of inflammatory conditions resulting from interaction between a pathogenic bacterial biofilm and susceptible host’s inflammatory response eventually leading to the destruction of periodontal structures and subsequent tooth loss. Hence, investigation of salivary proteins in individuals with periodontal diseases may be useful to enhance the knowledge of their roles in these diseases. Materials and Methods: This case-control study was conducted at A.B. Shetty Memorial Institute of Dental Sciences, Mangalore. The study comprised of 90 patients of age between 25-60 years who were clinically examined and divided into three groups of 30 each: namely clinically healthy, gingivitis and chronic periodontitis. These were classified according to the values of gingival index score, clinical attachment loss and probing pocket depth. Unstimulated saliva was collected and salivary mucin, amylase and total protein levels were determined. Statistical analysis: Results obtained were tabulated and statistically analyzed using ANOVA test and Karl pearson’s correlation test. Results: The results of the study showed an increased concentration of salivary mucin, amylase and total protein in gingivitis patients and increased levels of amylase and total protein in saliva of chronic periodontitis patients compared to healthy individuals which were statistically significant. A decrease in mucin concentration was observed in the periodontitis group compared to gingivitis group. A positive correlation was present between salivary mucin, amylase and total protein levels in the three groups. Conclusion: Salivary mucin, amylase and total protein may serve as an important biochemical parameter of inflammation of the periodontium. Also, it can be hypothesized that various enzyme inhibitors might be useful as a part of host modulation therapy in the treatment of periodontal diseases.

Evaluation of Ossifi ® as Alloplastic Bone Graft Material in Treatment of Periodontal Infrabony Defects

Introduction: The shift in therapeutic concepts from resection to regeneration has significantly impacted the practice of periodontology. Human studies have revealed that hydroxyapatite bone cement holds great promise as a grafting alloplastic material. Aims and Objectives: To evaluate the efficacy of OSSIFI® (combined beta tricalcium phosphate plus hydroxyapatite) in the treatment of periodontal infrabony defects. Materials and Methods: Ten study subjects were selected and divided into two groups. Group I (PD>7mm) and Group II (PD = 7mm). Both Groups I and II were treated by regenerative periodontal surgery using OSSIFI® as graft material. Plaque index, gingival index, pocket depth, clinical attachment levels were recorded clinically and bone fill, radiographically, at baseline, three months and six months. Results and Conclusion: Statistically significant reduction in pocket depth, plaque index, gingival index was seen after six months. There was significant bone fill seen from 3-6months with significant gain in clinical attachment levels.

Radiographic Evaluation of Mandible to Predict the Gender and Age

Deepti Bhardwaj, Jyothi Shiv Kumar, Vinay Mohan

Purpose: This study is been conducted using digital panoramic radiographs for predicting age in various age groups and the accuracy of the parameters were accessed as age advances. Materials and Methods: The selected 300 panoramic images were divided into 3 age group of Group A (25-34 years), Group B (35-44 years), and Group C (45 -54 years). Each group comprised of 100 subjects in which 50 were males & 50 females. The age changes were evaluated using five parameters collectively, which were: Gonial angle, Antegonial angle, Mental foramen, Mandibular canal, Mandibular foramen. These parameters were evaluated on panoramic radiographs for age prediction and changes in their position as age advances. Results: Among all the parameters changes in Mandibular canal and mandibular foramen was found to be highly significant (p value =0.05) as age advances. Conclusion: These parameters can be used to predict the age of the individual as there were significant changes in Mandibular canal and Mandibular foramen as age advances. For Further studies large sample size, and recent modalities in radiography like CBCT or CT scan are required.

Comparing Gray and White Mineral Trioxide Aggregate as a Repair Material for Furcation Perforation: An in Vitro Dye Extraction Study

Introduction: Furcation perforation can have a negative impact on the prognosis of the affected tooth by compromising the attached apparatus. Hence these perforations require immediate repair. A variety of materials have been suggested for repair, of that MTA is the most promising material. The purpose of this study was to compare the ability of Gray and White MTA to seal furcation perforations using a dye extraction method under spectrophotometer. Materials and Methods: A total of 60 permanent mandibular molars were randomly divided into four experimental groups of 15 samples each as follows: Group A: Perforation repaired with White MTA. Group B: Perforation repaired with Gray MTA. Group C: Perforation left unsealed (positive). Group D: without perforation (negative). Dye extraction was performed using full concentration nitric acid. Dye absorbance was measured at 550 nm using spectrophotometer. The data analyzed using one-way-Anova Ratio and Unpaired t-test showing statistically significance difference among the groups. Result: It was seen that Group D samples without perforation showed least absorbance followed by Group A (perforation repaired with White MTA) and Group B (perforation repaired with Gray MTA). Group C (perforation left unsealed) showed highest absorbance. Conclusion: The White and Gray Mineral Trioxide Aggregate performed similarly as a furcation perforation repair material. There was no significant difference between the Gray MTA and White MTA.

Comparison of Nano-Sized Hydroxyapatite and b-Tricalcium Phosphate in the Treatment of Human Periodontal Intrabony Defects

Rohit Jain, Harjit Kaur, Sanjiv Jain, Diljit Kapoor, Tarun Nanda, Megha Jain

Background: Since the advent of nanotechnology, various materials have been introduced for the treatment of the bone defects which have shown promising results. Aim: The purpose of this study was to compare the effect of nano-sized Hydroxyapatite (NHA) and ß-Tricalcium Phosphate (ß-TCP) in the treatment of human periodontal defects. Materials and Methods: Tweleve patients with a total of 24 sites which were almost identical as determined clinically and radiographically were selected for the study. The selected sites were treated with access flap surgery were divided into two groups: Group I was treated with NHA and Group II treated with ß-TCP. Following clinical and radiographic parameters were recorded at baseline, 3 months and 6 months post operatively: 1) Probing pocket depth (PPD); 2)Clinical attachment level (CAL); 3) Gingival recession (GR); 4) Radiographic Defect Depth. Results: Groups showed statistically significant improvements in soft and hard tissue parameters after 3 months and 6 months. Greater reduction in PPD, gain in CAL and Radiographic Defect Fill (RDF) was seen in Group I after three months whereas after six months were no statistically significant difference was seen with regard to soft and hard tissue measurements. Conclusion: Within limits of the study, both NHA and ß-TCP have proved to be beneficial in the management of periodontal defects. Treatment of intrabony periodontal defects with NHA leads to significant improvement in early clinical and radiographic outcomes as compared to ß-TCP.

Antibiotic Susceptibility Pattern of ES ß L Producing Klebsiella pneumoniae Isolated from Urine Samples of Pregnant Women in Karnataka

Background: Klebsiella pneumoniae possess a new problem to health care professionals worldwide, which complicates and limits therapeutic options. It is one of the leading nosocomial bacterial pathogens, and the present study aims to determine the prevalence of ES ß L producing K. pneumoniae isolates with their antibiotic susceptibility pattern in urine samples of the pregnant women with UTI. Materials and Methods: Using standard isolation and identification procedures a total of 41 isolates were obtained from 417 midstream urine samples of pregnant women with suspected UTI in Karnataka. The antibiotic resistance profile of each isolate was performed by Kirby-Bauer disc diffusion method and ES ß L production by standard phenotypic method. Results: Isolation rate of K. pneumoniae in pregnant women was 19.9% and overall incidence rate was 9.8%. Among the 41 K. pneumoniae isolates, 26 (63.4%) were ES ß L producers and all were found to be Multi Drug Resistance (MDR). The antibiotic susceptibility test (AST) for the isolates revealed that the highest number of K. pneumoniae were resistant to ampicillin (75.6%) followed by, nitrofurontoin and cefuroxime (73.1%) and least to chloramphenicol (12.1%). ES ß L producers were highly resistance to nitrofurontoin (69.2%) and cotrimonazole (65.2%) and lower resistance was (7.6%) to amaikacin, observed. A higher resistance pattern to these two antibiotics was observed against ES ß L non producing K. pneumonia but lowest to polymyxin B (13.3%) instead of amikacin (26.6%). All the isolates were found to be susceptible to imipenem. Conclusion: Present investigation revealed high prevalence of MDR- ES ß L producing Klebsiella pneumoniae , which indicates dire need for effective ES ß L surveillance in the community by using cost effective antimicrobials agents.

Correlation of CD4 T Cell Count and Plasma Viral Load with Reproductive Tract Infections/Sexually Transmitted Infections in HIV Infected Females

Background: Sexually transmitted infections (STIs) plays a major role in the spread of Human immunodeficiency virus (HIV) due to common route of transmission. These infections display an epidemiological synergy with HIV. Aim: The aim of this study was to analyse the correlation of CD4 T lymphocyte cell count, HIV-1 plasma viral load with Reproductive tract infections/Sexually transmitted infections(RTIs/STIs) in HIV infected females. Materials and Methods: The study included 60 HIV infected females. An informed consent was taken from all the study subjects. Relevant specimens (genital specimen and blood) were collected for laboratory diagnosis of various RTIs/STIs, CD4 cell count and plasma viral load estimation. Results: Mean CD4 count of females with bacterial vaginosis, vaginal candidiasis, trichomoniasis, syphilis and herpes simplex infection were lower as compared to other HIV infected cases and mean plasma viral load of bacterial vaginosis, vaginal candidiasis, trichomoniasis and syphilis were higher as compared to other HIV infected cases but this difference was not statistically significant. Conclusion: This study highlights the importance of routine screening for STIs/RTIs of all the HIV infected females for RTIs/ STIs irrespective of CD4 cell count and plasma viral load.

A Prospective Study of Comparison of Apache-IV & Saps-II Scoring Systems and Calculation of Standardised Mortality Rate in Severe Sepsis and Septic Shock Patients

Ajay Somabhai Dabhi, Suhas S Khedekar, Vadivelan Mehalingam

Context: Severe sepsis and septic shock are major causes of mortality in the Intensive Care Unit (ICU) Illness Scoring Systems can help in the prediction of outcome of these patients. Aim: To calculate and compare APACHE-IV and SAPS-II Scoring Systems along with calculation of Standardised Mortality Rate (SMR) in patients of severe sepsis and septic shock in the ICU. Study Design: Observational-analytical prospective study. Materials and Methods: The study was conducted on 84 patients with severe sepsis and septic shock admitted to the Medical ICU of a tertiary care teaching hospital. Results: Mean of Predicted Mortality Rate (PMR) for APACHE-IV was 37.85% and for SAPS-II, it was 72.36% which shows that APACHE-IV had under-predicted overall mortality while SAPS-II had over-predicted overall mortality of patients with severe sepsis and septic shock. Standardised Mortality Rate for APACHE-IV was 1.60 and for SAPS-II, it was 0.83. Conclusion: Predicted Mortality of APACHE-IV and SAPS-II Scoring Systems did not correlate with the observed mortality for patients with severe sepsis and septic shock.

A Comparative Study on the Efficacy of Glucose and Sucrose on the Vaccination Pain: A Randomized Controlled Clinical Trial

Objectives: This study was performed to compare the effectiveness of two analgesics for the management of vaccination pain. Materials and Methods: A total of 90 neonates to be vaccinated against Hepatitis B were assigned to Glucose, Sucrose and control groups at Shahid Mostafa Khomini hospital. 2cc oral Glucose 25% and 2cc oral Sucrose 25% with Syringe were given for 30 sec then 2 min later Hepatitis-B vaccine injected by vaccinator and pain intensity measured by Neonatal Infant Pain Scale (NIPS) during 1-2 min. The third group (control) no intervention was performed. The collected data were analysed by SPSS18 Software and ANOVA and LSD tests were used. Results: Research results showed that there were no significant differences between groups in term of Apgar score, delivery type, sex, head circumstance, weight and height. By comparison of pain severity in two groups, mean and Standard deviation of pain, group that received Glucose solution had more intensity than Sucrose group (3 ± 1.66 vs. 2.90 ± 1.44), but this difference was not significant statistically (p=0.78). Comparison of pain intensity in control and intervention groups showed that the pain intensity in control group is higher than intervention groups (p<0.001). Conclusion: Patients who received Glucose or Sucrose had lower pain intensity in comparison with the other. The pain intensity in patients who received sucrose was less than the glucose group, but this difference was not significant statistically.

Vitamin D Levels In Children with Bronchial Asthma

A. R. Somashekar, Ashwini B Prithvi, M. N.Vanitha Gowda

Versatility of Abbe–Estlander Flap in Lip Reconstruction – A Prospective Clinical Study

Aims & Objectives: Aim of this study was to evaluate the versatility of Abbe-Estlander flap in lip reconstruction with regard to function and aesthetic outcome and objectives were to present our experience and result in series of 10 cases of lip reconstruction by Abbe-Estlander flap. Materials & Methods: A total number of 10 patients were taken up in the study, age ranging from 35-71 y, mean age being 60. Out of 10 patients, 6 (60%) were male and 4 (40%) female. In all these patients, Abbe-Estlander flap that involved the commissure was used for reconstruction. Patients were recalled at intervals of three weeks, three months and six months for follow up. Results: All patients had satisfactory results in terms of aesthetic and functional outcome. Conclusion: Abbe-Estlander flap is safe and a reliable flap which is technically simple to perform, and provides functionally and aesthetically pleasing result and affords versatility in flap design.

Evaluation and Comparison of Anticonvulsant Activity of Telmisartan and Olmesartan in Experimentally Induced Animal Models of Epilepsy

Pushpa V H, Padmaja Shetty K, Suresha R N, Jayanthi M K, Ashwini V, Vaibhavi P S

Background: Epilepsy is one common neurological disorder requiring newer targets and newer drugs for its efficient management. In the recent days brain renin angiotensin system has gained immense importance because of its involvement in seizure regulation. Objective: To evaluate and compare antiepileptic activity of different doses olmesartan and telmisartan on MES and PTZ induced seizure models. Methods: Swiss albino mice weighing around 25-30g of either sex were divided into 6 groups: Control ( Distilled Water- 10ml/ kg), Standard – Sodium valproate (40mg/kg), O1 – Olmesartan (2.5mg/kg), O2 – Olmesartan (5mg/kg), T1 - Telmisartan (5mg/ kg), T2 – Telmisartan (10mg/kg). After 1hour of administration of control , test and standard drugs (orally), convulsions were induced by administering PTZ (70mg/kg – i.p.) in PTZ model. Seizure latency was the parameter recorded. In MES model, suppression of tonic hind limb extension was taken as measure of efficacy. Result: The results were analysed by one-way-ANOVA followed by Bonferroni’s multiple comparison test. In MES test, dose dependently olmesartan and telmisartan significantly reduced the duration of tonic hindlimb extension in comparison to control (p<0.05). T2 – 9 + 0.89secs significantly reduced the tonic hind limb extension compared to other test groups (p<0.05). The percentage inhibition of seizure was T2-44.3%, O2-28.2%, T1- 17.5%, O1- 12.3% respectively. In PTZ test, dose dependently olmesartan and telmisartan produced significant increase in seizure latency (p<0.05). T2 - 206.6+9.83secs significantly increased seizure latency compared to other test groups (p<0.05). Percentage protection from seizure is T2-52.6%, O2- 45.13%, T1- 37.5%, O1- 38.4% respectively. Conclusion: AT1 receptor antagonist, telmisartan and olmesartan in a dose dependent manner showed increase in antiepileptic activity. Temisartan at higher dose produced significant antiepileptic activity in comparison to olmesartan.

Varicose Vein Trauma: A Risk for Pulmonary Embolism

Parijat S Joy, Creticus P Marak, Anna M Ponea, Achuta K Guddati

Pulmonary embolism (PE) is a deceptive condition which is often incorrectly diagnosed leading to high morbidity and mortality. We present a case where symptoms were localised to different areas of the body starting with post-traumatic pain over lower extremity varicosities that migrated sequentially over a month to the knee, hip, back, abdomen and chest finally presenting as syncope. Despite a low pre-test clinical probability, a very high index of suspicion led to a timely diagnosis of a massive bilateral PE that eventually caused a troponin leak. The aetiology is highly suspicious of a thrombus which originated in the veins of the leg due to trauma over varicose veins.The case described here exemplifies the importance of considering trauma to varicosities as a risk factor for embolism when the clinical picture is concerning but other signs and symptoms of PE are not apparent

Effect of Infertility on the Quality of Life, A Cross – Sectional Study

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

Introduction: Infertility is a major life crisis which causes serious mental problems and stressful experience of infertile couples. Therefore, the aim of the present study was to compare the quality of life in fertile and infertile women. Materials and Methods: In a cross - sectional study compared the quality of life in 450 women attending both public and private health centers in Ilam, western of Iran, in 2013. Participants were divided in two groups’ fertilities and infertilities women. Data was collected by trained research midwives using demographic and SF-36 questionnaires. SPSS software Package 16 was used to analyze the data of this project. Differences were regarded statistically significant with an alpha error of 0.05. Results: Significant difference was reported in mean age between fertile and infertile women (p=0.003). Mean scores of all Mental dimensions of quality of life were higher in fertile women in comparison with infertile women. This difference was statistically significant (58.35±19.43 vs 56.56±13.18 respectively) (p= 0.000).The mean score of all physical dimensions have not statistically significant difference in fertile and infertile women (79.77± 23.19 vs 74.96±23.45 respectively) (p= 0.441). Conclusion: In most infertile women, the mean score of Mental dimensions of quality of life is lower in comparison with fertile women, therefore, it is necessary the used of counseling and treatment programs in infertile women.

Addition of L-dopa to HBSS in enhancing the maintenance of cell viability of Periodontal Ligament (PDL) cells: an in-vitro study

A.V.Rajesh Ebenezar, Mahendran T, Janani Priya

Aim: To investigate the viability of PDL cells in an avulsed tooth using a storage medium with and without L-dopa. Materials and Methods: Twenty freshly extracted non-impacted human teeth with closed apices and no caries beyond the CEJ were obtained for this study. The teeth were then randomly divided into 1 of the 4 experimental storage solution groups, namely group 1: deionized water; group 2: deionized water with L-dopa (1µg/µl); group 3: HBSS; and group 4: HBSS with L-dopa (1µg/µl). After storing the teeth in different test solutions for 45 minutes collagenase assay was performed and the number of viable PDL cells were counted under a light microscope using a hemocytometer at 20X magnification. Results: The mean number of viable PDL cells was highest in group 4, followed by group 3 and group 2. Group 1 shows the least number of viable PDL cells. Conclusion: The synergistic effect of L-dopa and HBSS paves way for its usage as an effective storage medium for an avulsed tooth.

Comparative Evaluation of the Effect of Menstruation, Pregnancy and Menopause on Salivary Flow Rate, pH and Gustatory Function

Objective: There are five situations in a women’s life during which hormone fluctuations make them more susceptible to oral health problems – during puberty, at certain points in the monthly menstrual cycle, when using birth control pills, during pregnancy, and at menopause. The present study aimed at evaluating the effect of menstruation, pregnancy and menopause on salivary flow rate, pH and gustatory function. Materials and Methods: The study was carried out on 120 patients including 30 controls (with normal menstrual cycle of 28 to 30 d) and 90 cases (30 patients within three days of menstruation, 30 pregnant and 30 postmenopausal). Paraffin-stimulated saliva samples were obtained by expectoration to calculate salivary flow rate, pH was measured electrometically and patients were prospectively evaluated for gustatory function. Then, whole mouth taste test was performed in which the quality identification and intensity ratings of taste solutions were measured. Results: No statistically significant difference was found between the groups with respect to salivary flow rate but pH values were significantly lower in post menopausal women (p<0.05). Regarding correct quality identification the results were non-significant. Intensity for taste perception for sucrose was significantly lower in postmenopausal women than intensity of taste perception for other tastes (p<0.05). Also, postmenopausal women reported change in their dietary habits as all of them expressed liking for sweeter food. Conclusion: Reduced salivary flow rate and pH in postmenopausal women may make them more prone to the occurrence of oral health problems. Also, pregnant and postmenopausal women appeared to have a reduced perception of sucrose, which can alter eating habits, such as intake of more sweet foods whereas no significant difference is observed in taste perception of NaCl, citric acid and quinine hydrochloride between the subjects.

Characterization, Localization and Patterning of Lymphatics and Blood Vessels in Oral Squamous Cell Carcinoma: A Comparative Study Using D2-40 and CD-34 IHC Marker

Objectives: Lymphatic metastasis has always been regarded as a major prognostic indicator for disease progression and as a guide for therapeutic strategies to oral squamous cell carcinoma (OSCC). Differentiating lymphatic vessels from blood vessels is difficult, partly due to lack of specific method for identifying lymphatics. A new lymphatic vessel reactive antibody D2-40 has been introduced recently. Here we examined immunohistochemical localization of lymphatic vessels and blood vessels using D2-40 and CD-34 respectively in different histological grades of OSCC. Their expression in intra-tumoural and peri-tumoural region was also compared. Materials and Methods: Forty two formalin-fixed paraffin-embedded tissue blocks of excised specimens of OSCC were immunohistochemically evaluated using D2-40 and CD-34 antibodies. Lymphatic vessel density (LVD) (D2-40 positivity) and micro vessel density (MVD) (CD34 positivity) in both intratumoural and peritumoural areas were assessed by hot spot method. Results: Regardless of histopathological differentiation, LVD and MVD in peritumoural areas were found greater than intratumoural areas (p>0.05). Interestingly, other than lymphatic vessels, D2-40 positivity was also detected in tumour cells as well as in basal layer of epithelium adjacent to OSCC. Two patterns of distribution of CD34 positive vessel - circumscribing type and penetrating type were also observed in the cancer nest area. Conclusion: D2-40 can be used as a marker to differentiate lymphatic vessels from blood vessels. Lymphatic and blood vessel proliferation might be much more extensive in the peritumoural area. D2-40 expression in epithelium adjacent to tumour indicates its role in the process of differentiation. Further, its expression in potential malignant disorder may provide better insight in predicting prognosis and pathogenesis of these lesions.

Effect of Periodontal Therapy on Salivary Interleukin-12 Levels in Chronic Periodontitis

Anamika Sharma, B.P. Khattak, S Naagtilak, Ganesh Singh, TaTanveer Bano

Background: Interleukin-12 (IL-12) is considered a central regulator of host resistance against a variety of pathogens. The influence of scaling and root planing was evaluated on amount of IL-12 in salivary fluid of patients with chronic generalized severe periodontitis, in relation to clinical parameters. Materials and Methods: A total of 50 subjects were enrolled, of which 25 had chronic generalized severe periodontitis, and 25 periodontally healthy as control. The clinical parameters included plaque index (PI), gingival index (GI), pocket probing depth (PPD) bleeding on probing (BOP) and clinical attachment loss (CAL). The level of IL-12 in salivary fluid was measured by ELISA kit at baseline and at four week following scaling and root planing. Results: Mean IL-12 levels in patients with periodontitis at baseline (9.79 ± 5.70 pg/ml) were higher than in controls (9.18±4.94 pg/ml; p=0.54. ) Scaling and root planing resulted in significant increase in IL-12 levels (mean: 15.93±12.09 pg/ ml; p =0.001) (control vs postoperative p <0.001). No significant correlations were found between IL-12 levels and any of the above clinical parameters. Conclusion: Short-term nonsurgical therapy resulted in a significant improvement in periodontal indices and a marked increase in IL-12 levels

A Rare Case of Acute Lymphoblastic Leukaemia in Pregnancy- Unique Maternal-Fetal Challenges

Shamim Khandaker, Shabana Munshi

Leukaemia in pregnancy is rare and lethal. Its incidence is estimated to be 1 in 75,000 pregnancies. Use of chemotherapeutic agents during pregnancy can give rise to maternal and fetal adversity; resulting in dilemma regarding proper management plan. A 25-year-old pregnant lady was presented at 24 wk of gestational age with cervical and inguinal lymphadenopathy and bicytopenia in complete blood counts. Diagnosis of acute lymphoblastic leukaemia was confirmed by bone marrow biopsy. Treated with appropriate chemotherapeutic regimen with some modification in the standard protocol due to pregnancy and delivered successfully by lower segment caesarean section at 34 wk of gestational age. Diagnosis of acute leukaemia during pregnancy need high index of suspicion and need prompt management with the proper chemotherapeutic regimen. Clinical judgement regarding the risk benefit ratio of using chemotherapeutic drugs ensures better mother and fetal outcome.

Klestadt’s Cyst with Radiographic Contrast Medium: A Case Report

Vijay Kumar A, Jaishankar H P, Shashidara, Jayanth B S

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

Pilomatrixoma Masquerading as Metastatic Adenocarcinoma. A Diagnostic Pitfall on Cytology

Divya Sharma, Shipra Agarwal, L Shyama Jain, Vinay Kamal

Pilomatrixoma (Px) is a relatively uncommon slowly growing, benign skin appendageal tumor with a wide morphological spectrum, and can pose diagnostic difficulties especially in cases with unusual clinical presentation. We report a case of young male who presented with a nodule over anterior abdominal wall, fine needle aspiration cytology (FNAC) revealed predominantly small cells in focal acinar pattern suggestive of metastatic carcinoma; however, histopathological diagnosis was Px. The case highlights the diagnostic pitfalls on cytology due to limited morphology.

Carcinosarcoma Masquerading as Giant Cystic Hematoma

Carcinoarcoma of breast is rare tumor with aggressive behaviour and poor prognosis. Histologically it is biphasic tumor with epithelial and mesenchymal component. Very few cases of carcinosarcoma, its presentation and behaviour have been reported in the literature, and due to its bizarre behaviour it is a diagnostic challenge to pathologist and clinicians. Here we present a rare case of carcinosarcoma breast in a 55-year-old female who initially presented with cystic mass( lump) in right breast which was reported as organised hematoma on FNAC, on frozen section it was diagnosed as malignant cystic tumour. This was followed by mastectomy. Histopathology with immune markers, the case was diagnosed as metaplastic carcinoma with biphasic type called carcinosarcoma. The case merits presentation because of its rare presentation as cystic lesion and difficult to diagnose mainly due to sarcomatous elements. An accurate diagnosis of this aggressive tumour is essential in order to optimally tailor adjuvant therapy.

Malignant Conversion of Oral Submucous Fibrosis in Surgically Treated Case

Oral submucous fibrosis (OSMF) is an insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx with epithelial atrophy leading to stiffness of the oral mucosa, causing trismus and inability to eat. However a more serious complication of this disease is the risk of the development of oral carcinoma. We reported the histopathologically proven case of OSMF with initial interincisal mouth opening 2mm which was treated surgically with nasolabial flap technique but failed to follow up and could not do active mouth opening exercises. Malignant conversion of OSMF was seen in this case. This is required to assess the progress and evaluate any malignant transformation at the earliest. So, the importance of active co-operation and frequent follow up cannot be overemphasized. The purpose of this study is to emphasize the importance of regular follow up and frequent biopsies to facilitate oral examination and to check any malignant conversion after the surgery.

Traumatic Peripheral Neuropraxias in Neonates: A Case Series

Sushma Malik, Heena Sudhir Bhandekar, Charusheela Sujit Korday

Traumatic peripheral nerve palsies in the newborn are uncommon but are a cause of severe anxiety in parents. Erb’s palsy, brachial plexus, radial nerve and facial nerve are the common nerves affected. Perinatal injuries are the most frequent cause of traumatic peripheral neuropraxias / nerve palsies. Usually these neuropraxias are self-limited with good recovery with conservative management in majority of cases.Ten neonates with peripheral neuropraxias were included in this retrospective study based on a review of these cases over a period of three and a half years. Their clinical profile, presenting symptoms, predisposing factors and management were analyzed. We encountered five neonates with erb’s palsy, three with facial palsy and two had radial nerve affection. Risk factors in our series included large babies, prolonged or difficult labour, instrumental delivery and shoulder dystocia. All cases of peripheral nerve involvement were managed conservatively with physiotherapy. Nine neonates were discharged and showed gradual improvement and one patient unfortunately succumbed due to severe birth asphyxia. Parental counseling and rehabilitation play an important part in management of these cases.

Riedel’s Thyroiditis in an Elderly Male Patient: A Rare Entity

Chumila Thinley Bhutia, Deepak Das

Riedel’s thyroiditis (RT) is a rare fibrosclerotic infiltrative thyroid disorder of unclear aetiology. It has been reported in 0.06% of thyroid surgeries and is more common in women. A 60-year-old euthyroid male presented with thyroid swelling and sinus discharge since three years, associated with pain and fever. Near total thyroidectomy revealed right lobe measuring 5x2.5x2 cm, well encapsulated, firm to hard with resistance on cutting. Microscopic examination showed variable sized colloid filled follicles with intervening areas of dense fibrosis admixed with lymphocytic aggregates and perivascular fibrosis extending to the thyroid capsule. The diagnosis of Riedel’s thyroiditis was made on histopathological examination. Hence, we would like to emphasize that Riedel’s thyroiditis requires diagnostic thyroidectomy and histopathological examination for confirmation.

Tibialis Anterior Partial Rupture Mimicking Muscle Hernia: A Rare Case Report

Rupture of tibialis anterior tendons is infrequently described in literature, and those described were around the ankle, either at the origin or in the tendon substance. To our known knowledge only very few cases of rupture of the tibialis anterior at musculotendinous junction were reported. We highlight the occurrence of rupture at the musculotendinous junction in tibialis anterior muscle after trauma, presenting as a soft tissue mass, the need to differentiate it from traumatic muscle hernia, mechanism of injury and its ultrasound and MRI findings.

Testicular Torsion in Cerebral Palsy – Resident´s Grey Area

The association of testicular torsion and cerebral palsy is a well-known fact. But the infrequent presentation to emergency room makes the clinician sceptical. Such a presentation often puzzles the residents regarding the diagnosis and the treatment. Here we present a case of an adolescent boy aged with cerebral palsy 13 years with incessant crying and not feeding well for last 3days. Right inguinal region showed a tender globular swelling with absence of testis in scrotum along with signs of septicaemia. The inguinal exploration was performed under general anaesthesia which revealed gangrenous right testis. Right orchidectomy and left orchidopexy was performed and the patient recovered well. This case is reported for its complexity due to lack of reliable history, delayed presentation and associated comorbidities posing challenges to the treating surgeons.

Successful Pregnancy Outcome in A Case of Eisenmenger Syndrome: A Rare Case Report

Setu Rathod, Sunil Kumar Samal

Pregnancy complicated with Eisenmenger syndrome is associated with high risk to the fetus as well as the mother. There is approximately 50% risk of sudden maternal death, frequently occuring a few days postpartum and the overall fetal wastage is reported to be up to 75%. Patients with Eisenmenger syndrome are advised to refrain from pregnancy or to terminate pregnancy by the end of first trimester itself. Management of these patients requires a co-ordinated multi-specialist care when such pregnancies reach a stage where safe termination is not advisable. However, inspite of all the risks, a few patients deliver successfully with a good maternal and neonatal outcome. We present a 27-year-old unbooked G3P1A1L0 admitted at 34 wk gestation with Eisenmenger syndrome. She was treated medically during pregnancy, underwent elective Caesarean section at 37 wk of gestation delivered a healthy baby and was subsequently discharged on the 10th postoperative day without any serious complications.

Waugh’s Syndrome: Blessing in Disguise

Chinmaya Ranjan Behera, Subrat K Mohanty

Waugh’s syndrome is the association between intestinal malrotion and intussusceptions. We report a case of Waugh’s syndrome in a one year old child who presented to us with acute bowel obstruction and bleeding per rectum. Due to malrotation, there was easy prolapsing of ileocolic region into the nonfixed ascending colon and the intussusceptum advanced into the descending colon and rectum without compromising vascularity of the bowel. In most of the cases the intussusceptum advancing into the rectum is associated with bowel gangrene even when ceacum is mobile. But in our case, mobile caecum with malrotation proved to be blessing in disguise in preventing such a complication. A Meckel’s diverticulum was also an incidental finding in this case. Waugh's syndrome is missed in cases of close reduction of intussusception and may be a reason for recurrence. Though a rare entity, the probability of Waugh’s syndrome should be kept in mind during surgery, during hydrostatic reduction of intussusceptions, and in case of recurrent ileocolic intussusceptions.

Keratomycosis: Etiology, Risk Factors and Differential Diagnosis- A Mini Review on Trichophyton spp

Yukti Sharma, Sanjay Jain, Jayachandran

Fungal keratitis is an infectious disease of the cornea. Lack of suspicion and delayed diagnosis herald the onset of complications often leading to permanent loss of vision or worse, enucleation. While a variety of pathogenic fungi especially non-dermatophyte molds associated with fungal keratitis have been identified, a comprehensive review identifying the Trichophyton spp. has not been completed. Trichophyton spp. is a rare but important entity implicated in fungal keratitis. Case reports from around the world designate it as a dangerous pathogen. Trichophyton spp. implicated in keratitis has not previously been reported and is considerably greater than suggested by incidence studies. Patient outcome is heavily reliant upon correct identification, timely intervention and effective treatment. Species identification, the risk factors associated with, and pathogenesis of keratitis will allow the development of improved therapies. This mini review provides a resource for clinicians and researchers to recognize Trichophyton spp. as a potent etiological agent capable of causing keratitis. It is no more a dermatophyte limited to infection of appendages.

Congenital Mucous Retention Cyst of the Anterior Hard Palate! the First Case Report

Children may be born with birth defects, the most common being oro-facial clefts and fissural cysts. A well circumscribed pedunculated soft tissue growth that occurs congenitally is known as congenital epulis of the newborn or ‘Neuman’s Tumour’ as described in the literature. It is a rare lesion and the diagnosis has to be confirmed histologically. We present a rare case of a 7-year-old child with a congenital growth in the pre-maxillary region of the anterior hard palate clinically diagnosed as congenital epulis however, histologically confirmed as a mucous retention cyst. An elaborate clinical differential diagnosis is discussed. The anterior hard palate is devoid of salivary glands and the presence of a mucous retention cyst in the area is suggestive of ectopic salivary gland tissue and in a child manifesting at birth is probably the first case to be reported in the English literature.

Hemodialysis Induced Amyloid Arthropathy of Hip Presenting as Pathological Fracture-A Case Report and Literature Review

Fahad Alshehri

Amyloid arthropathy is a recognized complication of chronic renal failure with long term dialysis. The amyloid, a beta 2microglobulin is not filtered by dialysis membrane and remains in the circulation, gets deposited over the synovium, articular bones and cartilage. As a result the large joints like shoulder, hips and knees show cystic bone lesions. The radiological features precede the clinical symptoms. The majority of the patients remain asymptomatic till the advanced stage or may present with pathological fracture. The patient in this case report had a long history of dialysis due to renal failure and presented with pain, limping and difficult to walk after the history of fall in bathroom. The radiological investigations, particularly MRI hip had typical signs of amyloid arthropathy; later on confirmed by biopsy. This case report is presented to call attention of clinicians and radiologists for the early and prompt diagnosis of amyloid arthropathy, avoiding false/delayed diagnosis which can increase morbidity and mortality.

Albright Hereditary Osteodystrophy: A Case Report

Deepa Hugar, Sangameshwar Sajjanshetty, Santosh Hugar, Megha Kadani

A dental practitioner with an eagle’s eye can diagnose many hidden disease through careful examination of the oral cavity. One such hereditary metabolic disorder is Albright hereditary osteodystrophy (AHO). Characteristic presentations in an individual affected by AHO were short stature, obesity and brachydactyly especially of 4th and 5th digits, which are the phenotypic features of genetic mutation. Pseudohypoparathyroidism (PHP) is characterized by inability of the body to respond appropriately to parathormone, mainly characterized by hypocalcemia, increased serum parathormone concentration, insensitivity to the biological activity of parathormone and hyperphosphatemia. AHO when seen in association with resistance to parathormone (PTH), it is called PHP. Here is, a case report of 32-year-old male patient with AHO with distinctive physical characteristics and oral manifestations

Is it Askin Tumour? A Question You Must Ask Even in Elderly

Nadeem Tanveer, Navneet Kaur, Kiran Mishra, Neelam Wadhwa, Navjeevan Singh

Primitive neuroectodermal tumour of chest wall has been given the name Askin tumour after FB Askin who first reported this distinctive clinicopathologic entity in 1979. Most of the patients are either children or adolescents, however, rarely it may affect older patients. This case report emphasizes on the diagnostic approach to this rare tumour and underlines the importance of keeping it in the differential diagnosis even in elderly patients. Since it is an aggressive tumour, a high index of suspicion is required to make a timely diagnosis.

Christ-Siemens-Touraine Syndrome: Case Report of 2 Brothers

Rita V Vora, Gopikrishnan Anjaneyan, Arvind Chaudhari, Abhishek P Pilani

Ectodermal dysplasia is a rare disorder. Christ-Siemens-Touraine syndrome (Hypohidrotic Ectodermal dysplasia (HED)) is a diffuse, non-progressive disease present at birth and involves at least two tissues of ectodermal origin. It is caused by mutation in gene ectodysplasin (EDA, EDA1) located at Xq12-13. Main clinical feature of HED is sparse or absent eccrine gland as well as hypotrichosis, nail, and teeth abnormality with characteristic faces. The absence or diminished activity of sweat gland results in patients having more chances of developing hyperthermia and with intolerance to warm environment. Most do well with simple measures such as wet clothes, air conditioning, wet bands etc. We present cases of two brothers, born of non-consanguineous marriage, who presented to us with complaints of heat intolerance and abnormal facial features.

Ovarian Pregnancy: Uncommon Mode of Presentation

Saubhagya Kumar Jena, Gayatri Kar, Soumya Samal, Basanta Kumar Behera

Ovarian pregnancy is very rare, and its incidence is 1 in 3000 live births. In this condition, common risk factors for ectopic pregnancy not usually found. It usually occurs in fertile women and more commonly with in-situ intrauterine device (IUD). Preoperative diagnosis is always not possible although the patient commonly presents with abdomen-pelvic pain, per vaginal bleeding and hypovolemic shock. High degree of suspicion with estimation of serum beta HCG, transvaginal ultrasonography by an experienced sonologist and laparoscopy is required for confirming the diagnosis. Though, the usual treatment is surgery, it can be managed by medical methods only in hemodynamically stable patients. In this case report, we describe the unusual mode of clinical presentation in an elderly woman with ovarian pregnancy.

Benign Osteoblastoma of Maxilla: A Case Report Emphasizing the Histopathological Differential Diagnosis

Deepak Pandiar, Shameena P M, Saaks hi Gulati, Vishal Singh Banyal, Amit Kumar

Benign osteoblastoma is a rare bone tumour characterized histologically by production of woven bone spicules, which are bordered by prominent osteoblasts. It mainly affects male teenagers and young adults. A case of benign osteoblastoma of maxilla in a 19 years old male is reported here. Also, histological comparison is made between benign osteoblastoma, aggressive osteoblastoma and osteosarcoma.

Oral Cysticercosis: A Diagnostic Difficulty

Jaya Joshi, Manjunatha Bhari Sharanesha, Rameshwar Jatwa, Shaleen Khetrapal

Cysticercosis is a rare disease caused by the ingestion of the parasite Cysticercus cellulosae, a larval stage of Taenia solium. The definitive host is human who harbors the adult worm and may accidentally or incidentally become the host. The larval form of cyst is commonly seen in the brain, meninges and eyes. Cases in the maxillofacial region including oral cavity and cheek muscles are rarely reported. Cysticercosis is not commonly considered in the diagnosis of swellings of the head and neck and a diagnostic and therapeutic dilemma for clinicians. Hence, they are of utmost interest to the practitioner and have to be studied. We present an unusual case of cysticercosis presenting as a solitary cystic nodule in the upper left vestibule of the oral cavity in an 18 year male and the diagnosis was made on histopathological examination.

Transthoracic Repair of Paraesophageal Diaphragmatic Hernia Presenting with Symptoms Mimicking Cardiac Disease (Chest Pain and Breathlessness)

Vikas Deep Goyal, Sanjeev Sharma, Som Mahajan, Ashwani Kumar

We discuss a case of 60-year-old female patient, who presented with history of chest pain radiating to left shoulder, breathlessness and postprandial discomfort. Patient was initially suspected to be suffering from cardiac pathology and was evaluated accordingly. Upper gastrointestinal endoscopy also missed the findings of paraesophageal hernia as the gastroesophageal junction was at its normal position. Chest roentgenogram raised the suspicion of diaphragmatic hernia, computed tomogram of chest and abdomen was done later on and showed characteristic features of paraesophageal hernia. Patient underwent transthoracic repair of the paraesophageal hernia along with partial fundoplication and had complete relief from the symptoms after surgery.

A Case of Vander Woude Syndrome with Rare Phenotypic Expressions

Van der Woude syndrome (VWS) is a rare developmental disorder with an autosomal dominant inheritance. The prevalence of VWS varies from 1:100,000 to 1:40,000 still born or live births. It has variable expressivity and generally expressed as orofacial manifestations like lower lip pits, cleft lip and/or cleft palate, hypodontia, cleft or bifid uvula, ankyloglossia and some extraoral anomalies involving hand, foot and genitalia. Thorough family history, clinical examination and genetic counseling helps in correct diagnosis of VWS as Popliteal pterygium syndrome has overlapping clinical manifestations. Most cases of Van der Woude syndrome have been associated with mutations and genetic changes. The current case has classical features of VWS with some rare features like undescended small testis and unreported finding of syndactyly of second and third toe adds on to the existing knowledge of VWS presentation.

Chondroid Syringoma with Extensive Bone Formation: A Case Report and Review of the Literature

Recep Bedir, Cuneyt Yurdakul, Ibrahim Sehitoglu, Hasan Gucer, Suphan Tunc

Chondroid syringoma is a rare, skin appendageal tumour, usually reported at the head and neck region. It is a mostly intradermal and rarely subcutaneous small painless nodule. The histopathological examination is characterized by a combination of epithelial and myoepithelial structures within a chondromyxoid and fibrous stroma. Herein, we present a rare case of chondroid syringoma with extensive bone formation.

Renal Leiomyoma: An Uncommon Differential Diagnosis of Renal Masses with a Clinical Relevance

Shaan Khetrapal, Anupam Bhargava, Sujata Jetley, Safia Rana, Zeeba Jairajpuri

Renal leiomyomas are an extremely rare neoplasm which account for 1.5% of the benign lesions and 0.29% of all treated renal tumours, with autopsy evidence of 4.2% to 5.2%. Given their exceptional incidence, they are rarely included in the differential diagnosis of renal masses, despite their capacity to grow to a considerable size. The definitive diagnosis of a leiomyoma is only possible after histopathological examination, most of the times of a nephrectomy specimen. However, due to the rising number of diagnosis resulting from improved medical imaging and interventions, renal leiomyomas should gain importance in the differential diagnosis of renal masses, specialy with respect to kidney sparing surgery. Hereby, we report a case of 60-year-old male patient with a large well circumscribed left renal mass, diagnosed as Renal cell carcinoma on imaging.

Can a Tight Saree Wear Cause Cancer? – A Rare Case Report

Skin cancer is rare in India with an incidence of about less than 1% of all cancers. Saree Cancer, a kind of skin cancer is rarer entity, which arises from the frequent abrasion over skin caused by tying the rope in inskirts, often tied tightly so that the saree does not slip. This causes hyperpigmented abrasion, ulcer and then may lead to cancer. This report is about a 40-year-old female with non-healing ulcer of six months duration with rapid increase in size over the past one month. The ulcer measured 4x2 cm in size. The patient underwent excision of the tumour and the margins were positive. Re-excision was done for positive margins and re-growth of the tumour. This is one the first few reports on saree cancer.

Ellis van Creveld Syndrome (EVCS) in an Iranian, Three-Year-old Girl: A Case Report

Alaee Ehsan, Shirafkan Ali, Hasheminejad Reihane, Tourisa Deilami, Alireza Kia

Ellis van Creveld syndrome (EVCS) is mainly characterized by dysplatic changes in skeletal structures along with variable inter- and intra-familial patterns. Shortening of bony structures such as ribs and limbs, postaxial polydactyly, and dysplastic teeth and nails are among the clinical presentation of this autosomal recessive disease.

Assistance of Pressure Conformer for Reconstruction of Lower Fornix

Pokpong Amornvit, Reiyal Goveas, Dinesh Rokaya, Sahana Bajracharya

Absence of fornix in anopthalmic socket can result in difficulty in prosthetic and cosmetic rehabilitation. A 30-year-old female was presented with absence of the lower fornix in anopthalmic socket. A stock conformer was used to create continuous downward pressure with the help of an acrylic rod, gauze and a medical adhesive tape. Eventually, a lower fornix was created and finally rehabilitated with ocular prosthesis.

Retroperitoneal Schwannoma: An Atypical Presentation

Schwannoma is a rare tumour arising from Schwann cells in myelinated neural sheath of the nerves. They can arise in various places like head, neck, extremities, adrenal, retro peritoneum, psoas muscle. We here present a case of 33-year-old male came with features of acute pancreatitis, with incidentally detected mass in presacral region on ultrasonography. Investigations like CECT and MRI were suggestive of neurofibroma, radical excision of the mass was done which showed solitary encapsulated tumour and cut sections showed areas of necrosis, and histopathologically it was proven as schwannoma. Most of the schwannoma’s are benign, but rarely malignant transformation can occur. It can be associated with von Recklinghausen disease. Benign tumours have excellent prognosis, malignant tumours can present at later date with metastasis after excision also. Radiology plays a key role in diagnosis and follows up. Treatment is radical excision of tumour; recurrence is most common and has to be carefully followed up.

Sertoli-Leydig Cell Tumour of Ovary with Menorrhagia: A Rare Case Report

Sertoli-Leydig cell tumours (SLCTs) are rare sex cord stromal neoplasms of ovary accounting for less than 0.5% of all ovarian tumours. These are found in women of all age groups (2-75 y), but are most common in reproductive age group with an average age of 25 y. Mostly these are unilateral, confined to ovaries and usually stage I at the time of clinical diagnosis. The common presenting complaints in these patients are due to either mass occupying lesion (mostly pelviabdominal mass and/or pain) or hormonal production (mostly androgen and more rarely oestrogen). Androgenic manifestations, seen in 80% of patients with SLCT, are virilism, hirsutism, receding hairline, breast atrophy, clitoromegaly, acne, hoarseness of voice, etc. Estrogenic manifestations are precocious puberty, abnormal uterine bleeding, abnormal vaginal bleeding, menstrual irregularities, generalised oedema, weight gain, breast hypertrophy, endometrial hyperplasia, endometrial polyps and endometrial carcinoma. Histologically these are classified (WHO) as well-differentiated, intermediately differentiated, poorly differentiated, with heterologous components and retiform type. Prognosis depends upon degree of tumour differentiation (grading) and tumour extent (staging). We herein report an unusual case of SLCT of ovary with oestrogenic manifestation of menorrhagia.

Adverse Reactions of Ferric Carboxymaltose

Harish Thanusubramanian, Navin Patil, Smita Shenoy, K L Bairy, Yashdeep Sarma

The author reports a 55-year-old female diagnosed of chronic kidney disease grade-5 with associated co-morbidities like type 2 diabetes mellitus, diabetic retinopathy and hypothyroidism was admitted for arteriovenous fistula construction. She was started on ferric carboxymaltose for the treatment of anaemia. She was given a test dose before administering the drug intravenously and she did not develop any reaction. The drug ferric carboxymaltose was then administered over a period of one hour. About half an hour after drug administration, the patient developed breathlessness and myalgia. After half hour of the above episode of breathlessness and myalgia. She also developed vomiting (one episode). Patient was managed with oxygen therapy, IV fluids and other drugs like corticosteroids, phenaramine maleate and nalbuphine which controlled the above symptoms.

Endocarditis in Mitochondrial Neurogastrointestinal Encephalomyopathy (MNGIE) Syndrome: The First in the Literature

Mustafa Yolcu, Canan Yolcu, Zekeriya Kaya, Ender Ozgun Cakmak, Yusuf Sezen

Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) syndromes is a rarely seen multisystem disorder with autosomal recessive inheritance due to thymidine phosphorylase gene mutation. It is characterized by progressive external ophthalmoplegia and/or pitosis, progressive gastrointestinal dismotility and abdominal pain, postprandial emesis, cachexia, demyelinating peripheral neuropathy, symmetrical and distal weakness especially in lower extremities and diffuse leucoencephalopathy in cranial magnetic resonance. Endocarditis is the infectious and inflammatory disease of the endothelial surface of the heart. MNGIE syndrome is a condition in which immune system is suppressed and infection risk increased. Herein we summarized a previously not reported endocarditis case in a patient with MNGIE syndrome who was under fallow up for three years. In MNGIE syndrome of acute dyspnea, infective endocarditis should be kept in mind and prompt evaluation for surgical treatment should be done.

Asymptomatic Transhiatal Pancreatic Herniation after Oesophagectomy

Transhiatal herniation of abdominal organs after oesophageal resection and reconstruction is rare and sparsely described in the literature. The commonest organ to herniate is the colon. Pancreatic herniation has been reported twice before. We report a case of postoesophagectomy transhiatal pancreatic herniation in an asymptomatic patient.

Neurorickettsioses: A Rare Presentation with Stroke in a Young Adult

Praveen Kumar S, Pramod K

Acute stroke-like presentations due to rickettsial infections have been sparsely reported in literature. We report a young patient who presented with high grade fever and acute encephalopathy with right hemiplegia. CT head showed left cerebral, bilateral thalamic and midbrain infarcts. The stroke in young work-up for conventional and non-conventional risk factors including few infections known to cause cerebral vasculitis was negative. He did not respond to empirical antimalarials and antibiotics. With a high index of suspicion of his ‘febrile cerebrovasculitis’ like presentation, serological test for rickettsia was done and found to be positive. He responded to doxycycline. This case expands the spectrum of presentation of neurorickettsioses and highlights the importance of considering rickettsial vasculitis as one of the potentially treatable causes of infections causing stroke.

Umbilical Metastasis as Primary Manifestation of Cancer: A Small Series and Review of the Literature

Umbilical metastasis is a rare manifestation of intra-abdominal cancer. It appears either as the first sign of a primary malignancy or as metastatic site of an already diagnosed cancer, representing an ominous prognostic finding. We report three cases of umbilical metastasis as the first sign of an underlying malignancy. Hypotheses about pathophysiology of umbilical metastasis are based on the embryological origin of the umbilicus and its residual communication with systematic, portal and lymphatic circulation.

Pulmonary and Ileal Tuberculosis Presenting as Fever of Undetermined Origin

Gajanan Surewad, Ivona Lobo, Preeti Shanbag

A 12-year-old girl presented with prolonged fever with no obvious focus on either history or clinical examination. High-resolution computerized tomography of the chest revealed the ‘tree-in-bud’ sign in the right lung and necrotic mediastinal lymph nodes. Barium meal showed multiple ileal strictures. The child was treated with anti-tuberculous therapy for six months. At follow-up six months later, the child had gained weight and had no signs of intestinal obstruction. Tuberculosis is a common cause of fever of undetermined origin and should be investigated for especially in countries with a high prevalence.

Enteropathy Associated T Cell Lymphoma – A Case Report of An Uncommon Extranodal T Cell Lymphoma

Geetha V, Ranjini Kudva, Anna Joseph Amprayil

Enteropathy associated T cell lymphoma is a rare primary intestinal lymphoma. It is often, but not always associated with celiac disease. Intraepithelial T cells are postulated as the cell of origin. It is a rare disease accounting for fewer than 5% of all gastrointestinal tract lymphomas. Recent studies indicate that EATL consists of two diseases that are morphologically and genetically distinct and differ with respect to their frequency of association with celiac disease. Current WHO classification recognises two subtypes of EATL – type 1 (classic) and type 2, based on morphology and immunophenotype. EATL type 1 is a large cell lymphoma which is more common and is more commonly associated with celiac disease compared to type 2. Most common site of involvement is the small intestine. We report a case of EATL type 1, in a 62-year-old female patient who presented with features of intestinal obstruction. However, she did not have spruce like featutes.

Volvulus of Sigmoid Colon During Full Term Pregnancy with Rectovaginal Fistula: A Case Report

Sanjeev Kumar, Shefali Gautam, Ravi Prakash, Kanishka Sidhartha, Shashikant

Intestinal obstruction due to sigmoid colon volvulus during pregnancy is a rare complication but associated with significant fetomaternal mortality. We describe a case of sigmoid volvulus in a patient with 37 wk pregnancy causing huge dilation of left colon. Patient developed rectovaginal fistula following nonmedical method to relieve distention by inserting stick as told by patient.

A Very Rare Presentation of Synovial Cell Sarcoma Arising from the Tendon Sheath of Flexor Hallucislongus Tendon and Causing Secondary Erosion of Calcaneum

C.J. Mani Kumar, B.S.S.S. Venkateswarlu

Synovial cell sarcoma is a rare variety of soft tissue tumour. Very few cases of this tumour affecting the tendon sheath have been reported so far. We report a rare presentation of synovial cell sarcoma of the flexor hallucislongus tendon in a 35-year-old female. She presented with a painful lump (tumour) arising from postero medial aspect of the right ankle. The mass produced erosion of the overlying calcaneum over the time of one year. She was managed surgically by enucleation of the tumour followed by augmentation of calcaneum with bone cement.

Skin to Serosa: Scar Endometrioma

Maya Menon, Sridevi. T.A , Chandrika.P.N , Sathish selvakumar.A.

Extra pelvic endometriosis, an underappreciated and misdiagnosed gynaecological problem has been reported here for its rare location. Patient presented with swelling and cyclical pain over vertical scar (caesarean) . Diagnosis was made on high index of clinical suspicion which was complimented by Magnetic Resonance Imaging (MRI). Scar endometrioma extended from the skin upto the uterine serosa which is extremely rare. Wide excision of endometrioma followed by mesh repair was done. Histopathology confirmed the diagnosis.

Bleeding Ureter: Endometriosis Mascarading as a Ureteral Malignancy - A Case Report

S.M.L. Prakash Babu, Puvvada Sandeep, Amey Pathade, H.K. Nagaraj

Ureteral endometriosis is a serious localization of disease burden that can lead to urinary tract obstruction, with subsequent hydroureter, hydronephrosis, and potential kidney loss. As the diagnosis is elusive, a heavy clinical suspicion is necessary. Surgical technique to treatment varies, but the goal is to salvage renal function and decrease disease burden. Here, we are presenting a rare case of bleeding ureter in a young lady who had endometriosis of the ureter.

Cystic Endosalpingiosis of Uterine Parametrium- A Scarcely Encountered and Sparsely Documented Entity

Hemalatha A. L, Ash Ok K. P, Anoosh A. K, Indira. C. S

“Endosalpingiosis” refers to the presence of fallopian tube-like epithelium outside fallopian tubes. It merits attention both by Clinicians and Pathologists since it is a benign, non- neoplastic condition which maybe easily misjudged as carcinoma mainly due to the rarity of its occurrence and lack of awareness owing to paucity of its documentation in literature. Further, salpingiosis can undergo massive cystic change thereby mimicking a tumour when it is referred to as cystic salpingiosis. We present one such extremely rare case of cystic salpingiosis of uterine parametrium in a 40-year-old lady along with an extensive review of literature which revealed that about 10 cases have been documented till date.

An Unusual ‘W’ Shaped Thyroid Gland with Absence of Isthmus – A Case Report

Rajan Singla, Ravikant Sharma Kulbir Kaur

Thyroid gland is one of the largest endocrine glands located in the neck opposite C5-T1 vertebrae. It consists of 2 lobes connected to each other by an isthmus. It depicts a number of congenital anomalies. One such variant was seen in a 55-year-old male cadaver whereby the gland was ‘W’ shaped in toto with each lobe consisting of medial & lateral limbs. The medial limbs of the 2 lobes united with each other in the midline in the form of an inverted ‘^’ and thus the gland was ‘W’ shaped. The isthmus as such was absent. It is an extremely rare condition which should be known to the surgeons operating in this area. Its ontogeny, phylogeny & clinical/surgical implications are discussed in detail.

Two Rare Presentations of Epidermal Cyst

Arun Rao, Bharathi Rao, Maria Joseph Kurian, Radha R. Pai

Epidermal cysts are very rare. It is more common in males than in females and the most common site of presentation are the hairy sites. We came across two rare cases of epidermal cysts. In one case, a parous lady presented with an adnexal mass and D/D of broad ligament fibroid or ovarian mass was considered which turned out to be a cyst containing cheesy pultaceous material. In the other case, a parous lady presented with a mass arising from the posterior fourchette that contained cheesy pultaceous material on excision. In both cases histopathology confirmed it to be epidermal cysts. Epidermal cysts known for its rare incidence by itself is now found to be presenting at rare sites which emphasizes on the need for further research into the etiopathogenesis of these cysts and its development at the various sites of the body.

Management of Ruptured Occult Left Hydronephrotic Kidney in 7-Year - Old Boy: A Case Report

Rajendra K Ghritlaharey, Santosh More

Pre-existing, occult, congenital renal anomalies are often discovered during evaluation of children for blunt injury of the kidney and abdomen, presenting with or without haematuria. This is a report of 7-year-old boy; who presented with blunt injury abdomen with haematuria following fall from motorcycle. He had pallor, and features of hypovolumic shock and peritonitis. Skiagram of the abdomen showed haziness of the abdomen, without free gas under diaphragm. u ltrasonography ( u SG) of the abdomen revealed significant hemoperitoneum and gross hydronephrosis of the left kidney, which was undiagnosed previously. Exploratory laparotomy was done for peritonitis and the findings were hemoperitoneum, hematoma at the left mesocolon and left retroperitoneum. Postoperative computed tomography (CT) scan of the abdomen reported left hydronephrosis due to pelvi-ureteric junction (P u J) obstruction with rupture of the renal pelvis. The ruptured hydronephrotic kidney was successfully managed by nephrostomy followed by delayed open dismembered Anderson-Hynes pyeloplasty. His postoperative recovery following pyeloplasty was uneventful and he was doing well at follow-up after a month of pyeloplasty.

Diagnosis and Conservative Treatment of Extraoral Submental Sinus Tract of Endodontic Origin: A Case Report

George G. Sotiropoulos, Eleftherios-Terry R. Farmakis

Sinus tracts (or fistulas) are a common manifestation of pulpal necrosis that requires conventional -or rarely surgical- endodontic treatment in order to heal. They are mainly identified intraorally and in rare cases they manifestate extraorally, depending on the causative tooth, root location, bone thickness and muscle inserts. Such conditions may be misdiagnosed and confused with other non-pulpal pathologies. A case of extra-oral submental sinus tract that was initially misdiagnosed by a physician as a non-odontogenic lesion is presented. Facial fistulas of endodontic origin, despite sparse, should be considered as an option in the differential diagnosis procedure. It is important that interaction occurs between physicians and dentists to avoid exposing patients to insufficient treatment schemes.

Rehabilitation of a Total Maxillectomy Patient by Three Different Methods

N.Vidyasankari, Ramesh, C.Dinesh Kumar, Neeraj Sharma, Yogesh.S

Rehabilitation of a patient with orbital defect is highly a challenging task, requiring an individualized design of the technique for each patient. The disfigurement associated with the loss of facial structures causes significant emotional stress and physical burdens.Various treatment modalities are available, one of which is the use of implants. Although implant-supported orbital prosthesis has a superior outcome, it may not be advisable in all the patients due to economic factors. The treatment of choice includes the silicone orbital prosthesis due to its life-like appearance. This article describes three different techniques, it’s advantages and limitations of fabricating a silicone orbital prosthesis for the same patient to achieve ideal fit and aesthetics.

A Novel Approach for Restoration of Hemisectioned Mandibular Second Molar with Modified Tunnel Restoration: A Case Report

Hemisection refers to sectioning of a mandibular molar into two halves followed by removal of the diseased root and its coronal portion. Hemisection of a mandibular molar may be a suitable treatment option when the decay is restricted to one root and the other root is healthy. The retained root is endodontically treated and the furcation area is made self-cleansable. Retained tooth structure is restored as premolar which helps to reduce the masticatory load. Hemisection of mandibular molar was often referred to as premolarization. Studies showed that the remaining coronal structure influenced the fracture resistance of endodontically treated maxillary first premolars. Clinical experience showed the viability of tunnel restoration as an alternative to class II conventional cavity preparation in initial proximal lesion. This article discusses a case that presents the novel technique involved in restoration of the remaining hemisected tooth using modified tunnel restoration

Juvenile Ossifying Fibroma with Aneurysamal Bone Cyst: A Case Report

The fibro osseous lesions of the jaws represent a diverse group of entities that are characterized by replacement of normal bone by a fibrous connective tissue matrix, with in which varying amounts of osteoid, immature and mature bone and in some instances, cementum like material are deposited. Fibro osseous lesions of the jaws include developmental (hamartomatous) lesions, reactive or dysplastic processes and neoplasms. Juvenile ossifying fibroma (JOF) is a unique fibro osseous neoplasm. It has 2 histopathological variants (1) Trabecular juvenile ossifying fibroma (TrJOF) and (2) Psammomatoid juvenile ossifying fibroma (PsJOF) with TrJOF affecting the jaws of children. Only 20% of the patients are over 15 years of age. JOF is more common in maxilla than mandible. Origin in extragnathic locations is extremely rare. It presents as an asymptomatic progressive, rapid expansion of jaws. Radiographically, tumour is well circumscribed, along with lack of continuity with adjacent bone, cortical expansion & perforation. Histopathologically it consists of a cell rich fibrous stroma with bundles of cellular osteoid and bone trabeculae without osteoblastic rimming, and aggregates of giant cells. It has a recurrence rate of 30-58%. Long standing lesions shows cystic changes. Aneurysmal bone cyst is the most common complication. Here we present a case report of 16 yr old female patient with clinical, radiographic & histopathological features of Trabecular JOF with Aneurysmal bone cyst.

Full Mouth Rehabilitation of a Patient with Extracoronal Attachments and Telescopic Prosthesis - A Case Report

Revathy Gounder, P.Laxman Rao, G.Ajay Kumar, Githanjali M, N.Chandr asekhar

The management of tooth wear is complex and challenging as it involves multidisciplinary approach. Proper diagnosis and elaborative treatment protocol is necessary to obtain successful and predictable outcome. The objective of full mouth rehabilitation includes identification of the cause, prevention and preservation of the remaining tooth structure. This case report presents the management of the remaining teeth by endodontic and periodontic intervention which was followed by porcelain fused to metal fixed prosthesis, telescopic denture for the upper missing teeth and extra-coronal attachments for the lower missing teeth. Segmental arch technique was utilized for the rehabilitation where anterior teeth were restored first followed by the posterior teeth. Patient had a satisfactory functional and aesthetic results.

Transient Patellar Dislocation Resulting in Simultaneous Osteochondral Fractures of Patella and Lateral Femoral Condyle – A Case Report

Divesh Jalan, Vivek Machhindra Morey, Ravi Mittal, Chaitanya Dev Pannu

Transient Patellar dislocations are commonly associated with bony contusions or osteochondral fractures involving the medial facet of patella or lateral femoral condyle. Simultaneous osteochondral fractures are rare and have not been reported in the adult. The authors report a case of combined osteochondral fracture of patella and lateral femoral condyle following acute patellar dislocation in an adult, which was misdiagnosed as meniscal injury. Both the osteochondral fracture fragments were rigidly fixed with headless compression screws and repair of the medial retinaculum was done. At latest follow up after two years, patient had regained full range of motion with no further episodes of patellar dislocation. The rarity of this combination of injury along with difficulty in interpreting radiographs makes this case interesting.

A Rare Case of Variant Morphology of Peroneus Tertius Muscle

Peroneus tertius (PT) is frequently used as a free muscle flap to treat the soft tissue defects and osteomyelitis, in the lower limb as it is functionally insignificant while balancing the foot during walking. The morphology of the PT is highly variable. In the present case we report a rare case of unusual morphology of the PT in a formalin embalmed male cadaver. At the level of ankle, PT divided into three tendons; two of them were inserted to the base of the distal phalanx of the fifth toe and base of the fifth metatarsal bone respectively. The smaller third tendon was attached to the fascia covering the capsule of the ankle joint. Further, extensor digitorum longus (EDL) gave only three tendinous slips for the second, third and fourth toes.

Aggressive Lymphoma in a 14 Year Old Indian Boy, Diagnosed on Fine Needle Aspiration Cytology

Smita C. Pathade, Ramkumar Kurpad, Manoj Narayanan, V K Sasikumar, S S Jadhav

Burkitt’s lymphoma(BL) is a highly aggressive B -cell Lymphoma of childhood with a doubling time of 24 to 48 h. Depending upon the clinical and epidemiological factors it is classified as Epidemic, Sporadic and Immunodeficiency associated Burkitt’s lymphoma. Sporadic Burkitt’s lymphoma has its own characteristics with few differences pertaining to specific geographical location. Here, we present a case of 14-year-old boy who presented with advanced stage disease. On examination he had cervical lymphadenopathy and CNS involvement in the form of nerve palsy.USG revealed multiple well defined solid lesions in liver, both kidneys and pancreas. However, PBS did not show the presence of lymphomatous cells. Fine needle aspiration cytology (FNAC) of cervical lymph node and liver lesion showed features suggestive of Burkitt’s lymphoma, which was further confirmed on Histopathological and immunohistochemical examination.

Short and Hypertrophic Ligament of Treitz: A Rare Cause of Superior Mesentric Artery Syndrome

Suhani, Lalit Aggarwal, Shadan Ali, Ashish jhaketiya, Shaji Thomas

Superior mesenteric artery syndrome (SMAS) is a rare form of upper intestinal obstruction in which the third part of the duodenum is compressed between the superior mesenteric artery and the aorta, secondary to any condition decreasing the angle between these two arteries. We recently cared for a young male who came with features of proximal small bowel obstruction. On investigation, there was extrinsic duodenal obstruction. Exploratory laparotomy was done which revealed a short and hypertrophic ligament of treitz leading to compression of 3rd part of duodenum. Release of the ligament with doudenojejunostomy was done. Postoperatively, patient recovered well. This case report highlights the occurrence and importance of hypertrophic and contracted ligament of treitz as a rare cause of SMAS.

Three Cases of Subungual Glomus Tumours of the Fingers – A Case Series

Surya Rao R V M, D. Alagar Raja

Subungual glomus tumours are rare tumours ( 2% of all hand tumours ) presenting with excruciating pin point pain under the nail which is often misdiagnosed. Diagnosis is often always clinical. Here, we report the case of three patients who had subungual glomus tumour not diagnosed earlier for many years.

Unusual Cause for Abdominal Pain in Cirrhosis : Thrombosed Intrahepatic Portal Vein Aneurysms

Senthil Kumar Aiyappan, Upasana Ranga, Saveetha Veeraiyan

Portal venous system aneurysm is a rare condition with very few reported cases in English literature. With the increasing availability of advanced imaging modalities like Doppler ultrasound, computed tomography and magnetic resonance imaging, portal venous system an - eurysms are being increasingly reported. Here, we report a rare case of multiple intrahepatic portal venous system aneurysms complicated by thrombosis in a young patient with chronic liver disease and portal hypertension.

Multiple Heriditary Exostoses in a Family for Three Generation of Indian Origin with Review of Literature

Kalyani R, Prabhakar K, Gopinath B, Sheik Naseer B, Krishnamurthy DS

Multiple hereditary exostoses (MHE) are an autosomal dominant disorder, consisting of multiple cartilage capped bone tumour arising from the metaphysis of long tubular bones. Mutations are seen in Exostosin-1 and Exostosin-2 genes. We present a family of MHE for three generations. The index case was a 10-year-old male presented with multiple exostoses in hand, forearm, leg, right knee and chest. Family history revealed similar complaints in younger brother, father, paternal uncle, paternal aunt & her daughter and grandfather.

Isolated Non-Necrotising Granulomatous Vasculitis of the Gall Bladder- A Rare Entity

Priavadhana Rajan Prasaad, Shubhranshu Shekhar, S. Anu Priyadharshini

Gall bladder diseases are a significant cause of morbidity and mortality worldwide. Gall bladder diseases comprise a wide spectrum of disease entities including non specific inflammatory diseases, acute and chronic cholecystitis, follicular cholecystitis, granulomatous cholecystitis, metaplasic and dysplastic diseases of the gall bladder mucosa, gall bladder polyps and carcinomas. Here, we describe an unusual and a rare case of granulomatous vasculitis of the gall bladder incidentally diagnosed in a 38-year-old female, in a routine cholecystectomy specimen. Granulomatous vasculitis has been reported as a part of localised vasculitis of the gastrointestinal tract in the literature. The case is presented here for the rarity of the diagnosis of an isolated non-necrotising granulomatous vasculitis of the gall bladder.

Gingival Diseases in Childhood – A Review

Role of Vitamin E in Prevention of Oral Cancer:-A Review

Md. Asad Iqubal, Mobeen Khan, Prabhakar Kumar, Anjani Kumar, Kratika Ajai

Oral cancer is one of the major global threads to public health. The development of oral cancer is tobacco related mainly. Vitamin-E can inhibit reaction of the tobacco specific nitrosamine which undergoes specific activation, detoxification process. Dietary substitute such as vitamin-E can prevent oral cancer at a very early stage that is in premalignant lesions, in premalignant conditions. Main action of vitamin E includes increase immunity, controls free radicals mediated cell disturbances, maintains membrane integrity, inhibit cancer cell growth, cytotoxicity. Many past studies suggest the role of antioxidant (vitamin-E) in treatment of oral mucosal lesions particularly includes oral leukoplakia, oral lichen planus, oral submucous fibrosis and oral cancer. Vitamin-E as an antioxidant helps in prevention and slow the growth of Head and Neck cancer, improve the effects of cancer chemotherapy and reduce the side effects from both chemotherapy and radiation therapy for cancer patients. As prevention modality use of Vitamin-E may be beneficial for human beings.

Dexmedetomidine in Current Anaesthesia Practice- A Review

Shagufta Naaz, Erum Ozair

Dexmedetomidine is an alpha 2 adrenergic receptor agonist, even ten times more selective than clonidine. It is a very versatile drug in anaesthesia practice, finding place in increasing number of clinical scenarios and is no more limited to intensive care unit (ICU) sedation. It is analgesic, has anaesthetic sparing effect, sympatholytic property, useful in other procedural sedation and also has cardiovascular stabilizing property. It reduces delirium and preserves respiratory function which adds benefits to its uses. The aim of this review is to make awareness of its role in present anaesthesia and discuss its limitations at the same time.

Escalating Role of Piezosurgery in Dental Therapeutics

Esha Agarwal, Sujata Surendra Masamatti, Ashish Kumar

Dentistry, an art in science and tranquilizer in medicine, has seen a lot of changing concepts over a decade and one such novel innovation is piezosurgery. Piezosurgery is a true revolution in bone surgery as it fulfils both biological and technical criteria. It has a variety of applications ranging from minor surgical procedures to complex implantology, plastic and reconstructive surgeries. Piezosurgery uses a low frequency modulated ultrasonic insert which produces microvibrations in the range of 60-200micro meter/sec and leads to safe and precise bony incision without damaging underlying vital structures like nerves, mucosa and vessels. It overcomes technical difficulties such as visibility by producing bloodless field during surgery and removes debris simultaneously through internal irrigation mechanism. The soft tissues remain safe and biological factors like release of certain cytokines promote bone healing and enhance patients recovery. This critical review outweighs piezosurgery over traditional tools and emphasizes on its clinical and biological aspects contributing to beneficial dental health

Role of Unani System of Medicine in Management of Orofacial Diseases: A Review

In recent times, oral diseases have gained an importance and are considered as a major health problem worldwide. Oral cancer, dental caries, and periodontal diseases are among the most important global oral health problems. Although new treatments and technologies for dealing with them are plentiful, nonetheless more and more patients are now looking for simpler, gentler therapies for improving the quality of life and avoiding iatrogenic problems. Traditional medical systems are easily accessible, cheaper and relatively safer than other conventional medicines. The time tested herbal formulations indicated in Unani material medica have been proven effective and safe. The exploration and identification of various botanicals used in traditional and complementary medicine, may lead to development of novel preventive or therapeutic strategies for oral health. The present scientific evidence based review is focused on possible role of Unani system of medicines in the management of various orofacial disorders.

Prosthodontic Perspective to All-On-4® Concept for Dental Implants

M.Taruna, B.Chittaranjan, N.Sudheer, Suchita Tella, Md.Abusaad

The clinical success and longevity of endosteal dental implants as load bearing abutments are controlled largely by the mechanical setting in which they function. The treatment plan is responsible for the design, number and position of the implants. In biomechanically compromised environment such as poor quality bone, strain to the crestal bone can be reduced by increasing the anterioposterior spread of implants, placement of longer implants and maximizing the number of implants. The All-on-4® concept is one such treatment procedure which enlightens us for its use in the completely edentulous patients and which also leaves behind the routine treatment alternative of conventional dentures with successful outcome in the short term, long term and the retrospective studies that have been done in the past. The area of concern for any treatment alternative lies in the success of the prosthesis and its prosthodontic perspective involving the principles of occlusion. This article reviews the All-on-4® concept and its prosthodontic aspects.

Desmoid Tumours: Our Experience of Six Cases and Review of Literature

Anji reddy Kallam, B.V.Ramakrishna, G.Kishore Roy, K.R.V.Karthik

Desmoid tumours represent aggressive fibroblastic proliferation of the musculoaponeurotic structures commonly from the anterior abdominal wall. These tumours infiltrate locally, recur frequently but do not metastasize. Antecedent trauma, pregnancy and estrogens play a role in the etiopathogenesis of these tumours. In familial adenomatous polyposis (FAP) genetic history associated with chromosomal abnormality and familial incidence as in Gardner's syndrome is reported and most of these tumours are intraperitoneal either in the mesentery or pelvis and may be multiple and they carry poor prognosis. Surgery is the most preferred treatment and requires wide excision with 1 cm margin followed by reconstruction of the defect in the anterior abdominal wall either with local musculoaponeurotic layers or with synthetic mesh. In intra-abdominal cases associated with FAP in addition to surgery, hormonal treatment, chemotherapy and Radiotherapy are also advised depending upon the particular condition but usually prognosis is not encouraging. In this article we present our personal experience in the successful treatment of six cases of sporadic desmoids, five in females of child bearing age, and all in the anterior abdominal wall and one extra abdominal in a child aged 13 y in the gluteal region (Case 6). It is very interesting and unique to see two desmoid tumours developing in the same patient (Case2)one in each of the Rectus abdominal muscles (Right & Left).

Colposcopy - A Novel Diagnostic Technique for Oral Mucosal Lesions

Ashwini Kumar, Y.Uday Shankar, Sathyaya Prakash, B.Radhika, Nikhat Fatima

The incidence of premalignant lesions and oral cancers is steadily increasing globally. In spite of advancement in early detection, there is increased mortality and morbidity related to oral cancers. The diagnosis of a dysplastic premalignant lesion of the oral mucosa cannot be based solely on clinical findings. Therefore histologic evaluation of a representative biopsy specimen is necessary. Therefore, the selection for a biopsy site is highly significant. In this article, we present a current review of the colposcope and oral application of the colposcopy technique and its use as an adjunct in the early diagnosis of premalignant and malignant lesions of the oral mucosa. We stress upon the fact that colposcopy (direct oral microscopy) of oral mucosal lesions helps in selecting more representative sites for biopsy than routine clinical examination alone. Because of its precision, versatility, ease of use, and being a non-invasive technique, colposcopy might prove to be a useful step toward continuing to learn and improve the care for our patients.

Regenerative Endodontics: A Road Less Travelled

Ramta Bansal, Aditya Jain, Sunandan Mittal, Tarun Kumar, Dilpreet Kaur

Although traditional approaches like root canal therapy and apexification procedures have been successful in treating diseased or infected root canals, but these modalities fail to re-establish healthy pulp tissue in treated teeth. Regeneration-based approaches aims to offer high levels of success by replacing diseased or necrotic pulp tissues with healthy pulp tissue to revitalize teeth. The applications of regenerative approaches in dental clinics have potential to dramatically improve patients’ quality of life. This review article offers a detailed overview of present regenerative endodontic approaches aiming to revitalize teeth and also outlines the problems to be dealt before this emerging field contributes to clinical treatment protocols. It conjointly covers the basic trilogy elements of tissue engineering.

Non Diabetic and Stress Induced Hyperglycemia [SIH] in Orthopaedic Practice What do we know so Far?

Navendu Goyal, Randeep Kaur, Ambuj Sud, Nilesh Ghorpade, Manu Gupta

Hyperglycemia is also seen amongst non-diabetics and can cause significant morbidity and mortality. SIH has been reported in literature and studied in relation to trauma and critically ill patients. However, literature specific to orthopaedics on this topic is very small. Further, management of hyperglycemia in such patients is still a matter of debate and no universal consensus exists regarding its management. Future studies are needed on this topic to provide appropriate management guidelines and optimal patient outcomes.

Aloe Vera in Dentistry

G.Sujatha, G.Senthil Kumar, J.Muruganandan, T.Srinivasa Prasad

Aloe vera is a medicinal plant which has been used for thousands of years. The health benefits of aloe vera is well known and the dental uses of this plant is multiple. Interest is gathering among researchers regarding the use of this plant. Studies have proved the antiseptic, anti inflammatory, antiviral and antifungal properties of aloe vera and the use of this plant is proved beneficial. This plant is proved to be non allergic and very good in building up the immune system. Aloe vera is gaining popularity in dentistry as it is completely natural and there is no side effects being reported with its use. This paper gives an overview of the uses of this miracle plant and its uses in dentistry.

Impacted Teeth: A Radiographic Pictorial Essay

Beena Varma R, Nidhin J Valappila, Nimisha Mathew

Neuroblastoma of Posterior Mediastinum: Classical Imaging Findings

Swapndeep Singh Atwal

A Rare Case of Round Ligament Leiomyoma: An Inguinal Mass

Harish E, Sowmya N S, Indudhara P B

Tumours of round ligament of uterus are rare. Leiomyoma of the round ligament can present as inguinal swelling mimicking an incarcerated/irreducible hernia / inguinal secondaries / lymph node. It arises from smooth muscle of round ligament. It can be diagnosed preoperatively by CT scan or following exploration. Surgery is the treatment of choice for this condition.

Primary Anterior Abdominal Wall Leiomyoma- A Diagnostic Enigma

Manojit Midya, Neeraj K. Dewanda

Infantile Cortical Hyperostosis: Two Cases with Varied Presentations

18F-FDG-PET/CT in a Patient with Suspected Large Vessel Vasculitis

Daniele Penna, Claudio Testa, Vincenzo Arena, Ettore Pelosi

Angiomyolipomas, Renal Cell Carcinomas and Pulmonary Lymphangioleiomyomatosis

Panagiotis J Vlachostergios, Bahareh Soroori Rad, Kamran Karimi, George Apergis

Attitudes and Opinions of Medical Students Concerning HIV and AIDS in Malaysia: the Next Steps

Kieran Walsh

Homocysteine levels in Indian women with Polycystic Ovary Syndrome

Mehmet Agilli, Fevzi Nuri Aydin, Tuncer Cayci, Yasemin Gulcan Kurt

Ethylenediaminetetraacetic Acid (EDTA) – Dependent Pseudothrombocytopenia: A Case Report

Izhar Shabnam, Chuphal D S, Joshi B C

Ovarian Juvenile Granulosa Cell Tumour in Childhood: Uncommon Gynecological Malignancy

An Intervention Study on Knowledge, Attitude and Practice Among Hiv Positive Individuals in Southern India

Lalitha Hande, Sambajirao, Sanjeev Badiger