Journal of clinical and diagnostic research

A Study on Sacral Index in Tamil Nadu and Andhra Pradesh Population of Southern India

Ravichandran D., Shanthi K.C., Shankar K., Harinath Chandra

Introduction: Human sacral bones are of great interest to the anatomists, forensic experts and anthropologists as it is one of the important bones used for identification of sex in skeletal remains. Various parameters and indices are available based on which the sex can be determined using sacrum. One such important parameter is the SI. Studies shows that SI significantly varies among male and female gender and among different populations. The calculation of Demarcation Point (DP) of SI increases the accuracy of identification of sex. A review of literature showed that many studies are available in the North Indian population whereas there is a dearth of information about the normal SI and DP in South Indian population particularly in the Tamil Nadu and Andhra Pradesh, Inida region. Therefore, the present study aims to create a database for the SI in the above mentioned population. Material and Methods: 123 bones of known sex (63 males and 60 females) belonging to Tamil Nadu and Andhra Pradesh, India region were studied. Bones with obvious pathology were excluded. The breadth and length of the sacra were measured using vernier calipers based on standard guidelines. The SI and DP were calculated. The statistical analysis was done using SPSS 15.0 package. Results: The mean SI for male and female sacra were found to be 96.32 + 5.40 and 102.92 +4.00 respectively. The Demarcating Point was found to be <90.29 in males and >112.43 in females. The mean length of male and female sacra was 97.8 mm and 90.6mm respectively. The mean width was 93.7mm and 92.91mm respectively for males and females. Conclusion: The average SI and DP identified in the present study would be of use to the anatomists, forensic experts and anthropologists of Tamil Nadu and Andhra Pradesh population.

An Osteological Study of Occipitocervical Synostosis: Its Embryological and Clinical Significance

Background: Synostosis or fusion of atlas with occipital bone is known as occipitocervical synostosis, occipitalization of the atlas, or atlanto-occipital fusion. This is a rare congenital malformation at craniovertebral junction. Its incidence ranges from 0.08%–3% in general population. Occipitocervical synostosis result in narrowing of foramen magnum which may compress the brain stem, vertebral artery and cranial nerves. Knowledge of occipitocervical synostosis is important for the surgeons during the surgeries in the craniovertebral region. Hence, the present study was undertaken to determine the incidence and to describe the morphology of the occipitocervical synostosis. Material and Methods: Two-hundred dry adult human skulls of Indian origin were studied in the Department of anatomy. The base of these skulls was observed for presence of atlanto-occipital fusion. The anteroposterior and transverse diameter of the foramen magnum and diameter of the inferior articular facets were measured in these skulls using digital vernier caliper. Results: 2 skulls showed occipitalization of Atlas (1%). One of the skulls showed partial fusion (0.5%) while the other showed complete occipitalization (0.5%). Conclusion: The knowledge of bony fusion between the cranial base and the first cervical vertebra is important as such skeletal anomaly may result in sudden unexpected death due to compression of the vital structures such as brain stem and vertebral arteries.

Anatomical Variations in Formation of Sural Nerve in Adult Indian Cadavers

Kavyashree A.N., Lakshmi Prabha Subhash, Asha K.R., Bindu Rani M.K.

Background: Sural nerve is formed by communication of medial sural cutaneous nerve, that arise from tibial nerve in popliteal fossa and peroneal communicating nerve, a branch directly from common peroneal nerve or from lateral sural cutaneous nerve. The sural nerve is universally recognized by surgeons as a site for harvesting an autologous nerve graft and for nerve biopsies in case of neuropathies. Setting and Design: Anatomy department and an observational study. Statistical Analysis: The Mean, Standard Deviation, relevant percentages and p value was calculated by Chi–square test. Material and Methods: The study consists of 50 lower limb specimens in 25 cadavers. All the male and female complete cadavers were included in the study. The data was collected by dissection method by using dissection instruments and parameters (measurements) were obtained by using measuring tape. Results: The sural nerve complex was dissected and observed in 50 formalin fixed lower limb specimens. Study was done in 16 male and 9 female cadavers. Three types of formation of sural nerve were observed were - Type A was seen in 36 specimens (72%) of cases. Type B was seen in 14 specimens (28%) of cases. Type C sural nerve was not found in present study. Site of union of components of SN was seen in the upper 3rd of leg in 5.6%, in middle 3rd it was in 33.3% and in lower 3rd it was in 58.3% of cases. The length of the sural nerve shows a wide range from 2 cm to 32 cm. The symmetrical distribution was seen in 62.5% in males and 55.6% in female. Conclusion: The normal anatomy and variations may help to guide during surgeries in the region.

Aortic Valve Annular Dimension in Indian Population

Aim: The Aortic Valve (AV) annular dimension with respect to the Body Surface Area (BSA) of the Indian population is compared against the standard values. Presence of discrepancies can lead to patient prosthesis mismatch during aortic valve replacement surgeries. Methods: This study was conducted on 406 subjects. AV diameter was examined by using parasternal long axis view, where the imaging plane transects the AV in an anteroposterior direction and its x axis is aligned parallel to the long axis of aorta. Data were statistically analysed with western population. Results: The AV dimension ranged from 12.2 mm to 21.2 mm in the BSA range of 0.6 to 1.9 m2, showing a linear increase in diameter with increasing BSA. There was an increase of about 2 mm, from 0.61 - 0.7 m2 BSA to 0.71 - 0.8 m2 BSA. A linear increase which ranged from 0.3 to 1 mm was observed for BSA which ranged from 0.81 m2 to 1.2 m2. In the BSA range of 1.21 – 1.3 m2, there was an increase of 1.5 mm. A steady increase which ranged from 0.4–1 mm was observed in the BSA which ranged from 1.31- 1.9 m2. Conclusions: There is a significant difference between Indian and western population in the aortic dimension, in the body surface ranges of 0.61-0.7, 1.11-1.2, 1.21-1.3, 1.51-1.6, 1.61-1.7, 1.71-1.8 and 1.8-1.9 m2. In the range of 1.21-1.3 m2, the diameter was larger than standard, whereas in all the other ranges, AV diameter was smaller than standard values. BSA, as a good predictor of AV dimension, has also been proved.

Detection of Proteinuria in Pregnancy: Comparison of Qualitative Tests for Proteins and Dipsticks with Urinary Protein Creatinine Index

Indu Saxena, Sangeeta Kapoor, Ramesh C Gupta

Background and Objectives: Excretion of urinary protein increases to 300 mg/d (from up to 150 mg/d) in normal pregnancy. Values above this may be due to disorders that can endanger the patient or her pregnancy. Quantitative analysis of 24-hour urine is considered the gold standard for ascertaining daily protein excretion. Routine laboratory tests performed on spot urine samples indicate protein concentration in the particular sample, and can lead to diagnostic error if urine output is less or more than 1L/d. The Protein Creatinine Index (PCI) shows good correlation with 24-hour protein estimation. However, PCI varies with sex and race. We have correlated the results of qualitative estimation procedures and the dipstick values with protein creatinine index. Material and Methods: We measured protein and creatinine in spot urine samples obtained from 57 pregnant and 80 non–pregnant healthy women of 18–36 years, and calculated PCI. We also tested the samples qualitatively for proteins by routine tests and dipsticks. Results: Normal range of PCI in non–pregnant women, determined by a non–parametric method was 30–150. PCI was increased significantly in pregnancy (maximum increase in the third trimester). Amongst the qualitative tests, heat coagulation test gave the lowest percentage of false positives and a slightly higher percentage of false negatives compared to Heller’s nitric acid and sulphosalicylic acid tests, and dipsticks. Interpretations and Conclusions: We conclude that heat coagulation test be used for initial screening, with PCI being performed on all samples testing positive to rule out false positives.

Prevalence of Metabolic Syndrome in Turkmen Ethnic Groups in Gorgan

Najmeh shahini, Iman shahini, Abdoljalal Marjani

Introduction: It has been estimated that the metabolic syndrome may predict cardiovascular disease and the occurrence of sudden death, independent of the presence of other cardiovascular risk factors. The aim of the present study was to assess the metabolic syndrome among Turkmen women in this area. Material and Methods: The present study consisted of 160 Turkmen women. Baseline data and prevalence of metabolic syndrome and the components of metabolic syndrome in Turkmen women were determined. Observations and Results: The prevalence of high levels of fasting glucose, low levels of high density lipoprotein-cholesterol, high triglyceride levels, high waist circumference and high blood pressure were shown to be 29.37%, 70.62%, 35.62%, 75% and 26.25%, respectively. It was shown that high waist circumference (75%) and Low HDL-cholesterol levels (70.62%) were the most frequent characteristics in comparison to other metabolic components. The prevalence of high waist circumference, high triglyceride levels, high levels of fasting glucose, high blood pressure and BMIs which were =25 were higher in subjects with metabolic syndrome (92.85%, 73.21%, 73.21%, 57.14% and 83.92%, respectively). Conclusion: Metabolic syndrome is more prevalent among Turkmen women. Our data has shown that the prevalence of abnormal waist circumference in this ethnic group was highest. The waist circumference can be used as a predictor for cardiovascular disease and coronary heart disease.

The Association of Hypomagnesaemia, High Normal Uricaemia and Dyslipidaemia in the Patients with Diabetic Retinopathy

Navin S, Krishnamurthy N, As haKiran S, C D Dayanand

Context: Diabetic retinopathy is fast becoming an important cause of a visual disability. The visual disability which results from diabetes is a significant public health problem; however, this morbidity is largely preventable and treatable. If it is managed with a timely intervention, the quality of life can be preserved. Aims: The objective of this study was to investigate the association of serum uric acid, magnesium and the lipid profile in diabetic retinopathy with Normal subjects and Diabetes mellitus without retinopathy, among the south Indian population. Settings and Design: The diabetic retinopathy patients were identified from the diabetic health camps which were held in rural areas, and they were compared with those with diabetes without complications and the normal subjects Material and Methods: The diabetic retinopathy patients were compared with the healthy subjects and with diabetes without retinopathy. Furthermore, the Diabetic retinopathy patients were grouped as proliferative and non-proliferative, based on the fundoscopic findings. Magnesium, uric acid, FPG, fructosamine and the lipid profile were measured in the above groups and they were analyzed. Statistical Analysis: The statistical analysis was done by using the SPSS software, by applying the Student ‘t’ test. Results: The mean serum magnesium concentration was observed to be low in the diabetic retinopathy group (1.43mg/dl) as compared to those in the controls and the diabetic subjects. The serum Uric acid concentration was high normal (4.84mg/dl), which was associated with the dyslipidaemia in diabetic retinopathy. Conclusions: The poor glycaemic control in diabetes is associated with hypomagnesaemia, and increased uric acid concentration with dyslipidaemia, which can be an initial picture of the ongoing biochemical changes in the complication of diabetes, which can help in predicting the onset of diabetic retinopathy in diabetes.

Oxidative Stress, Vitamin E, and Antioxidant Capacity in Knee Osteoarthritis

Background: Osteoarthritis (OA) is a chronic progressive degenerative joint disorder which is characterised by strongly age-related regressive changes in articular cartilage. The objective of this study was to evaluate oxidative stress and antioxidant parameters in plasma and synovial fluid of patients with primary knee osteoarthritis. Material and Methods: Thirty-five OA patients and 35 healthy controls were recruited for this study. Nitrite, malondialdehyde (MDA), vitamin E, Trolox Equivalent Antioxidant Capacity (TEAC), and Ferric Reducing Antioxidant Power (FRAP) levels in plasma and synovial fluid were determined. Results: Plasma nitrite levels in OA patients were significantly higher than those in healthy controls (p = 0.037). Furthermore, plasma MDA levels were significantly higher in OA patients than those in healthy controls (p < 0.001). Moreover, plasma vitamin E levels in OA patients were significantly lower than those in healthy controls (p < 0.001). Synovial fluid vitamin E levels of OA patients were significantly lower than paired plasma samples (p < 0.001). The total antioxidant capacities, as were measured by TEAC and FRAP assays in plasma of OA patients, were significantly lower than those in healthy controls (p < 0.01). MDA concentrations were positively correlated with nitrite concentrations but they were negatively associated with vitamin E and TEAC levels in synovial fluid of OA patients. Conclusion: The increased plasma levels of nitrite and MDA and the decreased plasma levels of vitamin E, TEAC, and FRAP indicated that oxidative stress was present in OA patients. These findings suggest that oxidative stress plays a potential role in pathophysiology of knee osteoarthritis.

Attenuation of Oxidative Stress, Inflammation and Insulin Resistance by Allium Sativum in Fructose–Fed Male Rats

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

Background: Fructose is widely used as a food ingredient and has potential to increase oxidative stress. Moreover, the beneficial health effects of medicinal plants are frequently attributed to their potent antioxidant effects. Objectives: The present study was aimed to explore the effects of garlic (Allium sativum) extract on insulin resistance, inflammation and oxidative stress in male wistar rats fed with high fructose diet. Material and Methods: Diabetes was induced in male albino Wistar rats by feeding 60% fructose rich diet. The fasting plasma glucose, insulin, insulin resistance, tumour necrosis factor alpha, total antioxidant status and the whole blood reduced glutathione, erythrocyte antioxidant enzyme activities were measured. Differences between the groups were assessed by using One Way Analysis of Variance with (ANOVA) Tukey post–hoc test. Results: The diabetic rats showed a significant increase in plasma fasting glucose, insulin, insulin resistance, tumour necrosis factor alpha and malondialdehyde level and decreased levels of total antioxidant status, reduced glutathione, catalase and glutathione peroxidase. Treatment with garlic extract restored all these biochemical changes. Conclusion: The garlic extract is effective in improving the high fructose induced oxidative stress, inflammation and insulin resistance in male wistar rats.

Trace Elements in Diabetes Mellitus

Praveeena S., Sujatha Pasula, K. Sameera

Introduction: Diabetes Mellitus is the commonest major metabolic disease and most prevalent diseases worldwide. Its related morbidity is due to its micro and macro angiopathic complications. Aim: The aim of this study was to measure and compare the serum levels of zinc and magnesium in normal individuals and in diabetic patients. Method: Analysis of minerals was done in plasma by using a Varian Spectra AA 220 model atomic absorption spectrophotometer. Result: Our observations showed a definite lowering of serum magnesium (p<0.001) and serum zinc levels (p<0.001) were significant in diabetic group. Conclusion: The cause of diabetic hypomagnesaemia is multifactorial. An altered metabolism, a poor glycaemic control and osmotic diuresis may be contributory factors. Decreased serum zinc levels in diabetes may be caused by an increase in urinary loss. These decreased levels of trace elements cause disturbances in glucose transport across cell membrane lead to insufficient formation and secretion of insulin by pancreas which compromise in the antioxidant defense mechanisms.

Anti Mullerian Hormone: A Potential Marker for Recruited Non Growing Follicle of Ovarian Pool in Women with Polycystic Ovarian Syndrome

P Saikumar, VS Kalai Selvi, K Prabhu, Prasana Venkatesh, Prashanth Krishna

Background: Polycystic ovarian disease is one of the most common causes of infertility in women of reproductive age. Anti– mullerian hormone (AMH), a member of transforming growth factor (TGF) family which is secreted by granulosa cells of growing follicle, is found to be increased to three to four fold in Poly Cystic Ovarian Syndrome (PCOS) patients as evidenced by previous studies. But the level of AMH in relation to the infertile status of PCOS was not studied yet. The present study was focused to determine the discriminative power of AMH in infertility subjects with regular cycles and infertility subjects associated with PCOS. Methods: The subjects under study were one hundred and twenty infertile women of age group ranging from 27–35 years. Subjects, were further divided into sixty infertile with regular cycles as controls (Group1) and sixty infertile subjects with PCOS as cases (Group 2). Hormones like FSH, E2 and AMH were assayed for all the subjects. Mean and student t– test for all hormones were compared between controls and cases. The diagnostic power of AMH pertaining to sensitivity and specificity was evaluated by Receiver operating characteristic (ROC) curve. Results: Serum AMH level were two fold higher in PCOS patients than in controls. The mean value of AMH also shows a test of significance between the two groups. The area under the receiver operating characteristic curve for the AMH assay was 0.95 in infertile group when 3.34ng/ml was used as cut off point indicating its better discriminative power and good diagnostic potency. Setting the AMH value at 3.34ng/ml sensitivity, specificity,Positive Predictive Value(PPV) and Negative Predictive Value(NPV) were observed 98% ,93%, 93% and 98% respectively. Conclusion: The diagnostic potency of Area Under Curve (AUC) for AMH in infertile subjects reflects that AMH is a potential marker for recruited non growing follicles rather than a simple marker for ovarian reserve as it is predominantly produced by small follicles rather than a simple marker for ovarian reserve.

Effect of Various Eye Exercise Techniques along with Pranayama on Visual Reaction Time: A Case Control Study

Nitin B. Gosewade, Vinod S. Shende, Shriniwas J. Kashalikar

Introduction: We depend on eyesight more than any other of our senses to maneuver through the space around us. In a fraction of a second, our eyes work with our brain to tell us the size, shape, colour, and texture of an object. Our eyes are body’s most highly developed sensory organs. The use of computers and television in the era of information technology has given new heights to the professional success rate and it saves time but on the other hand, it has led to an increase in the number of patients with ocular complaints. Aims: The objective of the study was to study the effect of eye exercise techniques along with kapalbhati pranayama on Visual Reaction Time (VRT). Material & Methods: Total 60 subjects in an age group of 18–30 were recruited in the study. All the subjects were divided into two equal groups (study group and control group) containing 30 subjects (18 male & 12 female) each. Both the male and female subjects were selected on the basis of their voluntary involvement. Visual reaction time for red and green light was recorded from all 60 subjects before the start of the study. Study group subjects were trained to practice various eye exercise techniques and kapalbhati pranayama for 8 weeks regularly whereas control group were busy with their routine activities. After 8 weeks, visual reaction time was measured for red and green light from all 60 subjects. Statistical Analysis: Data expressed as Mean ± S.D, Student t –test was applied for analysis of data, p value <0.05 is taken as statistically significant. Results: Statistical analysis of data shows that there is a significant decrease in the visual reaction time for red and green light after intervention in study group (p value <0.05). Whereas there is no significant decrease in VRT in control group (P value >0.05). Conclusion: The results of our study suggest that simple eye exercises along with pranayama helps in improvement of visual reaction time.

Alveolar Gas Exchange and Pulmonary Functions in Patients with Type II Diabetes Mellitus

Anandhalakshmi S, Manikandan S, Ganeshkumar P, Ramachandran C

Background: The incidence of diabetes is increasing tremendously throughout the world especially in the developing countries. This disease affects various organs like eyes, nerves, kidneys and the heart. In this study, we investigated whether lungs are also one of the target organs of diabetes mellitus or not. Aim: To assess the pulmonary function parameters including alveolar gas exchange in patients with Type 2 Diabetes mellitus and to find the influence of hyperglycaemia and duration of diabetes. Methodology: This cross sectional study involved 30 type II diabetic patients of age 30-60 years attending the diabetic outpatient department of SRM Medical College & Research Centre and 30 age and sex matched non-diabetic subjects as controls. The glycated haemoglobin (HbA1c) levels, fasting and post prandial blood glucose levels, pulmonary function parameters such as Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), Forced Expiratory Volume Percentage (FEV1 /FVC), Peak Expiratory Flow Rate (PEFR), Forced Expiratory Flow (25 – 75%), Peak Inspiratory flow ( PIF), Forced Inspiratory Vital Capacity ( FIVC), Total Lung Capacity ( TLC),Diffusing capacity of lung for carbon monoxide( DLCO) were measured for all the participants using Easyone Pro computerised spirometer. DLCO was measured by single breath Carbon Monoxide (CO) diffusion test. The alveolar membrane permeability was assessed by evaluating the ratio of DLCO to Alveolar Ventilation (VA). Results: The pulmonary function parameters FVC, FEV1, PEFR, PIF, FIVC, TLC , DLCO and DLCO/VA were significantly low (p<0.05) in patients with type II diabetes mellitus when compared to control group. The DLCO and DLCO/VA were significantly lower (p<0.05) in patients with poor glycemic control(HbA1c > 7). Conclusion: We conclude that the pulmonary function parameters like FVC, FEV1, PEFR, PIF, FIVC, TLC and alveolar gas exchange were significantly reduced in patients with type II diabetes. The patients with Type II diabetes mellitus had a restrictive pattern of respiratory abnormality. The patients with poor glycaemic control( HbA1c > 7) had reduced alveolar diffusion which was not dependent on the duration of diabetes. The impaired respiratory function may give way for the development of pulmonary complications. Spirometry can be used as a screening tool among diabetics as an early preventive measure.

Comparison of Effect of Regular Unstructured Physical Training and Athletic Level Training on Body Composition and Cardio Respiratory Fitness in Adolescents

Senthil Kumar Subramanian, Vivek Kumar Sharma, Vinayathan A

Background: Childhood obesity and hypertension are global problems that are on the rise in India. Improving physical activity is an accepted main line of strategy for overcoming poor body composition, hypertension and reduced cardio respiratory fitness (CRF) all of which are considered as independent risk factors for the development of future cardiovascular complications. Aim: Present study was conducted to evaluate the effect of regular unstructured physical training and athletic level training on anthropometric measures, body composition, blood pressure and cardio respiratory fitness in adolescents. Settings and Design: This is a collaborative study between the Department of physiology, Jawaharlal Institute of Postgraduate Medical Education and Research and Residential school, Jawahar Navodhya Vidyalaya, Puducherry, India. Method and Material: Student volunteers in the age group of 12-17 years were classified into athletes (group 1) and physically active non-athletes (group 2). Parameters measured and calculated were weight, height, body mass index, waist and hip circumference, body fat percentage (BF%), fat free mass (FFM), Systolic (SBP) & Diastolic blood pressure (DBP), Mean arterial pressure (MAP), Rate pressure product (RPP) and Predicted VO2 max. Statistical Analysis used: Mean difference between the groups was analysed using unpaired Student’s t–test. All statistical analysis was carried out for two-tailed significance at the 5 % level using SPSS version 19 (SPSSInc, USA). Results: Anthropometric measures, body composition measures and blood pressure values of both the group students were within the normal limits. There was no significant difference in anthropometric and body composition parameters between the group 1 and group 2 students. DBP, MAP and RPP were significantly lower in group 1 students when compared to group 2 students. VO2 max values were more in group 1 girls as compared to group 2 girls while the values of boys were comparable between the two groups. Conclusion: Regular unstructured physical activity for 60 minutes daily for the duration of one year can help the students to maintain their anthropometric parameters, body composition measures and CRF at par with the athletes of the same age and gender. However, athletic level training further reduces the cardiovascular load of the adolescent students.

The Acute Effects of a Single Bout of Moderate-intensity Aerobic Exercise on Cognitive Functions in Healthy Adult Males

Bijli Nanda, Jagruti Balde, S. Manjunatha

Introduction: Single acute bouts of moderately-intense aerobic exercise like walking have been found to improve cognitive control of attention in children, but some studies have reported no improvement in cognitive flexibility following acute aerobic exercise. Submaximal aerobic exercise performed for 60 minutes facilitated specific aspects of information processing in adults but extended exercises leading to dehydration compromised both information processing and memory functions. Improvement in executive functions has also been reported during cycling at 70% of Heart Rate Reserve (HRR) across young and older age groups. However, there are studies which have reported no correlation between physical activity and academic performance in children and a recent systematic review of 30 relevant studies reported no significant improvement in cognition with physical activity or exercise in adults. There seems to be lack of consensus on the effect of exercise on cognition, which may be because the exercise protocols used and cognitive functions tested by different researchers were not uniform. Aim: The primary aim of this study was to investigate the acute effects of aerobic exercise across different cognitive domains in healthy young individuals. Methods: A homogeneous group of 10 right handed healthy adult males participated in the study and was subjected to 8 cognitive function tests including 2 tests each across the four categories: Memory, Reasoning, Concentration and Planning using a pre-validated web based tool. Following baseline testing, subjects performed 30 minutes’ of cycling on a stationary bicycle ergometer at moderate intensity (60-70% of HRR). Post–test scores were recorded when heart rate returned to within 10% of baseline. Pre and post–test scores were compared using the paired t-test. Results: After exercise, there was significant improvement (Mean ± SD) in the Paired Associates (4.8±1.0 Vs 5.5 ± 1.0), Odd One Out (10.5 ± 3.0 Vs 13 ± 3.1) and Spatial Slider test (30.4 ± 17.8 Vs 40.5 ± 13.9), the tests of Memory, Reasoning and Planning respectively. No significant improvement was found for concentration. Total post-test time was significantly lower than the pre-test time (23.5 ± 2.55 Vs 21.2 ± 1.48 minutes). Conclusion: A single bout of moderate intensity aerobic exercise for as less as 30 minutes can improve some aspects of cognition, most prominently for memory, reasoning and planning and can shorten the time taken to complete the tests.

Effect of Cigarette and Cigar Smoking on Peak Expiratory Flow Rate

Tambi Medabala, Rao B.N., Glad Mohesh M.I., Praveen Kumar M.

Background: Tobacco smoking in India has been increasing alarmingly. Smoking is a known risk factor for chronic obstructive pulmonary disease (COPD), cardiovascular diseases and certain cancers, especially, the lung cancer. The percentage prevalence of cigarette smoking (18.5%) and cigar smoking (4%) in males is high in Andhra Pradesh compared to other southern states. There is not enough scientific literature to correlate about intensity of cigarette and cigar smoking and their impact on lung function though high prevalence is reported in Andhra Pradesh, India. Objectives: The purpose of this study was to examine whether PEFR differs between cigarette and cigar smokers compared to non-smokers and also to estimate the intensity of cigarette and cigar smoking on PEFR. Methods: PEFR was recorded in cigarette smokers (n=49) and cigar smokers (n=10) as well as in non-smokers (n=64) using Wright’s mini Peak Flow Meter. Results: PEFR is decreased in both cigarette as well in cigar smokers compared to non-smokers and the magnitude of decline was higher in cigar smoking elderly individuals. Conclusion: The intensity of cigarette and cigar smoking (pack-years) emerged as the main variable to influence airway obstruction in smokers that caused greater reduction in PEFR.

Effect of Traditional Aerobic Exercises Versus Sprint Interval Training on Pulmonary Function Tests In Young Sedentary Males: A Randomised Controlled Trial

Badaam Khaled M., Munibuddin A., Khan S.T., Choudhari S.P., Doiphode R.

Background:Physical inactivity is now a global non-communicable disease. Current recommendations from American College of Sports Medicine, American Heart Association and UK medical officers for physical activity are difficult to implement,due to time constraints and hence, they have less compliance. Purpose:To compare Sprint Interval Training (SIT) and traditional aerobic exercise (AE) with respect to changes in Vital capacity (VC), Maximum Voluntary Ventilation (MVV) and Physical Fitness Index (PFI) in young sedentary males. Study Design:This was a randomised, controlled trial. Methods:Fourteen young, sedentary, healthy males who were aged 18-25 years were randomly allocated to SIT group and AE group for 3 weeks. SIT group exercised at high intensity for 10 minutes a day, three days a week. AE group exercised at moderate intensity for 30 minutes a day, five days a week. Results:Improvement in FVC (litres) in AE group was 0.31 ± 0.11 and that in SIT group was 0.48 ± 0.17. The improvement in MVV (litres) in AE Group was 21.5 ± 11.6 and that in SIT group was 27.77 ± 7.03. Thus, SIT showed a better improvement in primary outcome i.e. FVC and MVV, although difference in improvement was statistically not significant (p= 0.09 and 0.29 respectively). Secondary outcome i.e. PFI improved by 5.57 ± 1.71% in AE group and by 10.28 ± 3.03% in SIT group. The difference in improvement was statistically significant (p= 0.003). Conclusions:SIT can be suggested as a time efficient option for improving cardiorespiratory fitness and hence, it can be used as a health promotion strategy.

Effect of ‘Water Induced Thermogenesis’ on Body Weight, Body Mass Index and Body Composition of Overweight Subjects

Vinu A. Vij, Anjali S. Joshi

Context: Drinking lots of water is commonly suggested as a part of weight loss regimens. However, only few systematic studies have addressed this notion. In this study, the effect of drinking 1500 ml of water, over and above the daily water intake on body weight, body mass index (BMI) and body composition of overweight subjects was assessed. Aim: To evaluate the role of drinking excessive water in weight reduction and body fat reduction of overweight subjects. Settings and Design: This study was conducted on 50 overweight girls for eight weeks, during which they were instructed to drink 500 ml of water, three times a day, half an hour before breakfast, lunch and dinner, which was over and above their daily water intake. Material and Methods: Body weight was measured in kilograms (kgs). BMI was calculated as weight in kilograms, which was divided by the square of height in metres. Body composition score was calculated as a sum of skin fold thickness in millimetres at three different sites, which was measured by using skin fold calipers. Pre and post-study body weight, body mass index and body composition scores were measured. Statistical Analysis: SPSS, version 14.0.1 and paired t-test were used to find out the statistical significance of the results. Results: The mean values of the pre-study and post-study body weight, body mass index and body composition scores were 65.86 kg and 64.42 kg, 26.7002 and 26.1224 and 79.626 mm and 76.578 mm respectively. All the three results were highly significant statistically. Conclusions: The decrease in body weight, body mass index and body composition scores of overweight subjects at the end of study period establishes the role of water induced thermogenesis in weight reduction of overweight subjects.

To Compare the Effect of Camylofin Dihydrochloride (Anafortin) with Combination of Valethamate Bromide (Epidosin) and Hyoscine Butyl-N-Bormide (Buscopan) on Cervical Dilation

Kaur Sarbhjit, Bajwa S.K., Kaur Parmjit, Bhupal Surinder

Background: Various drugs have been tried to hasten cervical dilatation so that problems and hazards of prolonged labour both for the mother and fetus are minimised without increasing maternal or perinatal mortality and morbidity. Aims and Objectives: To compare the effect of camylofin dihydrochloride with combination of valethemate bromide (epidosin) & hyoscine N butyl bromide (buscopan) on cervical dilatation, evaluate the incidence of side effects and to look for neonatal outcome. Material and Methods: Two hundred cases were included of primigravidae or multigravidae with gestational age of 37 to 40 weeks with full term with single foetus,vertex presentation and no major antenatal complication of women in labour, admitted to labour room of gynaecology Department, Government Medical College, Patiala, India, was studied and divided into 2 groups Group A–100 Cases – labour accelerated by camylofin dihydro chloride and Group B–100 Cases–labour accelerated by valethemate bromide (epidosin) and hyoscine N butyl bromide. Observations: The mean age, parity and period of gestation in Anafortan group was 24.13 ± 3.60 years, 49% primigravidae and 51% multigravidae and 38.81 ± 1.09 weeks, while that in Epidosin + Buscopan group was 24.43 ± 3.42 years, 45% primigravidae and 51% multigravidae and 38.94 ± 1.09 weeks respectively. The difference was insignificant and both the groups were comparable. Results: Mean duration of Active phase of 1st stage of labor was 141.40 ± 55.41 minutes in Anafortan group and 181.46 ± 75.58 minutes in Epidosin + Buscopan group. Mean rate of cervical dilatation according to active phase of first stage was 3.33 ± 1.03 cm/hours in Anafortan group and 2.69 ± 1.03 cm/hr in Epidosin + Buscopan group. The difference between the two groups is highly significant (p < 0.01) thus it is concluded that Anafortan hastened the rate of cervical dilatation.

The Effect of Carvedilol on Blood Glucose Levels In Normal Albino Rats

Background: Carvedilol is a commonly used drug in hypertension, congestive heart failure in diabetics. It has moderate calcium channel blocking property in addition to a1 and non selective ß antagonistic activity. Though some studies bring forth the beneficial effects of Carvedilol in cardiovascular comorbidities in diabetes, there is no consensus on its effects on glycaemic levels. Aims: To evaluate the effect of oral Carvedilol administration for 5 days on blood glucose levels in normal albino rats through Oral Glucose Tolerance Test. Material and Methods: Twelve adult albino rats of either sex weighing between 150 – 200 g were selected from central animal facility and randomly divided into 2 groups – Control [Distilled water (1ml/rat orally)] and Test (0.8mg/kg body weight orally) and the respective drugs were administered over 5 days. Following overnight fasting, on the fifth day 1 hour after the last dose of the respective drug, OGTT was performed. The CBG (Capillary Blood Glucose) levels were measured at 0 min, glucose (2g/kg body weight) dissolved in water was administered to all the rats orally. The blood sample from tail vein (obtained by tail snipping) at 60 and 150 minutes were analysed for CBG levels using a standardized glucometer. Statistical Analysis: Data was presented as Mean ± SEM. One way ANOVA, independent samples t-test, non–parametric tests, percentages and cross tabs were used in the analysis of data within the same group and between different groups when required. Results: Carvedilol group showed higher CBG levels at all time intervals of OGTT as compared to the Control group i.e., 0, 60 and 150 minutes, the highest being (103.8±5.029 )mg/dl at 60 minutes and was statistically significant. Carvedilol group however showed lesser inter–interval variation compared to the Control group at the same time intervals respectively but was statistically insignificant. Conclusions: Carvedilol has hyperglycaemic potential when given orally for 5 days in normal albino rats. Though it may be beneficial in diabetics for various comorbid conditions, the glycaemic control may worsen during its use in subjects with prediabetes, diabetes, high risk diabetes.

Bromocriptine, a Dopamine (D2) Receptor Agonist, Used Alone and in Combination with Glipizide in Sub–Therapeutic Doses to Ameliorate Hyperglycaemia

Introduction: Bromocriptine, an ergot derivative, is an agonist at the dopamine 2 receptor and a sympatholytic. It is a well established drug in Parkinsonism, hyperprolactinaemia and acromegaly and it has various other clinical indications like induction of ovulation in female infertility. Bromocriptine has been evaluated in alloxan induced diabetic rats for its anti-hyperglycaemic effect with and without simultaneous use of glipizide. Methods: Diabetes was induced in albino rats by giving a single subcutaneous injection of alloxan in a dose of 150 mg/kg body weight. After 72 hours of giving alloxan injection, depending upon their blood glucose levels (350mg/dl and above), the rats were included into the study and they were divided into four groups, each comprising of 6 rats (n=24): Group 1 which was taken as control was given distilled water. Group 2 was treated with glipizide, a standard drug. Group 3 was treated with the test drug, bromocriptine and Group 4 was treated with sub therapeutic doses of test and standard drugs. The drugs were given to the diabetic rats once daily by oral route for 30 consecutive days, in order to assess their effects in terms of reduction in blood glucose levels. Blood glucose was estimated on 0th, 10th, 20th, and 30th days of the study at fixed time intervals. Results and Conclusion: Bromocriptine, which was used alone, lowered the blood glucose levels appreciably; whereas the concomitant administration of bromocriptine and glipizide in sub therapeutic doses produced a much more appreciable reduction. The results which were obtained in the group which received simultaneous administration of test and standard drugs in sub therapeutic doses were comparable to those of the group which received reference drug, glipizide. Hence, it can be concluded that bromocriptine may serve as a valuable adjunct to available anti-diabetic medication.

Influence of Delivery Devices on Efficacy of Inhaled Fluticasone Propionate: A Comparative Study in Stable Asthma Patients

Bhanu Prakash Kolasani, Venu Madhavi Lanke, Sudheer Diyya

Background: Inhaled corticosteroids are the preferred treatment for long-term control of all grades of persistent asthma. These are administered by various delivery devices with very little information whether these devices can affect the efficacy of inhaled corticosteroids. Fluticasone propionate is a relatively new inhalational corticosteroid compared to older ones like beclomethasone and budesonide. Aims & Objective: To assess the relative efficacy of fluticasone propionate administered from different delivery devices to adult patients of chronic stable bronchial asthma as measured by pulmonary function test parameters. Material and Methods: This prospective study was undertaken to assess the relative efficacy of fluticasone propionate administered from different delivery devices to adult patients of chronic stable bronchial asthma as measured by pulmonary function test parameters. Fourty eight subjects were administered, fluticasone propionate (250 µg) by dry powder inhaler, metered dose inhaler, metered dose inhaler with spacer and fluticasone (1mg) via nebulizer consecutively each week for four weeks under direct supervision. Pulmonary function test was done before and one hour after administration of the drug on each visit. Results: After excluding nine patients who were lost to follow up, data was analysed for the remaining thirty nine patients and no significant difference in peak expiratory flow rate (p=0.77), forced expiratory volume in one second (p=0.95), forced vital capacity (p=0.24) and forced expiratory volume in one second and forced vital capacity ratio (p=0.22) was seen after giving fluticasone by different devices. Conclusion: Fluticasone propionate delivered by different devices like dry powder inhaler, metered dose inhaler, metered dose inhaler with spacer and nebulizer have similar effect on lung function in patients of chronic stable bronchial asthma and may be used interchangeably.

A Population Based Case Control Study on Breast Cancer and the Associated Risk Factors in a Rural Setting in Kerala, Southern India

P. Parameshwari, K. Muthukumar, H. Gladius Jennifer

Introduction: The incidence of breast cancer is increasing in developing countries over three decades. Despite good health indicators breast cancer is a public health problem in Kerala with an annual incidence of 14.9/100000 population. Identifying the risk factors helps to reduce the incidence in future. Method: A Population based case control study was conducted among all the breast cancer cases in the Arpookara Panchayat of Kottayam district in Kerala. 20 cases of breast cancer were paired with age matched controls from the same geographic area (ratio 1:4) with a total of 100 study participants. Data were collected by interviewing the participants using a pre tested structured questionnaire. Analysis was done by the authors using SPSS version 16.0 Results: Age group of participants ranged from 32-70 years with mean age of 49.7 + 10.39. Early menarche < 13 years [Odds Ratio =3.2, p= 0.03], being unmarried and single, family history of breast cancer [Odds Ratio = 3.5, p = 0.02], previous history of benign breast tumours [Odds Ratio =8.14, p= 0.04], breast feeding less than 2 years [Odds Ratio = 2.28, p = 0.01 ] were found to be the risk factors for the breast cancer and the birth of first child before 30 years [Odds Ratio =0.302, p = 0.03 ] was found to be a protective factor for breast cancer. 60% of cases belonged to lower socioeconomic status [Odds Ratio = 14.47, p = 0.03]. Despite high literacy status, significantly lower awareness about symptoms of breast cancer and self examination of the breast were noted [Odds Ratio =11.6, p= 0.03]. Conclusion: Awareness about symptoms of breast cancer and self examination of the breast were lacking in the study population. Health care personnel should be trained to spread the awareness of breast cancer in the community and to identify the vulnerable groups at the primary care settings itself. The policy makers can consider encouraging community participation by involving the non-governmental organizations, women self help groups and Public Private Partnerships in spreading the awareness of breast cancer.

A Hospital Based Serosurveillance Study of Dengue Infection in Jaipur (Rajasthan) , India

Smita Sood

Background: Dengue has been known to be endemic in India for over two centuries. There is a need to assess the magnitude of dengue virus establishment in the state of Rajasthan. A surveillance study was conducted to analyze dengue seropositivity among patients with clinical suspicion of dengue fever like illness, who presented to or were admitted at a tertiary care private hospital at Jaipur. Methods: Serum samples from 2169 suspected dengue cases (1356 males and 813 females) were received in the Serology lab over the four year study period (2008-2011). The samples were subjected to a rapid immuno-chromatography assay with differential detection of IgM and IgG antibodies. A primary dengue infection was defined by a positive IgM band and a negative IgG band, whereas a secondary infection was defined by a positive Ig G band with or without an IgM band. Result: Among the 2169 patients who were screened; 18.99% (412) were dengue specific IgM positive cases. 64. 49% (1399) cases were negative for dengue specific antibodies, 5.67% (123) were primary dengue cases, and 23.51% (510) were total secondary dengue cases. During the study period, the Dengue IgM seropositivity was highest in the year 2009 and was lowest in the year 2011. Most of the cases occurred in the post-monsoon season, with a peak in the month of October, each year. Conclusion: A detailed and continuous epidemiological surveillance is required, for monitoring the incrusion and spread of dengue viruses. This will help in undertaking and implementing effective control and management strategies.

Prevalence of Unrecognised Depression Among Outpatient Department Attendees of A Rural Hospital in Delhi, India

Charu Kohli, Jugal Kishore, Paras Agarwal, Satya Vir Singh

Background: Depression is one of the most common mental disorders affecting 121 million people in the world and it frequently goes unrecognised among patients. This study was carried out to find out the prevalence of unrecognised depression among out patient attendees of a rural hospital in Delhi, India and its socio demographic correlates. Material and Methods: This is a rural hospital based cross sectional study among 395 patients attending different non-psychiatric outpatient departments. Data was collected by using predesigned & pretested questionnaire and prevalence of depression was determined by PRIME MD (PHQ-9) and analysed by using SPSS version 16. Data was analysed using chi-square test with “p” value < 0.05 considered as significant. Independent association of socio demographic variables were determined by multi–variate logistic regression analysis using WHO EPI INFO software. Results: The study included 67% females and 33% males with mean age 31.73 + 12 years. Most were Hindu (80%), married (75%), illiterate (47%) and were unemployed (65%). Out of 395 patients, 119 (30.1%) were diagnosed to be having depression. Out of 119 patients who were found depressed, 25 (21%) were already diagnosed case of depression and 94 (79%) were detected by using PRIME-MD, giving prevalence of unrecognised depression 23.8%. Among socio demographic factors, gender, religion, education status and being widow/separated were found to be statistically significantly associated with hidden depression among the patients. Conclusion: Unrecognized depression is a common in non-psychiatric OPDs. There is a need to screen patients presenting in such OPDs for depression.

Menstrual Pattern among Unmarried Women from Northern India

Background: Menstruation disorders are also responsible for emotional, physical, behavioural and dietary practice changes. These changes affect their normal functioning and social life. The present study was carried out to find the prevalence of menstrual problems among unmarried girls of Chandigarh, India and to compare their knowledge and beliefs regarding menstruation in different sub–groups. Methodology: A community based cross-sectional study was conducted among 744 unmarried females in Rural, Urban and Slum strata of UT Chandigarh, India. Data were collected using a self-administered structured questionnaire on menstruation. Chi–square value was used for testing statistical significance. Results: The mean age of the respondents was 16.84±3.05 years. Maximum respondents (40.9%) were educated up to 10th standard/High school. 448 (60.2%) were aware of menstruation before starting of menarche. Awareness was found to be significantly associated (p=0.02) with age. Socio–economic status and prior knowledge of respondents was also found to be significantly associated (p< 0.001). 61% (454) of the respondents had a regular flow during menses. Normal flow was reported by 70.2 %( 522) of the respondents. Dysmenorrhea was found to be the most common problem suffered by 429 (57.7%) respondents. Conclusion: Menstrual hygiene is an issue that needs to be addressed at all levels. A variety of factors are known to affect menstrual behaviors, the most influential ones being economic status. It is essential to design a mechanism to address and for the access of healthy menstrual practices.

Possible Correlation of Transfusion Transmitted Diseases with Rh type and ABO Blood Group System

Surabhi Tyagi, Alok Tyagi

Background: screening of blood is mandatory for transfusion transmitted diseases and is routinely done in the blood banks. As blood is the major source transmission of hepatitis B, hepatitis C, human immunodeficiency virus & many other diseases the hazards can be minimised by effective donor selection and screening. Aim: To find out the correlation between the transfusion transmitted diseases and blood groups and the seroprevalence of HIV, HBV, HCV & syphilis among the apparently healthy human blood donors. Study, Setting & Design: This retrospective study was conducted at the blood bank of a tertiary health care teaching centre for a period of four years. Material and Methods: All voluntary and replacement donors reporting to the blood bank were screened for HIV-1 & 2, HBsAg, HCV and Syphilis. Anti–HIV -1 & 2, HBsAg & anti - HCV was tested using the appropriate Enzyme–linked immunosorbent assay (ELISA) technique using micro–elisa kit supplied by J.Mitra & Co.Ltd. The seropositive samples were again tested on ELISA kits of RFCL &/or BIORAD for further confirmation & ruling out any false positive or false negative results. The rapid plasma reagain (RPR) test was used for estimation of syphilis infection. Statistical Analysis: The data entry was carried out using Microsoft office excel worksheet and was analysed by percentage and comparison. Results: Total of 6000 donors were screened which included voluntary and replacement donors. Seroprevalence of HIV (0.1833 %), HCV (1.28%), HBsAg (1.5833 %) and syphilis (0.4333 %) was detected. In the study done it was also noted - that the NEGATIVE blood groups were more prone to TTIs. Blood group A negative was more prone to TTIs with HIV, HBsAg and VDRL while blood group B negative was more affected by HCV. Conclusion: Seroprevalence of these infections shows that routine screening is a must for blood and blood product safe transfusion. Do negative blood groups predispose to TTIs? A finding which makes us think….

Pterygium A Study Which Was Done on A Rural Based Population

Bhardwaj Veena M.S., Das Alaka Priyadarshani, Bhardwaj Gaurav

Introduction: Pterygium is a fibrous growth seen in bulber conjunctiva. It is a non malignant growth which may cause visual impairment. Material and Methods: Pterygium study was done on rural population in out patient department of NIMS Hospital and medical college, Jaipur, Rajasthan, India. Two hundred patients with 300 eyes which had Pterygium who attended the Eye OPD during 01/06/2011 to 01/03/2012 were taken for study. A detailed history, Visual Acuity, Refractive Status, Size of Pterygium and duration of the work which was done outdoors were recorded. All other physical illness were ruled out. The aim of the study is to find the incidence of Pterygium, male/female ratio, Comparison of size of Pterygium with duration of working hours in the outfield. Conclusion: The maximum number of patients of pterygium were seen in the age group 20-60years and there is no difference in male/female ratio. The size of pterygium depends on their duration of working hours in outfield.

Metabolic Syndrome among Urban and Rural Women Population – A Cross Sectional Study

Introduction: There is increased incidence of Metabolic Syndrome across the globe. Metabolic Syndrome a strong predictor of coronary vascular disorder and Diabetes Mellitus is not highlighted enough especially in women. This study was undertaken to learn the prevalence of Metabolic Syndrome among urban and rural women. Material and Methods: A detailed history, clinical examination along with mini glucose tolerance test, FBS and PPBS in a known diabetic and fasting lipid profile were done in 590 urban and 433 rural women. Metabolic Syndrome was defined using Modified NCEP ATP III Criteria. Results: Metabolic Syndrome was detected in 342 (57.96%) urban and 239 (55.19%) rural women. Individual components of Metabolic Syndrome like Waist circumference of > 80 cm was found in 283 (82.74%) urban and 171 (71.54 %) rural women, Systolic blood pressure > 130 mm Hg was found in 261 (76.31%) urban and 187 (78.24 %) rural women, Diastolic blood pressure of > 85 mm Hg was found in 201 (58.77%) urban and 143 (59.83 %) rural women, Triglycerides of > 150 mg/dl was found in 187 (43.85%) urban and 159 (66.52 %) rural women, High density lipoprotein of < 50 mg/dl was found in 309 (90.35%) urban and 224 (93.72 %) rural women and Fasting blood sugars of > 110 mg/dl was found in 93 (27.19%) urban and 44 (18.41 %) rural women. Conclusion: Our study showed increased prevalence of Metabolic Syndrome in urban women however there is also increasing prevalence in rural women due to changing life style pattern.

The Value of Magnetic Resonance Cholangio-Pancreatography (MRCP) in the Detection of Choledocholithiasis

Ankur Mandelia, Arun Kumar Gupta, Devendra Kumar Verma, Sanjeev Sharma

Introduction: Magnetic Resonance Cholangio-Pancreatography (MRCP) is a non-invasive radiological investigation which can be performed rapidly and which does not expose the patients to ionised radiations or iodinated contrast material. The present study was conducted to evaluate the role of MRCP in detection of Common Bile Duct (CBD) stones in patients with suspected choledocholithiasis. Material and Methods: This prospective study included 30 patients with a suspicion of choledocholithiasis which was based on clinical evaluation, biochemical or radiological investigations. Ultrasonography and MRCP were performed in all patients. All patients underwent open surgery. CBD exploration was performed in all patients, either due to presence of palpable stones or due to the presence of dilated CBD (> 7 mm). Demonstration of CBD stones intra-operatively was considered the ‘gold standard’ for their presence, defined as stones visualised and extracted or attempted for extraction during surgical CBD exploration. Results: Intra–operatively, 21 (70%) out of 30 patients had cholelithiasis. 26 (86.67%) out of 30 patients had dilated CBD stones intra-operatively. In 20 (66.67%) out of 30 patients, choledocholithiasis was detected intra-operatively. The sensitivity, specificity, positive and negative predictive value of ultrasonography in detecting CBD stones in the present study was 65%, 60%, 76.47% and 46.15% respectively. The sensitivity, specificity, positive and negative predictive value of MRCP in diagnosis of CBD stones in the present study was 95%, 90%, 95% and 90% respectively. Conclusions: MRCP is a non–invasive investigation without complications and it has high sensitivity, specificity and positive and negative predictive values in detection of CBD stones. MRCP should be done in all cases with a suspicion of CBD stones, where facilities and expertise are available.

Mortality in Typhoid Intestinal Perforation–A Declining Trend

Background: Typhoid fever is an important public health problem in developing countries. Intestinal perforation is one of the leading fatal complications of typhoid fever. Typhoid perforation occurs more commonly in terminal ileum. Morbidity and Mortality associated with typhoid perforation are high (9-22%). However this study aims to know whether there are any changes of the same. Aim: To analyse the clinical presentation, management, complications, morbidity and mortality associated with typhoid intestinal perforation and assess changing trends in mortality in typhoid intestinal perforation. Material & Methods: This is a retrospective observational study. Cases regarding the study have been analyzed by reviewing the patient records. It includes 40 patients who were diagnosed with typhoid intestinal perforation, admitted and treated in the Department of General Surgery from February 2011 to January 2012. Results: A total of 40 patients were considered for the study and their mean age was 35.75 years. 80% of patients were male. Pain abdomen was their main symptom which lasted for an average of 2.95 days. Leukocytosis (11,000 cells/cumm) was present in 57.5% patients. Single perforation was present in 31(77.5%) patients and primary closure was done in 30 of them. Culture sensitivity showed E coli as the main organism. Complications were seen in 42.5% of patients in post–operative period. Conclusion: Early recognition, timely surgical intervention with appropriate surgery and antibiotics, and effective peri-operative care reduces the mortality in typhoid intestinal perforation.

Stapled Hemorrhoidectomy, Results of a Prospective Clinical Trial in Saudi Arabia

Salman Yousuf Guraya, Gamal. A Khairy

Objectives: This study was designed to evaluate the effectiveness of stapled hemorrhoidectomy (SH) in terms of cure of the symptoms and post–operative pain control. Material and Methods: In this prospective clinical study, SH (Ethicon Endo-surgery, Cincinnati, OH) was performed for all patients with grade III and grade IV hemorrhoids, presenting to the surgical clinics of Ohud and Meeqat Hospitals Almadinah Almunawwarah Saudi Arabia. The results of SH were evaluated by a questionnaire focusing on the relief of symptoms, severity of post operative pain, and complications of SH. Results: Thirty patients (21 males and 9 females); with a mean age of 39.6 years were recruited in this study. Twenty six (86%) patients had grade III and 4 (14%) presented with grade IV hemorrhoids. Perianal prolapse was the most frequent presentation reported in 23 (76%). Mean operating time was 21.7 minutes (range; 17-36 minutes) whereas mean hospital stay was 1.9 days. Post–operative pain was tolerable (non-persistent) in 28 (93%) cases whereas 2 (7%) experienced mild pain requiring additional analgesia. Urinary retention was the most common complication found in 5 (16%) patients. All patients were cured of the hemorrhoids. Conclusion: SH is a safe, rapid, and convenient surgical remedy for grade III and grade IV hemorrhoids with low rate of complications, minimal postoepative pain, and early discharge from the hospital.

One Vs Two Stage Surgery Technique for Implant Placement in Finger Prosthesis

Background: The loss of the finger can lead to psychological problems. Although several reconstructive techniques may exist, the use of osseous-integrated implants to anchor digital prosthesis presents a suitable alternative for the amputation of finger. The surgery for implant placement has initially been described as a two-stage technique. However, no study in the literature has attempted to compare this technique with onestage technique and stated a clear superiority technique in the implant retained finger prosthesis. Methods: This article describes two cases of digital amputation as a result of accident; a 45-year-old female whose second finger of right hand was lost and a 25-year-old male patient with amputation of the first finger of right hand. Result and Conclusion: One-stage implant placement technique for implant retained finger prosthesis is a reliable, safe and efficient option that allows a good result in a significantly lower operating time and hospital visits compared to the twostage technique. It could therefore, be considered as good option for implant retained finger prosthesis.

Experience with Biodegradable Polymer Coated Sirolimus-Eluting Coronary Stent System in “Real-Life” Percutaneous Coronary Intervention: 24-Month Data from the Manipal-S Registry

Introduction: Despite the undeniable clinical efficacy of drug-eluting stents with durable polymers, concerns regarding their long-term safety have been raised, especially in more complex subsets. The Manipal-S Registry was designed to evaluate the safety and effectiveness of the biodegradable polymer coated Supralimus® Sirolimus-Eluting Coronary Stent for the treatment of coronary artery disease, across a wide range of patients who are treated in real-life clinical practice. Methods: All the consecutive 116 patients who underwent single-vessel or multiple vessel percutaneous coronary interventions with the use of Supralimus® sirolimus-eluting stents between September 2009 and December 2010, were included in this study. Patients were clinically followed-up at 1, 9, 12 and 24 months post-procedure. All clinical, procedural, and follow-up information were collected and analysed. Results: In total 116 patients, 126 lesions were implanted with 144 stents which had an average stent length of 25.8±8.0 mm. The incidences of any major adverse cardiac and cerebral events at 1, 9, 12 and 24 months were 0, 5 (4.3%), 8 (6.9%), and 10 (8.6%) respectively. Conclusion: These 24-month results clearly provide evidence for safety and effectiveness of the Supralimus® Sirolimus-eluting coronary stent system with the biodegradable polymer in real-life patients, even in those with acute myocardial infarctions.

The Unusual Presentation of a Usual Organism – the Changing Spectrum of the Clinical Manifestations of Plasmodium Vivax Malaria in Children: A Retrospective Study

Background: Malaria is a major public health problem in the south-east Asian region. Among all countries in the SE Asian region the highest number of cases and deaths are reported from India. Children below 14 years of age contribute to approximately 42% of all the deaths. A majority of the deaths are attributed to severe malaria which is caused by Plasmodium falciparum. It is considered that causes a benign causing febrile illness without significant complications. However, in recent years, the spectrum of is shifting from being the cause of benign fever, to more severe complications. There have been case reports of complications like thrombocytopaenia, cerebral malaria, a disseminated intravascular coagulation, the acute respiratory distress syndrome, hepatic dysfunction and renal involvement. Most of the case reports are from the adult population, with an occasional occurrence of paediatric cases. Objective: To highlight the increasing number of severe manifestations in P.vivax malaria in the children who were admitted in the malaria transmission season of 2011, at a tertiary care hospital. Design: A descriptive, cross-sectional study. Material and Methods: Study Subjects: Children with an acute febrile illness of a duration of < 7 days, which was confirmed as Plasmodium vivax positive malaria by testing the peripheral smears and/or by Rapid Diagnostic Testing, who were admitted in the paediatric ward of a tertiary care hospital in New Delhi (India), during May 2011 to October 2011, Case records of context cases were analysed retrospectively. Statistics: The data was summarised by calculating the rates, ratios, proportions, means, standard deviations and the 95% confidence intervals. The Chi square test was applied to assess the significant difference between two qualitative variables. Results: Among the case records of 54 patients, 40.7% were below 5 years. 61% were males and 38.9% were females. Besides hepatomegaly and splenomegaly which were the most common symptoms, which were seen in 81.5% and 72.2% children respectively, the various unusual manifestations seen were severe thrombocytopaenia (37%), jaundice with deranged LFT values (25.9%), abnormal bleeding (18.5%), impaired consciousness with a GCS of < 9 (18.5%), severe anaemia (14.8%), hypotension (11.1%), repeated convulsions (7.6%), pulmonary oedema/ARDS (5.6%) and ascites (5.6%). One case each showed haemoglobinuria, and pleural effusion. Conclusion: Plasmodium vivax is emerging as a cause of severe malaria. There is a further need to study the pathophysiology, virulence factors and the molecular mechanisms which are involved in malaria.

Pattern of Bacterial Colonization of Atopic Dermatitis in Saudi Children

Background: Atopic dermatitis is an inflammatory skin disorder. Although it is not a life threatening condition, it may become infected with microorganisms, especially in children. Objectives: The aim of this study was to determine bacterial colonisation in children with atopic dermatitis. Methods: A total of 80 children were randomly included in this study. Two swabs were taken from each child, one from the eczematous skin lesion and the other from apparently healthy skin, as a control. Bacteria were isolated and identified on the basis of the colonial morphology, gram staining and the Vitek System. Results: The mean age of children in this study was 1.4 years, with no gender difference (p=0.98) (n=80). A total of 240 bacterial colonies were grown from atopic dermatitis lesions in contrast to 193 colonies from non–lesional skin. Gram–positive cocci were found in 78 (97.5%) lesions and in 77 (96.2%) non–lesional skin. Staphylococci species were significantly detected in the lesions than in the non–lesional skin. Ent. Faecalis, Ent. Faecium, Ent. gallinarium and C. minutissium were significantly isolated from lesions as compared to non–lesional skin, whereas C. xerosis was insignificantly found to be more in the lesions (p=0.21). Gram–negative bacteria were isolated from 7(8.8%) lesions, but none were isolated from non–lesional skin. Recovered species were Pantoea agglomerans, Enterobacter cloacae, Chryseobacterium indologenes and Acinetobacter Iwoffii. Conclusion: Atopic dermatitis in children is complicated with streptococcal and gram–negative bacterial colonisations and the latter was correlated with the severity of the lesions. Enterococci and Corynebacterium species were significant residents. S. aureus remained the chief inhabitant. No causal relationship could be established between the skin microbiota and atopic dermatitis.

Managing Adnexal Masses: A Medical Quandary

Surender Mohan, Garima Kapoor, Praveen Kumar Nagpal, Raju Aggarwal, Neha Gami

Introduction: Management of Adnexal masses poses a double edged problem. There is a dilemma of performing extensive surgery in the form of staging laparotomy for a benign disease on one hand and the lurking fear of missing the diagnosis of malignancy on the other. Thus, it seems that it is important to establish risk profiles of all patients with adnexal masses so that they can reap the benefit of minimally invasive surgery wherever possible and be rightly subjected to staging laparotomy where indicated. Material and Methods: This prospective study was carried out at a Tertiary care Hospital. 136 women with an adnexal mass on ultrasound which met the said criteria were enrolled into the study from January 2008 to July 2011. They were then taken up for laparoscopic management. Results: All but 2 cases were found to be benign (134/136) after the final histopathology report using the said criteria. Conclusion: Hence, by using simple readily available investigations like ultrasound (pattern recognition approach, Tumour morphology and ascites) and CA–125, the nature of adnexal mass can be reliably predicted and these patients can be safely offered the benefits of laparoscopic surgery.

Sclerosing Stromal Tumour in Young Women: Clinicopathologic and Immunohistochemical Spectrum

Ecmel Isik Kaygusuz, Suna Cesur, Handan Cetiner, Hulya Yavuz, Nermin Koc

Aim: Sclerosing stromal tumor is a benign tumor of ovary. We aimed to review the clinical findings and immunohistochemical results of SSTs through the 7 diagnosed cases in our hospital. Material and Methods: As immunohistochemical, blocks were applied with estrogen receptor , progesterone receptor, inhibin, calretinin, melan-A, CD10, smooth muscle actin, desmine, vimentin, CD34, S-100, C-kit, cytokeratin , cytokeratin7. Results: Macroscopically, while 5 tumors had solid appearance, 2 tumors were composed of solid and cystic areas. All the tumors were in shape of ovarian masses with good limits. Microscopically, two types of cells were observed as fusiform fibroblast-like cells and theca-like cells with vacuolised cytoplasm. Immunohistochemical results: vimentin, smooth muscle actin, desmine, progesterone receptor, calretinin, inhibin were positive in all the cases; S-100, cytokeratin, cytokeratin7, estrogen receptor were negative in all the cases; CD-10 was positive in 2 cases; C-kit was positive in 5 cases; melan-A was positive in 4 cases. Conclusions: The significance of these tumors is that it is necessary to distinguish the histopathology in the frozen section in order to protect the other adnexa because of the characteristics to be observed at early ages (2nd and 3rd decades). Our findings support the conclusion that sclerosing stromal tumors are benign–character tumors that stem from over stroma and are hormonally active tumors because of the detected clinical and immunohistochemical results, although no hormonal effect that could be supported with laboratory tests was observed.

Introducing Physiology Practical Demonstration in Course Curriculum for the First Year Nursing Students

Introduction: Combination of didactic lecture, practical demonstration and performing experiments by students is followed in medicine, dentistry and bachelor of pharmaceutical sciences. The purpose of this study was to assess the attitudes of nursing students towards practical demonstration in physiology. Material and Methods: Seventy three nursing students of the first year underwent practical demonstration of Physiology experiments. Students indicated their agreement or disagreement with the 8 items by ticking one of the five alternative responses. Mean attitude scores were calculated for each item and for the total scale. Results: The overall mean attitude score of 3.76 was towards the favourable side. Eighty seven percent of students agreed that practical demonstration reinforces concepts. Eighty nine percent of students found practical demonstration is a good form of learning experience. Conclusion: The introduction of practical demonstration in addition to didactic lectures may help the students in understanding concepts in Physiology.

Prognostic Scoring Indicator in Evaluation of Clinical Outcome In Intestinal Perforations

Ashish Ahuja, Ravinder Pal

Introduction: Acute generalised peritonitis coming forth due to underlying intestinal perforation is a critical & life-threatening medical condition. It is a common surgical emergency most of the times across the world. Misleading data on crude morbidity and mortality due to the condition usually contaminates substantially the very purpose of medical audit. Thus, early prognostic evaluation is not only desirable but mandate to much extent. High-risk patients require timely & aggressive treatment especially in severe peritonitis & to select them reasonably well, evaluation through prognostic scoring is an approach of choice. Well sought after & reasonably reliable APACHE II scoring system is used for the purpose & scores are correlated well to accentuate & measure the various factors needed for better management of condition. Material and Methods: The study was conducted over the period of 18 months (Jan 2010 to June 2011) on 50 patients with confirmed diagnosis of intestinal perforation. APACHE II score was calculated and correlated with their symptoms & clinical outcomes regarding morbidity and mortality. Results: APACHE II score correlated well with the outcome of the study, showing score affects of two major aspects in the treatment outcome & management.1.) APACHE II score of less than 10 included 30 low risk group patients discharged in a satisfactory gratifying manner. Three out of four in high risk group with APACHE II score >20, shown adverse outcomes. 2.)Mean ICU stay of 9.75 days was found in patients with APACHE II score 20 or more compared to those with mean ICU stay of 0.13 days in patients with APACHE II score 10 or less. Conclusion: Acute generalized peritonitis being life–threatening medical emergency requires careful consideration in its management that needs to be economically viable, acceptably feasible and outcome oriented with better allocation & utilization of ICU resources that needs meticulous case analysis & prioritization. This present study helps the clinicians in three major ways: a) To take better decisions on case to case basis; b) To design strategies in order to prevent adverse outcomes; c) Last but not least, to make better use of ICU resources.

Phenotypic and Genotypic Methods for Detection of Extended Spectrum beta Lactamase Producing Escherichia coli and Klebsiella pneumoniae Isolated from Ventilator Associated Pneumonia

Background: Ventilator Associated Pneumonia (VAP) is one of the common nosocomial infections associated with high morbidity due to multidrug resistant pathogens. Rapid spread of resistance to broad spectrum beta-lactams in pathogenic strains causes antibiotics ineffectiveness and increased severity of illness. The CTX-M is the most dominant Extended Spectrum ß Lactamase (ESBL) among Enterobacteriaceae in many regions of the world. The aim of the study was to identify the occurrence of ESBL and detect the genes responsible for ESBL production by conventional Polymerase Chain Reaction (PCR) method. Methods: This prospective study included patients, clinically diagnosed as VAP. Endotracheal aspirates (EA) were collected and cultured by quantitative method. The bacterial isolates were identified as per standard methods. Isolates resistant to 3rd generation cephalosporins were screened for ESBL production by disk approximation method and combination disc diffusion method. Isolates confirmed as ESBL producers were subjected to genotyping by conventional PCR. Statistical Analysis: Statistical analysis was done by using MS Excel sheet. Descriptive statistics like percentage was done in the study. Results: Among the isolates from 428 patients who developed VAP, 144 isolates belonged to the Enterobacteriaceae family (Klebsiella pneumoniae 87 and Escherichia coli 57). A total of 66 isolates (28 Klebsiella pneumoniae and 38 Escherichia coli) were confirmed as ESBL producer by disc approximation method and 63 isolates by double disc combination method. In the present study by conventional PCR bla CTX-M was the common gene in 48.5% strains followed by 22.22% bla SHV and 14.81% bla TEM. Conclusion: The genotypic methods using specific PCR amplification of resistance genes seems to have 100% specificity and sensitivity in detection of ESBL when compared to phenotypic methods which lacks the constant sensitivity.

Changing Trends in Resistance Pattern of Methicillin Resistant Staphylococcus aureus

Background: Methicillin resistance in Staphylococcus aureus is associated with multidrug resistance, an aggressive course, increased mortality and morbidity in both community and health care facilities. Monitoring of newly emerging and prevalent Methicillin Resistant Staphylococcus aureus (MRSA) strains for their resistance patterns to conventional as well as novel drugs, are essential for infection control. Aims: To study the changing trends in resistance patterns of MRSA at our hospital. Settings and Design: This cross sectional study was carried out in a 750 bed tertiary care hospital in south India. Material and Methods: One hundred and two clinical isolates of MRSA which were obtained in 2004-2011 were identified by using oxacillin, cefoxitin disc diffusion test and oxacillin screening agar test. Antibiotic susceptibility test was done for commonly used non beta lactam anti-Staphylococcal drugs, as well as for anti-MRSA drugs like vancomycin, linezolid, mupirocin and rifampicin. Minimum inhibitory concentration (MIC) of vancomycin was determined by using Vancomycin HiComb strip (Himedia, Mumbai, India). Statistical Analysis which was done: Chi-square test and proportions were used to compare the two groups. Results: MRSA isolates showed high resistance to co-trimoxazole (82.3%), ciprofloxacin (76.4%), gentamicin (64.7%) and tetracycline (49%) as compared to other drugs. High prevalence of ciprofloxacin resistance was detected, particularly among outpatients. Multi resistant MRSA with a = 3 non-beta lactam agent resistance was 79%. All MRSA isolates were sensitive to vancomycin, linezolid, mupirocin and rifampicin. MRSA had displayed increase in resistance to most antibiotics except tetracycline in recent years. Conclusions: Taking into consideration the prevalence of multidrug resistance in MRSA, resistance patterns should be evaluated periodically and antibiotic therapy should be guided by susceptibility testing.

A Study on Clinico-Mycological Profile, Aetiological Agents and Diagnosis of Onychomycosis at a Government Medical College Hospital in Kashmir

Rubeena Lone, Deeba Bashir, Shabir Ahmad, Arshi Syed, Syed Khurshid

Background: Onychomycosis is a major public health problem with a high incidence, associated morbidity and a long lasting treatment with anti-fungal agents. This study was carried out to know the clinico-mycological pattern of onychomycosis, which could help in the control of this infection. Aims: The aim of this study was to determine the prevalence of various causative agents of onychomycosis and to study the clinical and mycological patterns of onychomycosis. Material and Methods: This was a prospective study which was carried over a period of one year, from 1st February 2011 to 31st January 2012 on samples from 150 patients with clinically suspected nail infections, who attended the Dermatology Department of SKIMS Medical college, Kashmir, India. The nails were evaluated clinically and the nail samples were subjected to direct microscopy and culture. Results: 60% samples were found to be positive by direct microscopy and culture. Males were infected more than females. The commonest age group which was infected was the 21-30 years age group. Finger nails were affected more frequently than toe nails and distolateral subungal onychomycosis was the most common clinical type of infection which was seen in 64.44% patients. The aetiological agents were dermatophytes (61.66%), Non–Dermatophyte Moulds (NDM) (31.66%) and yeasts (6.66%). Among dermatophytes, T. rubrum was the commonest aetiological agent. Conclusion: Although dermatophytes were the main causative agents, NDM and yeasts were also not uncommon aetiological agents of onychomycosis. This study also emphasized the need of performing both a direct examination and culture to improve sensitivity. Since onychomycosis can cause physical, psycological and occupational problems, the clinico-epidemiological data can be helpful in development of preventive and diagnostic strategies.

OXA-181 Beta Lactamase is not a Major Mediator of Carbapenem Resistance in Enterobacteriaceae

M. Shanthi, Uma Sekar, Arunagiri K., Hemant Goverdhandas Bramhne

Background: Detection of carbapenem hydrolyzing class D beta lactamase OXA-181, (a variant of OXA-48) in Enterobacteriaceae, is important, to institute appropriate therapy and to initiate preventive measures. This study was done to determine the presence of OXA 48 and its derivative OXA-181 in Enterobacteriaceae of pathogenic significance. Material and Methods: One hundred and eleven non–repetitive Enterobacteriaceae isolates which were resistant to any of the cephalosporin subclasses III and which exhibited reduced susceptibility to carbapenems were included in the study. Minimum inhibitory concentrations (MICs) to imipenem and meropenem was determined by broth microdilution. Production of carbapenamase was screened by Modified Hodge test (MHT). Polymerase Chain Reaction (PCR) was done to detect the presence of bla OXA-181 and bla OXA-48 .Coexistence of other carbapenemase encoding genes, namely, NDM-1, VIM, IMP and KPC were also looked for, by PCR. Results: Of all the isolates which were tested, only 2 (1.8%) revealed the presence of OXA-181 and OXA-48. These were Klebsiella pneumoniae and Citrobacter freundii. MICs of imipenem and meropenem for Klebsiella pneumoniae were 128mg/l and 64 mg/l and for Citrobacter freundii, they were 32mg/l and 16mg/l respectively. MHT was positive in both isolates. Conclusion: Production of OXA-48 / OXA-181 is not a major mechanism of carbapenem resistance. PCR is the gold standard for its routine identification in clinical microbiology laboratory.

Sub-Hepatic Caecum

Nagashree M V, Gireesh, Lakshmi Prabha Subhash, Veena Pai

Malrotation of gut is an intestinal gestational disorder which not only affects the positioning of the midgut, but also its vascular supply. It usually presents with the syndrome of bouts of colic and vomiting with little distention of abdomen and diarrhea. Though midgut malrotation is a common cause of intestinal obstruction in newborn, scant attention is given to this developmental anomaly as a cause of symptoms in adults. The development of midgut portion of alimentary canal suffers a large variety of variations. The surgical importance of abdominal situation of the portions of intestine derived from the midgut loop requires little attention. Sub–hepatic anatomical location of the appendix makes it more difficult to diagnose acute appendicitis at any age, including in older adults. Failure to recognize the nature and characteristic features of these misplacements may lead to grave errors in procedure, or to injurious prolongation of the operation. Here in we found a rare abnormality of caecum, which was present in the sub hepatic region with the absence of ascending colon during routine dissection classes for undergraduate students.

An Accessory Muscle of Pectoral Region: A Case Report

B.M. Bannur, Nagaraj Mallashetty, Preetish Endigeri

Among the variations of pectoral muscles, this case appears to be unique in the literature. This was a case of an accessory pectoral muscle which was located between pectoralis major and pectoralis minor muscles, which was discovered during a routine anatomy dissection. The accessory muscle originated from 6th and 7th ribs at costo-chondral junction, which travelled supero-laterally and inserted by fusing with fibres of pectoralis minor . This unusual muscle holds importance for surgeons while they perform dissectomies, in avoiding complications.

Splenic Tubercular Abscess in an Immunocompromised Patient–Rapid Diagnosis by Line Probe Assay

Diagnosing extra–pulmonary tuberculosis is a challenge that can confound even the most practiced clinicians as clinical manifestations are vague, non-specific and typical chest radiograph findings may not be evident till late in the disease. Conventional methods for mycobacteriological culture and drug susceptibility testing are slow and cumbersome. Novel technologies for rapid detection of Mycobacterium tuberculosis and its anti–TB drug resistance have therefore become a priority hence with the development of molecular line probe assays are most advanced. Herewith we are reporting a case of splenic tuberculosis in an immunocompromised patient for its rarity and to emphasis the fact that such patients can be diagnosed early for better treatment outcome to enhance the longevity if a health setup possesses all the modern diagnostic services.

Neoplastic (solid) Calcifying Ghost Cell Tumor, Intraosseous Variant: Report of A Rare Case and Review of Literature

Jyotsna Wader, Neha Gajbi

A neoplastic (solid), calcifying ghost cell tumour is a rare subtype of Calcifying Odontogenic Cyst. The most important features of this pathologic entity are histopathological features, which include a proliferating cystic lining which demonstrates characteristic “Ghost” epithelial cells which have a propensity to calcify. We are reporting a case of a 61–year–old male with a painful swelling in the lower right jaw. Radiology showed a bilocular, well circumscribed, radiolucent lesion in the mandible, which measured 2x1 cm, with radiopaque structures within it. Tooth extraction was done, with enucleation of the lesion, which histopathologically revealed features of a solid, calcifying ghost cell tumour, with an intraosseous variant. The case has been presented, with a brief review of literature.

Chronic Constipation Caused by Neurofibromatous Proliferation in A Case of Von Recklinghausen´s Disease – A Case Report

Honnappa Sridha, Rau R Aarathi, Mysorekar Vijaya, Jalihal Umesh

Neurofibromatosis (NF) is an autosomal dominant genetic disorder with a myriad of clinical manifestations . A gastrointestinal involvement which is present in 10 -25% of patients, is usually a systemic manifestation of generalised NF. We are describing a case of NF 1 with chronic constipation, in whom colonoscopy revealed a thickening of the colon wall with narrowing. A mucosal biopsy showed neural hyperplasia .This case emphasizes the value of minimally invasive endoscopic biopsies of GI lesions in NF1, where despite a limited sampling, correlation with clinical and endoscopic features may help in reaching a diagnosis of a neurofibromatous proliferation. We have also discussed the differential diagnosis of gastrointestinal lesions in NF with neural hyperplasia.

Osseous Metaplasia in A Juvenile Polyp: A Rare Case Report in India

Nanigopal Bhattacharya, Tirthankar Sarkar

Osseous metaplasia is a phenomenon which is described in a variety of tissue types with respect to both neoplastic and non-neoplastic conditions. In the gastrointestinal tract, osseous metaplasia (heterotopic bone formation) is rarely detected. Most of the reported cases were associated with malignant lesions. Here, we are reporting a rare case of a juvenile rectal polyp in a 14 years male, which showed osseous metaplasia on histological examination. This feature is a striking phenomenon on histological examination.

A Rare Case of Renal Tumour

K. Valarmathi, A. Jamila, S. Ravi, Selvambigai, Muthulatha

Primary Renal Lymphoma (PRL) is an unusual and a rare tumour of the kidney. By definition, PRL is a lymphoma without evidence of any systemic involvement. This report describes a case of PRL, which included clinical presentation, imaging findings, histopathology and immunohistochemistry.

Ganglioneur, Base of Tongue: A Rare Entity

Nidhi Mahajan, Jyotsna Naresh Bharti, Meeta Singh, Swapnil Agarwal, Nita Khurana

We have discussed the case of a solitary polypoid ganglioneuroma in a 45–year–old male patient, at the base of tongue, which mimicked a malignancy. The interest of this case lay in the rarity of its incidence at the base of tongue and its gross resemblance to the more common malignant polypoidal growths at this site. The presence of neural elements and ganglion cells at this site makes it important for an inexperienced histopathologist to differentiate it from other neural lesions of the tongue, in order to avoid a misdiagnosis and this can prevent the clinician from administering an inappropriate treatment. Exhaustive search revealed only a very few case reports on the tongue.

Bardet Biedel Syndrome: A Very Rare Entity in India

Bardet Biedel Syndrome (BBS) is a rare autosomal recessive disease which is characterized by obesity, retinitis pigmentosa, polydactyly, neuro-developmental retardation and renal defects amongst others. It is a genetically heterogeneous ciliopathic disorder with inter and intra familial variations. Very few cases have been reported from India. We are reporting here a case of an adolescent girl who was diagnosed at the age of 16, with additional features of insulin resistance and non-alcoholic fatty liver disease. A review of recent literature and a short discussion on the care and management of this uncommon condition follow.

Spontaneous Intrahepatic Type II Gallbladder Perforation: A Rare Cause of Liver Abscess – Case Report

A liver abscess formation is a rare complication of a gallbladder perforation, with a cholecystohepatic communication. Niemeier, in 1934, classified free gallbladder perforations and generalised biliary peritonitis as an acute or a Type I gallbladder perforation, a pericholecystic abscess and localised peritonitis as a subacute or a Type II gallbladder perforation, and cholecystoenteric fistulas as chronic or Type III gallbladder perforations. We are describing a 50–year–old male patient who presented with right upper quadrant pain and was found to have an intrahepatic perforation of the gallbladder. Our patient had a Type II perforation. We have discussed the diagnostic work-up and the management of this rare entity. Due to the high mortality that can be caused by a delay in making the correct diagnosis, a gallbladder perforation represents a special diagnostic and surgical challenge.

Recurrent Phaeohyphomycosis: A Case Report

SN Shirbur,SR Telkar,BV Goudar, Tony Mathew

Phaeohyphomycoses are rare, opportunistic, fungal infections which are usually seen in immunocompromised individuals. We are reporting a case of a 40-year-old man with recurrent cutaneous phaeohyphomycosis, who did not have any clinical evidence of immunodeficiency, who presented with signs which resembled a malignancy of the skin.

Peculiar Case of Mucocele of Appendiceal Tip

Sridhar M., Narayanaswamy Chetty Y.V., Bagalibaba Saheb

Mucocele of Appendix is a gross or clinical descriptive term for dilatation of the appendiceal lumen by mucus.It is a rare pathology with an overall incidence of 0.2 to 0.3% of all appendectomies. Majority of these cases present with mucocele involved whole length of the appendix. On extensive literature search,exact incidence of mucocele confined only to the tip of appendix is not known, though there are very few case reports. Here we report a peculiar case of large mucocele of appendix confined only to the tip, sparing significant length of proximal appendix and causing diagnostic dilemma pre-operatively in a 43 –years –old lady.

Mixed Tumour of Ala-Nasi: A Rare Case Report and Review

Anji Reddy Kallam, R. Krishna, Rayapa Reddy Thumma, Vidya Kedar setty

A chondroid syringoma or a mixed tumour of skin, is a rare, benign skin adnexal tumour of sweat gland origin, which is most commonly seen in the head and neck region of patients who are in the sixth and seventh decades. These tumours usually present as asymptomatic, slowly growing masses. We are reporting a rare case of a chondroid syringoma of Rt. ala nasi in a 50 years old female. The swelling had started 4 years back as a small nodule and it had gradually increased in size to 2x2 cms. It was located subcutaneously and it was projecting into the anterior nares. A clinical diagnosis of a benign adnexal tumour (adenoma) or a solitary neurofibroma was made and an excision was planned. Histopathology revealed features of a chondroid adenoma. We are reporting this case because of its rare and unusual site of occurrence and so far, in the available literature, no such case has been reported on tumours of alanasi.

Ovarian Gonadoblastoma with Dysgerminoma in a Young Girl with 46, XX Karyotype: A Case Report

Gonadoblastoma is a rare gonadal tumour consisting of a mixture of germ cells and sex cord stromal derivatives resembling immature granulosa and Sertoli cells. It usually arises in various types of gonadal dysgenesis containing Y chromosome like pure or mixed gonadal dysgenesis. Occurrence in phenotypically and chromosomally normal women is very rare. We report here a case of gonadoblastoma with dysgerminoma in a 14–years–old girl who presented with a huge tumour, virilisation and normal 46XX karyotype. Association of dysgerminoma is seen in 50% cases of gonadoblastomas. Elevated tumour markers like hCG and alpha Fetoprotein may make the diagnosis challenging.

Case Report : Hermansky Pudlak Syndrome (Presenting as late onset heavy Menstrual Bleeding)

Amita Ray, Sujoy Ray, Jose John Matthew

Inherited bleeding disorders contribute significantly to the incidence and prevalence of Heavy Menstrual Bleeding (HMB), and contrary to popular belief can present any time during the reproductive years of a woman’s life. The following case exemplifies this and is being presented as part of a rare syndrome. The incidence of this syndrome in the general population ranges from 1:500,000 to 1:1000, 000. Besides being rare the presentation was quite uncommon as majority of these cases present with pulmonary fibrosis.

Craniofacial Duplication: A Case Report

craniofacial duplication or diprosopus is an unusual variant of conjoined twinning. The reported incidence is one in 180,000-15 million births and 35 cases have been reported till date. The phenotype is wide, with the partial duplication of a few facial structures to complete dicephalus. A complete duplication is associated with a high incidence of anomalies in the central nervous system, cardiovascular system, gastrointestinal system and the respiratory system, whereas no major anomalies are found in the infants with a partial duplication. A term baby with the features of a craniofacial duplication has been described, with the proposed theories on embryogenesis and a brief review of the literature.

Brain Abscess as A Complication of Chronic Thromboembolic Pulmonary Hypertension – A Rare Case Report

Lakshmi K, Santhanam R, Chitralekha S

A brain abscess is a life threatening condition which can occur as a complication of various clinical conditions. An intra–cerebral abscess which occurs as a complication of pulmonary arterial hypertension is extremely rare. The present report has described such an uncommon case of an intra–cerebral abscess in a chronic pulmonary thrombo embolism patient with pulmonary hypertension. A–34–year old male who was a known case of chronic pulmonary thrombo embolism with pulmonary artery hypertension, who was diagnosed 6 months back, presented to the Out Patients Department (OPD) with headache and vomiting. He had right homonymous hemianopia. Contrast MRI (Magnetic Resonance Imaging) of brain showed a peripherally enhancing lesion in the left temporo-occipital lobe, with oedema and a mass effect. Left parieto–occipital craniotomy and excision of the abscess was done. Staphylococcus aureus was isolated from the aspirated pus.

Unfused Crossed Renal Ectopia with Ipsilateral Anorchia–A Rare Entity

Bijit Lodh, Vijayendra Kanwar, A.K. Kaku Singh, S. Rajendra Singh

The reported incidence of unfused crossed renal ectopia is 1 in 75,000 autopsies. A majority of such cases go unnoticed, as they remain asymptomatic and are found incidentally at autopsy. We have presented such a case for its rarity, unusual presentation and association, and have discussed it in light of the available literature. In this report, a 7–year–old boy was pre–operatively diagnosed as having left crossed renal ectopia with a cryptorchid left testis. At surgery, we noticed an ectopic, hydronephrotic left kidney with an absent left testis. Left Nephrectomy was performed, based on findings of a DTPA scan which was done. Post–operative course was uneventful. Histopathology revealed chronic pyelonephritis without any evidence of dysplastic changes.

Urolithiasis in a child with Spondylocarpotarsal Synostosis Syndrome: A Co-Incidence

Ankur Singh, Seema Kapoor, Gaurav Pradhan

Spondylocarpotarsal synostosis syndrome (SSS) is an autosomal recessive condition which is characterized by short stature, a carpotarsal coalition and a vertebral fusion, but without any rib anomaly. We are presenting a 7– year– old boy, who had uroliathiasis with the spondylocarpotarsal synostosis syndrome. This association, to the best of our knowledge, has not been reported so far.

Electronic Biomedical Literature Search for Budding Researcher

Subhash B. Thakre, Sushama S. Thakre S, Amol D. Thakre

earch for specific and well defined literature related to subject of interest is the foremost step in research. When we are familiar with topic or subject then we can frame appropriate research question. Appropriate research question is the basis for study objectives and hypothesis. The Internet provides a quick access to an overabundance of the medical literature, in the form of primary, secondary and tertiary literature. It is accessible through journals, databases, dictionaries, textbooks, indexes, and e-journals, thereby allowing access to more varied, individualised, and systematic educational opportunities. Web search engine is a tool designed to search for information on the World Wide Web, which may be in the form of web pages, images, information, and other types of files. Search engines for internet-based search of medical literature include Google, Google scholar, Scirus, Yahoo search engine, etc., and databases include MEDLINE, PubMed, MEDLARS, etc. Several web-libraries (National library Medicine, Cochrane, Web of Science, Medical matrix, Emory libraries) have been developed as meta-sites, providing useful links to health resources globally. A researcher must keep in mind the strengths and limitations of a particular search engine/database while searching for a particular type of data. Knowledge about types of literature, levels of evidence, and detail about features of search engine as available, user interface, ease of access, reputable content, and period of time covered allow their optimal use and maximal utility in the field of medicine. Literature search is a dynamic and interactive process; there is no one way to conduct a search and there are many variables involved. It is suggested that a systematic search of literature that uses available electronic resource effectively, is more likely to produce quality research.

History of Medical Understanding and Misunderstanding of Acid Base Balance

Christopher Geoffrey Alexander Aiken

To establish how controversies in understanding acid base balance arose, the literature on acid base balance was reviewed from 1909, when Henderson described how the neutral reaction of blood is determined by carbonic and organic acids being in equilibrium with an excess of mineral bases over mineral acids. From 1914 to 1930, Van Slyke and others established our acid base principles. They recognised that carbonic acid converts into bicarbonate all non-volatile mineral bases not bound by mineral acids and determined therefore that bicarbonate represents the alkaline reserve of the body and should be a physiological constant. They showed that standard bicarbonate is a good measure of acidosis caused by increased production or decreased elimination of organic acids. However, they recognised that bicarbonate improved low plasma bicarbonate but not high urine acid excretion in diabetic ketoacidosis, and that increasing pCO2 caused chloride to shift into cells raising plasma titratable alkali. Both indicate that minerals influence pH. In 1945 Darrow showed that hyperchloraemic metabolic acidosis in preterm infants fed milk with 5.7 mmol of chloride and 2.0 mmol of sodium per 100 kcal was caused by retention of chloride in excess of sodium. Similar findings were made but not recognised in later studies of metabolic acidosis in preterm infants. Shohl in 1921 and Kildeberg in 1978 presented the theory that carbonic and organic acids are neutralised by mineral base, where mineral base is the excess of mineral cations over anions and organic acid is the difference between mineral base, bicarbonate and protein anion. The degree of metabolic acidosis measured as base excess is determined by deviation in both mineral base and organic acid from normal.

Effect of Two Desensitizing Agents in Reducing Dentin Hypersensitivity: An in-vivo Comparative Clinical Trial

Objective: A randomized, double blind, split mouth, controlled clinical trial was conducted to evaluate the effect of two desensitizing agents on reduction of Dentin Hypersensitivity (DH). Material and Methodology: A sample of 73 teeth from 13 patients, among which at least 3 teeth had dentin hypersensitivity, was randomly allocated into 3 treatment groups: Group A: treated with 30% ethenolic extract of Indian Propolis, Group B: treated with GC tooth mousse, and Group C: treated with sterile water. A Verbal Rating Scale (VRS) was used to record the degree of hypersensitivity, based on patient’s response to tactile and air blast stimuli. The baseline scores were obtained. Each intervention group received applications of their respective agents consecutively on 1st, 7th, 14th and 21st days. After each application, the scores were recorded. Results: Both the 30% Indian Propolis and GC tooth mousse showed significant reductions in dentin hypersensitivity. Conclusion: GC tooth mousse was found to be significantly better in reducing the dentinal hypersensitivity as compared to Propolis and sterile water (p< 0.01).

Oral Health Status in Haemodialysis Patients

Objective: To assess the oral and dental manifestations in non- diabetic and diabetic uraemic patients who were undergoing haemodialysis and to estimate and compare the salivary pH in these two groups. Material and Methods: Ninety Seven uraemic patients who were undergoing maintenance haemodialysis were included in the study. Subjective and objective findings were evaluated and recorded in a specially designed proforma. Predialytic unstimulated whole salivary pH was recorded by using pH-measuring strips. Dental health assessment consisted of DMFT and CPITN indices. Results: A subjective oral manifestation of dysguesia was found to be more significant in non-diabetic patients (p<0.008). Statistically, a high significance was observed with mucosal petechiae in 31.9% patients of diabetic group .The overall DMFT score was significantly higher in diabetic group. A moderate significance was found with a CPI score of 5 (p<0.015). The pH of saliva was significantly higher among diabetic patients. Conclusion: The diabetic subjects who were on haemodialysis were at a high risk for developing periodontal disease and they exhibited a potential threat for dental decay and xerostomia. A lower salivary pH and a poor glycaemic control may affect their oral health. Further research is required to clarify the combined influence of diabetic nephropathy on oral health.

Evaluation of panoramic Radiographs as a Screening Tool of Osteoporosis in Post Menopausal Women: A Cross Sectional Study

Bosky Gaur, Arati Chaudhary, P.V. Wanjari, MK Sunil, Patthi Basavara

Background: Indian women, especially those from low-income groups consume diets that are deficient of calcium, proteins and micronutrients. Hence, they are prone to suffer from osteoporotic hip fractures at a much earlier age than western women. To detect early signs of osteoporosis, it is ideal to perform Bone Mineral Density testing of all post-menopausal women who are at risk. Aim: (i) To assess and compare the relative efficacy, ease of application and measurement of the various mandibular cortical indices which were obtained on the panoramic radiographs with bone densitometry data of post-menopausal women. and (ii) To evaluate the effectiveness of these measurements in the identification of cases of osteoporosis/osteopaenia. Method: A cross sectional sample which consisted of 40 randomly selected post menopausal women who were aged 40-69 years was subjected to dental panoramic radiography. Mental index, panoramic mandibular index, gonion index, mandibular cortical index and antegonial index were measured on each radiograph. The data were expressed as mean and standard deviation. Analysis of variance with post–hoc Tukey’s test was performed to determine group differences in mandibular measurements. Results: Based on the bone densitometry results, the sample was classified into normal (n=9), osteopaenic (n=15) and osteoporotic (n=16) groups. Statistically significant differences were found for mean Mental index (p=0.000), mean Panoramic Mandibular Index (p=0.007) and mean Gonial Index (p=0.000). The sensitivity (100%) and specificity (88.88%) of MCI showed good results. Conclusion: Dentists who use orthopantomographs may play a vital role in screening patients with osteoporosis, mainly among post menopausal women.

Effect of Cigarette Smoke on Acrylic Resin Teeth

Seema S. Patil, Dhakshaini M.R., Anil Kumar Gujjari

Background: The discolouration of artificial teeth, which hampers aesthetics, is one of the negative effects of cigarette smoking. Therefore, the effect of cigarette smoke on the colour stability of commercially available acrylic resin teeth needs to be evaluated for clinical success and to ascertain as to which brand has superior properties. Material and Methods: Three commercially available acrylic teeth were evaluated, after division into Group A (Premadent), Group B (Astra), and Group C (Sanyo- Dent). Selected brands were subdivided as study group and control group. Each set of acrylic resin teeth were stored in artificial saliva at 37±1oC for 24 hours. After 24 hours of immersion, the colour measurement of each tooth (T0) was performed. Second colour measurements were done after 21 days (T21) of exposure to cigarette smoke for study group and after immersion in artificial saliva for control group. All data was statistically analyzed by using Repeated Measures ANOVA and Two-way ANOVA.(p<0.05). Results: Group A showed least total colour change on exposure to cigarette smoke, followed by Group B and Group C had the highest total colour change. In control group, after immersion in artificial saliva, a slight increase in total colour change was observed for all groups, which was clinically acceptable. Conclusion: Group A (crosslinked acrylic resin teeth) was more colour stable and more resistant to the discolouration which was caused by cigarette smoke, followed by Group B (crosslinked acrylic resin teeth). Group C (Non-crosslinked acrylic resin teeth) was least colour stable and most susceptible to discolouration which was caused by cigarette smoke.

Oral Health of Pre-School Aged Children in Dhanbad District, Jharkhand, India- A Peek into their Mother’s Attitude

Introduction: Mothers are directly responsible for the dental health of their children and play a major role in shaping the dental health behaviors of their children. They also play an important role in preventing oral diseases in them. Objective: To assess the level of attitude of mothers in relation to their pre-school aged children, which in turn can influence the level of oral health. Method: A cross-sectional study was carried out among 312 mothers, selected randomly from eight blocks of Dhanbad district, Jharkhand, India. They were administered with a structured questionnaire on attitude, by an interviewer. Results: The overall data indicated that the attitude of mothers about oral health in their pre-school children increased as their age increased which was not statistically significant (p>.066). Mothers who had less than higher secondary school education and belonged to socio-economically lower groups had poor knowledge of oral health which was statistically significant (p<.001). Conclusion: Mothers should be motivated so that their attitude about their child’s oral health is enhanced which in turn would improve their oral health related quality of life.

Assessment of Oral Health Related Quality of Life Among Completely Edentulous Patients in Western India by Using GOHAI

Rajani A. Dable, Girish S. Nazirkar, Shailendra B. Singh, Pradnya B. Wasnik

Background: Quality of life in elderly is a very sensitive issue. It is important to know if the dental problems, general health and dental treatment have an impact on the quality of life in elderly. The elderly population has a typical set of mind regarding their oral health. This study examines the trends in patients’ behavioral patterns due to tooth loss, suggestive of some change in quality of life. Aims: The purpose of this study was to identify and acknowledge the problems of completely edentulous patients and their relationship to the Quality of Life (QOL). Also, the study was aimed at exploring the changes in global self–rated general health between the pre and post–treatment scores. Settings and Design: This is a randomized controlled clinical trial study which is done to evaluate the problems in the elderly and quality of life as long as their oral health is concerned. It is conducted on a group of people representing the elderly population with complete edentulism. Material and Methods: Sixty three patients with mean age 69.41 who needed dentures were investigated before and after 6 months of their treatment by administration of GOHAI (Geriatric Oral Health Assessment Index) scale. Comparison between Pre & Post–treatment values of various scores were done with McNemar–Bowker Test. Quantitative data was represented using Mean ± SD and Median, IQR (Interquartile range). Analysis of Pre & Post–treatment quantitative data was done using Wilcoxon Signed Rank Test. Results: The results of the present study showed GOHAI scores increased from 28.90 + 7.28 to 42.19 + 7.60 (p=highly significant). There was a significant change in the quality of life in elderly after their prosthodontic rehabilitation, though the self rated general health did not show any significant improvement. Conclusion: It is the responsibility of the entire dental fraternity to understand the needs of elderly associated to their oral health. It is important to evaluate and assess the psychological effects of tooth loss on their quality of life. A thorough investigation is necessary before and after the dental/prosthodontic care.

Oral Lichen Planus as an Extra–hepatic Manifestation of Viral Hepatitis–Evaluation in Indian Subpopulation

Mohan Kumar K.P., Harshavardhan S. Jois, Seema Hallikerimath, Alka D. Kale

Background: Oral Lichen Planus (OLP) is considered to be associated with numerous systemic conditions one of which includes Chronic Liver Disease (CLD). Hepatitis virus B and C (HBV and HCV) have known to be important causative agents of CLD and can be prevalent in asymptomatic carriers that can make them difficult to identify. Off late, the association of viral hepatitis with OLP has been a subject of controversy due to conflicting reports. Indian studies on this regard are sparse to evaluate the same. Association between the hepatitis virus and OLP, if present and established, can be of great help to format a protocol for identifying carrier states of viral hepatitis due to HBV and HCV. Methodology: Forty five cases of clinically and histologically confirmed OLP were subjected to a serological screening of hepatitis B and C viruses by detection of hepatitis B surface antigen and anti-hepatitis C virus antibodies. Results: None of OLP cases were seropositive for the hepatitis viruses. Conclusion: We could not demonstrate any association between OLP and viral hepatitis. This could be attributed to lower prevalence of hepatitis viruses compared to the countries hyper endemic for these viruses or genotypic variation of the viruses or other etiological factors contributing for the present group of patients.

Minimally Invasive Transmucosal Insertion and Immediate Provisonalization of OnePiece Implant in Partially Edentulous Posterior Mandible

Although dental implantology had evolved over number of years, many dental surgeons are unaware of the concept of immediate loading with use of titanium one-piece implants that began in the early 1960s. Although long term success have been revealed with the use of two piece implants over the period of years, many obstacles like pain, inflammation and the bacterial migration into the micro-gap of two-piece implants when they are loaded; loosening and even fractures of the internal screws when they are loaded which limits patient acceptance towards dental implants. Immediate loading of one piece implants by using provisional acrylic resin crown with minimally invasive or atraumatic, flapless surgical procedures provides a better soft tissue adhesion and seal to form a healthy collar, avoids a second stage surgical procedure and with higher patient acceptance . One-piece implant also allows a minimally invasive trans-mucosal flapless placement and limits the requirement of hard tissue grafting procedures. With all these conception, the present case report evaluated the clinical performance of a one-piece implant in a partially edentulous posterior mandible.

Hereditary Hypohidrotic Ectodermal Dysplasia: Report of a Rare Case

Hereditary Hypohidrotic Ectodermal Dysplasia (HHED), an X-linked, recessive, Mendelian character, is seen usually in males and it is inherited through female carriers. It is characterised by congenital dysplasia of one or more ectodermal structures and it is manifested by hypohidrosis, hypotrichosis and hypodontia. It results from abnormal morphogenesis of cutaneous and oral embryonic ectoderm. Here, we are presenting a rare case of HHED in a 19 year female with classic features of this condition.

Peripheral Ossifying Fibroma Secondary to Pulpo-Periodontal Irritation

Francis Akkara, Paul Chalakkal, Chandra Mohan Boyapati, Rajdeep Pavaskar

This report has discussed the endodontic and surgical management of a peripheral ossifying fibroma that had occurred in the anterior maxillary anterior region, between a central and a lateral incisor in a 12-year-old child. The lesion was diagnosed to have occurred secondary to a pulpo-periodontal irritation.

Accessory Mental Nerve: A Case Report

Mamatha N.S., Kedarnath N.S., Madhumathi Singh, Gourav Patel

The presence of an Accessory Mental Nerve (AMN) is rare. The mental foramen is an important landmark in the mandible for administration of local anaesthesia and mental nerve identification and its preservation is of paramount importance in various surgical procedures. This article presents a case of an incidental finding of accessory mental nerves during open reduction and fixation of a compound fracture of left body of mandible. Knowledge on anatomic variations is helpful in diagnosis, treatment planning and management during surgical procedures.

Oral Blistering - Report of Two Cases of Erythema Multiforme & Literature Review

Bharati Patil, Sushmini Hegde, Shobha Naik, Rakesh Sharma

Erythema multiforme and related disorders comprise a group of mucocutaneous disorders that often compromise the quality of life. The clinical classification of these disorders is variable, thus making definitive diagnosis difficult. Early recognition and prompt management will benefit the patients. This article highlights two such cases of erythema multiforme with detailed literature review on etiopathogenesis, clinical features, and treatment.

Surgical And Prosthetic Management of Suction Cup Induced Palatal Perforation: Case Report

Yogesh Rao, Pankaj Yadav, Jagjeet Singh, Divyang Patel, Amit Aggarwal

Construction of complete dentures with adequate retention is a complex procedure. Various techniques have been tried to improve the retention of dentures. Use of suction cup in maxillary denture is one of the techniques to improve retention. Suction cup provides retention and stability by inducing negative pressure on the mucosal surface. Palatal Suction cups which provide high retention are not being recommended because of their pathological effects on the palatal tissues. Here a case report of complete denture with suction cup induced palatal perforation which was surgically treated is presented.

An Unusual Type II Dens Invaginatus with Calcified Canals in a Maxillary Lateral Incisor – A Case Report

Dens invaginatus is a developmental malformation resulting from the invagination of enamel organ into the dental papilla. Management of dens invaginatus is an endodontic challenge. Presence of calcified canals in dens invaginatus makes it even more complicated. Modification of the treatment plan is required to treat such cases. This case report deals with the management of a Type II Dens Invaginatus in a lateral incisor with calcified canals.

Embryonal Rhabdomyosarcoma Occurring on Mandibular Gingiva in an Adult

An embryonal rhabdomyosarcoma (ERMS) is a primitive, malignant, soft tissue sarcoma that recapitulates the phenotypic and biological features of embryonic skeletal muscles. Occurrence of intraoral ERMS in adults is extremely rare. This unique case report highlights the clinical, radiographic, histopathological and immunohistochemical findings of an intraoral ERMS.

Solitary Plexiform Neurofibroma of the Gingiva: Unique Presentation in the Oral Cavity

Suramya S., Pratibha Shashikumar, Shreeshyla H.S., Sheela Kumar G.

Neurofibromas are benign tumours originating from the nerve sheath. Amongst the histological variants, plexiform types are considered exclusive. These are poorly circumscribed, locally invasive and may exhibit sarcomatous potential. Plexiform neurofibromas are key features of Neurofibromatosis – 1 and their solitary intra–oral presentation is uncommon. The following case report describes a unique case of an isolated solitary plexiform neurofibroma of the maxillary anterior gingival region in a middle aged female patient.

Stereolithographic Surgical Template: A Review

Shilpa Sudesh Dandekeri,Sowmya M.K.,Shruthi Bhandary

Implant placement has become a routine modality of dental care.Improvements in surgical reconstructive methods as well as increased prosthetic demands,require a highly accurate diagnosis, planning and placement. Recently,computer-aided design and manufacturing have made it possible to use data from computerised tomography to not only plan implant rehabilitation,but also transfer this information to the surgery.A review on one of this technique called Stereolithography is presented in this article.It permits graphic and complex 3D implant placement and fabrication of stereolithographic surgical templates. Also offers many significant benefits over traditional procedures.

Microenvironment–A Role in Tumour Progression and Prognosis

In addition to malignant cells, solid tumours comprise supporting stromal tissue that consists of Extra Cellular Matrix (ECM), connective tissue cells, inflammatory cells and blood vessels. The stromal compartment and the malignant cells together shape the tumour microenvironment that in turn determines tumour progression and efficacy of anti-tumour treatments. It is now recognized that the host microenvironment undergoes extensive change during the evolution and progression of cancer. This involves the generation of Tumour-Associated Fibroblasts (TAFs), which, through release of growth factors and cytokines, lead to enhanced angiogenesis, increased tumour growth and invasion. It has also been demonstrated that TAFs may modulate the Cancer Stem Cell (CSC) phenotype, which has therapeutic implications. Understanding the various components in the tumour microenvironment may afford us the opportunity to develop new drugs that target these reversible nonmutational events in the prevention and treatment of cancer.

Evaluation of Early Infant Diagnosis of HIV 1 in Government hospital, Dhule

Meckel Gruber Syndrome

Jayeeta Roy,Manidip pal

Salmonella Typhi Isolation in a Pregnant Woman: Determining the Importance

Neelam Kaistha, Nidhi Singla, Neha Bansal, Jagdish Chander

Short Communication: Drug Information Unit as an Effective Tool for Promoting Rational Drug Use- ARTICLE RETRACTED

Pugazhenthan Thangaraju, Harmanjit Singh, Amitava Chakrabarti

This article has been retracted by the Editorial due to problems with Data discovered on post publication reanalysis of paper following a complaint. Details of the issues related to the data methodology and results, found on re-evaluation can be obtained from the Journal (editors@jcdr.net) . Date of Retraction: 18.11.14